Methicillin-resistant Staphylococcus aureus (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 < 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 > 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.Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of bloodstream infection (BSI) and has been associated with mortality rates of between 20 and 30% (16,18,24,30,33). Invasive infections caused by MRSA have been implicated in over 18,000 deaths annually (14). Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported (3,7,24). There is also growing evidence that infection with an organism with an increased vancomycin MIC that is still within the susceptible range may also be associated with increased rates of vancomycin failure (9,23,29,30). Evidence suggests that the increased risk associated with a vancomycin MIC of 2 g/ml is not mitigated by targeting higher vancomycin trough concentrations in the range of 15 to 20 g/ml (9). It has been postulated that strategies such as increasing the vancomycin trough concentration or the area under the curve (AUC)/MIC ratio may theoretically be associated with better outcomes in MRSA BSI; however, this has yet to be proven in prospective clinical trials (27).Given the emerging information relating to outcomes of vancomycin treatment in cases of MRSA BSI, a comprehensive evaluati...

Treatment options for Achromobacter xylosoxidans are limited. Eight cystic fibrosis patients with A. xylosoxidans were treated with 12 cefiderocol courses. Pre-treatment in vitro resistance was seen in 3/8 cases. Clinical response occurred after 11/12 treatment courses. However, microbiologic relapse was observed after 11/12 treatment courses, notably without emergence of resistance.

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The widespread transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to propagate the coronavirus disease 2019 (COVID-19) pandemic with solid organ transplant (SOT) recipients being an exceptionally vulnerable population for poor outcomes. Treatments for COVID-19 are limited; however, monoclonal antibodies are emerging as a potential therapeutic option to change the trajectory of high-risk patients. This retrospective single center cohort study evaluated the outcomes of SOT recipients with mild to moderate COVID-19 who received bamlanivimab monotherapy. Eighteen SOT recipients (15 kidney, 2 liver, and 1 heart)

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