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Content Update
February 22, 2023
Clinical Updates for Managing Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Adults: Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) are infections with notably high morbidity and mortality. High rates of persistent bacteremia and resource constraints have prompted practitioners to examine novel treatment modalities to improve patient outcomes. New literature has evaluated combination therapy with vancomycin or daptomycin with beta-lactam antibiotics as well as sequential long-acting lipoglycopeptides to facilitate early discharge in patients with MRSA BSI.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Describe how antimicrobials differ from other drug classes in terms of their effects on individual patients as well as on society as a whole.
Recognize that antimicrobial resistance is an inevitable consequence of antimicrobial therapy.
Identify guiding principles to consider when treating patients with antimicrobials, and apply these principles in patient care.
Differentiate between microbial colonization and infection based on patient history, physical examination, and laboratory and culture results.
Evaluate and apply drug-specific considerations when selecting antimicrobial therapy.
Evaluate and apply patient-specific considerations when selecting antimicrobial therapy.
Identify and apply principles of patient education and monitoring response to antimicrobial therapy.
Discuss causes of patients failing to improve while on antimicrobials.
Define antimicrobial stewardship and describe the purpose of such a program.
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Antimicrobials are among the most commonly prescribed medications. Antimicrobial is a broad term referring to agents including antibiotics, antivirals, antiprotozoals, and antifungals. In this chapter, we will refer primarily to antimicrobials; however, when an example is specific to the antibiotic class or treatment of a bacterial infection, the term antibiotic will be used. 
Antimicrobials are different from other classes of pharmaceuticals because they exert their action on microbes infecting the host as opposed to acting directly on the host. Today, there are many antimicrobials available for clinical use. However, in many cases, differences in mechanisms of action between antimicrobials are minor, and the microbiologic properties of the agents are similar. An estimated 50% of hospitalized patients will receive an antimicrobial and about 10% of ambulatory care visits are associated with an antibiotic prescription; however, antimicrobial use is not without risk.1,2 An inevitable consequence of exposing microbes to antimicrobials is that some organisms will develop resistance to the antimicrobial. The CDC’s 2019 Antibiotic Resistance Threats in the United States estimates more than 2.8 million patients per year are infected with resistant pathogens resulting in approximately 35,000 deaths.3 For several decades, infectious disease–related mortality in the United States has increased, in part owing to increases in antimicrobial resistance. Because antimicrobial use in one patient affects not only that patient but also other patients if they become infected with resistant bacteria, correct selection, use, and monitoring of clinical response are paramount. Antimicrobial stewardship programs promote the ...