Outcomes of Daptomycin Plus Ceftaroline Versus Alternative Therapy for Persistent Methicillin-resistant Staphylococcus aureus (MRSA) Bacteraemia |
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| Affiliation: | 1. Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA;2. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA;3. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA;4. Present affiliation: Emory Johns Creek Hospital, Johns Creek, Georgia, USA;1. National Clinical Research Centre for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Centre for Kidney Disease, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province, China;2. Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China;3. Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden;4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;5. Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;6. Department of Nephrology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China;7. Department of Nephrology, Sir Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Zhejiang, Hangzhou, China;8. Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, China;9. Department of Nephrology, Shenzhen Second People''s Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen University, Shenzhen, China;10. Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, Jiangsu, China;11. Children''s Hospital of Fudan University, China;12. Renal Department and Institute of Nephrology, Sichuan Provincial People''s Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Centre for Kidney Diseases, China;13. Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China;14. Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, China;15. Department of Critical Care Medicine, Maoming People''s Hospital, Guangdong Province, China;p. Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Guangdong, China;q. Huizhou Municipal Central Hospital, Guangdong, China;r. Guizhou Provincial People''s Hospital, Guiyang, China;s. Foshan First People''s Hospital, Guangdong, China;t. The Third Affiliated Hospital of Southern Medical University, China;u. Shunde Hospital, Southern Medical University, The First People''s Hospital of Shunde, Guangdong, China;v. Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia;w. Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia;1. CHU Grenoble Alpes, Service Universitaire de Gériatrie Clinique, Grenoble, France;2. T-Raig, TIMC-IMAG, UMR 5525 Université Grenoble Alpes, Grenoble, France;3. Gérontopole AURA, Saint Etienne, France;4. CHU Grenoble Alpes, Département Santé publique, Grenoble, France;1. Laboratoire de Bactériologie, Département de Biologie des Agents Infectieux, CHU Angers, Angers, France;2. Service des Maladies Infectieuses et Tropicales, CHU Angers, Angers, France;3. Univ Angers, Nantes Université, CHU Angers, Inserm, CNRS, INCIT, Angers, France;1. Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT;2. Department of Pathology, Division of Clinical Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA;3. Division of Microbiology, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA;4. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX;5. Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY;6. Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA;7. Department of Pathology and Laboratory Medicine, Dartmouth Health, Lebanon, NH;8. Banner Health, Phoenix, AZ;9. Sonora Quest Laboratories, Phoenix, AZ;10. Department of Pathology, University of Arizona College of Medicine, Phoenix, AZ;11. Department of Medical Laboratory Science, Marquette University, Milwaukee, WI;12. Department of Pathology and Laboratory Medicine, University of Connecticut Health Center, Farmington, CT;13. Department of Pathology, Eastern Connecticut Health Network, Manchester, CT;14. Cape Regional Health System, Cape May Court House, NJ;15. Division of Infectious Diseases, Hartford Hospital, Hartford, CT;1. Infectious Disease Pharmacokinetics Lab, Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA;2. Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA;3. Department of Pharmacy, UF Health Shands Hospital, Gainesville, FL, USA;4. North West Ventilation Unit, Manchester University NHS Foundation Trust, Manchester, UK;5. Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK;6. Department of Pharmacology and Clinical Pharmacology, Christian Medical College, Vellore, India.;1. Department of Clinical Pharmacy, OLVG, Amsterdam, the Netherlands;2. Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;3. Department of Pharmacy, Centre of Expertise in Mycology Radboudumc/CWZ and Radboud Institute of Health Science, University of Nijmegen, Radboudumc Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;4. Department of Haematology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;5. Department of Haematology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands;6. Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;7. Department of Mathematics and Computer Science, Eindhoven University of Technology, 5612 AZ, Eindhoven, the Netherlands;8. Department of Haematology, Meander Medical Centre Amersfoort, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands;9. Department of Oncology and Haematology, Oldenburg Clinic, Rahel-Straus-Straße 10, 26133, Oldenburg, Germany;10. Department of Haematology, University Medical Centre Utrecht, University Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherland;11. Department of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;12. Department of Internal Medicine and Infectious Diseases, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands;13. Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands;14. Department of Medical Microbiology, Radboudumc Nijmegen, the Netherlands; Centre of Expertise in Mycology Radboudumc/CWZ, Radboud University, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands;15. Department of Haematology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands;p. Department of Haematology, Haga Hospital, Els Borst-Eilersplein 275, 2545 AA, The Hague, the Netherlands;q. Department of Haematology, Radboudumc Nijmegen, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands; Radboud Institute of Health Sciences, Geert Grooteplein Zuid 21, 6525 EZ, Nijmegen, the Netherlands;r. Groningen Research Institute of Pharmacy, Pharmacotherapy, Epidemiology & Economics, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;s. Department of Internal Medicine and Department of Pulmonary Diseases and Tuberculosis Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands;t. Faculty of Medicine and Health, Sydney Pharmacy School, University of Sydney, Camperdown NSW 2006, Sydney, Australia;u. Westmead Hospital, Westmead, Sydney, NSW 2145, Australia |
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| Abstract: | ObjectivesThis study aimed to evaluate both efficacy and safety of combination therapy with daptomycin plus ceftaroline (DAP/CPT) versus alternative therapy in the treatment of persistent methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB).MethodsThis retrospective, single-centre study investigated adult patients who underwent a change in antibiotic therapy for persistent MRSAB. Daptomycin plus ceftaroline was compared with alternative therapy after initial treatment with vancomycin or DAP monotherapy was modified. The primary outcome was in-hospital mortality, and several secondary efficacy and safety outcomes were evaluated.ResultsA total of 68 patients with persistent MRSAB had initial therapy switched to DAP/CPT (n = 43) or alternative therapy (n = 25). In-hospital mortality was similar with DAP/CPT versus alternative therapy (16.3% vs. 16%; P = 1.0). On average, the total duration of bacteraemia was numerically 1 day less in patients switched to DAP/CPT (11.4 days vs. 12.5 days; P = 0.5). Daptomycin plus ceftaroline was de-escalated in 81% of patients after receiving combination therapy for an average of 12.5 days. Secondary outcomes, including rates of adverse events and emergence of antimicrobial resistance, were similar between the two groups.ConclusionsSwitching to DAP/CPT after approximately 1 week of persistent MRSA bacteraemia may result in similar clinical outcomes when compared with alternative therapy. Rates of adverse events and emergence of antimicrobial resistance were low without a statistically significant difference observed between DAP/CPT and alternative therapy. These findings, as well as the impact of earlier switch or prolonged treatment with the combination, require further investigation. |
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