Discordance of vancomycin minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus at 2 μg/mL between Vitek II, E-test, and Broth Microdilution
| العنوان: | Discordance of vancomycin minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus at 2 μg/mL between Vitek II, E-test, and Broth Microdilution |
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| المؤلفون: | Chon Fu Lio, Yi Ting Chou, Hsiang Ting Chen, Fu-Chieh Chang, Yu-Ting Tina Wang, Kevin Sheng-Kai Ma, Chien-Feng Kuo, Shin-Yi Tsai |
| المصدر: | PeerJ, Vol 8, p e8963 (2020) PeerJ |
| بيانات النشر: | PeerJ Inc., 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Veterinary medicine, medicine.drug_class, Antibiotics, lcsh:Medicine, Antimicrobial stewardship, medicine.disease_cause, Global Health, Microbiology, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Minimum inhibitory concentration, 0302 clinical medicine, Internal Medicine, Medicine, 030212 general & internal medicine, Methicillin-resistant Staphylococcus aureus (MRSA), 0303 health sciences, Hospital-acquired MRSA, 030306 microbiology, business.industry, General Neuroscience, Health Policy, Community-acquired MRSA, E-test, Broth microdilution, lcsh:R, General Medicine, biochemical phenomena, metabolism, and nutrition, medicine.disease, Antimicrobial, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Minimal inhibitory concentration (MIC ), Infectious Diseases, Staphylococcus aureus, Bacteremia, Microbial automatic identification system (Vitek II), Clinical and Laboratory Standards Institute (CLSI), Vancomycin, The inter-test agreements, General Agricultural and Biological Sciences, business, Broth Microdilution, medicine.drug |
| الوصف: | Background Vancomycin, the first line antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, is often administered inappropriately when MIC is greater than 2 µg/mL, including ‘susceptible’ strains. This study assessed the discordance of vancomycin minimum inhibitory concentration (MIC) for methicillin-resistant Staphylococcus aureus (MRSA). Methods In total, 229 MRSA isolates from blood cultures collected between 2009 and 2015 at a tertiary hospital in Taiwan were examined. The MICs of vancomycin were measured using Vitek 2, E-test, and standard broth microdilution at the level of 2 µg/mL. Results The geometric mean of the MICs of hospital-acquired MRSA was higher than that of community-acquired MRSA (P E-test. Overall, E-test (98.1%) had more categorical accordance than did Vitek 2 (94.0%; P = 0.026). Vitek 2 had a tendency to overestimate MRSA in high-MIC isolates, whereas E-test inclined underestimation in low-MIC isolates. Surprisingly, the discordance rates of MRSA vancomycin MICs were higher in hospital-acquired isolates (13.3%–17.0%) than in community-acquired isolates (6.2%–7.0%). Conclusion The Infectious Diseases Society of America recommends the use of alternative antimicrobial agents when vancomycin MIC is ≥ 2 µg/mL; in this study, only 53.6% of the isolates tested using Vitek 2 showed a high MIC in the broth microdilution method. Accurate identification of the resistance profile is a key component of antimicrobial stewardship programs. Therefore, to reduce inappropriate antibiotic use and mitigate the emergence of resistant strains, we recommend using complementary tests such as E-test or Broth microdilution to verify the MIC before administering second-line antibiotics. Strengths (1) We compared the categorical agreement between different methods measuring MRSA MICs level. (2) Physicians should incorporate this information and consider a complementary test to verify the appropriateness of the decision of shifting vancomycin to second-line antibiotic treatment to improve patients’ prognosis. (3) MRSA-vancomycin MICs at a cutoff of 2 µg/mL obtained using Vitek II exhibited a higher sensitivity level and negative predictive value than those obtained using E-test in the prediction of categorical agreement with standard broth microdilution. Limitation (1) Our research was based on a single hospital-based study. (2) The MRSA strains in this study were stored for more than 12 months after isolation. (3) We did not collect information on clinical prognosis. |
| اللغة: | English |
| تدمد: | 2167-8359 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::4e107faa1a4b7f5b177242d6c9b412c5Test https://peerj.com/articles/8963.pdfTest |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....4e107faa1a4b7f5b177242d6c9b412c5 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 21678359 |
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