Oxacillin plus ertapenem combination therapy leads to rapid blood culture clearance and positive outcomes among patients with persistent MSSA bacteraemia: a case series.
Oxacillin plus ertapenem combination therapy leads to rapid blood culture clearance and positive outcomes among patients with persistent MSSA bacteraemia: a case series.
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DOI：
10.1093/jacamr/dlab148
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发表时间：
2021-09
影响因子：
3.4
通讯作者：
Shields R
中科院分区：
文献类型：
--
作者：
El-Dalati S;Sridaran S;Uricchio M;Kline EG;Shields R
MSSA 引起的血流感染与显着的发病率和死亡率相关。 MSSA 菌血症的传统治疗方法包括静脉注射抗葡萄球菌 β-内酰胺，并在有指征时进行手术源控制。旨在评估接受抗葡萄球菌青霉素加碳青霉烯联合治疗的持续性 MSSA 菌血症患者的血培养清除时间以及院内死亡率和 90 天死亡率。研究人员确定了连续接受联合治疗的持续性 MSSA 菌血症患者，并由独立临床医生进行审查。开始联合治疗的决定是由咨询临床医生或多学科心内膜炎团队做出的。在 10 名持续 MSSA 菌血症中位时间为 5 天的患者中，使用抗葡萄球菌青霉素加碳青霉烯治疗，所有患者的血培养物均被灭菌。血培养清除时间中位数为 1 天，患者接受联合治疗的时间中位数为 6 天。七名接受原发感染部位源头控制的患者中，有四名在手术干预前通过联合治疗清除了菌血症。所有患者均存活至出院以及出院后 90 天。这些数据扩展了先前的发现，并提供了进一步的证据，表明联合治疗对持续性 MSSA 菌血症患者的潜在益处。
Bloodstream infections caused by MSSA are associated with significant morbidity and mortality. Traditional treatment of MSSA bacteraemia includes an IV antistaphylococcal β-lactam and surgical source control when indicated. To evaluate the time to blood culture clearance as well as in-hospital and 90 day mortality in patients with persistent MSSA bacteraemia treated with combination antistaphylococcal penicillin plus carbapenem therapy. Consecutive patients with persistent MSSA bacteraemia treated with combination therapy were identified by study investigators and reviewed by independent clinicians. The decision to initiate combination therapy was made by the consulting clinician or by the institution’s multidisciplinary endocarditis team. Among 10 patients with a median of 5 days of persistent MSSA bacteraemia, treatment with an antistaphylococcal penicillin plus carbapenem led to sterilization of blood cultures in all patients. Blood culture clearance occurred in a median of 1 day and patients received a median of 6 days of combination treatment. Four of seven patients who underwent source control of their primary site of infection cleared their bacteraemia on combination therapy prior to the surgical intervention. All patients survived to hospital discharge and 90 days post-discharge. These data extend prior findings and provide further evidence that suggests the potential benefits of combination therapy among patients with persistent MSSA bacteraemia.