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Title: | Epidemiology and prognosis of coagulase-negative staphylococcal endocarditis: impact of vancomycin minimum inhibitory concentration |
Author: | García de la Mària, Cristina Cervera, Carlos Pericàs, Juan M. Castañeda, Ximena Armero, Yolanda Soy Muner, Dolors Almela, M. (Manel) Ninot, Salvador Falces Salvador, Carles Mestres Lucio, Carlos-Alberto Gatell, José M. Moreno Camacho, Ma. Asunción Marco Reverté, Francesc Miró Meda, José M. Sitges Carreño, Marta |
Keywords: | Infeccions per estafilococs Endocarditis Antibiòtics Epidemiologia Estudi de casos Staphylococcal infections Endocarditis Antibiotics Epidemiology Case studies |
Issue Date: | 11-May-2015 |
Publisher: | Public Library of Science (PLoS) |
Abstract: | This study describes coagulase-negative staphylococcal (CoNS) infective endocarditis (IE) epidemiology at our institution, the antibiotic susceptibility profile, and the influence of vancomycin minimum inhibitory concentration (MIC) on patient outcomes. One hundred and three adults with definite IE admitted to an 850-bed tertiary care hospital in Barcelona from 1995-2008 were prospectively included in the cohort. We observed that CoNS IE was an important cause of community-acquired and healthcare-associated IE; one-third of patients involved native valves. Staphylococcus epidermidis was the most frequent species, methicillin-resistant in 52% of patients. CoNS frozen isolates were available in 88 patients. Vancomycin MICs of 2.0 μg/mL were common; almost all cases were found among S. epidermidis isolates and did not increase over time. Eighty-five patients were treated either with cloxacillin or vancomycin: 38 patients (Group 1) were treated with cloxacillin, and 47 received vancomycin; of these 47, 27 had CoNS isolates with a vancomycin MIC <2.0 μg/mL (Group 2), 20 had isolates with a vancomycin MIC ≥2.0 μg/mL (Group 3). One-year mortality was 21%, 48%, and 65% in Groups 1, 2, and 3, respectively (P=0.003). After adjusting for confounders and taking Group 2 as a reference, methicillin-susceptibility was associated with lower 1-year mortality (OR 0.12, 95% CI 0.02-0.55), and vancomycin MIC ≥2.0 μg/mL showed a trend to higher 1-year mortality (OR 3.7, 95% CI 0.9-15.2; P=0.069). Other independent variables associated with 1-year mortality were heart failure (OR 6.2, 95% CI 1.5-25.2) and pacemaker lead IE (OR 0.1, 95%CI 0.02-0.51). In conclusion, methicillin-resistant S.epidermidis was the leading cause of CoNS IE, and patients receiving vancomycin had higher mortality rates than those receiving cloxacillin; mortality was higher among patients having isolates with vancomycin MICs ≥2.0 μg/mL. |
Note: | Reproducció del document publicat a: http://dx.doi.org/10.1371/journal.pone.0125818 |
It is part of: | PLoS One, 2015, vol. 10, num. 5, p. e0125818 |
URI: | http://hdl.handle.net/2445/102796 |
Related resource: | http://dx.doi.org/10.1371/journal.pone.0125818 |
ISSN: | 1932-6203 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Medicina) |
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