Treatment of persistent methicillin‐susceptible <i>Staphylococcus aureus</i> bacteremia and presumed osteomyelitis with oxacillin and ertapenem in a premature neonate

Hitchins, Margaret R.; O’Mara, Keliana; Edwards, Laura; Bouchard, Jeannette

doi:10.1002/phar.2745

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Previous case reports/series have primarily used various ertapenem-based regimens for persistent MSSAB. [6][7][8][9]12,13 Ulloa and colleagues described 11 patients who received cefazolin plus ertapenem. 6 Of these 11 patients, 36.3% were admitted to ICU, Pitt bacteremia scores were not reported, and 54.5% had endocarditis representing a potentially less critically ill population than ours.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Few antibiotic salvage regimens exist for persistent MSSAB, and data are limited to case reports and case series to describe their effectiveness and safety. [5][6][7][8][9][10][11][12][13] Ertapenem plus cefazolin or an ASP has been predominately described, but identifying alternative carbapenem-sparing options is consistent with antibiotic stewardship efforts and may decrease the risk of antibiotic-associated Clostridioides difficile infection (CDI). [14][15][16] Daptomycin is a lipopeptide antibiotic with activity against only gram-positive bacteria and has been shown to be effective in combination with a beta-lactam (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Daptomycin Plus Oxacillin for Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Kufel,

Zagoria,

Blaine

et al. 2023

Ann Pharmacother

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Background: The preferred antibiotic salvage regimen for persistent methicillin-susceptible Staphylococcus aureus bacteremia (MSSAB) is unclear. Ertapenem with cefazolin or an antistaphylococcal penicillin has been primarily described, but identifying alternative carbapenem-sparing options may support antibiotic stewardship efforts and decrease the risk of antibiotic-associated Clostridioides difficile infection. Objective: We sought to evaluate the effectiveness and safety of daptomycin plus oxacillin (D/O) for persistent MSSAB. Methods: This was a single-center, retrospective cohort of patients with persistent MSSAB who received D/O between January 1, 2014, and January 1, 2023. Adult patients were included if they had blood cultures positive for MSSA ≥72 hours and received D/O combination for ≥48 hours. Patients were excluded if they were pregnant, incarcerated, or received another antibiotic considered to have excellent activity against MSSA. The primary outcome was time to MSSA bacteremia clearance post-daptomycin initiation. Secondary outcomes included microbiological cure, hospital length of stay, 90-day all-cause mortality, MSSA bacteremia-related mortality, 90-day readmission for MSSAB, and incidence of antibiotic-associated adverse effects. Time to MSSAB clearance post-D/O initiation was plotted using Kaplan-Meier estimation. Results: Seven unique patient encounters were identified including 4 with endocarditis. Despite a median MSSA bacteremia duration of 7.8 days, median clearance was 2 days post-daptomycin initiation. All achieved microbiological cure, and no adverse effects were reported. Ninety-day all-cause mortality, MSSAB-related mortality, and 90-day readmission for MSSAB occurred in 28.6%, 14.3%, and 14.3% of patients, respectively. Conclusions and Relevance: D/O was an effective, well-tolerated salvage regimen in this cohort and may represent a carbapenem-sparing option for persistent MSSAB.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Daptomycin Plus Oxacillin for Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Kufel,

Zagoria,

Blaine

et al. 2023

Ann Pharmacother

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Carbapenem combination therapy versus standard of care for persistent methicillin-susceptible Staphylococcus aureus bacteraemia

Shah,

Clarke,

Ludwig

et al. 2024

Journal of Antimicrobial Chemotherapy

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Background Successful use of carbapenems in combination with cefazolin or oxacillin for treatment of MSSA bacteraemia has been described; however, comparative data to standard treatment approaches are lacking. Methods This was a multicentre, retrospective study of adult patients with MSSA bacteraemia for >48 h. Standard treatment was considered monotherapy with cefazolin, oxacillin or nafcillin. Combination therapy was defined as the addition of ertapenem or meropenem to standard treatment for at least 24 h. The primary outcome was duration of bacteraemia defined as time from administration of an antibiotic with in vitro activity to first negative blood culture. Time to blood culture sterilization was compared through risk-set matching with aid of a propensity score. Results Overall, 238 patients were included; 66% (157/238) received standard treatment and 34% (81/238) received combination therapy. The median (IQR) time to carbapenem initiation was 4.7 (3.63–6.5) days. Patients who received combination therapy were younger (P = 0.012), more likely to have endocarditis (P = 0.034) and had longer median duration of bacteraemia (P < 0.001). After applying risk-set matching, patients who received combination therapy experienced faster time to blood culture sterilization compared with control patients [HR = 1.618 (95% CI; 1.119–2.339) P = 0.011]. Using a paired hazard model, 90 day mortality rates were not statistically different among patients who received combination therapy versus matched controls [HR = 1.267 (95% CI; 0.610–2.678), P = 0.608]. Discussion Carbapenem combination therapy resulted in faster time to blood culture sterilization, but no differences in overall mortality rates. Randomized trials are critical to determine the utility of carbapenem combination therapy.

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Treatment of persistent methicillin‐susceptible Staphylococcus aureus bacteremia and presumed osteomyelitis with oxacillin and ertapenem in a premature neonate

Cited by 2 publications

References 18 publications

Daptomycin Plus Oxacillin for Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Daptomycin Plus Oxacillin for Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

Carbapenem combination therapy versus standard of care for persistent methicillin-susceptible Staphylococcus aureus bacteraemia

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