Department of Medicine, Duke University, Durham, North Carolina, USA.
Duke Clinical Research Institute, Durham, North Carolina, USA.
Clin Infect Dis. 2022 Oct 29;75(9):1668-1674. doi: 10.1093/cid/ciac364.
A positive follow-up blood culture for methicillin-resistant Staphylococcus aureus (MRSA) while on seemingly appropriate therapy is a common and ominous development. However, the definition and management of persistent MRSA bacteremia is unstandardized. In this Opinion Paper, we identify the presence of bacteremia for > 1 calendar day as a "worry point" that should trigger an intensive diagnostic evaluation to identify metastatic infection sites. Next, we define the duration of MRSA bacteremia that likely constitutes antibiotic failure and outline a potential management algorithm for such patients. Finally, we propose pragmatic clinical trial designs to test treatment strategies for persistent MRSA bacteremia.
在看似适当的治疗过程中，耐甲氧西林金黄色葡萄球菌 (MRSA) 的血培养呈阳性，这是一种常见且危险的情况。然而，持续性 MRSA 菌血症的定义和管理尚未标准化。在本观点文章中，我们将血培养阳性持续>1 个日历日定义为“关注点”，这应该触发强化诊断评估以确定转移性感染部位。接下来，我们定义了可能构成抗生素治疗失败的 MRSA 菌血症持续时间，并概述了此类患者的潜在管理算法。最后，我们提出了实用的临床试验设计，以测试持续性 MRSA 菌血症的治疗策略。
