Internal Medicine Commons^™

Atypical Lyme Disease Rash: A Case Report, Selena Khanna, Lynne J. Goebel

Internal Medicine

Lyme disease (LD), caused in the United States primarily by Borrelia burgdorferi sensu lato, is a tick-borne illness characterized by a spectrum of clinical manifestations depending on the stage of illness. Most clinicians are familiar with the classic bullseye appearance of the erythema migrans (EM) rash that occurs inthe early stage of the disease. However, many providers may not be aware of alternate appearances for the rash. This paper reports the case of a 69-year-old female with LD, exhibiting an atypical rash with purplish discoloration that was devoid of an outer ring or central clearing. In geographic areas with a …

Effectiveness Of Antibiotic Stewardship For Healthcare Providers At Urgent Care Clinics, Helen T. Adewole

Electronic Theses and Dissertations

Antibiotics have revolutionized modern medicine; however, the overuse in urgent care and primary care significantly contributes to the global burden of infections resistant to available antimicrobial medicines. Approximately 30% of the antimicrobials prescribed in acute care settings are unnecessary. Patient demand for antibiotics has seemingly skyrocketed following the recent COVID-19 pandemic. Practitioners must be knowledgeable about antibiotic stewardship initiatives, such as the wait-and-see approach, to reduce antibiotic overuse and improve the trajectory of antibiotic resistance and patient health outcomes. The gap in practice was the limited awareness of scientific evidence-based tools to partner with patients and improve antibiotic prescription patterns. …

Rare Case Of Mycobacterium Avium Complex Peritonitis In A Patient With Multiple Myeloma Undergoing Peritoneal Dialysis, Sacide S. Ozgur, Nida Ansari, Dhruv Patel, Ryan Rahman, Raymond Shih

Journal of Community Hospital Internal Medicine Perspectives

Mycobacterium avium complex (MAC) infections can present as a variety of severe diseases. While it has a predilection for immunocompromised patients such as those with Human immunodeficiency virus (HIV), it can also affect immunocompetent patients as well. One of the rare yet severe diseases that MAC infections can present is MAC peritonitis. Often hard to distinguish from other causes of peritonitis, high clinical suspicion should be maintained for those who are susceptible. Here we present an 85-year-old female with a past medical history of end-stage renal disease on peritoneal dialysis who presented with nausea and vomiting. She was found to …

Using Phosphatidylethanol As An Adjunct To Self-Reported Alcohol Use Improves Identification Of Liver Fibrosis Risk, Pamela M. Murnane, Majid Afshar, Gabriel Chamie, Robert L. Cook, Tekeda Ferguson, Lamia Y. Haque, Karen R. Jacobson, Amy C. Justice, Theresa W. Kim, Mandana Khalili, Evgeny Krupitsky, Kathleen A. Mcginnis, Patricia Molina, Winnie R. Muyindike, Bronwyn Myers, Veronica L. Richards, Kaku So-Armah, Scott Stewart, Mark S. Sulkowski, Phyllis C. Tien, Judith A. Hahn

School of Public Health Faculty Publications

Introduction: Accurate assessment of alcohol use informs prevention and management of liver disease. We examined whether phosphatidylethanol (PEth, an alcohol metabolite) blood concentrations are associated with liver fibrosis risk independently of self-reported alcohol use, among persons with and without HIV. Methods: We pooled individual-level data from 12 studies from the United States, Russia, Uganda, and South Africa with PEth, AUDIT-C (Alcohol Use Disorders Identification Test-Consumption), and FIB-4 measurements. We conducted mixed-effects logistic regression of the relationship between PEth and AUDIT-C as continuous variables (after checking linearity), with high FIB-4 ( ≥ 2.67). We divided PEth (range 0-1000) by 83.3 to …

Dialysis Modality, Transplant Characteristics, And Incident Atrial Fibrillation After Kidney Transplant: An Observational Study Using Usrds Data, Leonardo Pozo Garcia, Sai Liu, Colin R Lenihan, Maria E Montez-Rath, Tara I Chang, Wolfgang C Winkelmayer, Pascale Khairallah

Faculty, Staff and Students Publications

RATIONALE & OBJECTIVE: Atrial fibrillation is the most common arrhythmia and is increasing in prevalence. The prevalence of atrial fibrillation is high among patients receiving dialysis, affecting ∼21.3% of the patients receiving hemodialysis and 15.5% of those receiving peritoneal dialysis. The association of previous dialysis modality with incident atrial fibrillation in patients after receiving their first kidney transplant has not been studied.

