{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T14:50:06Z","timestamp":1761663006400},"reference-count":37,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2011,10,1]],"date-time":"2011-10-01T00:00:00Z","timestamp":1317427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2011,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Methicillin-resistant\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Staphylococcus aureus<\/jats:named-content>\n            (MRSA) is a common cause of bloodstream infection (BSI) and is often associated with invasive infections and high rates of mortality. Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported. We conducted a comprehensive evaluation of the factors (patient, strain, infection, and treatment) involved in the etiology and management of MRSA BSI to create a risk stratification tool for clinicians. This study included consecutive patients with MRSA BSI treated with vancomycin over 2 years in an inner-city hospital in Detroit, MI. Classification and regression tree analysis (CART) was used to develop a risk prediction model that characterized vancomycin-treated patients at high risk of clinical failure. Of all factors, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, with a cutoff point of 14, was found to be the strongest predictor of failure and was used to split the population into two groups. Forty-seven percent of the population had an APACHE-II score &lt; 14, a value that was associated with low rates of clinical failure (11%) and mortality (4%). Fifty-four percent of the population had an APACHE-II score \u2265 14, which was associated with high rates of clinical failure (35%) and mortality (23%). The risk stratification model identified the interplay of three other predictors of failure, including the vancomycin MIC as determined by Vitek 2 analysis, the risk level of the source of BSI, and the USA300 strain type. This model can be a useful tool for clinicians to predict the likelihood of success or failure in vancomycin-treated patients with MRSA bloodstream infection.\n          <\/jats:p>","DOI":"10.1128\/aac.00115-11","type":"journal-article","created":{"date-parts":[[2011,8,9]],"date-time":"2011-08-09T06:30:16Z","timestamp":1312871416000},"page":"4581-4588","update-policy":"http:\/\/dx.doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":32,"title":["Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool"],"prefix":"10.1128","volume":"55","author":[{"given":"Carol L.","family":"Moore","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"},{"name":"Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faiqa","family":"Cheema","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Osaki-Kiyan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Beth","family":"Perri","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Donabedian","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia Z.","family":"Haque","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"},{"name":"Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus J.","family":"Zervos","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Henry Ford Hospital, Detroit, Michigan"},{"name":"Wayne State University School of Medicine, Detroit, Michigan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2005.07.018"},{"key":"e_1_3_2_3_2","volume-title":"Classification and regression trees","author":"Breiman L.","year":"1984","unstructured":"BreimanL. 1984. 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