Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children: Executive Summary

Department of Medicine, Division of Infectious Diseases, University of California-San Francisco, San Francisco, California 94102, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 02/2011; 52(3):285-92. DOI: 10.1093/cid/cir034
Source: PubMed


Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.

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    • "We found that 4.6% MRSA were resistant to Vancoplus while 26 to 80 % resistance observed for other drugs. The susceptibility of MRSA to vancomycin may be declining and reports of treatment failures are increasing [33] [34] [35] [36] [37]. The varied level of vancomycin resistance was reported from different parts of the world [13] [16] [38] [39]. "

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    • "In clinical practice, it is unfeasible to obtain an AUC, since serial plasma concentrations are needed for calculation of the AUC. The trough serum concentrations may be used as another parameter to reflect drug exposure [16]. The causative CNS spp. in our patients showed an MIC ≥ 1.5, which is comparable to CNS MIC data from the European EUCAST reference database, where 93% of coagulase-negative Staphylococci showed an MIC in the range of 1.0 to 2.0 mg/L [17]. "
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    ABSTRACT: Background Vancomycin is effective against gram-positive bacteria and the first-line antibiotic for treatment of proven coagulase-negative staphylococcal infections. The aim of this study is bipartite: first, to assess the percentage of therapeutic initial trough serum concentrations and second, to evaluate the adequacy of the therapeutic range in interrelationship with the observed MIC-values in neonates. Methods In this study, preterm and term neonates admitted at a tertiary NICU in the Netherlands from January 2009 to December 2012 and treated with vancomycin for a proven gram-positive infection were included. Trough serum concentrations were measured prior to administration of the 5th dose. Trough concentrations in the range of 10 to 15 mg/L were considered therapeutic. Staphylococcal species minimal inhibitory concentrations (MIC’s) were determined using the E-test method. Species identification was performed by matrix-assisted laser desorption/ionisation mass spectrometry. Results Of the 112 neonates, 53 neonates (47%) had sub-therapeutic initial trough serum concentrations of vancomycin, whereas 22% had supra-therapeutic initial trough serum concentrations. In all patients doses were adjusted on basis of the initial trough concentration. In 40% (23/57) of the neonates the second trough concentration remained sub-therapeutic. MIC’s were determined for 30 coagulase-negative Staphylococcus isolates obtained from 19 patients. Only 4 out of 19 subjects had a trough concentration greater than tenfold the MIC. Conclusions Forty-seven percent of the neonates had sub-therapeutic initial trough serum concentrations of vancomycin. The MIC-data indicate that the percentages of underdosed patients may be greater. It may be advisable to increase the lower limit of the therapeutic range for European neonates.
    BMC Pediatrics 07/2014; 14(1):193. DOI:10.1186/1471-2431-14-193 · 1.93 Impact Factor
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    • "The use of vancomycin, an anti-infective active against Gram-positive organisms, has increased nearly 100-fold over the last three decades [1-3]. This surge in utilization likely reflects the growing prevalence of staphylococcal infections, often methicillin-resistant Staphylococcus aureus (MRSA), for which vancomycin is considered first-line therapy [4,5]. Since vancomycin has a narrow therapeutic window, routine therapeutic drug monitoring with serum trough concentrations is recommended [4,5]. "
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    ABSTRACT: Introduction Serum cystatin C can improve glomerular filtration rate (GFR) estimation over creatinine alone, but whether this translates into clinically relevant improvements in drug dosing is unclear. Methods This prospective cohort study enrolled adults receiving scheduled intravenous vancomycin while hospitalized at the Mayo Clinic in 2012. Vancomycin dosing was based on weight, serum creatinine with the Cockcroft-Gault equation, and clinical judgment. Cystatin C was later assayed from the stored serum used for the creatinine-based dosing. Vancomycin trough prediction models were developed by using factors available at therapy initiation. Residuals from each model were used to predict the proportion of patients who would have achieved the target trough with the model compared with that observed with usual care. Results Of 173 patients enrolled, only 35 (20%) had a trough vancomycin level within their target range (10 to 15 mg/L or 15 to 20 mg/L). Cystatin C-inclusive models better predicted vancomycin troughs than models based upon serum creatinine alone, although both were an improvement over usual care. The optimal model used estimated GFR by the Chronic Kidney Disease Epidemiology Collaborative (CKD-EPI) creatinine-cystatin C equation (R2 = 0.580). This model is expected to yield 54% (95% confidence interval 45% to 61%) target trough attainment (P <0.001 compared with the 20% with usual care). Conclusions Vancomycin dosing based on standard care with Cockcroft-Gault creatinine clearance yielded poor trough achievement. The developed dosing model with estimated GFR from CKD-EPIcreatinine-cystatin C could yield a 2.5-fold increase in target trough achievement compared with current clinical practice. Although this study is promising, prospective validation of this or similar cystatin C-inclusive dosing models is warranted.
    Critical care (London, England) 05/2014; 18(3):R110. DOI:10.1186/cc13899 · 4.48 Impact Factor
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