{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T14:30:59Z","timestamp":1761489059555,"version":"build-2065373602"},"reference-count":35,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T00:00:00Z","timestamp":1357776000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec><jats:title>Study Objective<\/jats:title><jats:p>To evaluate a clinical pathway using daptomycin in patients with bacteremia caused by methicillin\u2010resistant <jats:italic><jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>taphylococcus aureus<\/jats:italic> (<jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content>) isolates exhibiting vancomycin minimum inhibitory concentrations\u00a0(MICs) greater than\u00a01\u00a0mg\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Two\u2010phase quasi\u2010experimental study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Level <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> trauma center in <jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>etroit, <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>ichigan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>The study population consisted of a total of 170 patients with <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> bacteremia susceptible to vancomycin: 70 patients who had initial blood <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> isolates exhibiting a vancomycin MIC &gt;\u00a01\u00a0mg\/L and were treated with vancomycin were included in phase <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> (retrospective baseline period [2005\u20132007]) and 100 patients who were switched to daptomycin after initial vancomycin therapy according to the institutional <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> bacteremia treatment pathway were included in phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> (the period after implementation of the treatment pathway [2008\u20132010]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> bacteremia treatment pathway was as follows: vancomycin therapy was initiated, optimizing target trough concentrations to 15\u201320\u00a0mg\/L; for isolates demonstrating vancomycin <jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>s\u00a0greater than\u00a01\u00a0mg\/L, therapy was switched to daptomycin, initiated at dosages of\u00a06\u00a0mg\/kg\/day or higher.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements and Main Results<\/jats:title><jats:p>Infection characteristics, patient outcomes, and costs were evaluated. Patient characteristics were similar between the phase <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> and phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> groups. Phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> patients were more likely to achieve clinical success than were phase I patients (75.0% vs 41.4%, p&lt;0.001). Phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> patients demonstrated a shorter total hospital length of stay and shorter durations of inpatient therapy, fever, and bacteremia. Treatment during phase I was independently associated with failure. Nine patients during phase <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> experienced nephrotoxicity, and two patients during phase <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> experienced increases in creatine kinase level. Costs were similar between phases <jats:styled-content style=\"fixed-case\">I<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content> ($18,385 vs $19,755, p&gt;0.05), although the hospital readmission rate was higher in phase I (33% vs 21%, p=0.08).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Among the patients with bacteremia who had <jats:styled-content style=\"fixed-case\">MRSA<\/jats:styled-content> isolates that exhibited elevated vancomycin <jats:styled-content style=\"fixed-case\">MIC<\/jats:styled-content>s, the switch to daptomycin improved clinical success without increasing treatment cost.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.1220","type":"journal-article","created":{"date-parts":[[2013,1,10]],"date-time":"2013-01-10T08:47:27Z","timestamp":1357807647000},"page":"3-10","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Implementation of an Antimicrobial Stewardship Pathway with Daptomycin for Optimal Treatment of Methicillin\u2010Resistant <i><scp>S<\/scp>taphylococcus aureus<\/i> Bacteremia"],"prefix":"10.1002","volume":"33","author":[{"given":"Ravina","family":"Kullar","sequence":"first","affiliation":[{"name":"Anti\u2010Infective Research Laboratory"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan L.","family":"Davis","sequence":"additional","affiliation":[{"name":"Anti\u2010Infective Research Laboratory"},{"name":"Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University Detroit Michigan"},{"name":"Department of Pharmacy Services Henry Ford Hospital Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith S.","family":"Kaye","sequence":"additional","affiliation":[{"name":"Infection Prevention, Epidemiology and Antimicrobial Stewardship Detroit Medical Center\/Wayne State University Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald P.","family":"Levine","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases Department of Medicine School of Medicine, Wayne State University Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason M.","family":"Pogue","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Sinai\u2010Grace Hospital, Detroit Medical Center Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Rybak","sequence":"additional","affiliation":[{"name":"Anti\u2010Infective Research Laboratory"},{"name":"Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University Detroit Michigan"},{"name":"Division of Infectious Diseases Department of Medicine School of Medicine, Wayne State University Detroit Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,1,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1086\/375057"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2004.10.001"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/367653"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/00019053-200725090-00004"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/345476"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2001.tb143562.x"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2005.02.007"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.24.3012"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2005.01289.x"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1086\/595011"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir124"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1086\/524667"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir078"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00113-08"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.6.2398-2402.2004"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir935"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa053783"},{"volume-title":"Product information: Cubicin\u00ae, daptomycin for injection","year":"2003","author":"Cubist Pharmaceuticals, Inc","key":"e_1_2_6_19_1"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1592\/phco.31.5.441"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp080434"},{"volume-title":"Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically; 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