Abstract

MONTUFAR ANDRADE, Franco E.  and  GRUPO DE INVESTIGACION GIERI et al. Coagulase-negative Staphylococcus bacteremia with Vancomycin minimum inhibitory concentrations ≥ 2 . Infect. [online]. 2016, vol.20, n.1, pp.3-8. ISSN 0123-9392.  https://doi.org/10.1016/j.infect.2015.05.001.

Introduction: Currently, coagulase-negative Staphylococcus (CNS) bacteremia is an infection that leads to significant morbidity and mortality given the type of patients affected and the recent changes in antimicrobial susceptibility. Objective: To describe the characteristics of patients with CNS blood isolates with vancomycin MIC ≥ 2. Methodology: Descriptive observational study on hospitalised patients ≥ 2 15 years of age. Results: Of 130 isolates, 38 (29,23%) contained vancomycin MIC ≥ 2. The median age was 54 years and the male:female ratio was 1.37:1. The most frequent species were S. epidermidis (71.1%), S. haemolyticus (13.2%) and S. hominis (7.9%). Some 44.7% of patients had a history of immunosuppression, including: neoplasms (28.9%), rheumatologic disease (5.2%) and HIV (2.6%). Some 81,5% had vascular access; 97.3% had previous hospitalisations and 60.5% had required intensive care. A total of 81.4% of the patients had prior exposure to antibiotics and the most commonly used were beta-lactams (78.9%) and vancomycin (50%). Infective endocarditis was documented in 2.6%. Of the CNS isolates with vancomycin MIC ≥ 2, 26.3% were sensitive to methicillin. The main treatments received were: daptomycin (31.5%), vancomycin (21%), linezolid (15.7%) and betalactams (10.5%). Combined therapy was performed in 10.5%. The overall mortality was 15.8% and attributable mortality was 33.3%. Conclusion: A significant proportion of isolates were hetero-resistant to vancomycin. The bacteremia was associated with vascular access, previous hospitalisations, intensive care treatments and prior antibiotic exposure. Immunosuppression is the most important comorbidity and mortality is significant.

Keywords : Coagulase negative Staphylococcus; Vancomycin; Minimum inhibitory concentration; Bacteremia.

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