Doubtful model utility in predicting high vancomycin minimum inhibitory concentration methicillin-resistant staphylococcus aureus bloodstream infection episodes

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TO THE EDITOR—High vancomycin minimum inhibitory concentration (MIC) methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) have increasingly been associated with increased treatment failure and mortality [1, 2]. Recent MRSA treatment guidelines support the need for alternative antibiotic therapy in clinically failing patients, especially if the vancomycin MIC is 2 μg/mL or greater [3]. The current evidence suggests that vancomycin Etest is the method of choice for determining susceptibility [4]. However, because it is a nonautomated method, multiple laboratory issues arise. The ability to predict high vancomycin MIC episodes would circumvent some of these concerns. Therefore, we read with interest the prediction model proposed by Lubin and colleagues