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Tytuł pozycji:

A trial of discontinuation of empiric vancomycin therapy in patients with suspected methicillin-resistant Staphylococcus aureus health care-associated pneumonia.

Tytuł :
A trial of discontinuation of empiric vancomycin therapy in patients with suspected methicillin-resistant Staphylococcus aureus health care-associated pneumonia.
Autorzy :
Boyce JM; Hospital Epidemiology and Infection Control Program, Yale-New Haven Hospital, New Haven, CT, USA. />Pop OF
Abreu-Lanfranco O
Hung WY
Fisher A
Karjoo A
Thompson B
Protopapas Z
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Źródło :
Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2013 Mar; Vol. 57 (3), pp. 1163-8. Date of Electronic Publication: 2012 Dec 17.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Original Publication: Washington, American Society for Microbiology
MeSH Terms :
Cross Infection/*diagnosis
Cross Infection/*drug therapy
Pneumonia/*diagnosis
Pneumonia/*drug therapy
Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Cross Infection/mortality ; Culture Media ; Female ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Nasal Cavity/microbiology ; Pharynx/microbiology ; Pneumonia/mortality ; Retrospective Studies ; Survival Analysis ; Vancomycin/therapeutic use
References :
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Substance Nomenclature :
0 (Anti-Bacterial Agents)
0 (Culture Media)
6Q205EH1VU (Vancomycin)
Entry Date(s) :
Date Created: 20121221 Date Completed: 20130730 Latest Revision: 20181113
Update Code :
20210210
PubMed Central ID :
PMC3591869
DOI :
10.1128/AAC.01965-12
PMID :
23254432
Czasopismo naukowe
Healthcare-associated pneumonia (HCAP) guidelines recommend de-escalating initial antibiotic therapy based on results from lower-respiratory-tract cultures. In the absence of adequate lower respiratory cultures, physicians are sometimes reluctant to discontinue empirical vancomycin, which is given for suspected methicillin-resistant Staphylococcus aureus (MRSA) HCAP. We evaluated a strategy of discontinuing vancomycin if both nasal and throat cultures were negative for MRSA when lower-respiratory-tract cultures were not available. An antimicrobial stewardship team identified patients receiving empirical vancomycin for suspected or proven HCAP but for whom adequate lower-respiratory-tract cultures were not available. Nasal and throat swab specimens were obtained and plated on MRSA selective media. If both nasal and throat MRSA cultures were negative, the stewardship team recommended discontinuation of empirical vancomycin. Demographic and clinical aspects, a clinical pulmonary infection score (CPIS) on the day of the stewardship recommendation, and mortality of patients for whom vancomycin was discontinued were obtained by retrospective chart review. A convenience sample of 91 patients with nasal and throat cultures negative for MRSA in the absence of adequate respiratory cultures had empirical vancomycin therapy discontinued. A retrospective review revealed that 88 (97%) patients had a CPIS of ≤6 on the day of the stewardship recommendation. In-hospital mortality (7.7%) was similar to that of a previous study of de-escalation of antibiotics in pneumonia patients without adequate cultures. In the absence of adequate lower-respiratory-tract cultures, it is reasonable to discontinue empirical vancomycin HCAP therapy in patients with negative MRSA nasal and throat cultures and a CPIS of <6.

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