{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T07:12:33Z","timestamp":1776064353182,"version":"3.50.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T00:00:00Z","timestamp":1554249600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Data suggest that vancomycin + \u03b2-lactam combinations improve clearance of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs). However, it is unclear which specific \u03b2-lactams confer benefit. This analysis evaluates the impact of concomitant empiric cefepime on outcomes of MRSA BSIs treated with vancomycin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study of adults with MRSA BSI from 2006 to 2017. Vancomycin + cefepime therapy was defined as \u226524 hours of cefepime during the first 72 hours of vancomycin. The primary outcome was microbiologic failure, defined as BSI duration \u22657 days and\/or 60-day recurrence. Multivariable logistic regression was used to evaluate the association between vancomycin + cefepime therapy and binary outcomes. Cause-specific and subdistribution hazard models were used to evaluate the association between vancomycin + cefepime and BSI clearance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hundred fifty-eight patients were included, 129 vancomycin and 229 vancomycin + cefepime. Vancomycin + cefepime therapy was independently associated with reduced microbiologic failure (adjusted odds ratio [aOR], 0.488; 95% confidence interval [CI], 0.271\u20130.741). This was driven by a reduction in the incidence of BSI durations \u22657 days (vancomycin + cefepime aOR, 0.354; 95% CI, 0.202\u20130.621). Vancomycin + cefepime had no association with 30-day mortality (aOR, 0.952; 95% CI, 0.435\u20132.425). Vancomycin + cefepime was associated with faster BSI clearance in both cause-specific (HR, 1.408; 95% CI, 1.125\u20131.762) and subdistribution hazard models (HR, 1.264; 95% CI, 1.040\u20131.536).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Concomitant empiric cefepime improved MRSA BSI clearance and may be useful as the \u03b2-lactam component of synergistic vancomycin + \u03b2-lactam regimens when empiric or directed gram-negative coverage is desired.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ofid\/ofz079","type":"journal-article","created":{"date-parts":[[2019,4,3]],"date-time":"2019-04-03T08:40:11Z","timestamp":1554280811000},"source":"Crossref","is-referenced-by-count":10,"title":["The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin"],"prefix":"10.1093","volume":"6","author":[{"given":"Evan J","family":"Zasowski","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"},{"name":"Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas"},{"name":"Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trang D","family":"Trinh","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"},{"name":"Department of Clinical Pharmacy, UCSF School of Pharmacy, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safana M","family":"Atwan","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Merzlyakova","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdalhamid M","family":"Langf","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahil","family":"Bhatia","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Rybak","sequence":"first","affiliation":[{"name":"Anti-Infective Research Laboratory, 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"},{"name":"Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"2020061514032146200_CIT0001","volume-title":"Antibiotic resistance threats in the United States","author":"Centers for Disease Control and 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