![\"test\"](\"http:\/\/blogs.jwatch.org\/hiv-id-observations\/wp-content\/uploads\/2010\/03\/test-150x150.jpg\" "\\"test\\"")
As noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking.<\/p>\nAs noted here, I recently had to answer a question on management of MRSA bacteremia as part of an every-10-year cycle of test-taking.<\/p>\n
(For more on that joyous process, read this interesting debate\u00a0here in the<\/a> New England Journal of Medicine.<\/a>)<\/p>\n The question seemed to have no obvious right answer, so I did what one is\u00a0explicitly allowed to do<\/em> in this phase of the process\u00a0– in other words, I asked some experts for their advice.<\/p>\n As a reminder, the case is a guy with positive blood cultures for MRSA (vancomycin MIC 2.0) on hospital day 4 despite receiving vancomycin (trough 15) and having undergone resection of a mycotic aneursym on hospital day 3.<\/p>\n Choices were: \u00a01) continue current vancomcyin dose; 2) increase vancomycin to achieve trough of 20; 3) change to daptomycin; 4) change to linezolid.<\/p>\n Expert Number One said the following:<\/p>\n What a terrible question. \u00a0A classic case of “what is the writer thinking and how much does he\/she know?” 4 is clearly wrong, but I wouldn’t be surprised to hear that this is what they want. \u00a0If the MIC is really 2, \u00a0you need a trough of 40, which is not an option, so 2 is wrong. \u00a0Given that he is only 5 days out and average duration of bacteremia in this setting is 7 days or so, you could consider 1 with reassessment in 2 or 3 days (but this is not really given here) and with MIC of 2, probably won’t work. \u00a0That leaves 3 by default, but with MIC of 2, \u00a0there is a significant possibility of heteroresistance to bothvanco and dapto. \u00a0A terrible question. \u00a0I wouldn’t know how to guess what they want!<\/p>\n<\/blockquote>\n\n