Impact of empirical-therapy selection on outcomes of intravenous drug users with infective endocarditis caused by methicillin-susceptible Staphylococcus aureus.

Albany College of Pharmacy, Albany, NY 12208-3492, USA.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.45). 11/2007; 51(10):3731-3. DOI: 10.1128/AAC.00101-07
Source: PubMed

ABSTRACT This study compares beta-lactam and vancomycin among intravenous drug users with infective endocarditis caused by methicillin-susceptible Staphylococcus aureus. Patients who received vancomycin had higher infection-related mortality, even if they were switched to beta-lactam once culture results became available; this relationship persisted after logistic regression analysis controlling for clinical characteristics.

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    ABSTRACT: The Verigene Gram-positive blood culture assay (BC-GP) is a microarray-based rapid diagnostic test which includes targets for 12 bacterial species and three resistance determinants. We prospectively compared the diagnostic accuracy of the BC-GP to routine microbiologic methods and evaluated the potential of the BC-GP for antimicrobial stewardship programs. A total of 143 consecutive patients with Gram-positive bacteremia were included in the analysis. BC-GP correctly identified 127/128 (99.2%) of organisms from monomicrobial blood cultures and 9/14 (64.3%) from polymicrobial, including all methicillin-resistant S. aureus and vancomycin-resistant enterococci. Stewardship interventions were possible in 51.0% of patients, most commonly stopping or preventing unnecessary vancomycin or starting a targeted therapy. In Monte Carlo simulations, unnecessary antibiotics could be stopped at least 24 hours earlier in 65.6% of cases and targeted therapy could be started at least 24 hours earlier in 81.2%. BC-GP is a potentially useful test for antibiotic stewardship in patients with Gram-positive bacteremia.
    Diagnostic Microbiology and Infectious Disease 10/2014; 81(1). DOI:10.1016/j.diagmicrobio.2014.09.025 · 2.57 Impact Factor


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