Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Pneumonia with Ceftaroline Fosamil in a Patient with Inhalational Thermal Injury

Abstract

A 48-year-old female, who was found unresponsive and suffered inhalation injury secondary to a house fire, was transferred to our burn center for definitive treatment. Post tracheostomy, the patient became febrile and tachycardic. On hospital day (HD) 5, the patient expressed thick yellow secretions during suctioning and diffuse rhonchi was noted on physical exam. Blood cultures and a culture from the broncheo-alvelolar lavage grew Gram-positive cocci in clusters and the patient was started on empiric vancomycin. Despite aggressive vancomycin dosing (1750 mg intravenously every 6 h), the patient’s status continued to deteriorate. The organism was identified as methicillin-resistant Staphylococcus aureus (MRSA) with a vancomycin minimum inhibitory concentration (MIC) of 2 mg/L. Based on the potential for drug–drug interactions with linezolid, the patient was started on ceftaroline fosamil (MIC = 0.5 mg/L) 600 mg intravenously every 8 h with a prolonged 2-h infusion to anticipate suboptimal concentrations secondary to thermal burn injury. Post change in antibiotic therapy, a rapid clinical improvement was observed with the patient becoming afebrile at 48 h after initiation of ceftaroline. The patient completed a total of 14 days of ceftaroline therapy and was subsequently weaned from the ventilator on HD 22 and decannulated 2 days later. To our knowledge, this is the first report of the use of ceftaroline for the treatment of MRSA pneumonia in a patient with thermal injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0096-4) contains supplementary material, which is available to authorized users.

Principles of Antibiotic Management of Community-Acquired Pneumonia

“…Other agents for the treatment of CA-MRSA are under evaluation, and ceftaroline, although not approved for MRSA pneumonia, has been reported to show efficacy in treating MRSA pneumonia and bacteremia unresponsive to vancomycin. 43…”

Systematic review of ceftaroline fosamil in the management of patients with methicillin-resistantStaphylococcus aureuspneumonia

“…As of 10 January 2023, there were 541 results for the search "ceftaroline AND MRSA" and 195 results for the search "ceftaroline AND MRSA AND pneumonia". In total, 14 publications were identified for data extraction and inclusion in the qualitative analysis, ranging in publication date from 2012 to 2021 [53][54][55][56][57][58][59][60][61][62][63][64][65][66] publications reported the use of ceftaroline fosamil doses and/or duration of treatment that do not reflect current approved labelling. Across the 14 included publications, a total of 1908 patients were treated with ceftaroline fosamil and 264 patients were reported to have MRSA pneumonia or MRSA isolated from a lower respiratory tract source.…”

“…Across three studies that reported outcomes for 44 patients with unspecified MRSA pneumonia treated with ceftaroline fosamil, clinical success rates were 50–80%; 85–100% of patients in these studies had received prior antimicrobial therapy for MRSA [ 55 , 62 , 63 ]. In two individual case studies of patients with MRSA HAP or VAP, clinical success rates were zero out of one (0%) and one out of one (100%), respectively; in both of these cases, ceftaroline fosamil was given as second-line treatment following inadequate responses to other anti-MRSA treatments [ 56 , 61 ]. The case which reported clinical failure (MRSA pneumonia in a 65-year-old female admitted to the ICU) was also associated with eosinophilic pneumonia which was attributed to ceftaroline fosamil and subsequently resolved with additional medical treatment [ 61 ].…”

Evaluation of in Vitro Ceftaroline Activity against Methicilin Resistant Staphylococcus aureus

“…Bu sonuçlarla birlikte seftarolinin onay aldığı CYDİ ve TK-Pnömoni dışındaki endikasyonlarda başarı ile kullanılabileceğini gösteren benzeri in vitro ve in vivo çalışmalar da bulunmaktadır (12,16,18,24,30) .…”