{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T15:32:15Z","timestamp":1784302335142,"version":"3.55.0"},"reference-count":34,"publisher":"American Society for Microbiology","issue":"12","license":[{"start":{"date-parts":[[2011,12,1]],"date-time":"2011-12-01T00:00:00Z","timestamp":1322697600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Despite emerging evidence that dysfunction in the accessory gene regulator (\n            <jats:italic>agr<\/jats:italic>\n            ) locus is associated with deleterious outcomes among patients treated with vancomycin for methicillin-resistant\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Staphylococcus aureus<\/jats:named-content>\n            (MRSA) infections, factors predictive of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction have not been evaluated. This study describes the epidemiology of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction, identifies predictors of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction in MRSA isolates among those with MRSA bloodstream infections, and describes the relationship between\n            <jats:italic>agr<\/jats:italic>\n            dysfunction and other microbiologic phenotypes. A cross-sectional study of patients with MRSA bloodstream infections at two institutions in upstate New York was performed. Clinical data on demographics, comorbidities, disease severity, hospitalization history, and antibiotic history were collected. Microbiologic phenotypes, including\n            <jats:italic>agr<\/jats:italic>\n            dysfunction, MIC values by broth microdilution (BMD) and Etest, and vancomycin heteroresistance (hVISA) were tested. Multivariable analyses were performed to identify factors predictive of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction. Among 200 patients with an MRSA bloodstream infection, the proportion of strains with\n            <jats:italic>agr<\/jats:italic>\n            dysfunction was 31.5%. The distribution of MICs determined by both BMD and Etest were equivalent across\n            <jats:italic>agr<\/jats:italic>\n            groups, and there was no association between\n            <jats:italic>agr<\/jats:italic>\n            dysfunction and the presence of hVISA. Severity of illness, comorbidities, and hospitalization history were comparable between\n            <jats:italic>agr<\/jats:italic>\n            groups. In the multivariate analysis, prior antibiotic exposure was the only factor of variables studied found to be predictive of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction. This relationship was predominantly driven by prior beta-lactam and fluoroquinolone administration in the bivariate analysis. Identifying these institution-specific risk factors can be used to develop a process to assess the risk of\n            <jats:italic>agr<\/jats:italic>\n            dysfunction and guide empirical antibiotic therapy decisions.\n          <\/jats:p>","DOI":"10.1128\/aac.00407-11","type":"journal-article","created":{"date-parts":[[2011,9,20]],"date-time":"2011-09-20T08:18:33Z","timestamp":1316506713000},"page":"5433-5437","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":36,"title":["Predictors of\n            <i>agr<\/i>\n            Dysfunction in Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates among Patients with MRSA Bloodstream Infections"],"prefix":"10.1128","volume":"55","author":[{"given":"Jill M.","family":"Butterfield","sequence":"first","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian T.","family":"Tsuji","sequence":"additional","affiliation":[{"name":"University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Brown","sequence":"additional","affiliation":[{"name":"University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Dodds","family":"Ashley","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dwight","family":"Hardy","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center, Rochester, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Forrest","sequence":"additional","affiliation":[{"name":"University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas P.","family":"Lodise","sequence":"additional","affiliation":[{"name":"Albany College of Pharmacy and Health Sciences, Albany, New York"},{"name":"Ordway Research Institute, Albany, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn198"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M309836200"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/JB.01464-06"},{"key":"e_1_3_2_5_2","unstructured":"Clinical and Laboratory Standards Institute. 2009. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically approved standard M7-A7 8th ed. 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