STUDY DESIGN: We used the United States Renal Data System to retrospectively identify adult, Medicare-insured patients who received their first kidney transplant between January 1, 2005, and September 30, 2012 and who had not previously been diagnosed with …

Angka Kejadian Dan Karakteristik Klinis Pasien Infeksi Jamur Invasif Di Rsup Dr. Hasan Sadikin Tahun 2020 – 2022, Ariella Alessandro, Nisa Fauziah, Imam Megantara, Rudi Wisaksana, Intan Mauli Warma Dewi

Jurnal Penyakit Dalam Indonesia

Introduction. Invasive fungal infection (IFI) is increasingly common in patients at risk, especially those with impaired immune response. In Indonesia, there is currently a low prevalence of IFI which may be influenced by challenges in diagnosis. This study aimed to determine the prevalence and clinical characteristics of IFI patients in Dr. Hasan Sadikin Hospital in Bandung, Indonesia.

Methods. This cross-sectional study was conducted at Dr. Hasan Sadikin Hospital. Data were collected using medical records of IFI patients diagnosed between 2020 and 2022 which were selected using total sampling method. Demographic data, clinical symptoms, radiological appearance, and laboratory results …

A Rare Case Of Candida Glabrata Cervical Spondylodiscitis, Angelina Hong, Lily Hyungjung Lim, Ali Tariq Alvi, Pallavi Aneja

HCA Healthcare Journal of Medicine

Introduction

Invasive candidiasis can lead to numerous life-threatening sequelae. Candida glabrata is the second-most common causative species of invasive candidiasis. This species possesses a high risk for persistent infection and candidemia. An uncommon complication of invasive candidiasis is spondylodiscitis and can rarely affect the cervical spine.

Case Presentation

The patient is a female in her late 50s with a complex medical history inclusive of chronic obstructive pulmonary disease, chronic pain, multiple abdominal surgeries, prolonged intensive care unit admission, and administration of total parenteral nutrition and broad-spectrum antibiotics who presented with complaints of worsening neck pain. She was last hospitalized 3 …

Surgical Site Infections Post Cesarean Section And Associated Risk Factors: A Retrospective Case-Control Study At A Tertiary Hospital In Kenya, David Odada, Jasmit Shah, Annastacia Mbithi, Reena Shah

Internal Medicine, East Africa

Background: Surgical site infection is a common healthcare-associated infection that affects maternal health, yet it can be prevented or controlled. Caesarian sections are most likely to develop surgical site infections. The rates of delivery by caesarian section in reported to be higher that the acceptable rates in some healthcare facilities. Risk factors for surgical site infections can be identified and modified to reduce the occurrence of surgical site infections. This study aims to determine the risk factors that contribute to surgical site infections post caesarian section in a tertiary teaching hospital in Kenya.

Methods: This was a retrospective …

A Multicenter Retrospective Cohort Study To Characterize Patients Hospitalized With Multisystem Inflammatory Syndrome In Adults And Coronavirus Disease 2019 In The United States, 2020-2021, Michael Melgar, Joseph Y Abrams, Shana Godfred-Cato, Ami B Shah, Amit Garg, Andrew Strunk, Mangala Narasimhan, Jonathan Koptyev, Alexandra Norden, David Musheyev, Fahmida Rashid, Rachel Tannenbaum, Rosa M Estrada-Y-Martin, Bela Patel, Siddharth Karanth, Chad J Achenbach, Gavin T Hall, Sara M Hockney, Matthew Caputo, Lilian M Abbo, Laura Beauchamps, Stephen Morris, Renzo O Cifuentes, Annabelle De St Maurice, Douglas S Bell, Kavitha K Prabaker, Fernando J Sanz Vidorreta, Evan Bryant, David K Cohen, Rohith Mohan, Christopher P Libby, Spencer Soohoo, Tristel J Domingo, Angela P Campbell, Ermias D Belay

Faculty, Staff and Student Publications

Background: The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem inflammatory syndrome in adults (MIS-A) requires distinguishing it from acute coronavirus disease 2019 (COVID-19) and may affect clinical management.

