Clinical Outcomes With Definitive Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia With Retained Daptomycin and Ceftaroline Combination Therapy vs De-escalation to Monotherapy With Vancomycin, Daptomycin, or Ceftaroline

Nichols, Courtney; Wardlow, Lynn; Coe, Kelci E; Sobhanie, Mohammad Mahdee

doi:10.1093/ofid/ofab327

Cited by 13 publications

(8 citation statements)

References 25 publications

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“…Our findings are consistent with previously published data, suggesting that dual therapy does not provide a mortality benefit over monotherapy, after controlling for confounding factors. 10,25 However, the mean time to dual therapy initiation in our cohort was 6.1 days (SD 2.4). Considering the suggested updates to the definition of persistent bacteremia 9 , dual therapy in our cohort may have been initiated too late to provide a mortality benefit.…”

Section: Discussionmentioning

confidence: 74%

A Retrospective Cohort Study Comparing Dual Therapy With Ceftaroline With Vancomycin or Daptomycin Monotherapy for High-Grade or Persistent MRSA Bacteremia

Cabanilla,

Bernauer,

Briski

et al. 2024

Journal of Pharmacy Technology

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a serious clinical infection associated with a high risk of mortality. Dual therapy is often used in patients with persistent bacteremia. Objective: This study aimed to compare the outcomes of vancomycin or daptomycin monotherapy with those of dual therapy with ceftaroline in high-grade or persistent MRSA bacteremia. Methods: We conducted a retrospective cohort study at a university teaching hospital between January 2014 and June 2021, involving adults initially treated with vancomycin or daptomycin. Patients were categorized into monotherapy and dual therapy groups. The primary outcome was 30-day mortality. Secondary outcomes included microbiological relapse and antibiotic-related adverse events. Results: In a group of 155 patients, 30-day mortality rates were similar between the monotherapy (23.4%) and dual therapy (22.6%) groups, with comparable microbiological relapse rates (6.5%). In inverse probability of treatment weighting analysis, we found no significant association between dual therapy and mortality (adjusted risk ratio [ARR] 1.38, 95% CI 0.64-2.41, P = 0.38) or microbiological relapse (ARR 0.95, 95% CI 0.31-2.73, P = 0.93). Dual therapy was associated with a lower risk of antibiotic-related adverse events (ARR 0.45, 95% CI 0.21-0.89, P = 0.02). Infectious diseases (ID) consultation was associated with a reduced mortality risk (ARR 0.27, 95% CI 0.07-0.95, P = 0.04). Conclusions: Dual therapy with ceftaroline did not reduce mortality risk compared with monotherapy in patients with MRSA bacteremia. However, patients with ID consultations showed a 73% reduction in mortality rates. Large-scale, prospective, and randomized controlled trials are needed to provide conclusive evidence regarding the potential benefits of dual therapy with ceftaroline for MRSA bacteremia.

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Section: Discussionmentioning

confidence: 74%

A Retrospective Cohort Study Comparing Dual Therapy With Ceftaroline With Vancomycin or Daptomycin Monotherapy for High-Grade or Persistent MRSA Bacteremia

Cabanilla,

Bernauer,

Briski

et al. 2024

Journal of Pharmacy Technology

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“…It is unknown if the median time to blood culture clearance post‐ceftaroline initiation would have been shorter if ceftaroline was added sooner. The optimal duration of using combination therapy is also unclear, but more recent data have suggested that the “second” antibiotic does not need to be continued for the entire duration 31 . Ceftaroline was continued for a median duration of 13.9 days from the first negative blood culture in our study.…”

Section: Discussionmentioning

confidence: 81%

“…The optimal duration of using combination therapy is also unclear, but more recent data have suggested that the "second" antibiotic does not need to be continued for the entire duration. 31 Ceftaroline was continued for a median duration of 13.9 days from the first negative blood culture in our study. Lastly, there are currently no large-scale, comparative data evaluating the optimal salvage regimen for persistent MRSAB.…”

Section: Discussionmentioning

confidence: 88%

Vancomycin plus ceftaroline for persistent methicillin‐resistant Staphylococcus aureus bacteremia

et al. 2022

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Study Objective:The preferred antibiotic salvage regimen for persistent methicillinresistant Staphylococcus aureus bacteremia (MRSAB) is unclear. We sought to evaluate the effectiveness and safety of vancomycin plus ceftaroline for persistent MRSAB.The primary outcome was time to MRSAB clearance post-ceftaroline initiation.Secondary outcomes included microbiological cure, hospital length of stay, 90-day readmission for MRSAB, 90-day all-cause mortality, MRSAB-related mortality, and incidence of antibiotic-associated adverse effects.

