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Mortality outcomes similar between vancomycin, beta-lactam for BSI

12 Sep 2019

The 30-day all-cause mortality is similar between definitive therapy with vancomycin or a beta-lactam among patients with an ampicillin-susceptible enterococcal bloodstream infection (BSI), a recent study has shown.

Definitive therapy was given to 186 patients with an ampicillin-susceptible enterococcal BSI, of which 45 (24.2 percent) received vancomycin and 141 (75.8 percent) beta-lactam.

No between-group difference was seen in the primary outcome of 30-day all-cause mortality (6.7 percent vs 7.1 percent; p=0.992). However, the vancomycin group had significantly higher all-cause mortality in a posthoc analysis 1 year after the index BSI (51 percent vs 33 percent; p=0.032).

In addition, definitive therapy with vancomycin had been shown to increase the risk of all-cause mortality at 1 year (hazard ratio [HR], 2.39, 95 percent CI, 1.41–4.04) in a Cox proportional hazards regression model.

“Whether definitive vancomycin is associated with poor long-term outcomes warrants further exploration,” the authors said.

This retrospective cohort study sought to determine whether definitive antibiotic selection affected outcomes for patients with an ampicillin-susceptible enterococcal BSI.

The authors included patients aged >18 years receiving definitive therapy with vancomycin or a beta-lactam for one or more blood cultures positive for Enterococcus spp. isolates between 2007 and 2014. A Kaplan-Meier curve with log-rank test was used to examine survival differences.

“De-escalation to a beta-lactam improves outcomes for patients with a methicillin-susceptible Staphylococcus aureus BSI,” the authors said. “Whether a similar strategy is appropriate for enterococcal species is less clear.”

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Most Read Articles
Elvira Manzano, 4 days ago

The US Preventive Services Task Force (USPSTF), in an update of its 2013 recommendations, called on clinicians to offer risk-reducing medications to women who are at increased risk for breast cancer but at low risk for adverse effects.

Pearl Toh, 5 days ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.
Yesterday
Cryptococcosis is more common in nonhuman immunodeficiency virus (HIV) nontransplant (NHNT) patients, and this population tends to have more localized pulmonary cryptococcosis and significantly higher 90-day mortality, reports a study.
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Type 2 diabetes (T2D) is an independent risk factor for all-cause dementia, with the greatest risk observed in patients who are insulin-dependent and obese, a recent study has found.