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<jats:sec><jats:title>Background:</jats:title><jats:p> The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. </jats:p></jats:sec><jats:sec><jats:title>Objective:</jats:title><jats:p> To develop a methodology for evaluating local epidemiology and validating local risk factors for P aeruginosa and MRSA. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Risk factors for MRSA and P aeruginosa were evaluated using multivariable logistic regression and reported as adjusted odds ratios (aORs). </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> There were 10 723 cases evaluated. Lung abscess/empyema had the highest odds associated with MRSA (aOR = 4.24; P &lt; 0.0001), followed by influenza (aOR = 2.34; P = 0.01), end-stage renal disease (ESRD; aOR = 2.09; P = 0.006), illicit substance use (aOR = 1.7; P = 0.007), and chronic obstructive pulmonary disease (COPD; aOR = 1.26; P = 0.04). For P aeruginosa, the highest odds were in bronchiectasis (aOR = 6.13; P &lt; 0.0001), lung abscess/empyema (aOR = 3.36; P = 0.005), and COPD (aOR = 1.84; P &lt; 0.0001). Isolated COPD without other risk factors did not pose an increased risk of either organism. </jats:p></jats:sec><jats:sec><jats:title>Conclusion and Relevance:</jats:title><jats:p> Influenza, ESRD, lung abscess/empyema, and illicit substance use were local risk factors for MRSA. Bronchiectasis and lung abscess/empyema were risk factors for Pseudomonas. COPD was associated with MRSA and Pseudomonas. However, isolated COPD had similar rates of MRSA and Pseudomonas pneumonia compared with the total population. This study established a feasible methodology for evaluating local risk factors. </jats:p></jats:sec>

<jats:sec><jats:title>Objective:</jats:title><jats:p> To compare the efficacy of antimicrobial therapies used in the management of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. </jats:p></jats:sec><jats:sec><jats:title>Data Sources:</jats:title><jats:p> A literature search using the PubMed database (inception to December 2022) was conducted using the search terms “ Staphylococcus aureus bacteremia,” “methicillin-susceptible Staphylococcus aureus bacteremia,” “persistent methicillin-susceptible Staphylococcus aureus bacteremia,” and “refractory methicillin-susceptible Staphylococcus aureus bacteremia .” In addition, therapeutic agents which could be used as treatment for MSSA including “nafcillin,” “oxacillin,” “cefazolin,” “ceftaroline,” “gentamicin,” “rifampin,” and “daptomycin” were also combined with the aforementioned search terms to capture data using these agents. </jats:p></jats:sec><jats:sec><jats:title>Study Selection/Data Extraction:</jats:title><jats:p> Clinical data were limited to those published in the English language. Articles and abstracts were considered for inclusion in addition to ongoing trials identified through ClinicalTrials.gov. </jats:p></jats:sec><jats:sec><jats:title>Data Synthesis:</jats:title><jats:p> A total of 78 articles were reviewed including 17 in vitro or animal model studies and 39 studies including patient data. The remaining 22 articles included guidelines, review articles, and editorials. Recent data evaluating use of dual β-lactam regimens for persistent MSSA bacteremia were limited to 8 case reports or case series. </jats:p></jats:sec><jats:sec><jats:title>Relevance to Patient Care and Clinical Practice:</jats:title><jats:p> At present, there is little guidance on how to best manage patients with persistent MSSA bacteremia. This narrative review collates the available data to assist clinicians in selecting the best possible antimicrobial regimen when facing this clinical conundrum. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Modification of antimicrobial therapy, in conjunction with source control and infectious diseases consultation, may all be necessary to sterilize blood cultures in patients with persistent MSSA bacteremia. </jats:p></jats:sec>