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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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