Vancomycin plus ceftaroline for persistent methicillin‐resistant <i>Staphylococcus aureus</i> bacteremia

Kufel, Wesley D; Parsels, Katie A; Blaine, Bruce; Steele, Jeffrey; Mahapatra, Rahul; Paolino, Kristopher; Thomas, Stephen J.

doi:10.1002/phar.2741

Cited by 6 publications

(8 citation statements)

References 34 publications

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“…The antibiotic resistance of MRSA has become a serious issue, necessitating the exploration of new drug regimens for MRSA infection. 44 , 48–50 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of Multidrug-Resistant Pathogens Causing Neonatal Early and Late Onset Sepsis, a Retrospective Study from the Tertiary Referral Children’s Hospital

Fang¹,

Gao²,

Yang³

et al. 2023

IDR

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Introduction Sepsis is the most severe infectious disease with the highest mortality rate, particularly among neonates admitted to the neonatal intensive care unit (NICU). This study retrospectively analyzed the epidemiology, antibiotic resistance profiles, and prevalence of multidrug-resistant (MDR) bacteria isolated from blood or cerebrospinal fluid (CSF) cultures in order to evaluate the appropriateness of initial empirical therapy for neonatal sepsis. Methods A retrospective study was conducted in the NICU from January 1, 2015, to December 31, 2022. Microbiological data from patients admitted to the NICU were anonymously extracted from the Laboratory of Microbiology database. Neonatal sepsis was classified into two types: early-onset sepsis (EOS), which occurs within the first 72 hours of life, and late-onset sepsis (LOS) for those begins later. Results A total of 679 bacterial strains, 543 from blood and 136 from CSF, were detected in 631 neonates. Among these, 378 isolates (55.67%) were Gram-positive bacteria, and 301 isolates (44.33%) were Gram-negative bacteria. The most frequently isolated pathogens were Coagulase-negative staphylococci (CoNS) (36.52%), followed by Klebsiella pneumoniae (20.47%) and Escherichia coli (13.84%). In EOS, 121 strains were found, CoNS represented the majority (33.88%), followed by Klebsiella pneumoniae (23.97%) and Escherichia coli (8.26%). Early-onset septicemia exhibited 67 (55.37%) MDR bacteria. In LOS, 558 strains were isolated, CoNS represented the majority of pathogens (37.10%), followed by Klebsiella pneumoniae (19.71%) and Escherichia coli (15.05%). Late-onset septicemia showed 332 (59.50%) MDR bacteria. High rates of MDR were found in CoNS (76.21%), carbapenem-resistant Klebsiella pneumoniae (66.91%), and MRSA (33.33%). Conclusion The study revealed an alarming prevalence of MDR strains isolated from neonatal sepsis, emphasizing the necessity of finding effective prevention and treatment measures. Colistin can be used for MDR Gram-negative bacteria, while vancomycin and teicoplanin can be considered treatment therapies for staphylococcal infections.

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“…The antibiotic resistance of MRSA has become a serious issue, necessitating the exploration of new drug regimens for MRSA infection. 44 , 48–50 …”

Section: Discussionmentioning

confidence: 99%

Prevalence of Multidrug-Resistant Pathogens Causing Neonatal Early and Late Onset Sepsis, a Retrospective Study from the Tertiary Referral Children’s Hospital

Fang¹,

Gao²,

Yang³

et al. 2023

IDR

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“…While few studies have evaluated combination therapy with vancomycin or daptomycin alongside ceftaroline and reported mostly favorable outcomes and safety in this practice [ 15 , 21 , 22 ], our study (to the best of our knowledge) represents the first attempt to describe the impact of ceftaroline combination therapy duration following bacteremia clearance. The results of our study suggest that continuing ceftaroline combination therapy for prolonged periods (i.e., ≥ 7 days) beyond bacteremia clearance did not result in reduced 30-day all-cause mortality.…”

Section: Discussionmentioning

confidence: 98%

Short versus long duration of ceftaroline combination therapy and outcomes in persistent or high-grade MRSA bacteremia: A retrospective single-center study

Cabanilla,

Bernauer,

Atallah

et al. 2024

PLoS ONE

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Background Methicillin-resistant Staphylococcus aureus (MRSA) is associated with high mortality rates. Despite antibiotic therapy, persistent bacteremia is challenging to treat. Combination therapy with ceftaroline has emerged as a potential treatment option; however, the optimal duration and clinical implications after bacteremia clearance are unknown. Methods This retrospective cohort study examined patients with high-grade or persistent MRSA bacteremia who were treated with ceftaroline combination therapy at the University of New Mexico Hospital between January 2014 and June 2021. Patients were categorized into short- (<7 days) or long-duration (≥7 days) groups based on the duration of combination therapy after bacteremia clearance. Outcomes included 30-day all-cause mortality, bacteremia recurrence, post-bacteremia clearance length of stay, and adverse events. Results A total of 32 patients were included in this study. The most common sources of bacteremia were bone/joint and endovascular (28.1%, 9/32 each). The median duration of combination therapy after clearance was seven days (IQR 2.8, 11). Patients in the long-duration group had a lower Charlson comorbidity index (1.0 vs 5.5, p = 0.017) than those in the short-duration group. After adjusting for confounders, there was no significant difference in the 30-day all-cause mortality between the groups (AOR 0.17, 95% CI 0.007–1.85, p = 0.18). No association was found between combination therapy duration and recurrence (OR 2.53, 95% CI 0.19–inf, p = 0.24) or adverse drug events (OR 3.46, 95% CI 0.39–74.86, p = 0.31). After controlling for total hospital length of stay, there was no significant difference in the post-bacteremia clearance length of stay between the two groups (p = 0.37). Conclusions Prolonging ceftaroline combination therapy after bacteremia clearance did not significantly improve outcomes in patients with persistent or high-grade MRSA bacteremia. The limitations of this study warrant cautious interpretation of its results. Larger studies are needed to determine the optimal duration and role of combination therapy for this difficult-to-treat infection.

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“…This was a single-center, retrospective cohort of patients with persistent MSSAB treated with D/O between January 1, 2015, and January 1, 2023, at the State University of New York Upstate University Hospital, a 748-bed tertiary care, academic medical center in Syracuse, NY. Patients 18 years of age and older were included if they had blood cultures positive for MSSA ≥72 hours [21][22][23] and received D/O combination for ≥48 hours for MSSAB. Selection of and when to add daptomycin to oxacillin was based on the clinical judgment of the infectious disease (ID) physician and pharmacist during consultation.…”

Section: Methodsmentioning

confidence: 99%

“…MSSAB-related mortality was defined as death prior to blood culture clearance or within 2 weeks following blood culture clearance using the date of first positive blood cultures as day 1. 23 Hospital LOS was calculated from the date of the first positive blood culture to the date of discharge and/or death.…”

Section: Methodsmentioning

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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Vancomycin plus ceftaroline for persistent methicillin‐resistant Staphylococcus aureus bacteremia

Cited by 6 publications

References 34 publications

Prevalence of Multidrug-Resistant Pathogens Causing Neonatal Early and Late Onset Sepsis, a Retrospective Study from the Tertiary Referral Children’s Hospital

Prevalence of Multidrug-Resistant Pathogens Causing Neonatal Early and Late Onset Sepsis, a Retrospective Study from the Tertiary Referral Children’s Hospital

Short versus long duration of ceftaroline combination therapy and outcomes in persistent or high-grade MRSA bacteremia: A retrospective single-center study

Daptomycin Plus Oxacillin for Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia

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