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Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections.

Publication ,  Journal Article
Fletcher, JM; Kram, SJ; Sarubbi, CB; Anderson, DJ; Kram, BL
Published in: J Pharm Pract
August 2019

BACKGROUND: De-escalation to a beta-lactam improves outcomes for patients with a methicillin-susceptible Staphylococcus aureus bloodstream infection (BSI). Whether a similar strategy is appropriate for enterococcal species is less clear. OBJECTIVE: To determine whether definitive antibiotic selection affects outcomes for patients with an ampicillin-susceptible enterococcal BSI. METHODS: This retrospective cohort study included patients over 18 years of age receiving definitive therapy with vancomycin or a beta-lactam for one or more blood cultures positive for Enterococcus spp. isolates between 2007 and 2014. Survival differences were examined using a Kaplan-Meier curve with log-rank test. RESULTS: One-hundred eighty-six patients received definitive therapy with either vancomycin (n = 45, 24.2%) or a beta-lactam (n = 141, 75.8%). The primary outcome, 30-day all-cause mortality, was not different between groups (6.7% vs 7.1%; P = .992). A post hoc analysis of all-cause mortality 1 year after the index BSI was significantly higher in the vancomycin group (51% vs 33%; P = .032). In a Cox proportional hazards regression model, definitive vancomycin was associated with an increased risk of all-cause mortality at 1 year (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.41-4.04). CONCLUSION: For patients with an ampicillin-susceptible enterococcal BSI, definitive therapy with vancomycin or a beta-lactam was not independently associated with a difference in 30-day all-cause mortality. Whether definitive vancomycin is associated with poor long-term outcomes warrants further exploration.

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Published In

J Pharm Pract

DOI

EISSN

1531-1937

Publication Date

August 2019

Volume

32

Issue

4

Start / End Page

375 / 381

Location

United States

Related Subject Headings

  • beta-Lactams
  • Vancomycin
  • Treatment Outcome
  • Retrospective Studies
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Gram-Positive Bacterial Infections
  • Female
 

Citation

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ICMJE
MLA
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Fletcher, J. M., Kram, S. J., Sarubbi, C. B., Anderson, D. J., & Kram, B. L. (2019). Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections. J Pharm Pract, 32(4), 375–381. https://doi.org/10.1177/0897190017751208
Fletcher, Jesse M., Shawn J. Kram, Christina B. Sarubbi, Deverick J. Anderson, and Bridgette L. Kram. “Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections.J Pharm Pract 32, no. 4 (August 2019): 375–81. https://doi.org/10.1177/0897190017751208.
Fletcher JM, Kram SJ, Sarubbi CB, Anderson DJ, Kram BL. Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections. J Pharm Pract. 2019 Aug;32(4):375–81.
Fletcher, Jesse M., et al. “Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections.J Pharm Pract, vol. 32, no. 4, Aug. 2019, pp. 375–81. Pubmed, doi:10.1177/0897190017751208.
Fletcher JM, Kram SJ, Sarubbi CB, Anderson DJ, Kram BL. Effectiveness of Vancomycin or Beta-Lactam Therapy in Ampicillin-Susceptible Enterococcus spp. Bloodstream Infections. J Pharm Pract. 2019 Aug;32(4):375–381.
Journal cover image

Published In

J Pharm Pract

DOI

EISSN

1531-1937

Publication Date

August 2019

Volume

32

Issue

4

Start / End Page

375 / 381

Location

United States

Related Subject Headings

  • beta-Lactams
  • Vancomycin
  • Treatment Outcome
  • Retrospective Studies
  • Pharmacology & Pharmacy
  • Middle Aged
  • Male
  • Humans
  • Gram-Positive Bacterial Infections
  • Female