| Title |
Optimizing the detection of methicillin-resistant Staphylococcus aureus with elevated vancomycin minimum inhibitory concentrations within the susceptible range
|
|---|---|
| Published in |
Infection and Drug Resistance, May 2016
|
| DOI | 10.2147/idr.s107961 |
| Pubmed ID | |
| Authors |
Cameron J Phillips, Nicholas A Wells, Marianne Martinello, Simon Smith, Richard J Woodman, David L Gordon |
| Abstract |
Determination of vancomycin minimum inhibitory concentration (MIC) can influence the agent used to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. We studied diagnostic accuracy using E-test and VITEK(®) 2 against a gold standard broth microdilution (BMD) methodology, the correlation between methods, and associations between vancomycin MIC and MRSA phenotype from clinical isolates. MRSA isolates were obtained from April 2012 to December 2013. Vancomycin MIC values were determined prospectively on all isolates by gradient diffusion E-test and automated VITEK(®) 2. The Clinical and Laboratory Standards Institute reference BMD method was performed retrospectively on thawed frozen isolates. Diagnostic accuracy for detecting less susceptible strains was calculated at each MIC cutoff point for E-Test and VITEK(®) 2 using BMD ≥1 µg/mL as a standard. The correlation between methods was assessed using Spearman's rho (ρ). The association between MRSA phenotype and MIC for the three methods was assessed using Fisher's exact test. Of 148 MRSA isolates, all except one (E-test =3 µg/mL) were susceptible to vancomycin (MIC of ≤2 µg/mL) irrespective of methodology. MICs were ≥1.0 µg/mL for 9.5% of BMD, 50.0% for VITEK(®) 2, and 27.7% for E-test. Spearman's ρ showed weak correlations between methods: 0.29 E-test vs VITEK(®) 2 (P=0.003), 0.27 E-test vs BMD (P=0.001), and 0.31 VITEK(®) 2 vs BMD (P=0.002). The optimal cutoff points for detecting BMD-defined less susceptible strains were ≥1.0 µg/mL for E-test and VITEK(®) 2. E-test sensitivity at this cutoff point was 0.85 and specificity 0.29, while VITEK(®) 2 sensitivity and specificity were 0.62 and 0.51, respectively. Multiresistant MRSA strains tended to have higher MIC values compared to nonmultiresistant MRSA or epidemic MRSA 15 phenotypes by E-test (Fisher's exact P<0.001) and VITEK(®) 2 (Fisher's exact P<0.001). Overall diagnostic accuracy and correlations between MIC methods used in routine diagnostic laboratories and the gold standard BMD showed limited overall agreement. This study helps optimize guidance on the effective use of vancomycin. |
X Demographics
The data shown below were collected from the profiles of 4 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Australia | 2 | 50% |
| United Kingdom | 1 | 25% |
| Unknown | 1 | 25% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 3 | 75% |
| Science communicators (journalists, bloggers, editors) | 1 | 25% |
Mendeley readers
The data shown below were compiled from readership statistics for 21 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 21 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 5 | 24% |
| Student > Master | 3 | 14% |
| Other | 2 | 10% |
| Lecturer > Senior Lecturer | 2 | 10% |
| Researcher | 2 | 10% |
| Other | 3 | 14% |
| Unknown | 4 | 19% |
| Readers by discipline | Count | As % |
|---|---|---|
| Biochemistry, Genetics and Molecular Biology | 4 | 19% |
| Agricultural and Biological Sciences | 3 | 14% |
| Medicine and Dentistry | 3 | 14% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | 10% |
| Immunology and Microbiology | 1 | 5% |
| Other | 3 | 14% |
| Unknown | 5 | 24% |
Attention Score in Context
This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 July 2016.
All research outputs
#14,267,420
of 22,879,161 outputs
Outputs from Infection and Drug Resistance
#516
of 1,659 outputs
Outputs of similar age
#159,521
of 298,395 outputs
Outputs of similar age from Infection and Drug Resistance
#6
of 9 outputs
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