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Clin Infect Dis. 2014 Nov 15;59(10):1455-61. doi: 10.1093/cid/ciu583. Epub 2014 Jul 21.

Avoiding the perfect storm: the biologic and clinical case for reevaluating the 7-day expectation for methicillin-resistant Staphylococcus aureus bacteremia before switching therapy.

Author information

1
Department of Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
2
Infectious Disease Clinical Outcomes Unit (ID-CORE), Los Angeles Biomedical Research Institute, David Geffen School of Medicine, University of California Department of Medicine, Torrance Memorial Medical Center.
3
Division of Pediatric Pharmacology and Drug Discovery, University of California San Diego School of Medicine, La Jolla.

Abstract

Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (MRSAB) is associated with poor outcomes and serious complications. The MRSA guidelines define treatment failure and persistent bacteremia as lasting ≥7 days; however, this definition requires reevaluation. Aggressively reducing the bacterial inoculum promptly is critical because factors already in place before clinical presentation are driving resistance to the few antibiotics that are available to treat MRSAB. Alternative approaches to treat MRSAB should be considered within 3-4 days of persistent MRSAB. With rapid molecular diagnostics emerging in clinical microbiology laboratories and biomarkers as a potential for early patient risk stratification, a future shorter threshold may become possible.

KEYWORDS:

MRSA bacteremia; daptomycin; persistent bacteremia; rapid diagnostics; vancomycin

PMID:
25048852
PMCID:
PMC4215066
DOI:
10.1093/cid/ciu583
[Indexed for MEDLINE]
Free PMC Article

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