Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia
Abstract Purpose Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We prese...
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BMC
2025-01-01
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| Series: | Annals of Clinical Microbiology and Antimicrobials |
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| Online Access: | https://doi.org/10.1186/s12941-025-00773-z |
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| author | Addison S. Hicks Mackenzie A. Dolan Megan D. Shah Sarah E. Elwood James A. Platts-Mills Gregory R. Madden Zachary S. Elliott Joshua C. Eby |
| author_facet | Addison S. Hicks Mackenzie A. Dolan Megan D. Shah Sarah E. Elwood James A. Platts-Mills Gregory R. Madden Zachary S. Elliott Joshua C. Eby |
| author_sort | Addison S. Hicks |
| collection | DOAJ |
| description | Abstract Purpose Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We present an assessment of outcomes of patients initiated on early combination therapy for MRSA-B. Methods This was a single-center, retrospective study of adult patients admitted with MRSA-B between July 1, 2017 and April 31, 2023. During this period, there was a change in institutional practice from routine administration of monotherapy to initial combination therapy for most patients with MRSA-B. Combination therapy included vancomycin or daptomycin plus ceftaroline within 72 h of index blood culture and monotherapy was vancomycin or daptomycin alone. The primary outcome was a composite of persistent bacteremia, 30-day all-cause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were assessed. All outcomes were assessed using propensity score-weighted logistic regression. Results Of 213 patients included, 118 received monotherapy (115 vancomycin, 3 daptomycin) and 95 received combination therapy with ceftaroline (76 vancomycin, 19 daptomycin). The mean time from MRSA-positive molecular diagnostic blood culture result to combination therapy was 12.1 h. There was no difference between groups for the primary composite outcome (OR 1.58, 95% CI 0.60, 4.18). Time to microbiological cure was longer with combination therapy (mean difference 1.50 days, 95% CI 0.60, 2.41). Adverse event rates were similar in both groups. Conclusions Early initiation of ceftaroline-based combination therapy did not improve outcomes for patients with MRSA-B in comparison to monotherapy therapy. |
| format | Article |
| id | doaj-art-925964aaf7aa4935a62def7804f76e00 |
| institution | Kabale University |
| issn | 1476-0711 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Annals of Clinical Microbiology and Antimicrobials |
| spelling | doaj-art-925964aaf7aa4935a62def7804f76e002025-01-19T12:13:28ZengBMCAnnals of Clinical Microbiology and Antimicrobials1476-07112025-01-0124111010.1186/s12941-025-00773-zEarly initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremiaAddison S. Hicks0Mackenzie A. Dolan1Megan D. Shah2Sarah E. Elwood3James A. Platts-Mills4Gregory R. Madden5Zachary S. Elliott6Joshua C. Eby7Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia HealthDepartment of Pharmacy, University of Virginia HealthDepartment of Pharmacy, University of Virginia HealthDivision of Infectious Diseases and International Health, Department of Medicine, University of Virginia HealthDivision of Infectious Diseases and International Health, Department of Medicine, University of Virginia HealthDivision of Infectious Diseases and International Health, Department of Medicine, University of Virginia HealthDepartment of Pharmacy, University of Virginia HealthDivision of Infectious Diseases and International Health, Department of Medicine, University of Virginia HealthAbstract Purpose Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We present an assessment of outcomes of patients initiated on early combination therapy for MRSA-B. Methods This was a single-center, retrospective study of adult patients admitted with MRSA-B between July 1, 2017 and April 31, 2023. During this period, there was a change in institutional practice from routine administration of monotherapy to initial combination therapy for most patients with MRSA-B. Combination therapy included vancomycin or daptomycin plus ceftaroline within 72 h of index blood culture and monotherapy was vancomycin or daptomycin alone. The primary outcome was a composite of persistent bacteremia, 30-day all-cause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were assessed. All outcomes were assessed using propensity score-weighted logistic regression. Results Of 213 patients included, 118 received monotherapy (115 vancomycin, 3 daptomycin) and 95 received combination therapy with ceftaroline (76 vancomycin, 19 daptomycin). The mean time from MRSA-positive molecular diagnostic blood culture result to combination therapy was 12.1 h. There was no difference between groups for the primary composite outcome (OR 1.58, 95% CI 0.60, 4.18). Time to microbiological cure was longer with combination therapy (mean difference 1.50 days, 95% CI 0.60, 2.41). Adverse event rates were similar in both groups. Conclusions Early initiation of ceftaroline-based combination therapy did not improve outcomes for patients with MRSA-B in comparison to monotherapy therapy.https://doi.org/10.1186/s12941-025-00773-zMethicillin-resistant Staphylococcus aureus bacteremiaCombination therapyVancomycinDaptomycinCeftaroline |
| spellingShingle | Addison S. Hicks Mackenzie A. Dolan Megan D. Shah Sarah E. Elwood James A. Platts-Mills Gregory R. Madden Zachary S. Elliott Joshua C. Eby Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia Annals of Clinical Microbiology and Antimicrobials Methicillin-resistant Staphylococcus aureus bacteremia Combination therapy Vancomycin Daptomycin Ceftaroline |
| title | Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia |
| title_full | Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia |
| title_fullStr | Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia |
| title_full_unstemmed | Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia |
| title_short | Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia |
| title_sort | early initiation of ceftaroline based combination therapy for methicillin resistant staphylococcus aureus bacteremia |
| topic | Methicillin-resistant Staphylococcus aureus bacteremia Combination therapy Vancomycin Daptomycin Ceftaroline |
| url | https://doi.org/10.1186/s12941-025-00773-z |
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