Daptomycin Plus β-Lactam Combination Therapy for Methicillin-resistant Staphylococcus aureus Bloodstream Infections: A Retrospective, Comparative Cohort Study
| Autor: | Jacinda C Abdul-Mutakabbir, Sarah C J Jorgensen, Trang D Trinh, Sahil Bhatia, Sara Alosaimy, Evan J Zasowski, Ryan P. Mynatt, Susan L. Davis, Noor Sabagha, Abdalhamid M Lagnf, Michael J. Rybak |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Methicillin-Resistant Staphylococcus aureus 0301 basic medicine Microbiology (medical) medicine.medical_specialty Combination therapy 030106 microbiology Bacteremia beta-Lactams medicine.disease_cause Cohort Studies 03 medical and health sciences 0302 clinical medicine Daptomycin Vancomycin Internal medicine medicine Humans 030212 general & internal medicine Retrospective Studies business.industry Confounding Odds ratio Staphylococcal Infections medicine.disease Methicillin-resistant Staphylococcus aureus Confidence interval Anti-Bacterial Agents Infectious Diseases business Cohort study medicine.drug |
| Zdroj: | Clinical Infectious Diseases. 71:1-10 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciz746 |
| Popis: | BackgroundMounting evidence suggests the addition of a β-lactam (BL) to daptomycin (DAP) results in synergistic in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and bolsters the innate immune response to infection. This study’s objective was to provide clinical translation to these experimental data and determine if DAP+BL combination therapy results in improved clinical outcomes compared with treatment with DAP alone in patients with MRSA bloodstream infections (BSIs).MethodsThis was a retrospective, comparative cohort study conducted at 2 academic medical centers between 2008 and 2018. Adults with MRSA BSI treated with DAP for ≥72 hours and initiated ≤5 days of culture collection were included. Patients who received a BL for ≥24 hours and initiated ≤24 hours of DAP comprised the DAP+BL group. The primary outcome was composite clinical failure (60-day all-cause mortality and/or 60-day recurrence). Analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW).ResultsA total of 229 patients were included (72 DAP+BL and 157 DAP). In unadjusted and IPTW-adjusted analyses, DAP+BL was associated with significantly reduced odds of clinical failure (odds ratio [OR], 0.362; 95% confidence interval [CI], .164–.801; adjusted OR, 0.386; 95% CI, .175–.853). Adjusted analyses restricted to prespecified subgroups based on infection complexity and baseline health status were consistent with the main analysis.ConclusionsThe addition of a BL to DAP was associated with improved clinical outcomes in patients with MRSA BSI. This study provides support to ongoing and future studies evaluating the impact of combination therapy for invasive MRSA infections.Patients treated with daptomycin plus a β-lactam for MRSA bloodstream infection had lower odds of composite clinical failure defined as 60-day all-cause mortality and/or 60-day recurrence compared with patients treated with daptomycin monotherapy after adjusting for confounding variables using inverse probability of treatment weighting. |
| Databáze: | OpenAIRE |
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