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027, adjusted odds ratio 13.3) as positive predictor and vancomycin trough levels (p?0.016, adjusted odds ratio 0.29) as negative predictor. Pneumonia remained as a risk factor in the multivariate model, but did not PRDX5 reach statistical significance (p?>0.05). Management of MRSA bacteraemia remains a substantial challenge. In the present retrospective cohort study we detected high 28-day and 1-year mortalities of 30.4% and 45.2%, respectively, in a mixed population dominated by patients with haemato-oncological diseases, solid organ transplantation, end-stage kidney disease or alcoholic liver cirrhosis. In a review by van Hal et?al., a mortality rate between 10% and 30% was reported in patients with S. aureus bacteraemia [14]. Recently, Pastagia et?al. demonstrated a 90-day all-cause mortality of 31.5% for 603 patients with MRSA bacteraemia [15]. As expected, the most important aspect of MRSA treatment in our study was timely identification of methicillin resistance. MRSA is a rare bloodstream pathogen in Austrian patients [16] and all patients who did not receive MRSA-active treatment died from fulminant sepsis selleck screening library our institution most frequently, in 50.8% patients with MRSA bacteraemia. this website However, at least in univariate analysis, vancomycin monotherapy was associated with persistent MRSA bacteraemia ��7?days. Most authors agree that vancomycin has limitations such as low tissue penetration, nephrotoxicity and increasing rates of treatment failure in invasive MRSA infections [8]. During the observation period, in vitro susceptibility testing against MRSA in our institution was routinely performed using agar diffusion tests (standard Etest on M��ller-Hinton agar or Etest detection of glycopeptide resistance using a vancomycin�Cteicoplanin double-sided gradient test). According to Performance Standards for Antimicrobial Susceptibility Testing/CLSI or EUCAST clinical breakpoints, all MRSA isolates were originally reported as susceptible to vancomycin (data not shown). However, low level resistance to vancomycin continues to evolve [7, 18]. We therefore retrospectively assessed the in vitro susceptibility of MRSA blood isolates using the broth microdilution reference method in addition and detected reduced susceptibility to vancomycin, defined as MIC of 2?mg/L, in 27.4% of MRSA isolates. One single strain had a vancomycin MIC of 4?mg/L on re-testing, but had been initially reported as susceptible by the standard Etest method in 2002 because of the higher vancomycin breakpoint of ��4?mg/L in use at that time.