Common Use of the Empirical Combination of Vancomycin and a β-Lactam for

McConeghy et al of treatment for staph-ylococcal bacteremia using an empirical combination of vancomycin and a β-lactam was insightful [1]. They and other investigators have speculated that using initial empirical coverage with activity against bothmethicillin-resistant Staphylo-coccus aureus and methicillin-susceptible S. aureus (MSSA) may lead to improved clinical outcomes [2, 3]. Empirical antibacterial coverage in-cluding vancomycin and β-lactam anti-biotics with significant coverage for gram-negative pathogens has been re-ported with varying frequency [4, 5]. At our institution, we frequently encounter patients with a variety of indications (sepsis, fever, skin and skin structure in-fections, pneumonia, and others) who are receiving empirical therapy with vanco-mycin plus either piperacillin/tazobac-tam or cefepime. In discussions with multiple infectious disease physicians across the nation, we have commonly heard similar anecdotal observations, although published data in this regard are limited. β-Lactam agents such as piperacillin/ tazobactam and cefepime may offer sig-nificant coverage for MSSA as well as for gram-negative organisms [6, 7]. Al-though these β-lactam antibiotics may not usually be considered as antistaphy-lococcal drugs as are nafcillin, oxacillin, and cefazolin, their antistaphylococcal activity may already be achieving the objective as suggested by McConeghy et al [1]. Current clinical practice may thus have already accomplished part of the goal McConeghy et al outlined. We caution as well that pressure related to the goal of antimicrobial stewardship may lead to premature de-escalation to vancomycin monotherapy before sus-ceptibility results are known, leading to less desirable clinical outcomes