Avoiding the Perfect Storm: The Biologic and Clinical Case for Reevaluating the 7-Day Expectation for Methicillin-Resistant Staphylococcus aureus Bacteremia Before Switching Therapy

Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (MRSAB) is associated with poor outcomes and serious complications. The MRSA guidelines define treatment failure and persistent bacteremia as lasting ≥7 days; however, this definition requires reevaluation. Aggressively reducin...

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Bibliographic Details
Published in:Clinical infectious diseases 2014-11, Vol.59 (10), p.1455-1461
Main Authors: Kullar, Ravina, McKinnell, James A., Sakoulas, George
Format: Article
Language:English
Subjects:
Animals
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antimicrobials
Bacteremia
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Biomarkers
Clinical outcomes
CLINICAL PRACTICE
Cubism
Drug resistance
Drug Substitution
Drug Therapy, Combination
Endocarditis
Health outcomes
Human bacterial diseases
Humans
Infections
Infectious diseases
Invited
Medical sciences
Medical treatment
Methicillin resistant staphylococcus aureus
Methicillin-Resistant Staphylococcus aureus - drug effects
Microbiology
Mortality rates
Staphylococcal Infections - complications
Staphylococcal Infections - diagnosis
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Staphylococcal infections, streptococcal infections, pneumococcal infections
Staphylococcus aureus
Staphylococcus infections
Time Factors
Treatment Failure
Treatment Outcome
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Summary:Persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (MRSAB) is associated with poor outcomes and serious complications. The MRSA guidelines define treatment failure and persistent bacteremia as lasting ≥7 days; however, this definition requires reevaluation. Aggressively reducing the bacterial inoculum promptly is critical because factors already in place before clinical presentation are driving resistance to the few antibiotics that are available to treat MRSAB. Alternative approaches to treat MRSAB should be considered within 3-4 days of persistent MRSAB. With rapid molecular diagnostics emerging in clinical microbiology laboratories and biomarkers as a potential for early patient risk stratification, a future shorter threshold may become possible.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciu583