Open Access
Research (Published online: 25-04-2017)
2. The importance of timely introduction of vancomycin therapy against methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and severity of MRSA bacteremia at Teaching Hospital, Anuradhapura, Sri Lanka
Jayaweera Arachchige Asela Sampath Jayaweera, Malika Karunarathne and Wikum Widuranga Kumbukgolla
International Journal of One Health, 3: 7-11

Jayaweera Arachchige Asela Sampath Jayaweera: Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University Saliyapura, Sri Lanka.
Malika Karunarathne: Consultant Microbiologist, Teaching Hospital, Anuradhapura, Sri Lanka.
Wikum Widuranga Kumbukgolla: Department of Biochemistry, Faculty of Medicine and Allied Sciences, Rajarata University Saliyapura, Sri Lanka.

doi: 10.14202/IJOH.2017.7-11

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Article history: Received: 01-03-2017, Accepted: 31-03-2017, Published online: 25-04-2017

Corresponding author: Jayaweera Arachchige Asela Sampath Jayaweera


Citation: Sampath Jayaweera JAA, Karunarathne M, Kumbukgolla WW. The importance of timely introduction of vancomycin therapy against methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and severity of MRSA bacteremia at Teaching Hospital, Anuradhapura, Sri Lanka. Int J One Health 2017;3:7-11

Aim: Worldwide, an estimated 2 billion healthy people carry Staphylococcus aureus (SA) and of these, up to 53 million are thought to carry methicillin-resistant SA (MRSA). MRSA bacteremia patients are more critical to manage and timely introduction of antibiotics is life-saving. The aim of the study was to elucidate the prevalence of MRSA bacteremia in different units of Teaching Hospital, Anuradhapura (THA), Sri Lanka and assess the clinical characteristics and associated mortality related to timely introduction of vancomycin therapy.

Materials and Methods: The data on MRSA bacteremia which were obtained from THA, for the period of March 2012 to December 2013 were statically analyzed emphasizing the unit-wise prevalence, severity, and comorbidity and timely introduction of vancomycin therapy.

Results: The laboratory records of total 13,260 blood cultures were analyzed. Of those, MRSA bacteremia was detected in 61 cultures (9.3%). The highest prevalence of MRSA bacteremia was observed in the nephrology unit. The survival rate of the patients when the vancomycin therapy started before 24 h of receiving the blood culture report was 94.9% and in the instances of the treatment started after 24 h of blood culture report, the survival rate decreased down to 50%. High Pitt Bacteraemia score (PBS) (p<0.05) and initiation of vancomycin therapy after 24 h following the receipt of blood culture report (p<0.05) independently affected the MRSA bacteremic patient's 7th day mortality. Having comorbidities have not shown significant impact on 7th day mortality.

Conclusion: The start of vancomycin therapy as earlier as possible following arrival of antibacterial susceptibility test reduces the likelihood of mortality.

Keywords: MRSA bacteremia, timing of vancomycin, severity.


1. Abdulamir AS, Jassim SA, Hafidh RR, Bakar FA. The potential of bacteriophage cocktail in eliminating Methicillin-resistant Staphylococcus aureus biofilms in terms of different extracellular matrices expressed by PIA, ciaA-D and FnBPA genes. Ann Clin Microbiol Antimicrob 2015;14:49. [Crossref] [PubMed] [PMC]

2. McCarthy H, Rudkin JK, Black NS, Gallagher L, O'Neill E, O'Gara JP. Methicillin resistance and the biofilm phenotype in Staphylococcus aureus. Front Cell Infect Microbiol 2015;5:1. [Crossref] [PubMed] [PMC]

3. Negi B, Kumar D, Kumbukgolla W, Jayaweera S, Ponnan P, Singh R, et al. Anti-methicillin resistant Staphylococcus aureus activity, synergism with oxacillin and molecular docking studies of metronidazole-triazole hybrids. Eur J Med Chem 2016;115:426-37. [Crossref] [PubMed]

4. Stefani S, Chung DR, Lindsay JA, Friedrich AW, Kearns AM, Westh H, et al. Meticillin-resistant Staphylococcus aureus (MRSA): Global epidemiology and harmonisation of typing methods. Int J Antimicrob Agents 2012;39:273-82. [Crossref] [PubMed]