Methods: In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention case definition to identify adults hospitalized with MIS-A at 6 academic medical centers from 1 March 2020 to 31 December 2021. Patients MIS-A were matched by age group, sex, site, and admission date at a 1:2 ratio to patients hospitalized with acute symptomatic COVID-19. Conditional logistic regression was used to compare demographic characteristics, …

Acute Aseptic Meningoencephalitis Due To Covid-19 In An Otherwise Healthy Patient: A Case Report, Shyama Appareddy, Norma Moncayo, Ronkino T. Mccoy, Jared Sperling, George Huddleston, Raza L. Kahn

Research Colloquium

Several studies have shown the extrapulmonary manifestations of COVID-19 disease caused by the SARS-CoV2 virus. Although extrapulmonary manifestation to the heart, kidney, blood, and skin are common, neurological and cerebrovascular manifestations are rare with most of these cases being described in patients who also have the pulmonary manifestation of the disease. Here we present the case of an 18 year-old male with no prior history of respiratory symptoms who presented to the emergency department with altered mental status. Neurology was consulted and the patient was started empirical on ceftriaxone, vancomycin, dexamethasone, and acyclovir for meningoencephalitis. Urine drug screen, head CT, …

Antibiotic Stewardship In Skin And Soft Tissue Infections, Shah Z. Ali, Stephen Gore, Jose E. Campo Maldonado

Research Colloquium

Introduction: Skin and soft tissue infections (SSTIs) are characterized by microbial invasion of the skin layers and are common in various healthcare settings. A study conducted between 2005-2010 in the United States, found a combined total of 2.3 million cases of SSTIs in ambulatory and inpatient settings. This was higher than the rates of pneumonia and urinary tract infections during the same time period. Another study found that between 2000 and 2012, there was a 40% increase (2.4 million to 3.3 million) in cases of SSTIs. Our aim is to study the primary uses of vancomycin and piperacillin/tazobactam and their …

Rare Case Of Prosthetic Joint Infection Caused By Salmonella Enterica - A Case Report, Carlos Ramos, Shyama Appareddy, Peter J. Gonzalez

Research Colloquium

Introduction: Collectively, over 1 million total knee arthroplasties (TKA) and total hip arthroplasties (THA) are performed in the United States each year. In 2010 it was estimated that 1.58% of the United States general population has received a TKA. Prosthetic joint infections (PJI) are the most common indication for a TKA revision1 . In total, S. aureus is responsible for about 50% of all prosthetic joint infections, and about 15% are caused by gram negative pathogens2 .

Objective: This is a case report which describes the presentation and clinical course of a 59-yearold female with Salmonella enterica septic arthritis of …

A Simple Case Of Viral Myopericarditis Or A Complication Of Monoclonal Antibody Infusion?, Jose A. Rivera, Michael Menowsky

Research Colloquium

Background: Myocarditis has been a rare, but well-documented side effect of the mRNA-based vaccines against SARS-CoV-2 as well as a complication of viral infections including SARS-CoV-2. However, myopericarditis as a complication of monoclonal antibody infusion or as complication of allergic reaction to antibody infusions might be and underreported.

Case presentation: In this case, we report a 30-year-old man with a previous diagnosis of COVID infection 1 week prior to presentation, unvaccinated for SARS-CoV-2 who was referred from a monoclonal infusion center where he received casirivimab and imdevimab and 15 minutes after infusion began to complain of chills, chest pain, shortness …

Covid-19 As A Second Hit For Anti-Phospholipid Syndrome, Himabindu Kolli, Pooja Maknoor, Celin Rajan, Nevin Varghese

Research Colloquium

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis, usually in setting of underlying autoimmune disorders. Here, we present a case of anti-phospholipid syndrome post covid infection.