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“…Several clinical studies may support the efficacy of combining daptomycin with ceftaroline in the management of MRSA BSIs, IE, or PVE [ 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. An RCT including 40 patients randomized to combination therapy with daptomycin plus ceftaroline or to daptomycin/vancomycin monotherapy of MRSA BSIs (ICU admission up to 18%) showed that combination therapy was associated with significantly lower in-hospital mortality rate (0% vs. 26%; p = 0.029) [ 32 ].…”

Section: Targeted Treatment Of Infections Caused By Staphyl...mentioning

confidence: 99%

“…The surprising findings led the investigators to stop early the study due to an unacceptable higher risk of mortality in the monotherapy arm. Conversely, two large retrospective studies found no difference in terms of mortality rate, hospital readmission, and BSI recurrence of combination therapy with daptomycin plus ceftaroline vs. standard of care monotherapy with vancomycin, daptomycin, or ceftaroline in the treatment of MRSA BSI [ 33 , 34 ]. However, in a subgroup of patients with severe disease (median Charlson Comorbidity Index ≥ 3) and with a primary endovascular source of infection, treatment with daptomycin plus ceftaroline within 72 h from index cultures resulted in a trend toward reduced mortality rate (4.3% vs. 20.8%; p = 0.16) [ 33 ].…”

Section: Targeted Treatment Of Infections Caused By Staphyl...mentioning

confidence: 99%

Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence

et al. 2023

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(1) Introduction: To develop evidence-based algorithms for targeted antibiotic therapy of infections caused by Staphylococcus aureus in critically ill adult patients. (2) Methods: A multidisciplinary team of four experts had several rounds of assessment for developing algorithms concerning targeted antimicrobial therapy of severe infections caused by Staphylococcus aureus in critically ill patients. The literature search was performed by a researcher on PubMed-MEDLINE (until August 2022) to provide evidence for supporting therapeutic choices. Quality and strength of evidence was established according to a hierarchical scale of the study design. Two different algorithms were created, one for methicillin-susceptible Staphylococcus aureus (MSSA) and the other for methicillin-resistant Staphylococcus aureus (MRSA). The therapeutic options were categorized for each different site of infection and were selected also on the basis of pharmacokinetic/pharmacodynamic features. (3) Results: Cefazolin or oxacillin were the agents proposed for all of the different types of severe MSSA infections. The proposed targeted therapies for severe MRSA infections were different according to the infection site: daptomycin plus fosfomycin or ceftaroline or ceftobiprole for bloodstream infections, infective endocarditis, and/or infections associated with intracardiac/intravascular devices; ceftaroline or ceftobiprole for community-acquired pneumonia; linezolid alone or plus fosfomycin for infection-related ventilator-associated complications or for central nervous system infections; daptomycin alone or plus clindamycin for necrotizing skin and soft tissue infections. (4) Conclusions: We are confident that targeted therapies based on scientific evidence and optimization of the pharmacokinetic/pharmacodynamic features of antibiotic monotherapy or combo therapy may represent valuable strategies for treating MSSA and MRSA infections.

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Clinical Outcomes With Definitive Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia With Retained Daptomycin and Ceftaroline Combination Therapy vs De-escalation to Monotherapy With Vancomycin, Daptomycin, or Ceftaroline

Cited by 13 publications

References 25 publications

A Retrospective Cohort Study Comparing Dual Therapy With Ceftaroline With Vancomycin or Daptomycin Monotherapy for High-Grade or Persistent MRSA Bacteremia

A Retrospective Cohort Study Comparing Dual Therapy With Ceftaroline With Vancomycin or Daptomycin Monotherapy for High-Grade or Persistent MRSA Bacteremia

Vancomycin plus ceftaroline for persistent methicillin‐resistant Staphylococcus aureus bacteremia

Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence

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