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Pierre Tattevin, MD; Cédric Arvieux, MD; Christian Michelet, MD, PhD

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In a recently published article, Hidayat et al¹ observed a high prevalence of clinical methicillin-resistant Staphylococcus aureus (MRSA) strains with an elevated vancomycin minimum inhibitory concentration (2 µg/mL) in a prospective cohort, and they studied treatment outcomes with high-dose vancomycin hydrochloride. The authors concluded that (1) these strains require aggressive empirical vancomycin dosing to achieve trough plasma concentrations greater than 15 µg/mL and (2) combination or alternative therapy should be considered for invasive infections caused by these strains.¹ Although they provide convincing data supporting the first part of this conclusion, the reader may feel disappointed with the data supporting the second part (ie, the place of combination or alternative therapy). Indeed, of the 95 patients included in this study, only 15 received vancomycin in combination with linezolid, daptomycin, and/or rifampin, and the only information we have about them from this . . . [Full Text of this Article]

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