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Clinical Therapeutics

Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia: Does β-Lactam Class Matter?

Thomas J. Dilworth, Anthony M. Casapao, Omar M. Ibrahim, David M. Jacobs, Dana R. Bowers, Nicholas D. Beyda, Renee-Claude Mercier
Thomas J. Dilworth
aAurora Health Care, Department of Pharmacy Services, Milwaukee, Wisconsin, USA
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Anthony M. Casapao
bUniversity of Florida College of Pharmacy, Jacksonville, Florida, USA
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Omar M. Ibrahim
cIndependent Researcher, Gainesville, Florida, USA
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David M. Jacobs
dUniversity at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
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Dana R. Bowers
eWashington State University College of Pharmacy and Pharmaceutical Sciences, Yakima, Washington, USA
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Nicholas D. Beyda
fUniversity of Houston College of Pharmacy, Houston, Texas, USA
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Renee-Claude Mercier
gUniversity of New Mexico College of Pharmacy, Albuquerque, New Mexico, USA
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DOI: 10.1128/AAC.02211-18
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  • TABLE 1

    Treatment assignment and persistent bacteremia, univariable analyses

    CharacteristicTreatment assignmentaBacteremia durationa
    Combob (n = 90)VAN (n = 66)P value<5 days (n = 103)≥5 days (n = 53)P value
    Age (yr, mean ± SD)58 ± 1661 ± 170.31758 ± 1660 ± 170.539
    Male50 (55.6)35 (53.0)0.87157 (53.3)28 (52.8)0.865
    Race/ethnicity0.4170.392
        Caucasian55 (61.1)36 (54.5)63 (61.2)28 (52.8)
        Other35 (38.9)30 (45.5)40 (38.8)25 (47.2)
    Diabetes mellitus43 (47.8)27 (40.9)0.41945 (43.7)25 (47.2)0.735
    Cancer16 (17.8)15 (22.7)0.54318 (17.5)13 (24.5)0.299
    Lung disease20 (22.2)10 (15.2)0.30917 (16.5)13 (24.5)0.284
    Congestive heart failure14 (15.6)8 (12.1)0.64416 (15.5)6 (11.3)0.628
    End-stage renal disease27 (30.0)20 (30.3)>0.99932 (31.1)15 (28.3)0.854
    Hemodialysis15 (16.7)15 (22.7)0.41219 (18.5)11 (20.8)0.831
    PITT bacteremia score ≥419 (12.2)12 (18.8)0.69023 (22.1)8 (15.4)0.397
    Intensive care unit admission41 (45.6)22 (33.3)0.14043 (41.8)20 (37.7)0.731
    Bacteremia source0.1670.156
        Primary endovascular27 (30.0)24 (36.4)32 (31.1)19 (35.9)
        Secondary50 (55.6)27 (40.9)56 (54.4)21 (39.6)
        Catheter related13 (14.4)15 (22.7)15 (15.0)13 (24.5)
    Prosthesis14 (15.6)18 (27.3)0.10720 (19.4)12 (22.6)0.678
    VAN MIC ≤1 mg/liter74 (82.2)57 (86.4)0.51784 (81.6)47 (88.6)0.357
    Initial VAN level (mg/liter; median [IQR])17.8 (14.0–23.4)15.7 (11.3–20.2)0.04117.5 (14.0–23.0)15.0 (11.1–23.2)0.108
    VAN therapy duration (days [range])12 (8–26)11.5 (7–22)0.77312 (7–31)13 (9–19)0.990
    Persistent bacteremia24 (26.7)29 (43.9)0.027
    In-hospital mortality14 (15.6)9 (13.6)0.82214 (13.6)9 (17.0)0.636
    Acute kidney injury17 (18.9)5 (7.6)0.06213 (12.6)9 (17.0)0.474
    • ↵a Data presented as n (%) unless noted otherwise.

    • ↵b Piperacillin-tazobactam (60.0%), cefepime (15.6%), ceftriaxone (12.2%), meropenem (4.4%), imipenem-cilastatin (3.3%), ampicillin-sulbactam (2.2%), cefazolin (1.1%), and doripenem (1.1%).

  • TABLE 2

    Rates of persistent bacteremia and acute kidney injury by β-lactam class

    CharacteristicRate (n [%]) with:
    Carbapenem (n = 8)Cephalosporin (n = 25)Penicillin (n = 56)Vancomycina (n = 66)
    Persistent bacteremia0 (0)8 (32)15 (26.8)29 (43.9)
    Acute kidney injury1 (12.5)4 (16)12 (21.4)5 (7.6)
    • ↵a Vancomycin is listed for reference.

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Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia: Does β-Lactam Class Matter?
Thomas J. Dilworth, Anthony M. Casapao, Omar M. Ibrahim, David M. Jacobs, Dana R. Bowers, Nicholas D. Beyda, Renee-Claude Mercier
Antimicrobial Agents and Chemotherapy Feb 2019, 63 (3) e02211-18; DOI: 10.1128/AAC.02211-18

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Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia: Does β-Lactam Class Matter?
Thomas J. Dilworth, Anthony M. Casapao, Omar M. Ibrahim, David M. Jacobs, Dana R. Bowers, Nicholas D. Beyda, Renee-Claude Mercier
Antimicrobial Agents and Chemotherapy Feb 2019, 63 (3) e02211-18; DOI: 10.1128/AAC.02211-18
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KEYWORDS

bacteremia
β-lactam
combination therapy
methicillin-resistant Staphylococcus aureus
vancomycin

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