{"title":"各种 MRSA 临床分离株的抗菌药敏感性以及糖肽 MICs 对临床和微生物学结果的影响。","authors":"Elif M Sarıcaoğlu, Fügen Yörük","doi":"10.36519/idcm.2024.330","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>While vancomycin has remained the mainstay of the treatment for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections, there is growing evidence of the clinical impact of increased glycopeptide minimum inhibitory concentrations (MICs) in MRSA isolates. This study aimed to determine the susceptibility of various MRSA isolates to different antibiotics with antistaphylococcal activity and the impact of glycopeptide MICs on clinical and microbiological outcomes.</p><p><strong>Materials and methods: </strong>This retrospective cohort study, conducted between 2013 and 2017, evaluated the susceptibility of MRSA strains isolated from various clinical samples to antistaphylococcal antibiotics using the gradient strip method. The clinical and laboratory features of patients infected with MRSA isolates with elevated glycopeptide MICs (>1 mg/L) and with isolates that had low glycopeptide MICs (≤1 mg/L) were compared.</p><p><strong>Results: </strong>A total of 104 patients infected with MRSA strains were included in this study. Male sex (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.01-6.10, <i>p</i>=0.048), two or more comorbidities (OR=2.48, 95% CI=1.03-6.50, <i>p</i>=0.044), history of MRSA infection (OR=4.91, 95% CI=1.70-14.28, <i>p</i>=0.003) and a longer hospital stay prior to MRSA infection (OR=2.32, 95% CI=1.05-7.85, <i>p</i>=0.040) were independent risk factors for high glycopeptide MICs. In MRSA infections with a teicoplanin MIC of >0.75mg/L, the microbiological and treatment failures were 46.2% (<i>p</i>=0.044) and 60.6% (<i>p</i>=0.042), respectively.</p><p><strong>Conclusion: </strong>This study showed that the critical MIC value, which suggested treatment failure as well as microbiological failure in the teicoplanin-treated MRSA infections, was >0.75 mg/L rather than >1 mg/L in our study cohort. The identification of high-risk patients;for treatment failures and mortality considering gradient strip method MIC values is crucial for the effective management of MRSA infections.</p>","PeriodicalId":519881,"journal":{"name":"Infectious diseases & clinical microbiology","volume":"6 2","pages":"102-111"},"PeriodicalIF":0.0000,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11243782/pdf/","citationCount":"0","resultStr":"{\"title\":\"Antimicrobial Susceptibility of Various MRSA Clinical Isolates and the Impact of Glycopeptide MICs on Clinical and Microbiological Outcomes.\",\"authors\":\"Elif M Sarıcaoğlu, Fügen Yörük\",\"doi\":\"10.36519/idcm.2024.330\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>While vancomycin has remained the mainstay of the treatment for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections, there is growing evidence of the clinical impact of increased glycopeptide minimum inhibitory concentrations (MICs) in MRSA isolates. This study aimed to determine the susceptibility of various MRSA isolates to different antibiotics with antistaphylococcal activity and the impact of glycopeptide MICs on clinical and microbiological outcomes.</p><p><strong>Materials and methods: </strong>This retrospective cohort study, conducted between 2013 and 2017, evaluated the susceptibility of MRSA strains isolated from various clinical samples to antistaphylococcal antibiotics using the gradient strip method. The clinical and laboratory features of patients infected with MRSA isolates with elevated glycopeptide MICs (>1 mg/L) and with isolates that had low glycopeptide MICs (≤1 mg/L) were compared.</p><p><strong>Results: </strong>A total of 104 patients infected with MRSA strains were included in this study. Male sex (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.01-6.10, <i>p</i>=0.048), two or more comorbidities (OR=2.48, 95% CI=1.03-6.50, <i>p</i>=0.044), history of MRSA infection (OR=4.91, 95% CI=1.70-14.28, <i>p</i>=0.003) and a longer hospital stay prior to MRSA infection (OR=2.32, 95% CI=1.05-7.85, <i>p</i>=0.040) were independent risk factors for high glycopeptide MICs. In MRSA infections with a teicoplanin MIC of >0.75mg/L, the microbiological and treatment failures were 46.2% (<i>p</i>=0.044) and 60.6% (<i>p</i>=0.042), respectively.