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Background  The aim of this study was to determine whether clinical outcome of patients with methicillin-resistant  Staphylococcus aureus  (MRSA) bacteraemia was correlated with vancomycin susceptibility of the corresponding strains.    Methods  A retrospective study on MRSA bacteraemia was performed at a teaching hospital between January 1998 and October 2005 by linking vancomycin susceptibility profiles of patients' isolates with hospitalization data.    Results  A total of 20 out of 209 MRSA bacteraemia patients were treated with vancomycin for at least 5 days with adequate trough levels, and fulfilled the study's inclusion and exclusion criteria. Twenty-two  S. aureus  isolates from these patients' blood cultures were identified as MRSA, including two  hetero -VISA from separate patients and two VISA with vancomycin MIC of 4 mg/L from one patient. Between patients who showed 'good' vancomycin response and patients who did not, there was a significant difference (p < 0.01) in their corresponding MRSAs' vancomycin susceptibility expressed by 'area under curve' (AUC) of population analysis. Significant correlations were found between AUC and initial vancomycin therapeutic response parameters of 'days till afebrile' ( r  = 0.828, p < 0.01) and 'days till CRP ≦ 30% of maximum' ( r  = 0.627, p < 0.01)    Conclusion  Our study results caution healthcare personnel that early consideration should be given to cases with a poor vancomycin treatment response that could signify the involvement of MRSA with reduced susceptibility to vancomycin.

Impact of reduced vancomycin susceptibility on the therapeutic outcome of MRSA bloodstream infections