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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
01 Dec 2019
Macrolide antibiotics are derived from the Streptomycesspecies. These contain either 14-membered (erythromycin [ERM],clarithromycin [CAM], roxithromycin [RXM]), 15-membered(azithromycin [AZM]) or 16-membered (spiramycin, josamycin,midecamycin) macrocyclic lactone rings. They inhibit proteinsynthesis by reversibly binding to the 23S ribosomal RNA (rRNA)in the 50s subunit of the bacterial ribosome. Traditionally,macrolides are used as first-line agents in respiratory, skin,soft tissue, and urogenital infections, and they are also activeagainst gram-positive cocci and atypical pathogens.
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Nonsmall cell lung cancer (NSCLC) patients harbouring sensitive EGFR mutations may fare well with the third-generation tyrosine kinase inhibitor osimertinib as an upfront therapy, with the results of a network meta-analysis showing that the drug tops other currently available options in terms of progression-free survival and tolerability.
01 Dec 2019
Pneumonia is a common infection– affecting around 3,200 people inSingapore in 2016 – making it the thirdmost common cause of hospitalisation inthe country. Its common complications,especially with delayed or inappropriatetreatment, include bacteraemia andseptic shock, lung abscesses, pleuraleffusions, empyema, pleurisy, respiratoryfailure and renal failure.