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Indeed, many reports suggest a link between a higher vancomycin MIC of the infecting pathogen and a worse clinical outcome in patients with an MRSA infection [ 10].
In addition, a series of studies showed a relation between a higher vancomycin MIC of the infecting pathogen and a worse clinical outcome of patients with an MRSA infection [ 10].
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Comparison of the vancomycin resistance-conferring Tn 1549 transposon between Aus0004 and Aus0085 revealed differences in transposon length and insertion site, and van locus sequence variation that correlated with a higher vancomycin MIC in Aus0085.
We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype.All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included.
Comparative data of patients with or without a high vancomycin MIC MSSA strain are shown in Table 1.
13, 24 However, the prevalence of MRSA clinical strains with a high vancomycin MIC and whether higher trough concentrations increase the efficacy of vancomycin and/or risk of nephrotoxicity remain uncertain, particularly in the elderly.
Several studies have established a relationship between high vancomycin MIC and a worse prognosis for patients with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) (1 – 5 ).
In this study, we found that ALBC loaded with liquid vancomycin presented a 3.3-fold higher vancomycin release than ALBC loaded with powder vancomycin.
Not surprisingly, recent vancomycin exposure prior to a suspected or proven MRSA infection, even in a single dose, is a strong predictor of higher vancomycin MICs [ 49].
We created a model with an interaction variable for both higher vancomycin (≥ 2 μg/ml) and lower initial vancomycin trough level (< 15 mg/L), however this interaction variable was not associated with increased mortality (data not shown).
A first-order interaction term of initial vancomycin trough level (< or ≥ 15 μg/dL) and vancomycin MIC was created to determine if a lower vancomycin trough and higher vancomycin MIC independently increased mortality.
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