</p><p><strong>Conclusion: </strong>This study showed that the critical MIC value, which suggested treatment failure as well as microbiological failure in the teicoplanin-treated MRSA infections, was >0.75 mg/L rather than >1 mg/L in our study cohort. The identification of high-risk patients;for treatment failures and mortality considering gradient strip method MIC values is crucial for the effective management of MRSA infections.</p>\",\"PeriodicalId\":519881,\"journal\":{\"name\":\"Infectious diseases & clinical microbiology\",\"volume\":\"6 2\",\"pages\":\"102-111\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-06-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11243782/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infectious diseases & clinical microbiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.36519/idcm.2024.330\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infectious diseases & clinical microbiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36519/idcm.2024.330","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：虽然万古霉素仍是治疗耐甲氧西林金黄色葡萄球菌（MRSA）感染的主要药物，但越来越多的证据表明，MRSA分离物中糖肽最低抑菌浓度（MIC）的升高会对临床产生影响。本研究旨在确定各种 MRSA 分离物对不同抗葡萄球菌活性抗生素的敏感性，以及糖肽最低抑菌浓度对临床和微生物学结果的影响：这项回顾性队列研究在 2013 年至 2017 年间进行，采用梯度条带法评估了从各种临床样本中分离出的 MRSA 菌株对抗葡萄球菌抗生素的敏感性。比较了感染糖肽 MIC 值升高（>1 mg/L）的 MRSA 分离株和感染糖肽 MIC 值较低（≤1 mg/L）的分离株的患者的临床和实验室特征：本研究共纳入了104名感染MRSA菌株的患者。男性（几率比[OR]=2.48，95% 置信区间[CI]=1.01-6.10，P=0.048）、两种或两种以上合并症（OR=2.48，95% CI=1.03-6.50，P=0.044）、MRSA 感染史（OR=4.91，95% CI=1.70-14.28，p=0.003）和MRSA感染前住院时间较长（OR=2.32，95% CI=1.05-7.85，p=0.040）是高糖肽MICs的独立危险因素。在 Teicoplanin MIC >0.75mg/L 的 MRSA 感染中，微生物和治疗失败率分别为 46.2% (p=0.044) 和 60.6% (p=0.042)：本研究表明，在我们的研究队列中，提示治疗失败和微生物学失败的替考拉宁治疗MRSA感染的临界MIC值是>0.75 mg/L，而不是>1 mg/L。根据梯度条带法 MIC 值确定治疗失败和死亡的高危患者对于有效治疗 MRSA 感染至关重要。
Antimicrobial Susceptibility of Various MRSA Clinical Isolates and the Impact of Glycopeptide MICs on Clinical and Microbiological Outcomes.
Objective: While vancomycin has remained the mainstay of the treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections, there is growing evidence of the clinical impact of increased glycopeptide minimum inhibitory concentrations (MICs) in MRSA isolates. This study aimed to determine the susceptibility of various MRSA isolates to different antibiotics with antistaphylococcal activity and the impact of glycopeptide MICs on clinical and microbiological outcomes.
Materials and methods: This retrospective cohort study, conducted between 2013 and 2017, evaluated the susceptibility of MRSA strains isolated from various clinical samples to antistaphylococcal antibiotics using the gradient strip method. The clinical and laboratory features of patients infected with MRSA isolates with elevated glycopeptide MICs (>1 mg/L) and with isolates that had low glycopeptide MICs (≤1 mg/L) were compared.
Results: A total of 104 patients infected with MRSA strains were included in this study. Male sex (odds ratio [OR]=2.48, 95% confidence interval [CI]=1.01-6.10, p=0.048), two or more comorbidities (OR=2.48, 95% CI=1.03-6.50, p=0.044), history of MRSA infection (OR=4.91, 95% CI=1.70-14.28, p=0.003) and a longer hospital stay prior to MRSA infection (OR=2.32, 95% CI=1.05-7.85, p=0.040) were independent risk factors for high glycopeptide MICs. In MRSA infections with a teicoplanin MIC of >0.75mg/L, the microbiological and treatment failures were 46.2% (p=0.044) and 60.6% (p=0.042), respectively.
Conclusion: This study showed that the critical MIC value, which suggested treatment failure as well as microbiological failure in the teicoplanin-treated MRSA infections, was >0.75 mg/L rather than >1 mg/L in our study cohort. The identification of high-risk patients;for treatment failures and mortality considering gradient strip method MIC values is crucial for the effective management of MRSA infections.
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