{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:27:26Z","timestamp":1789644446927,"version":"4.0.0"},"reference-count":33,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":1,"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":[[2017,11]]},"abstract":"\n Study Objective<\/jats:title>\n \n To determine whether early administration of adjuvant \u03b2\u2010lactam in combination with vancomycin (\n COMBO<\/jats:styled-content>\n ) affects clinical outcomes compared to standard vancomycin therapy alone (\n STAN<\/jats:styled-content>\n ) among patients with methicillin\u2010resistant\n Staphylococcus aureus<\/jats:italic>\n (\n MRSA<\/jats:styled-content>\n ) bloodstream infection.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective, multicenter cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Five academic or community hospitals throughout the United States.<\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n \n Adults with\n MRSA<\/jats:styled-content>\n bloodstream infections treated with vancomycin (\u2265\u00a072\u00a0hrs)\u00a0with or without\u00a0an intravenous \u03b2\u2010lactam (\u2265\u00a048\u00a0hrs) initiated within 24\u00a0hours of initiating vancomycin.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements and Main Results<\/jats:title>\n \n The primary outcome was clinical failure, a composite endpoint including 30\u2010day mortality, persistent bacteremia (\u2265\u00a07\u00a0days), bacteremia relapse, or change in antibiotic therapy during treatment due to clinical worsening. A multivariable logistic regression examined the impact of patient\u2010, treatment\u2010, and pathogen\u2010level characteristics on clinical failure. A total of 201 patients were evaluated of whom 97 (48.3%) met the criteria for study inclusion; 40 (41.2%) in\n STAN<\/jats:styled-content>\n and 57 (58.8%) in\n COMBO<\/jats:styled-content>\n groups. Among patients in the\n STAN<\/jats:styled-content>\n and\n COMBO<\/jats:styled-content>\n groups, 30% and 24.6% experienced clinical failure, respectively (p=0.552). The median (interquartile range) duration of bacteremia in the\n STAN<\/jats:styled-content>\n and\n COMBO<\/jats:styled-content>\n groups was 4\u00a0days (2.5\u20136.5) and 3\u00a0days (2\u20135), respectively (p=0.048). In a multivariable analysis, receipt of\n COMBO<\/jats:styled-content>\n therapy was inversely associated with clinical failure (adjusted odds ratio [\n aOR<\/jats:styled-content>\n ] 0.237, 95% confidence interval [\n CI<\/jats:styled-content>\n ] [0.057\u20130.982]; p=0.047). Other independent predictors of clinical failure included complicated bacteremia (\n aOR<\/jats:styled-content>\n 6.856, 95%\n CI<\/jats:styled-content>\n [1.641\u201328.649]; p=0.008) and antibiotic therapy not continued at discharge (\n aOR<\/jats:styled-content>\n 45.404, 95%\n CI<\/jats:styled-content>\n [9.383\u2013219.714]; p<0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Receipt of\n COMBO<\/jats:styled-content>\n therapy did not decrease the rate of clinical failure but was associated with expedited bacteremia clearance. Early adjuvant \u03b2\u2010lactam therapy deserves continued evaluation and clinical consideration.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/phar.2034","type":"journal-article","created":{"date-parts":[[2017,9,26]],"date-time":"2017-09-26T10:38:57Z","timestamp":1506422337000},"page":"1347-1356","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":51,"title":["Early Administration of Adjuvant \u03b2\u2010Lactam Therapy in Combination with Vancomycin among Patients with Methicillin\u2010Resistant\n Staphylococcus aureus<\/i>\n Bloodstream Infection: A Retrospective, Multicenter Analysis"],"prefix":"10.1002","volume":"37","author":[{"given":"Anthony M.","family":"Casapao","sequence":"first","affiliation":[{"name":"Husson University School of Pharmacy Bangor Maine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"University at Buffalo School 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