Case Presentation: 41-year-old lady presented to the ER with complaints of left sided facial droop for 3-day duration. On further evaluation, she was found to have subacute ischemic stroke and was managed with anticoagulation and supportive treatment. Past medical history is significant for a recent diagnosis of Covid infection and for subsequent development of lower extremity deep vein thrombosis (DVT). She was started on anticoagulation with rivaroxaban for …

Manajemen Koinfeksi Malaria Berat Dengan Hiv Belum Mendapat Terapi Antiretrovirus Di Era Pandemi Covid-19: Sebuah Laporan Kasus, Paul Harijanto, Rosye Mawuntu, Novia Rusli, Randy Adiwinata, Agung Nugroho

Jurnal Penyakit Dalam Indonesia

Severe malaria is a serious infectious disease that required immediate diagnosis and prompt treatment. Severe malaria may result several organ failures which is similar with other infectious diseases like SARS-CoV-2, sepsis, dengue, and HIV infection. Most of those infection have similar symptoms such as fever, myalgia, and headache, therefore physician should have high suspicion regarding co-infection with other infectious agents. The overlapping symptoms of co-infections may become a challenge for physician in diagnosing and delivering prompt therapy. Failure to deliver prompt treatment may lead to fatal outcome such as in severe malaria case. Stigmatization of all patients with fever and …

Patchy Alopecia In A Young Adult With A Generalized Rash, Oscar Rodrigo Zamudio Herrera, Nevin Varghese

Research Symposium

Background: Syphilis is a sexually transmitted infection that has been increasing in the United States. The prevalence of syphilis rose by 6.8% during 2019-to 2020. Secondary syphilis typically presents with a generalized maculopapular rash on palms and soles, however, can also have subtle dermatological findings such as alopecia. Syphilitic alopecia is an atypical manifestation of secondary syphilis, seen in 2.9 to 7% of the cases.

Case presentation: An 18-year-old Hispanic male presented to the clinic after noticing patchy loss of hair on the scalp for 2 weeks and one week of generalized non pruritic rash. His past medical history was …

Real-World Use Of Mold-Active Triazole Prophylaxis In The Prevention Of Invasive Fungal Diseases: Results From A Subgroup Analysis Of A Multicenter National Registry, M Hong Nguyen, Luis Ostrosky-Zeichner, Peter G Pappas, Thomas J Walsh, Joseph Bubalo, Barbara D Alexander, Marisa H Miceli, Jeanette Jiang, Yi Song, George R Thompson

Faculty, Staff and Student Publications

BACKGROUND: Antifungal prophylaxis can prevent invasive fungal diseases (IFDs) in high-risk, immunocompromised patients. This study assessed the real-world use of mold-active triazoles (MATs) for the prevention of IFDs.

METHODS: This subgroup analysis of a multicenter, observational, prospective registry in the United States from March 2017 to April 2020 included patients who received MATs for prophylaxis (isavuconazole, posaconazole, and voriconazole) at study index/enrollment. The primary objective was to describe patient characteristics and patterns of MAT use. Exploratory assessments included the frequency of breakthrough IFDs and MAT-related adverse drug reactions (ADRs).

RESULTS: A total of 1177 patients (256 isavuconazole, 397 posaconazole, 272 …

An Unusual Presentation Of Infective Endocarditis, Ethan J. Peterson, Jordan Jackson, Syed M. Zaidi, Jorge Perez

HCA Healthcare Journal of Medicine

Introduction

Leukocytoclastic vasculitis is the inflammation of small blood vessels due to leukocyte migration that comprises a wide range of differentials. It can be caused by autoimmune disorders, infections, neoplasms, or certain medications and warrants prompt recognition and therapy for optimal patient outcomes.

Case Presentation

Here we present a case of a 37-year-old male who presented with a painful, petechial rash on his torso and extremities. Skin biopsy revealed leukocytoclastic vasculitis, thereby prompting a comprehensive investigation into the underlying etiology leading to the diagnosis of Pseudomonas aeruginosa infective endocarditis.

