Ceftaroline fosamil: clinical experience after 23-month prescription in a tertiary hospital

Abstract

Objective. To determine the indications, success rate and adverse effects of ceftaroline fosamil treatment in a tertiary hospital. Material and methods. In total, 84 cases from February 2018 to December 2019 were retrospectively analysed. No exclusion criteria were applied. Results. Eighty-four patients, with a median age of 70 years, of which, 6.7% (56) were male, were treated with ceftaroline fosamil for a median of 14 days. Most indications were off-label, including 29 endocarditis (34.5%), 14 bacteraemia (16.6%), 5 Central nervous system (CNS) infections (6%) and 19 osteoarticular infections (22.6%). Staphylococcus aureus was the most frequently isolated microorganism, including 28 methicillin-sensitive S. aureus (MSSA; 33.3%) and 14 methicillin-resistant S. aureus (MRSA; 16.7%), followed by coagulase-negative Staphylococcus (23, 27.4%). The main reason for ceftaroline fosamil prescription was the failure of previous treatment (41.7% of cases). Treatment was successful in 60/84 patients (71.4%) and failed clinically or microbiologically in 14 (16.7%). Eight patients died for a reason not related to the infection and two were found to have a non-infectious condition. Twenty-two of thirty-five (62.8%) patients prescribed ceftaroline because of failure of previous treatment improved, including eight endocarditis and seven bacteraemia. Adverse effects were reported in five patients (5.9%) including neutropenia, thrombocytopenia, transaminases elevation and creatinine elevation; all except one were mild and all resolved after discontinuation of treatment. Conclusions. Ceftaroline fosamil is a well-tolerated cephalosporine, effective against multi- resistant gram-positive and many gram-negative microorganisms. Our experience suggests that it is effective as a rescue or first-line therapy in other indications than those currently approved.

Ceftaroline for Central Nervous System Infections: Case Report of a Young Infant, and Scoping Review

“…11,13 Additional hematologic adverse effects included warm autoimmune hemolytic anemia after treatment with vancomycin and ceftaroline. 37 Other laboratory abnormalities attributed to ceftaroline included hepatotoxicity/transaminase elevation 26,28 and creatinine elevation that resolved once ceftaroline was discontinued. 18 A cohort study of 37 adults with spine infections treated with ceftaroline for more than 28 days, of whom 21 had epidural abscesses, identified one patient that developed eosinophilic pneumonia and one patient with ceftaroline-related drug fever.…”

“…10,[14][15][16][17]22,24,31 For patients with MRSA infections, the decision to use ceftaroline was often driven by elevated MICs to vancomycin and daptomycin or clinical or microbiologic nonresponse to recommended agents. 10,[15][16][17]26,28 Other resistant pathogens infecting patients in our review included methicillin-resistant S. epidermis 13 and penicillin-resistant S. pneumoniae. 12…”

“…Several studies reported adverse events associated with ceftaroline use during the treatment of CNS infections. A common adverse effect attributed to ceftaroline was reversible myelosuppression, 11,13,24,[26][27][28][29] and granulocyte-colony stimulating factor was occasionally needed to boost neutrophil counts. 11,13 Additional hematologic adverse effects included warm autoimmune hemolytic anemia after treatment with vancomycin and ceftaroline.…”

Use of ceftaroline in complex central nervous system infections

“…Here, ceftaroline was used against methicillin-resistant S. epidermidis after clinical failure with vancomycin, being linezolid ruled out because of resistance. Ceftaroline fosamil is a fifth-generation cephalosporin approved for skin and soft tissue infections and pneumonia, but its use in out-off-label indications is increasing, as we have previously reported in this journal [1]. It is particularly valuable in serious infections with participation of resistant gram-positive microorganisms, in which other options as vancomycin, linezolid or daptomycin may be restricted because of adverse effects or low efficacy.…”

“…In the last 5 years, we have recorded 5 CNS infections treated with ceftaroline [ 1 ]. We here present two of them which were evaluable.…”