Combination Antimicrobial Therapy for Gram (+) Bacteremia
Bacteremia is a major cause of morbidity and mortality in the critically ill patient.
S.aureus remains a common isolate in patients with either hospital-acquired or community-acquired bacteremia.
In cases of suspected endocarditis due to S.aureus, traditional teaching has been to give an aminoglycoside (i.e. gentamicin) in combination with vancomycin or an antistaphylococcal penicillin.
Importantly, there is no strong evidence to support this combination in patients with suspected S.aureus bacteremia.
Furthermore, patients receiving the aminoglycoside combination have higher rates of renal impairment without any added clinical benefit.
References
Abad CL, Kumar A, Safdar N. Antimicrobial therapy of sepsis and septic shock - When are two drugs better than one? Crit Care Clin 2011;27:e1-e27.
