Ahmad Omar, Crawford Timothy N, Myint Thein
Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA.
Department of Population and Public Health Sciences, Wright State University, Dayton, OH, USA.
Infect Dis Ther. 2020 Mar;9(1):77-87. doi: 10.1007/s40121-019-00277-2. Epub 2019 Nov 28.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia confers considerable morbidity and mortality. Although vancomycin or daptomycin monotherapy is usually curative, prolonged bacteremia necessitating supplemental ceftaroline has occurred. The practice has led to the question of whether to continue with ceftaroline following bacteremia resolution.
Adult patients hospitalized with MRSA bacteremia at the University of Kentucky Medical Center between January 2015 and December 2017 were retrospectively reviewed. Study subjects required supplemental ceftaroline due to 4 or more days of bacteremia despite vancomycin or daptomycin. They additionally had accompanying native valve infective endocarditis, osteomyelitis, or brain abscess. Patients were divided into two cohorts. One group continued with ceftaroline plus vancomycin or daptomycin following bacteremia resolution (combination therapy group). The other group received vancomycin or daptomycin alone (monotherapy group). All involved received 6-8 weeks of therapy. Patients' Pitt bacteremia score (PBS) and Charlson comorbidity index (CCI) values were calculated. Treatment outcomes of inpatient mortality, recurrence of bacteremia, 30-day readmission, acute kidney injury, and leukopenia were recorded and compared.
A total of 30 patients comprised the study population. 15 patients were assigned to each cohort. The median PBS value of the combination therapy group was 2, compared with 1 among the monotherapy group. The median CCI score of both groups was 0. No statistically significant difference in the aforementioned treatment outcomes was seen between the two groups.
In subjects with complicated and prolonged MRSA bacteremia requiring supplemental ceftaroline, clinical outcomes did not differ among patients prescribed vancomycin or daptomycin alone following bacteremia resolution versus patients who continued combination therapy.
耐甲氧西林金黄色葡萄球菌（MRSA）菌血症会导致相当高的发病率和死亡率。尽管万古霉素或达托霉素单药治疗通常可治愈，但仍有出现菌血症持续时间延长而需要补充头孢洛林的情况。这种做法引发了菌血症消退后是否继续使用头孢洛林的问题。
对2015年1月至2017年12月在肯塔基大学医学中心住院治疗MRSA菌血症的成年患者进行回顾性研究。研究对象尽管使用了万古霉素或达托霉素，但因菌血症持续4天或更长时间而需要补充头孢洛林。他们还伴有自身瓣膜感染性心内膜炎、骨髓炎或脑脓肿。患者被分为两个队列。一组在菌血症消退后继续使用头孢洛林加万古霉素或达托霉素（联合治疗组）。另一组仅接受万古霉素或达托霉素（单药治疗组）。所有患者均接受6 - 8周的治疗。计算患者的皮特菌血症评分（PBS）和查尔森合并症指数（CCI）值。记录并比较住院死亡率、菌血症复发、30天再入院、急性肾损伤和白细胞减少等治疗结果。
共有30名患者纳入研究人群。每个队列分配15名患者。联合治疗组的PBS中位数为2，而单药治疗组为1。两组的CCI评分中位数均为0。两组在上述治疗结果方面未见统计学显著差异。
在患有复杂且持续时间长的MRSA菌血症并需要补充头孢洛林的患者中，菌血症消退后单独使用万古霉素或达托霉素的患者与继续联合治疗的患者临床结果并无差异。
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