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219 Risk Factors for Vancomycin Intermediate Staphylococcus Aureus (VISA) Bloodstream Infection (BSI): Results from a Case Control Study in a Singapore Tertiary Hospital

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Anupama Vasudevan, BDS , National University Health System, Singapore, Singapore
Revathi Sridhar, MBBS , National University Health System, Singapore, Singapore
Diana Goh, BSc, (HONs), Comp , National University Health System, Singapore, Singapore
Hsu Li Yang, MRCP, MPH , National University Health System, Singapore, Singapore
Khean Teik Goh, MBBS , National University Health System, Singapore, Singapore
Dale Fisher, FRACP , National University Health System, Singapore, Singapore
Paul Ananth Tambyah, MBBS , National University Health System, Singapore, Singapore
Background: Vancomycin-Intermediate Staphylococcus Aureus has emerged as a serious nosocomial pathogen associated with poor outcomes. Risk factors for these infections are not well described.

Objective: To determine the risk factor for VISA bacteraemia

Methods: Four patients with VISA BSI (Vancomyin MIC 4µg/ml) were admitted at our 900 bedded teaching hospital between May 07 and Sep 09. A matched case control Study was done (1:3) matched for age, gender and month of admission to the hospital.

Results: Three of the patients with VISA BSI were female and their ages ranged between 57 and 76. They were treated with Linezolid, Daptomycin and Fusidic Acid/Rifampicin and 2 of 4 died. Overall, patients with VISA BSI had a higher mortality (95% CI 2-∞ p: 0.05) and longer length of stay (median 4 vs. 47, p =0.003).
Risk factors identified for VISA bacteraemia were renal dialysis (95% CI 2-∞ p: 0.05), Wound infection with MRSA 95% CI 5.5 - ∞, p: 0.003), Nursing home residence (95% CI 4.64 - ∞, p: 0.003). Vancomycin therapy (OR, 95% CI 13.34-∞, p =0.001).Diabetes, Hypertension, Renal Impairment, were not different between cases and controls.   

Conclusions: With the increasing incidence of VISA, it is critical to identify patients at risk of VISA infection and adopt strict infection control precautions to prevent the dissemination of this difficult to treat nosocomial pathogen.