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

Autor: Cabanilla MG; Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America.; Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America., Bernauer ML; RS21, Albuquerque, New Mexico, United States of America., Atallah LM; Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America., Briski MJ; Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America., Koury J; Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America., Thompson CM; TriCore Reference Laboratories, Albuquerque, New Mexico, United States of America., Rodriguez CN; Department of Pharmacy, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America., Jakeman B; Department of Pharmacy Practice and Administrative Sciences, University of New Mexico College of Pharmacy, Albuquerque, New Mexico, United States of America., Byrd TF; Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 May 20; Vol. 19 (5), pp. e0304103. Date of Electronic Publication: 2024 May 20 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0304103
Abstrakt: 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.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Cabanilla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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