5. Abramson MA, Bronstein MZ, Oden MA. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: At what cost? Infect Control Hosp Epidemiol 1999;20:408-41. [Crossref] [PubMed]

6. Wijesekara PN, Kumbukgolla WW, Jayaweera JA, Ravat DS. Review on usage of vancomycin in livestock and humans: Maintaining its efficacy, prevention of resistance and alternative therapy. Vet Sci 2017;4:6. [Crossref]

7. Anuradhapura Teaching Hospital. Available from: [Last cited on 2017 Feb 21; Last retrieved on 2017 Feb 21].

8. Altun O, Almuhayawi M, Luthje P, Taha R, Ullberg M, Ozenci V. Controlled evaluation of the new BacT/Alert virtuo blood culture system for detection and time to detection of bacteria and yeasts. J Clin Microbiol 2016;54:1148-51. [Crossref] [PubMed] [PMC]

9. Paterson DL, Ko WC, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, et al. International prospective study of Klebsiella pneumoniae bacteremia: Implications of extended-spectrum beta-lactamase production in nosocomial infections. Ann Intern Med 2004;140:26-32. [Crossref] [PubMed]

10. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40:373-83. [Crossref]

11. SAS Institute Inc. SAS® 9.1.3. Language Reference: Concepts. 3rd ed. Cary, NC, USA: SAS Institute Inc.; 2005.

12. Tong SY, Davis JS, Eichenberger E, Holland TH, Fowler VG Jr. Staphylococcus aureus Infections: Epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015;28:603-61. [Crossref] [PubMed] [PMC]

13. Mejer N, Westh H, Schonheyder HC, Jensen AG, Larsen AR, Skov R, et al. Stable incidence and continued improvement in short term mortality of Staphylococcus aureus bacteraemia between 1995 and 2008. BMC Infect Dis 2012;12:260. [Crossref] [PubMed] [PMC]

14. Groome MJ, Albrich WC, Wadula J, Khoosal M, Madhi SA. Community-onset Staphylococcus aureus bacteraemia in hospitalised African children: High incidence in HIV-infected children and high prevalence of multidrug resistance. Paediatr Int Child Health 2012;32:140-6. [Crossref] [PubMed]

15. Eshwara VK, Munim F, Tellapragada C, Kamath A, Varma M, Lewis LE, et al. Staphylococcus aureus bacteremia in an Indian tertiary care hospital: Observational study on clinical epidemiology, resistance characteristics, and carriage of the Panton-Valentine leukocidin gene. Int J Infect Dis 2013;17:e1051-5. [Crossref] [PubMed]

16. Lentino JR, Hennein H, Krause S, Pappas S, Fuller G, Schaaff D, et al. A comparison of pneumonia caused by gentamicin, methicillin-resistant and gentamicin, methicillin-sensitive Staphylococcus aureus: Epidemiologic and clinical studies. Infect Control 1985;6:267-72. [Crossref] [PubMed]

17. Corea E, de Silva T, Perera J. Methicillin-resistant Staphylococcus aureus: Prevalence, incidence and risk factors associated with colonization in Sri Lanka. J Hosp Infect 2003;55:145-8. [Crossref]

18. Morbidity and Mortality Weekly Report. Invasive Methicillin-Resistant Staphylococcus aureus Infections among Dialysis Patients - United States, Mortality Weekly Report 2005. Centers for Disease Control and Prevention (CDC), March 9; 2007. p. 197-9.

19. Nickerson EK, West TE, Day NP, Peacock SJ. Staphylococcus aureus disease and drug resistance in resource-limited countries in south and East Asia. Lancet Infect Dis 2009;9:130-5. [Crossref]

20. Madani TA, Al-Abdullah NA, Al-Sanousi AA, Ghabrah TM, Afandi SZ, Bajunid HA. Methicillin-resistant Staphylococcus aureus in two tertiary-care centers in Jeddah, Saudi Arabia. Infect Control Hosp Epidemiol 2001;22:211-6. [Crossref] [PubMed]

21. van Hal SJ, Fowler VG Jr. Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections? Clin Infect Dis 2013;56:1779-88. [Crossref] [PubMed] [PMC]

22. van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev 2012;25:362-86. [Crossref] [PubMed] [PMC]