Multicenter Cohort of Patients With Methicillin-Resistant
antimicrobial resistance
combination
gram-positive
salvage therapy
vancomycin
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
30
09
2019
accepted:
17
12
2019
entrez:
16
1
2020
pubmed:
16
1
2020
medline:
16
1
2020
Statut:
epublish
Résumé
Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant This is a retrospective, matched cohort study MRSAB patients at 4 hospitals in the United States. Patients receiving DAP-CPT for ≥72 hours at any point in therapy were matched 2:1 when possible, 1:1 otherwise, to SOC, first by infection source, then age and renal function. SOC was empiric treatment with vancomycin or daptomycin and any subsequent combination antibiotic(s), except for DAP-CPT. Fifty-eight patients received DAP-CPT with 113 matched SOC. Ninety-six percent of SOC received vancomycin, and 56% (63/113) escalated therapy at least once in the treatment course. Twenty-four patients received DAP-CPT within 72 hours of index culture; 2 (8.3%) died within 30 days vs 14.2% (16/113) with SOC (P > .05). Subgroup analysis identified numerically lower mortality in DAP-CPT patients with a Charlson comorbidity index ≥3, endovascular source, and receipt of DAP-CPT within 72 hours of index culture. The median MRSAB duration was 9.3 vs 4.8 days for DAP-CPT and SOC, respectively. DAP-CPT was initiated on day 6 on average; after receipt of DAP-CPT, MRSAB duration was 3.3 days. DAP-CPT treatment is often delayed in MRSAB. Combination therapy may be more beneficial if initiated earlier, particularly in patients at higher risk for mortality. Blinded, randomized, prospective studies are needed to eliminate selection bias inherent in retrospective analyses when examining DAP-CPT vs SOC.
Sections du résumé
BACKGROUND
BACKGROUND
Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant
METHODS
METHODS
This is a retrospective, matched cohort study MRSAB patients at 4 hospitals in the United States. Patients receiving DAP-CPT for ≥72 hours at any point in therapy were matched 2:1 when possible, 1:1 otherwise, to SOC, first by infection source, then age and renal function. SOC was empiric treatment with vancomycin or daptomycin and any subsequent combination antibiotic(s), except for DAP-CPT.
RESULTS
RESULTS
Fifty-eight patients received DAP-CPT with 113 matched SOC. Ninety-six percent of SOC received vancomycin, and 56% (63/113) escalated therapy at least once in the treatment course. Twenty-four patients received DAP-CPT within 72 hours of index culture; 2 (8.3%) died within 30 days vs 14.2% (16/113) with SOC (P > .05). Subgroup analysis identified numerically lower mortality in DAP-CPT patients with a Charlson comorbidity index ≥3, endovascular source, and receipt of DAP-CPT within 72 hours of index culture. The median MRSAB duration was 9.3 vs 4.8 days for DAP-CPT and SOC, respectively. DAP-CPT was initiated on day 6 on average; after receipt of DAP-CPT, MRSAB duration was 3.3 days.
CONCLUSIONS
CONCLUSIONS
DAP-CPT treatment is often delayed in MRSAB. Combination therapy may be more beneficial if initiated earlier, particularly in patients at higher risk for mortality. Blinded, randomized, prospective studies are needed to eliminate selection bias inherent in retrospective analyses when examining DAP-CPT vs SOC.
Identifiants
pubmed: 31938716
doi: 10.1093/ofid/ofz538
pii: ofz538
pmc: PMC6951465
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofz538Subventions
Organisme : NIAID NIH HHS
ID : R01 AI132627
Pays : United States
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Références
Infect Dis Ther. 2014 Jun;3(1):35-43
pubmed: 25134810
Antimicrob Agents Chemother. 2019 Apr 25;63(5):
pubmed: 30858203
Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2421-8
pubmed: 22382823
Clin Microbiol Rev. 2012 Apr;25(2):362-86
pubmed: 22491776
Antimicrob Agents Chemother. 2015 Aug;59(8):4497-503
pubmed: 25987623
Nephron. 1976;16(1):31-41
pubmed: 1244564
Antimicrob Agents Chemother. 1992 Dec;36(12):2639-44
pubmed: 1482131
Antimicrob Agents Chemother. 2012 Dec;56(12):6192-200
pubmed: 22985884
Intern Med J. 2001 Mar;31(2):97-103
pubmed: 11480485
Antimicrob Agents Chemother. 2012 Oct;56(10):5046-53
pubmed: 22802248
Clin Ther. 2014 Oct 1;36(10):1303-16
pubmed: 25444563
Clin Infect Dis. 2019 Aug 12;:null
pubmed: 31404468
Antimicrob Agents Chemother. 2017 Jan 24;61(2):
pubmed: 27895012
PLoS One. 2017 Feb 2;12(2):e0170236
pubmed: 28152067
J Infect. 2014 Sep;69(3):226-34
pubmed: 24844825
Clin Infect Dis. 2011 Feb 1;52(3):285-92
pubmed: 21217178
Antimicrob Agents Chemother. 2013 Jan;57(1):66-73
pubmed: 23070161
Clin Infect Dis. 2016 Jan 15;62(2):173-180
pubmed: 26349552
J Infect Dis. 2012 Nov 15;206(10):1604-11
pubmed: 22966128
Antimicrob Agents Chemother. 2014 May;58(5):2541-6
pubmed: 24550331
J Antimicrob Chemother. 2015 Jan;70(1):311-3
pubmed: 25125677
Pharmacotherapy. 2017 Nov;37(11):1347-1356
pubmed: 28949410
Int J Infect Dis. 2017 Aug;61:3-6
pubmed: 28533166
Clin Ther. 2014 Oct 1;36(10):1317-33
pubmed: 25017183
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
J Antimicrob Chemother. 2015 Feb;70(2):505-9
pubmed: 25246437
Antimicrob Agents Chemother. 2014;58(1):102-9
pubmed: 24145519
Antimicrob Agents Chemother. 2013 Jun;57(6):2664-8
pubmed: 23545533
Clin Infect Dis. 2017 May 15;64(10):1406-1412
pubmed: 28205673
Int J Antimicrob Agents. 2019 May;53(5):644-649
pubmed: 30711613
Drug Resist Updat. 2013 Jul-Nov;16(3-5):73-9
pubmed: 24268586
J Infect Chemother. 2013 Feb;19(1):42-9
pubmed: 22797874
Antimicrob Agents Chemother. 2012 Oct;56(10):5296-302
pubmed: 22869564
Am J Health Syst Pharm. 2009 Jan 1;66(1):82-98
pubmed: 19106348
J Antimicrob Chemother. 2016 Mar;71(3):576-86
pubmed: 26565015
Clin Infect Dis. 2011 Feb 1;52(3):e18-55
pubmed: 21208910