Community-Acquired and Healthcare-Associated MRS - 0 views
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methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA)
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that has continued to grow now. It approaches 60% across the United States in many of the intensive care units (ICUs)
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One is a strict search-and-destroy policy: patients from other countries and those with MRSA are isolated upon hospital admission until screening cultures for MRSA are proven negative. The second is a restrictive prescribing policy in which the defined daily dosage used per 1000 people per day in primary healthcare is around 8.9.
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resistant organisms lead to delays in appropriate treatment, and that delays in appropriate treatment lead to resistant organisms
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vancomycin has the FDA indications, with linezolid second. Daptomycin and tigecycline are approved for skin and skin-structure infections, but quinupristin-dalfopristin is not approved for complicated skin and skin-structure infections with MRSA.
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surgical patients with resistant gram-positive cocci showed a higher mortality rate and increased length of stay
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fluoroquinolones, macrolides, previous hospitalizations, enteral feeds, surgery, and the length of stay before culture are independently associated with MRSA infections.
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HA-MRSA patients are in long-term care facilities, have comorbidities (such as diabetes), are on dialysis, have prolonged hospitalization, and are ICU patients
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In HA-MRSA, one sees nosocomial pneumonia, catheter-related urinary tract infections, bloodstream infections, and skin and skin-structure infections.
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initially resulted from a recombination event, one involving the gene encoding in existing PBP and an inducible beta-lactamase gene.
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In terms of microbiologic cure rates at the test-of-cure visit, linezolid was also superior to vancomycin.
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Pharmacoeconomic analysis of this comparative trial in complicated skin and skin-structure infections showed that compared with vancomycin, linezolid reduced the length of stay and duration of IV treatment by about 2 days.
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Vancomycin is IV only. It is more costly -- even as a generic, based on pharmacoeconomic data -- relative to linezolid.
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Linezolid is relatively new; is more expensive (on an acquisition basis) compared with vancomycin; has reversible hematologic and, with long courses, neurologic effects; and has developed some resistance, mainly in enterococcal infections, with prolonged use and with failure to remove retained foreign bodies.
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Daptomycin is IV only; quite new; has limited indications; is also expensive, compared with vancomycin; has a muscle effect requiring monitoring of creatine phosphokinase; is inactivated by surfactants, thus obviating its use in pulmonary infections; and to date has no pharmacoeconomic data.
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Tigecycline is IV only, very new, and has a broader spectrum than any of the other agents in that it has some gram-negative activity
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Dalbavancin is IV only, and we need to have the official data on safety, tolerance, efficacy, indication, and pharmacoeconomics, which will probably be available later this year.