Vancomycin monotherapy vs. combination therapy for the treatment of persistent methicillinresistant staphylococcus aureus bacteremia

摘要

Persistent MRSA bacteremia is associated with complications such as infective endocarditis, leading to worse clinical outcomes including longer hospitalization and increased mortality.'Specific genotypes (e.g., accessory gene global regulator [agr] group II), higher vancomycin minimum inhibitory concentration (MIC), prior vancomycin use,presence of heterogeneous vancomycin intermediate S. aureus (hVISA) metastatic infections, retained implants,7 and inadequate source control are associated with persistent MRSA (pMRSA) bacteremia. Predictors of mortality in MRSA bacteremia include higher MICs, age greater than 65 y,u delay in appropriate antibiotic therapy, inadequate vancomycin levels,10 metastatic infections, higher Charlson comorbidity index,9 and presence of malignancy.