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Infectious Diseases

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Henry Ford Hospital


Introduction: Daptomycin (dap) is approved as an alternative to vancomycin (van) for therapy of MRSA bloodstream infection (BSI). Cases of therapy failure associated with the emergence of daptomycin-nonsusceptible (DNS) MRSA strains have been documented. Information on the treatment and outcome of DNS MRSA BSI is scarce. This study describes the treatment and outcome of patients (pts) with DNS MRSA BSI at our healthcare center. Methods: This is a retrospective review of pts with DNS MRSA BSI at a tertiary healthcare center in Detroit, MI, between 9/24/2005 and 3/31/2018. The variables collected were: source of BSI, inpatient and discharge antibiotic therapy, BSI duration, in-hospital and 90-day mortality, and 90-day MRSA BSI recurrence. Results: A total of 32 non-duplicate pts with DNS MRSA BSI were identified. One pt with an inaccessible chart was excluded. The source of BSI was endovascular in 9 (29%) pts, secondary BSI in 14 (45%), central-line associated in 3 (10%)). A total of 24 different antibiotic regimens were used to treat DNS MRSA BSI. Conclusion: A variety of therapeutic regimens were used to treat DNS MRSA BSI in our cohort. Vancomycin monotherapy was used most commonly for both inpatient and discharge therapy, followed by daptomycin + ceftaroline. The overall 90-day mortality was 35%.

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Treatment and Outcomes of Daptomycin-Nonsusceptible MRSA Bloodstream Infection