title: Avoiding the perfect storm: the biologic and clinical case for reevaluating the 7-day expectation for methicillin-resistant Staphylococcus aureus bacteremia before switching therapy.
abstract: 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.
authors.affiliation: Department of Medical Affairs, Cubist Pharmaceuticals, Lexington, Massachusetts.
authors.forename: Ravina
authors.initials: R
authors.lastname: Kullar
authors.affiliation: Infectious Disease Clinical Outcomes Unit (ID-CORE), Los Angeles Biomedical Research Institute, David Geffen School of Medicine, University of California Department of Medicine, Torrance Memorial Medical Center.
authors.forename: James A
authors.initials: JA
authors.lastname: McKinnell
authors.affiliation: Division of Pediatric Pharmacology and Drug Discovery, University of California San Diego School of Medicine, La Jolla.
authors.forename: George
authors.initials: G
authors.lastname: Sakoulas
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia; D015415:Biomarkers; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D013203:Staphylococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers
keywords: MRSA bacteremia; daptomycin; persistent bacteremia; rapid diagnostics; vancomycin