Conclusion

Pseudomonas aeruginosa is a rare cause of infective endocarditis with …

Dengue Outbreak Response During Covid-19 Pandemic, Key Largo, Florida, Usa, 2020, Devin Rowe, Catherine Mcdermott, Ysla Veliz, Alison Kerr, Mark Whiteside, Mikki Coss, Chad Huff, Andrea Leal, Edgar Kopp, Alexis Lacrue, Lea A Heberlein, Laura E Adams, Gilberto A Santiago, Jorge L Munoz-Jordan, Gabriela Paz-Bailey, Andrea M Morrison

Faculty, Staff and Student Publications

We report a dengue outbreak in Key Largo, Florida, USA, from February through August 2020, during the COVID-19 pandemic. Successful community engagement resulted in 61% of case-patients self-reporting. We also describe COVID-19 pandemic effects on the dengue outbreak investigation and the need to increase clinician awareness of dengue testing recommendations.

Trends Of Azole Antifungal Prescription In The United States: Medicare Part D Provider Utilization And Payment Data Analysis, Mohanad M Al-Obaidi, Luis Ostrosky-Zeichner, David E Nix

Faculty, Staff and Student Publications

BACKGROUND: Invasive fungal infections carry a substantial risk of mortality and morbidity. Azole antifungals are used in the treatment of such infections; however, their extensive use can lead to the emergence of antifungal resistance and increased costs to patients and healthcare systems. The aim of this study is to evaluate trends in these antifungals use and costs.

METHODS: The secular and regional trends of outpatient azole antifungals were analyzed using Medicare Part D Prescriber Public Use Files for the years 2013-2020. The total days supply (TDS), total drug cost (TDC) per 100 000 enrollees, and cost per day (CPD) were …

Neurotropic Manifestations As A Potential Risk Factor For Schizophrenia Following In Utero Exposure To Sars-Cov-2, Mir Ali R Talpur, Omar H. Elsayed, Rif S. El-Mallakh

The University of Louisville Journal of Respiratory Infections

Background: COVID-19 infection is associated with neurologic and psychiatric morbidity that suggests a direct effect of the virus or secondary effect of an inflammatory process. These neuropsychiatric consequences may increase the likelihood of schizophrenia in the offspring of women who become infected with COVID-19 during their pregnancy.

Methods: We performed a directed narrative review of the literature focusing on the proposed pathophysiological processes that lead to schizophrenia and known pathological consequences of COVID-19 infection.

Results: Schizophrenia in adult offspring has been associated with maternal infections during pregnancy by a wide range of respiratory and neurotropic pathogens. Spikes in the incidence …

Steroids For The Treatment Of Viral Encephalitis: A Systematic Literature Review And Meta-Analysis, Emira Hodzic, Rodrigo Hasbun, Alejandro Granillo, Anna R Tröscher, Helga Wagner, Tim J Von Oertzen, Judith N Wagner

Faculty, Staff and Student Publications

Background: Specific antiviral treatment is only available for a small subset of viral encephalitis (VE). Adjunctive steroids are used, but there is scant evidence evaluating its utility. We present a systematic review and meta-analysis on the outcome of steroid use in VE.

Methods: We conducted a systematic literature review and reported it according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Two observational studies from unpublished or partially published data were added. For the meta-analysis, we employed the metaphor package of the statistical software R-4.3.1.

Results: We screened 378 studies and included 50. 155 patients were …

Adenocarcinoma Of The Transverse Colon Presenting As Anterior Abdominal Wall Abscess, Jenn Klein, Nima Avin, Sunil Gandhi

HCA Healthcare Journal of Medicine

Introduction

Locally invasive colon carcinoma comprises a small fraction of the incidence of colon carcinoma. Complications, such as perforation and obstruction, can occur in less than 0.5% of cases and often present differently based on location.

Case Presentation

We present a case of an 85-year-old woman who presented with an acute abdominal wall abscess which was caused by perforation of transverse colon carcinoma.

Conclusion

En-bloc resection increases 5-year survival, and adjuvant chemotherapy reduces the risk of recurrence in patients with stage II resectable colon carcinoma.

