Multicenter Cohort of Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia Receiving Daptomycin Plus Ceftaroline Compared With Other MRSA Treatments
BackgroundDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRS...
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| Published in: | Open forum infectious diseases Vol. 7; no. 1; p. ofz538 |
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| Main Authors: | , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Oxford University Press
01.01.2020
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| ISSN: | 2328-8957, 2328-8957 |
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| Abstract | BackgroundDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB.MethodsThis 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.ResultsFifty-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.ConclusionsDAP-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.This multicenter, retrospective, exploratory, matched study compares demographics and clinical outcomes of patients receiving daptomycin plus ceftaroline at any time in treatment course versus other therapy for MRSA bacteremia. This combination used within 72 hours of index culture may be more beneficial for survival than as salvage therapy. |
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| AbstractList | BackgroundDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB.MethodsThis 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.ResultsFifty-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.ConclusionsDAP-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.This multicenter, retrospective, exploratory, matched study compares demographics and clinical outcomes of patients receiving daptomycin plus ceftaroline at any time in treatment course versus other therapy for MRSA bacteremia. This combination used within 72 hours of index culture may be more beneficial for survival than as salvage therapy. Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB. 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. This multicenter, retrospective, exploratory, matched study compares demographics and clinical outcomes of patients receiving daptomycin plus ceftaroline at any time in treatment course versus other therapy for MRSA bacteremia. This combination used within 72 hours of index culture may be more beneficial for survival than as salvage therapy. BackgroundDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB.MethodsThis 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.ResultsFifty-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.ConclusionsDAP-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. Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB.BACKGROUNDDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been compared with other therapies. This study provides an exploratory analysis of patients placed on DAP-CPT vs standard of care (SOC) for MRSAB.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.METHODSThis 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.RESULTSFifty-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.CONCLUSIONSDAP-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. |
| Author | Geriak, Matthew McCreary, Erin K Rybak, Michael J Kullar, Ravina Rose, Warren E Zasowski, Evan J Zervos, Marcus J Vasina, Logan Rizvi, Khulood Haddad, Fadi Schulz, Lucas T Ouellette, Krista Sakoulas, George |
| AuthorAffiliation | 4 Infectious Disease, Sharp Healthcare , San Diego, California, USA 1 Department of Pharmacy, University of Wisconsin Health , Madison, Wisconsin, USA 3 Pharmacy Department, Sharp Memorial Hospital , San Diego, California, USA 6 Wayne State University School of Medicine , Detroit, Michigan, USA 9 School of Pharmacy, University of Wisconsin-Madison , Madison, Wisconsin, USA 7 Division of Infectious Diseases, Henry Ford Health System , Detroit, Michigan, USA 8 Division of Host-Microbe Systems & Therapeutics, Center for Immunity, Infection & Inflammation, University of California-San Diego School of Medicine , La Jolla, California, USA 2 Expert Stewardship , Newport Beach, California, USA 5 Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan, USA |
| AuthorAffiliation_xml | – name: 6 Wayne State University School of Medicine , Detroit, Michigan, USA – name: 3 Pharmacy Department, Sharp Memorial Hospital , San Diego, California, USA – name: 2 Expert Stewardship , Newport Beach, California, USA – name: 1 Department of Pharmacy, University of Wisconsin Health , Madison, Wisconsin, USA – name: 9 School of Pharmacy, University of Wisconsin-Madison , Madison, Wisconsin, USA – name: 4 Infectious Disease, Sharp Healthcare , San Diego, California, USA – name: 8 Division of Host-Microbe Systems & Therapeutics, Center for Immunity, Infection & Inflammation, University of California-San Diego School of Medicine , La Jolla, California, USA – name: 7 Division of Infectious Diseases, Henry Ford Health System , Detroit, Michigan, USA – name: 5 Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, Michigan, USA |
| Author_xml | – sequence: 1 givenname: Erin K surname: McCreary fullname: McCreary, Erin K organization: Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin, USA – sequence: 2 givenname: Ravina surname: Kullar fullname: Kullar, Ravina organization: Expert Stewardship, Newport Beach, California, USA – sequence: 3 givenname: Matthew surname: Geriak fullname: Geriak, Matthew organization: Pharmacy Department, Sharp Memorial Hospital, San Diego, California, USA – sequence: 4 givenname: Evan J surname: Zasowski fullname: Zasowski, Evan J organization: Infectious Disease, Sharp Healthcare, San Diego, California, USA – sequence: 5 givenname: Khulood surname: Rizvi fullname: Rizvi, Khulood organization: Wayne State University School of Medicine, Detroit, Michigan, USA – sequence: 6 givenname: Lucas T surname: Schulz fullname: Schulz, Lucas T organization: Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin, USA – sequence: 7 givenname: Krista surname: Ouellette fullname: Ouellette, Krista organization: Pharmacy Department, Sharp Memorial Hospital, San Diego, California, USA – sequence: 8 givenname: Logan surname: Vasina fullname: Vasina, Logan organization: Pharmacy Department, Sharp Memorial Hospital, San Diego, California, USA – sequence: 9 givenname: Fadi surname: Haddad fullname: Haddad, Fadi organization: Infectious Disease, Sharp Healthcare, San Diego, California, USA – sequence: 10 givenname: Michael J surname: Rybak fullname: Rybak, Michael J organization: Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA – sequence: 11 givenname: Marcus J surname: Zervos fullname: Zervos, Marcus J organization: Wayne State University School of Medicine, Detroit, Michigan, USA – sequence: 12 givenname: George surname: Sakoulas fullname: Sakoulas, George organization: Infectious Disease, Sharp Healthcare, San Diego, California, USA – sequence: 13 givenname: Warren E orcidid: 0000-0001-5012-5993 surname: Rose fullname: Rose, Warren E email: warren.rose@wisc.edu organization: Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31938716$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
| Copyright_xml | – notice: The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. 2019 – notice: The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. – notice: The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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| Keywords | vancomycin salvage therapy antimicrobial resistance gram-positive combination |
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| License | This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com http://creativecommons.org/licenses/by-nc-nd/4.0 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Present affiliation: Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA |
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| Snippet | BackgroundDaptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely... Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant bacteremia (MRSAB), but have rarely been compared with other... Daptomycin and ceftaroline (DAP-CPT) have been used for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but have rarely been... This multicenter, retrospective, exploratory, matched study compares demographics and clinical outcomes of patients receiving daptomycin plus ceftaroline at... |
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| SubjectTerms | Cohort analysis Editor's Choice Major Staphylococcus infections |
| Title | Multicenter Cohort of Patients With Methicillin-Resistant Staphylococcus aureus Bacteremia Receiving Daptomycin Plus Ceftaroline Compared With Other MRSA Treatments |
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