Carbapenem combination therapy versus standard of care for persistent methicillin-susceptible Staphylococcus aureus bacteraemia.

Autor:	Shah S; Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Clarke LG; Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Ludwig J; Office of Quality and Clinical Research Innovation, University of Pittsburgh Medical Center, Pittsburgh, PA, USA., Burgdorf S; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Arbulu Guerra RD; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Shields RK; Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Aug 01; Vol. 79 (8), pp. 1990-1997.
DOI:	10.1093/jac/dkae198
Abstrakt:	Background: Successful use of carbapenems in combination with cefazolin or oxacillin for treatment of MSSA bacteraemia has been described; however, comparative data to standard treatment approaches are lacking. Methods: This was a multicentre, retrospective study of adult patients with MSSA bacteraemia for >48 h. Standard treatment was considered monotherapy with cefazolin, oxacillin or nafcillin. Combination therapy was defined as the addition of ertapenem or meropenem to standard treatment for at least 24 h. The primary outcome was duration of bacteraemia defined as time from administration of an antibiotic with in vitro activity to first negative blood culture. Time to blood culture sterilization was compared through risk-set matching with aid of a propensity score. Results: Overall, 238 patients were included; 66% (157/238) received standard treatment and 34% (81/238) received combination therapy. The median (IQR) time to carbapenem initiation was 4.7 (3.63-6.5) days. Patients who received combination therapy were younger (P = 0.012), more likely to have endocarditis (P = 0.034) and had longer median duration of bacteraemia (P < 0.001). After applying risk-set matching, patients who received combination therapy experienced faster time to blood culture sterilization compared with control patients [HR = 1.618 (95% CI; 1.119-2.339) P = 0.011]. Using a paired hazard model, 90 day mortality rates were not statistically different among patients who received combination therapy versus matched controls [HR = 1.267 (95% CI; 0.610-2.678), P = 0.608]. Discussion: Carbapenem combination therapy resulted in faster time to blood culture sterilization, but no differences in overall mortality rates. Randomized trials are critical to determine the utility of carbapenem combination therapy. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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