On The Respiratory Syncytial Virus Vaccine, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Tenofovir Induced Hypokalaemia - A Case Report, Ankisha Gupta, Kiran P. K, Rajendra Prasad S

Digital Journal of Clinical Medicine

Tenofovir, an important medication for HIV/AIDS, carries the risk of hypokalemia in patients receiving treatment. Factors such as dietary deficits, vomiting, or diarrhea further increase this risk. Tenofovir acts as a mitochondrial toxin by inhibiting the DNA polymerase gamma enzyme, crucial for mitochondrial DNA replication. Consequently, ATP generation is depleted through the aerobic pathway, leading to dysfunction in the proximal tubule. This dysfunction manifests as renal acidosis type 2, which involves reduced bicarbonate excretion by the proximal tubule, resulting in renal bicarbonate wasting and decreased serum bicarbonate levels. Consequently, the lumen of the distal nephron becomes negatively charged, leading to …

Tapped Twice: A Case Of A Rapidly Re-Accumulating Hepatic Hydrothorax In A Patient With Spontaneous Bacterial Empyema, Amir Khalil, Suma Alzouhayli, Silvia Novakova, Saad Shams, Ahmad Baiyasi, Maria Khalil, Mohammed Uddin, Aryan Shiari, Kareem Bazzy

The University of Louisville Journal of Respiratory Infections

Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had …

Prevalence And Impact Of Gastrointestinal Manifestations In Covid-19 Patients: A Systematic Review, Bassam Hossain, Shoreh Qazi, Sumair Ahmad, Atif Saleem, Amanke Oranu, Fahad Malik

Journal of Community Hospital Internal Medicine Perspectives

Background and Objective: The aim of this study is to systematically analyze and summarize the implications of COVID-19 on the digestive system by quantitatively evaluating the prevalence of gastrointestinal symptoms such as nausea, vomiting, abdominal pain, constipation, diarrhea, anorexia. reported in COVID-19 cases. We simultaneously investigated other variables to determine the association of such symptoms in COVID-19 patients which can potentially influence the disease prognosis and outcome. This systematic review presents an updated literature on the issue as it requires more scientific discussion in order to better inform the medical community and authorities so that appropriate measures can be taken …

Home Oxygen And Monitoring For Covid-19 Patients: A Multidisciplinary Team Approach, Mahta Salehi, Shehrose Chaudry, Rebecca B. Newman, Josette Hartnett, Suzanne J. Rose, Forugh Homayounrooz

Journal of Community Hospital Internal Medicine Perspectives

Introduction: During the initial COVID-19 pandemic peak, Stamford Hospital implemented a home oxygen program (HOP) to create a comprehensive, multi-disciplinary outpatient initiative without sacrificing a safe discharge. Primary care physicians monitored program participants, whose only indication for remaining admitted was an oxygen requirement. We retrospectively examined participant co-morbidities and outcomes, including death and readmission rates to evaluate HOP safety.

Methods: A retrospective analysis of program participants discharged between April 2020-Janurary 2021 was performed. Variables included demographics, oxygen requirement, days enrolled in the HOP, and major comorbidities such as cardiovascular disease (CVD), diabetes (DM), hypertension (HTN), obesity, chronic kidney disease, malignancies …

Knowledge And Misconceptions Among Lebanese Community On Immunizations, Hala Ahmadieh, Tala Safa, Ihab Nahle, Yahya Obeid, Dalal Hariri, Etaf Rawass, Tala Kanaan, Ahmad Sabalbal

BAU Journal - Health and Wellbeing

Two centuries ago, immunization practices have become the greatest land mark in medical history as they significantly contributed to a decline in several major infectious diseases worldwide thus decreasing both the mortality and morbidity. Moreover, they have been able to eradicate small pox and eliminate poliomyelitis in most regions of the world. However, in recent years the general opinion towards vaccination began shifting due to the emergence of certain opposing views to it, questioning the vaccine's safety and efficacy. This study aims to shed light on the vaccination status in Lebanon by assessing the knowledge, attitude, awareness, and misconceptions among …

Review Of Salvage Therapy For Mrsa Bacteremia At Beaumont Health System, Hazem Alakhras, Matthew D. Sims, Tracey A.H. Taylor

Posters

Treating methicillin-resistant Staphylococcus aureus (MRSA) effectively is imperative to reduce mortality rates, as it contributes to a large amount of healthcare-associated bacteremia in the U.S. However, due to the insufficient and sometimes contradicting studies to guide salvage therapy, there is a lack of clear consensus on treatment of MRSA bacteremia after vancomycin failure. The goal of this study is to showcase the salvage therapies of choice for patients with MRSA bacteremia at Beaumont Health System.