scholarly journals Combination Therapy Did Not Reduce 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia (SAB)

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Natasha Holmes ◽  
J. Owen Robinson ◽  
Sebastian Van Hal ◽  
Wendy Munckhof ◽  
Eugene Athan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Treatment Failure ◽  
Day Treatment ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Prediction Model to Identify Patients at Risk of 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Natasha Holmes ◽  
J. Owen Robinson ◽  
Sebastian Van Hal ◽  
Wendy Munckhof ◽  
Eugene Athan ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Prediction Model ◽  
Day Treatment ◽  
Staphylococcus Aureus Bacteremia ◽  
Patients At Risk

scholarly journals Is Cefazolin Inferior to Nafcillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia?

2011 ◽  
Vol 55 (11) ◽  
pp. 5122-5126 ◽  
Author(s):  
Shinwon Lee ◽  
Pyoeng Gyun Choe ◽  
Kyoung-Ho Song ◽  
Sang-Won Park ◽  
Hong Bin Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Propensity Scores ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Failure ◽  
Content Type ◽  
Staphylococcus Aureus Bacteremia ◽  
Matched Case ◽  
Control Study

ABSTRACTAbout 20% of methicillin-susceptibleStaphylococcus aureus(MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n= 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n= 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P> 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P> 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%;P= 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.

scholarly journals Adjunctive ceftaroline in combination with daptomycin or vancomycin for complicated methicillin-resistant Staphylococcus aureus bacteremia after monotherapy failure

2019 ◽  
Vol 6 ◽  
pp. 204993611988650 ◽  
Author(s):  
Joseph Patrik Hornak ◽  
Seher Anjum ◽  
David Reynoso
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Treatment Options ◽  
Source Control ◽  
Optimal Timing ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia

Background: Methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) may fail to improve with standard monotherapy, particularly in patients with multifocal infection, incomplete source control, or persistent bacteremia. Synergy observed in vitro between ceftaroline (CPT) and daptomycin (DAP) or vancomycin (VAN) may translate into clinical benefit. Here, we describe our experience with DAP/CPT and VAN/CPT for complicated MRSA-B after monotherapy failure. Methods: Single-center, retrospective review of consecutive patients treated with DAP/CPT or VAN/CPT for MRSA-B after monotherapy failure from 1 January 2016 to 30 November 2018. Results: We identified 11 instances of combination therapy in 10 patients (DAP/CPT = 6, VAN/CPT = 5) with 1 patient receiving VAN/CPT followed by DAP/CPT. Rates of multifocal infection, incomplete source control, persistent bacteremia, and infective endocarditis were high (100%, 80%, 60%, and 60%, respectively). Combination therapy was initiated most commonly for persistent bacteremia (60%). When patients were persistently bacteremic, median preceding duration was 13 days and median time to clearance was 3 days. Total microbiologic cure rate was 100%. There were zero instances of bacteremia relapse at 30 days (30D) or 60 days (60D). All-cause 30D and 60D mortality rates were 11.1% and 33.3%, respectively. Conclusions: Combination therapy demonstrated success in diverse cases of refractory MRSA-B, including instances of persistent bacteremia paired with incomplete source control. Optimal timing and therapeutic cadence for combination therapy remain unclear. Our findings suggest that DAP/CPT and VAN/CPT can be considered for complicated MRSA bacteremia when other treatment options fail or are unavailable. We propose persistent bacteremia with incomplete source control to be a clinical niche particularly worthy of further investigation.

scholarly journals A Comparison of Cefazolin Versus Ceftriaxone for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia in a Tertiary Care VA Medical Center

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Dustin R Carr ◽  
Usha Stiefel ◽  
Robert A Bonomo ◽  
Christopher J Burant ◽  
Sharanie V Sims
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Skilled Nursing Facility ◽  
Suppressive Therapy ◽  
Published Data ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Population Potential

Abstract Background Cefazolin and ceftriaxone are frequently used to treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, especially in the realm of outpatient parenteral antimicrobial therapy. Both antimicrobials have been associated with favorable clinical outcomes for mixed MSSA infections. However, limited published data exist specifically comparing the use of these agents for the treatment of MSSA bacteremia. Methods We conducted a retrospective cohort study of Veteran patients with MSSA bacteremia who received ≥14 days of cefazolin or ceftriaxone between 2009 and 2014. Rates of treatment failure were compared between both groups. Treatment failure was defined as therapy extension, incomplete therapy, unplanned oral suppressive therapy, relapse of infection, or hospital admission or surgery within 90 days. Results Out of 71 patients, 38 received treatment with cefazolin and 33 with ceftriaxone. The overall rate of treatment failure was 40.8%, with significantly more failures among patients receiving ceftriaxone (54.5% versus 28.9%; P = .029). Factors associated with treatment failure included longer duration of parenteral therapy, heart failure, and treatment in an external skilled nursing facility as compared with treatment in the Department of Veterans Affairs attached Community Living Center. Conclusions Ceftriaxone had a higher rate of treatment failure than cefazolin for the treatment of MSSA bacteremia in a Veteran population. Potential reasons for this could include the higher protein binding of ceftriaxone, ultimately resulting in lower serum concentrations of free drug, or other unknown factors. Further studies are warranted to confirm these results.

scholarly journals Focusing the Lens on the CAMERA Concepts: Early Combination β-Lactam and Vancomycin Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia

2020 ◽  
Vol 64 (7) ◽  
Author(s):  
H Andrew Wilsey ◽  
Donna R. Burgess ◽  
David S. Burgess
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Health Care Systems ◽  
Vancomycin Therapy ◽  
Initial Management ◽  
Methicillin Resistant ◽  
Content Type ◽  
Staphylococcus Aureus Bacteremia ◽  
Early Use ◽  
Care Systems

ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) has grown to become a major burden on health care systems. The cumulation of limited therapeutic options and worsened patient outcomes with persistent MRSA bacteremia has driven research in optimizing its initial management. The guidelines published by the Infectious Diseases Society of America currently recommend combination therapy for refractory MRSA bacteremia, but the utility of combining antibiotics from the start of therapy is under investigation. The alternative strategy of early use of β-lactam antibiotics in combination with vancomycin upon initial MRSA bacteremia detection has shown promise. While this concept has gained international attention, providers should give this strategy serious consideration prior to implementation. The objective of this review is to examine retrospective and prospective evidence for early combination with vancomycin and β-lactam antibiotics, as well as explore potential consequences of combination therapy.

scholarly journals Anti-Clumping Factor A Immunoglobulin Reduces the Duration of Methicillin-Resistant Staphylococcus aureus Bacteremia in an Experimental Model of Infective Endocarditis

2003 ◽  
Vol 47 (11) ◽  
pp. 3400-3406 ◽  
Author(s):  
John Vernachio ◽  
Arnold S. Bayer ◽  
Thuan Le ◽  
Yin-Li Chai ◽  
Bradley Prater ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Combination Therapy ◽  
Rabbit Model ◽  
Human Fibrinogen ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Fibrinogen Binding ◽  
Human Polymorphonuclear Leukocytes

ABSTRACT SA-IGIV is a human polyclonal immunoglobulin containing elevated levels of antibodies specific for the fibrinogen-binding MSCRAMM protein clumping factor A (ClfA). In vitro, SA-IGIV specifically recognized ClfA that was expressed on the surface of Staphylococcus aureus and inhibited bacterial adherence to immobilized human fibrinogen by >95%. Moreover, SA-IGIV efficiently opsonized ClfA-coated fluorescent beads and facilitated phagocytosis by human polymorphonuclear leukocytes. To determine its potential therapeutic efficacy, SA-IGIV was evaluated in combination with vancomycin in a rabbit model of catheter-induced aortic valve infective endocarditis (IE) caused by methicillin-resistant S. aureus (MRSA). The combination therapy was more effective than vancomycin alone in sterilizing all valvular vegetations when used therapeutically during early (12-h) IE. The combination therapy resulted in clearance of bacteremia that was significantly faster than that of vancomycin alone in animals with well-established (24-h) IE. Therefore, in both early and well-established MRSA IE, the addition of SA-IGIV to a standard antibiotic regimen (vancomycin) increased bacterial clearance from the bloodstream and/or vegetations.

scholarly journals Predictors of Adverse Outcomes in Children With Staphylococcus aureus Bacteremia

2017 ◽  
Vol 22 (3) ◽  
pp. 218-226
Author(s):  
Ganesh Kumarachandran ◽  
Jennifer Kristie Johnson ◽  
Debbie-Ann Shirley ◽  
Eileen Graffunder ◽  
Emily L. Heil
Keyword(s):  
Staphylococcus Aureus ◽  
Minimum Inhibitory Concentration ◽  
High Risk ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Inhibitory Concentration ◽  
Factors Associated ◽  
Staphylococcus Aureus Bacteremia ◽  
Vancomycin Minimum Inhibitory Concentration ◽  
Risk Source

OBJECTIVES Staphylococcus aureus bacteremia is a common infection, associated with significant morbidity and mortality in children. Factors associated with adverse treatment outcomes are poorly understood in the pediatric population. METHODS Our study compared clinical and microbiologic characteristics of children admitted during a 5-year period (2007–2012) to a large university-based hospital and found to have S aureus bacteremia with outcome measures, in order to identify risk factors associated with treatment failure (defined as 30-day mortality, delayed microbiologic resolution, or recurrence of S aureus bacteremia within 60 days of completing effective antibiotic therapy). RESULTS In all, 71 patients were found to have S aureus bacteremia, and of these, 17 patients (24%) experienced treatment failure. Based on the logistic regression model, only high vancomycin minimum inhibitory concentration in combination with a high-risk source of infection (i.e., infected graft or device, intra-abdominal infection, or respiratory tract infection) was significantly associated with risk of treatment failure. CONCLUSIONS Infection associated with a high-risk source may increase the chance of treatment failure in pediatric patients with S aureus bacteremia. Vancomycin minimum inhibitory concentration alone was not found to be a predictor of treatment outcomes.

Successful Treatment of Apparent Methicillin-Resistant S. Aureus Endocarditis with Gentamicin and Cephalothin

1979 ◽  
Vol 13 (3) ◽  
pp. 150-154 ◽  
Author(s):  
Cal W. Greenlaw ◽  
Franklin B. Ott
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Treatment Failure ◽  
Pediatric Patient ◽  
Methicillin Resistance ◽  
Initial Dosage ◽  
Synergistic Activity ◽  
Rapid Improvement ◽  
Trough Serum ◽  
Staphylococcus Aureus Endocarditis

A pediatric patient with Staphylococcus aureus endocarditis was treated unsuccessfully with methicillin 74 mg/kg/day as an initial dosage and 185 mg/kg/day as a maximum dosage over a 21-day period. Treatment failure was a result of apparent methicillin resistance, which may have been induced by the initial use of suboptimum methicillin dosages. The methicillin was discontinued and the patient became afebrile within six hours of receiving a combination of cephalothin and gentamicin. Combination therapy was continued for a total of 42 days, with eventual trough serum MBC dilutions of 1:32 and gentamicin and cephalothin dosages of 2.7 and 166 mg/kg/day respectively. The patient was cured without any adverse sequelae. The rapid improvement in this patient's condition and his cure after receiving the combination therapy was probably due to the synergistic activity of gentamicin and cephalothin against S. aureus.

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