Ceftaroline for bloodstream infections caused by methicillin-resistant Staphylococcus aureus: a multicentre retrospective cohort study.

Autor:	Villa S; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Electronic address: sofiadela.villa@salud.madrid.org., Escrihuela-Vidal F; Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Barcelona, Spain., Fernández-Hidalgo N; Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain., Escudero-Sánchez R; CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain; Infectious Disease Department, Ramon y Cajal University Hospital, Madrid, Spain; Instituto de Salud Carlos III (IRYCIS), Madrid, Spain., Cabezón I; Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain., Boix-Palop L; Infectious Diseases Department, Hospital Universitari Mútua de Terrassa, Barcelona, Spain., Díaz-Pollán B; CIBER de Enfermedades Infecciosas (CIBERINFECT), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain., Goikoetxea AJ; Infectious Diseases Department, Hospital Universitario de Cruces, Barakaldo, Spain., García-País MJ; Internal Medicine Department, Hospital Universitario Lucus Augusti, Lugo, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain., Pérez-Rodríguez MT; Infectious Diseases Unit, Internal Medicine Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain; Galicia Sur Health Research Institute, Vigo, Spain., Crespo Á; Internal Medicine Department, Hospital Universitario de León, León, Spain., Buzón-Martín L; Infectious Diseases Department, Complejo Asistencial Universitario de Burgos, Burgos, Spain., Sanz-Peláez O; Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain., Ramos-Merino L; Infectious Diseases Department, Hospital La Coruña, La Coruña, Spain., Fiorante S; Internal Medicine Department, Hospital El Escorial, Madrid, Spain., Muñoz P; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2024 Nov 23. Date of Electronic Publication: 2024 Nov 23.
DOI:	10.1016/j.cmi.2024.11.022
Abstrakt:	Objectives: To evaluate the effectiveness of ceftaroline vs. vancomycin or daptomycin in the treatment of methicillin-resistant Staphylococcus aureus bloodstream infections (BSIs) (MRSA-BSIs). Methods: This multicentre retrospective study conducted in 15 Spanish hospitals included data from the first MRSA-BSIs of adult patients between January 2019 and December 2022. The ceftaroline group included patients who received ceftaroline for ≥72 hours within the first week of BSI onset; the standard-of-care (SOC) group included patients who received vancomycin or daptomycin ≥72 hours after BSI onset. Primary outcome was 30-day all-cause mortality; secondary outcomes included 90-day mortality and incidence of adverse events (AEs). Propensity-score matching and Cox proportional hazards analyses were performed. Results: A total of 429 MRSA-BSIs were included: 133 in the ceftaroline group and 296 in the SOC group. More patients in the ceftaroline group had a Sequential Organ Failure Assessment score >2 (51.1% vs. 36.5%; p < 0.01), complicated BSI (66.2% vs. 42.2%; p < 0.01), infective endocarditis (18.8% vs. 6.4%; p < 0.01) and prescribed in combination treatment (65.4% vs. 11.5%; p < 0.01), with no statistically significant differences in 30-day mortality: 23.3% ceftaroline (95% CI, 16.1-30.5%) vs. 16.2% SOC (95% CI, 12.0-20.4%), p 0.08. There were no statistically significant differences in 90-day mortality (33.1% ceftaroline vs. 26.7% SOC; p 0.17). After propensity-score matching, 105 patients treated with ceftaroline were matched with 105 controls: the 30-day mortality rates were 21.9% and 16.2% (p 0.38). Cox regression analysis of the entire cohort (n = 429) revealed that age (hazard ratio [HR], 1.05; 95% CI, 1.03-1.07) and Sequential Organ Failure Assessment score >2 (HR, 2.34; 95% CI, 1.50-3.65) were associated with 90-day mortality risk, although ceftaroline treatment did not demonstrate a significant effect (HR, 1.00; 95% CI, 0.97-1.02). Incidence of AEs was 12.0% in ceftaroline vs. 4.4% in the SOC group (p < 0.01). Most AEs occurred when ceftaroline was used in combination vs. monotherapy (17.2% vs. 2.2%; p 0.01). Discussion: Ceftaroline was an effective treatment for MRSA-BSIs but was commonly prescribed in combination showing a higher incidence of AEs. (Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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