Methicillin-resistant Staphylococcus aureus (MRSA) is associated with substantial morbidity and mortality.
Vancomycin (VAN) has been used as the gold standard treatment for invasive MRSA
infections for decades but, unfortunately, the reliance of VAN as the primary treatment option against these
infections has led to a reduction in VAN susceptibility in MRSA isolates. Although
daptomycin (DAP) is another common treatment option against invasive MRSA
infections, it has been shown that the development of VAN resistance can lead to DAP nonsusceptibility. VAN or DAP backbone regimens in combination with other
antibiotics has been advocated as an alternative approach to improve patient outcomes in VAN/DAP-susceptible
infections, enhance outcomes in
infections caused by isolates with reduced VAN/DAP susceptibility, and/or prevent the emergence of VAN/DAP resistance or further resistance. A peer-reviewed literature search was conducted using Medline, Google Scholar and PubMed databases. The primary purpose of this review is to describe the mechanisms and epidemiology of MRSA isolates with a reduction in VAN and/or DAP susceptibility, evaluate in vitro and in vivo literature describing combination
therapy (CT) against MRSA isolates with reduced VAN and/or DAP susceptibility and describe studies involving the clinical outcomes of patients treated with CT against invasive MRSA
infections.