Outcomes of Daptomycin Plus Ceftaroline Versus Alternative Therapy for Persistent Methicillin-resistant Staphylococcus aureus (MRSA) Bacteraemia

• Published in: International journal of antimicrobial agents Vol. 61; no. 3; p. 106735
• Main Authors: Patel, Darshan, Brown, Matthew L., Edwards, Seth, Oster, Robert A., Stripling, Joshua
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-03-2023
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antimicrobial resistance; Bacteremia - drug therapy; Ceftaroline; Combination; Daptomycin; Daptomycin - therapeutic use; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; MRSA bacteraemia; Retrospective Studies; Staphylococcal Infections - drug therapy; Staphylococcus aureus; MRSA bacteraemia; Antimicrobial resistance; Ceftaroline; Combination; Daptomycin
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2023.106735

•Persistent methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB) significantly increases mortality risk•There is a lack of data for the ideal management of persistent MRSAB•A combination of daptomycin plus ceftaroline (DAP/CPT) has been successfully used in persistent MRSAB•Switching to DAP/CPT after 1 week of persistent MRSAB did not lead to better outcomes
This study aimed to evaluate both efficacy and safety of combination therapy with daptomycin plus ceftaroline (DAP/CPT) versus alternative therapy in the treatment of persistent methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB).
This retrospective, single-centre study investigated adult patients who underwent a change in antibiotic therapy for persistent MRSAB. Daptomycin plus ceftaroline was compared with alternative therapy after initial treatment with vancomycin or DAP monotherapy was modified. The primary outcome was in-hospital mortality, and several secondary efficacy and safety outcomes were evaluated.
A total of 68 patients with persistent MRSAB had initial therapy switched to DAP/CPT (n = 43) or alternative therapy (n = 25). In-hospital mortality was similar with DAP/CPT versus alternative therapy (16.3% vs. 16%; P = 1.0). On average, the total duration of bacteraemia was numerically 1 day less in patients switched to DAP/CPT (11.4 days vs. 12.5 days; P = 0.5). Daptomycin plus ceftaroline was de-escalated in 81% of patients after receiving combination therapy for an average of 12.5 days. Secondary outcomes, including rates of adverse events and emergence of antimicrobial resistance, were similar between the two groups.
Switching to DAP/CPT after approximately 1 week of persistent MRSA bacteraemia may result in similar clinical outcomes when compared with alternative therapy. Rates of adverse events and emergence of antimicrobial resistance were low without a statistically significant difference observed between DAP/CPT and alternative therapy. These findings, as well as the impact of earlier switch or prolonged treatment with the combination, require further investigation.