Copyright ©The Author(s) 2015.
World J Clin Infect Dis. May 25, 2015; 5(2): 14-29
Published online May 25, 2015. doi: 10.5495/wjcid.v5.i2.14
Table 1 Staphylococcus aureus glycopeptide minimum inhibitory concentration cut-off values (μg/mL) as defined by Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing (determined by broth microdilution)
AntibioticCLSI (2011)
EUCAST (2011)
Vancomycin ≤ 24-8≥ 16 ≤ 2> 2
Teicoplanin ≤ 8-≥ 32 ≤ 2> 2
Table 2 Treatment recommendations in Staphylococcus aureus with reduced vancomycin susceptibility infections1
General recommendations
Removal of indwelling hardware (prosthetic devices, surgical material, intravascular catheter, etc.)
Surgical debridement of infected wounds and abscess drainage Follow specific guidelines and local protocols, based on infection site, for treatment duration decisions
Antibiotic treatment considerations
VancomycinIf used aim: AUC0-24/MIC ≥ 400 or trough blood concentrations of 15-20 mg/L Careful monitoring of renal function is imperative
DaptomycinBactericidal. Good results with VISA and VRSA endovascular infections Consider administration of higher doses (i.e., 10 mg/kg per day) in severe infections and if vancomycin MIC > 2 μg/mL (including VISA)2 Consider synergic combinations (i.e., cloxacillin, aminoglycosides, betalactans, fosfomycin) in infections involving high inoculum (as in IE) and prosthetic devises It is inhibited by pulmonary surfactant, therefore should be avoided in SA respiratory or lung infections Monitor CK and liver function
LinezolidBacteriostatic Protein synthesis inhibitor. Inhibits bacterial toxin synthesis High tissue bioavailability Good results in SSTI and pneumonia (including VAP) Oral formulation with similar bioavailability Myelotoxicity: Monitor CBC Severe interactions with SSRIs and MAOIs, must not be given simultaneously
TigecyclineLow plasma concentrations. Bacteriostatic. Avoid monotherapy
Table 3 Infection control recommendations for patients colonized or infected by drug-resistant Staphylococcus aureus (vancomycin-intermediate Staphylococcus aureus, vancomycin-resistant Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus, Centers for Disease Control and Prevention recommendations1
Spread prevention
Isolate patient in a private room
Facilitate gowns and gloves to enter the room
Facilitate mask protection
If risk of aerosol spread consider mask use
Practice hand hygiene with an antibacterial agent (preferably chlorhexidine-based soaps or solutions)
Avoid sharing equipment among patients
Continue isolation until results of tests of nares and infected sites are negative 3 times over 3 wk (including hospital readmission)
Minimize number of staff caring for patient
Educate staff about appropriate precautions and assess compliance
Infection control in nosocomial spread and evaluation
Perform baseline and weekly cultures of hands and nares of healthcare workers in charge of index patient
Consider baseline and weekly cultures for other healthcare workers and persons with extensive contact
Decolonize index patient and healthcare workers with topical mupirocine
Consider avoiding direct patient-contact of colonized healthcare workers until negative culture