Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia continues to cause significant morbidity and mortality despite advances in medical therapy. Vancomycin therapy remains the standard of care for most cases of MRSA bacteremia but has pharmacokinetic and pharmacodynamic limitations, dosing complications, and known toxicity. Welcomed clinical trials have recently addressed some of the controversies that plague this field, including optimization of vancomycin dosing and use of combination therapy. In this review, we discuss these trials and their implications for clinical care and future research.
Highlights
Staphylococcus aureus bacteremia (SAB) remains a distinct entity in the realm of infectious disease, singular in its ability to adhere to vascular structures, cause deep-seated infections, disseminate, and result in a high mortality despite targeted antibiotic therapy
methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been associated with longer hospitalizations, longer durations of bacteremia, more severe disease, and a higher 30-day mortality in comparison with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia[2]
Threshold (AUC/MICBMD > 650 mg*hour/L or AUC/MICe-test > 320 mg*hour/L depending upon whether the MIC was determined by broth microdilution [BMD] or e-test). This multicenter observational study prospectively evaluated the association between vancomycin exposure and treatment failure, defined as 30-day mortality or persistent bacteremia of at least 7 days, in patients with MRSA bacteremia[8]
Summary
Staphylococcus aureus bacteremia (SAB) remains a distinct entity in the realm of infectious disease, singular in its ability to adhere to vascular structures, cause deep-seated infections, disseminate, and result in a high mortality despite targeted antibiotic therapy. Studies have reported increased nephrotoxicity with vancomycin AUC/MIC of at least 600 mg*hour/L6 despite being within the accepted target range of the 2009 national guidelines. This recommended target range was based on limited data from predominantly retrospective studies that suggested that a high AUC/MIC was associated with less clinical failure[7]. Based in part on the PROVIDE trial data, 2020 U.S.national guidelines added a ceiling to the goal AUC/MIC range, recommending a target AUC /MIC of 400 to 600 mg *hour /L for MRSA bacteremia and other serious MRSA infections in adult patient[9].
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