Department of Pharmacy Practice, College of Pharmacy.
Clin Infect Dis. 2013 Dec;57(12):1760-5. doi: 10.1093/cid/cit560. Epub 2013 Aug 28.
The high prevalence of methicillin resistance among Staphylococcus aureus bacteremias leads to common use of vancomycin as empirical therapy. However, investigators have reported poor outcomes with vancomycin treatment for methicillin-susceptible Staphylococcus aureus bacteremia. We review the evidence supporting empirical combination of both vancomycin and a β-lactam agent for Staphylococcus aureus bacteremia. Vancomycin therapy for methicillin-susceptible Staphylococcus aureus bacteremia is associated with 2-3 times the risk of morbidity and mortality compared to an antistaphylococcal penicillin (oxacillin and nafcillin) or first-generation cephalosporin (cefazolin). De-escalation of empirical vancomycin to definitive β-lactam therapy still appears inferior to initial β-lactam therapy. Although there is no clinical trial supporting combination therapy, a scientific rationale for benefit exists and should be weighed against the risks (adverse events, antibiotic resistance, and cost) of additional pharmacotherapy. The empirical combination of vancomycin and a β-lactam (either nafcillin, oxacillin, or cefazolin) for staphylococcal bacteremia may improve infection-related clinical outcomes.
金黄色葡萄球菌菌血症中耐甲氧西林金黄色葡萄球菌的高流行率导致万古霉素被普遍用作经验性治疗。然而，研究人员报告称，万古霉素治疗甲氧西林敏感金黄色葡萄球菌菌血症的效果不佳。我们回顾了支持万古霉素和β-内酰胺类药物联合经验性治疗金黄色葡萄球菌菌血症的证据。与抗葡萄球菌青霉素（苯唑西林和萘夫西林）或第一代头孢菌素（头孢唑林）相比，万古霉素治疗甲氧西林敏感金黄色葡萄球菌菌血症的发病率和死亡率风险增加 2-3 倍。与初始β-内酰胺类药物治疗相比，将经验性万古霉素降级为明确的β-内酰胺类药物治疗似乎仍然较差。虽然没有临床试验支持联合治疗，但确实存在获益的科学依据，应权衡额外药物治疗的风险（不良事件、抗生素耐药性和成本）。万古霉素和β-内酰胺类药物（苯唑西林、萘夫西林或头孢唑林）联合治疗葡萄球菌菌血症可能改善与感染相关的临床结局。
