The Empirical Combination of Vancomycin and a Beta-Lactam for Staphylococcal Bacteremia.
Clin Infect Dis. 2013 Aug 28;
Authors: McConeghy KW, Bleasdale SC, Rodvold KA
The high prevalence of methicillin-resistance among Staphylococcus aureus bacteremias leads to common use of vancomycin as empirical therapy. However, investigators have reported poor outcomes with vancomycin treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We review the evidence supporting empirical combination of both vancomycin and a beta-lactam agent for Staphylococcus aureus bacteremia. Vancomycin therapy for methicillin-susceptible Staphylococcus aureus bacteremia is associated with 2-3 times the risk of morbidity and mortality compared to an antistaphylococcal penicillin (oxacillin and nafcillin) or first-generation cephalosporin (cefazolin). De-escalation of empirical vancomycin to definitive beta-lactam therapy still appears inferior to initial beta-lactam therapy. Although there is no clinical trial supporting combination therapy, a scientific rationale for benefit exists and should be weighed against the risks (adverse events, antibiotic resistance, and cost) of additional pharmacotherapy. The empirical combination of vancomycin and a beta-lactam (either nafcillin, oxacillin or cefazolin) for Staphylococcal bacteremia may improve infection-related clinical outcomes.
PMID: 23985343 [PubMed - as supplied by publisher]