ÎFor isolates with a vancomycin MIC ≤ 2, eg, "susceptible" according to CLSI breakpoints, the patient's clinical response should determine the continued use of vancomycin, independent of the MIC (A-III).
> If the patient has had a clinical and microbiologic response to vancomycin, then it may be continued with close follow-up
> If the patient has not had a clinical or microbiologic response to vancomycin despite adequate debridement and removal of other foci of infection, an alternative to vancomycin is recommended regardless of MIC.
ÎFor isolates with a vancomycin MIC > 2 mcg/mL, eg, vancomycin- intermediate
(VISA) or vancomycin-resistant (VRSA), an alternative to vancomycin should be used (A-III).
Persistent MRSA Bacteremia and Vancomycin Treatment Failures in Adults
ÎA search for and removal of other foci of infection, drainage or surgical debridement is recommended (A-III).
ÎHigh-dose daptomycin, if the isolate is susceptible, in combination with other agents should be considered (B-III).
> Please see antibiotic recommendations in full text guidelines for details at http://www.idsociety.org/content.aspx?id=4432#mrsa
ÎIf reduced susceptibility to vancomycin and daptomycin are present, options may include: quinupristin-dalfopristin 7.5 mg/kg/dose IV every 8 hours, trimethoprim/sulfamethoxazole 5 mg/kg/dose IV twice daily, linezolid 600 mg PO/IV twice daily, or telavancin 10 mg/kg/ dose IV once daily (C-III).
These options may be given as a single agent or in combination with other antibiotics.
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