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Evolving Resistance Among Gram-positive Pathogens

Antimicrobial therapy is a key component of modern medical practice and a cornerstone for the development of complex clinical interventions in critically ill patients. Unfortunately, the increasing problem of antimicrobial resistance is now recognized as a major public health threat jeopardizing the care of thousands of patients worldwide. Gram-positive pathogens exhibit an immense ...

Editorial Commentary: Surgical Therapy for Staphylococcus aureus Prosthetic Valve Endocarditis: Proceed With Caution (Caveat Emptor)

Adolf W. Karchmer 1 Arnold S. Bayer () 0 0 Harbor-UCLA Medical Center, David Geffen School of Medicine, University of California , Los Angeles 1 Beth Israel Deaconess Medical Center, Harvard Medical

Failure of High-Dose Daptomycin for Bacteremia Caused by Daptomycin-Susceptible Enterococcus faecium Harboring LiaSR Substitutions

High-dose daptomycin (DAP) therapy failed in a neutropenic patient with bloodstream infection caused by a DAP-susceptible Enterococcus faecium (minimum inhibitory concentration, 3 µg/mL) harboring genetic changes associated with DAP resistance, with persistent bacteremia and selection of additional resistances. Daptomycin monotherapy should be used cautiously against ...

Initial Low-Dose Aminoglycosides in Staphylococcus aureus Bacteremia: Good Science, Urban Legend, or Just Plain Toxic?

Arnold S. Bayer () 1 Barbara E. Murray 0 0 Division of Infectious Diseases and Center for the Study of Emerging and Re-emerging Pathogens, University of Texas Medical School at Houston 1 Department

Staphylococcus aureus Bacteremia at 5 US Academic Medical Centers, 2008–2011: Significant Geographic Variation in Community-Onset Infections

Background. The incidence of community-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) bacteremia rose from the late 1990s through the 2000s. However, hospital-onset (HO) MRSA rates have recently declined in the United States and Europe. Methods. Data were abstracted from infection prevention databases between 1 January 2008 and 31 December 2011 at 5 US academic ...

Use of Antistaphylococcal β-Lactams to Increase Daptomycin Activity in Eradicating Persistent Bacteremia Due to Methicillin-Resistant Staphylococcus aureus: Role of Enhanced Daptomycin Binding

We used daptomycin plus antistaphylococcal β-lactams (ASBL) to clear refractory MRSA bacteremia. In vitro studies showed enhanced daptomycin bactericidal activity, increased membrane daptomycin binding, and decrease in positive surface charge induced by ASBLs against daptomycin nonsusceptible MRSA. Addition of ASBLs to daptomycin may be of benefit in refractory MRSA bacteremia. ...

Influence of the Timing of Cardiac Surgery on the Outcome of Patients With Infective Endocarditis and Stroke

Background. The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Methods. Data were obtained from the International Collaboration on Endocarditis–Prospective Cohort Study of 4794 patients with definite IE who ...

Combination Antibiotic Therapy for Infective Endocarditis

Despite the availability of new and potent antibiotics, modern echocardiography, and advanced surgical techniques, infective endocarditis (IE) is still associated with high morbidity and mortality rates. Use of synergistic antibiotic combinations is an appealing way to optimize therapy for IE. This review focuses on evidence-based recommendations for combination antimicrobial ...

Clinical and Epidemiologic Characteristics Cannot Distinguish Community-Associated Methicillin-Resistant Staphylococcus aureus Infection from Methicillin-Susceptible S. aureus Infection: A Prospective Investigation

Background. Community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infection has become common worldwide. Some researchers have argued that empirical therapy for MRSA should be given only to patients with suspected CA S. aureus infections who have risk factors for acquisition of MRSA. However, there are no prospective data examining this approach. Methods. We ...

A Prospective Investigation of Outcomes after Hospital Discharge for Endemic, Community-Acquired Methicillin-Resistant and -Susceptible Staphylococcus aureus Skin Infection

Arnold S. Bayer 0 1 5 0 Los Angeles Biomedical Research Institute, Harbor-University of California- Los Angeles Medical Center , Torrance 1 Received 4 August 2006; accepted 7 November 2006; electronically