Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Int J Antimicrob Agents. 2021 Aug;58(2):106363. doi: 10.1016/j.ijantimicag.2021.106363. Epub 2021 May 24.
Staphylococcus aureus (S. aureus) is the leading cause of bacteraemia and infective endocarditis worldwide. The preferred management of patients with methicillin-susceptible S. aureus (MSSA) bacteraemia includes definitive therapy with intravenous anti-staphylococcal beta-lactam (ASBL) antibiotics. Daptomycin (DAP) has been targeted as a viable substitute for beta-lactam allergic or intolerant patients.
This single-center retrospective cohort study assessed clinical outcomes of DAP compared with ASBL antibiotics [nafcillin (NAF) or cefazolin (CFZ)] for the treatment of MSSA bacteraemia in patients hospitalised from 01 November 2011 to 31 October 2018. The primary outcome was a composite of the following: clinical failure, MSSA recurrence and MSSA persistence or inpatient infection-related mortality. Secondary outcomes included duration of MSSA bacteraemia, infection-related length of stay, infection-related 90-day readmission, 30-day all-cause mortality, and adverse events necessitating a change in therapy.
Of 89 patients with MSSA bacteraemia who were included: 29 received DAP, 30 received NAF and 30 received CFZ. There was no difference in the composite primary outcome in patients treated with DAP compared with ASBL (10% vs. 5%, P = 0.39). The DAP cohort had a longer hospital length of stay compared with the ASBL group (20 days vs. 11.5 days, P = 0.0007). No differences were detected between other secondary outcomes.
This study suggests that DAP may serve as a comparable alternative to ASBLs for treatment of MSSA bacteraemia, as no differences in clinical outcomes were identified. Larger studies are needed to confirm these findings.
金黄色葡萄球菌（S. aureus）是全球导致菌血症和感染性心内膜炎的主要原因。治疗耐甲氧西林金黄色葡萄球菌（MSSA）菌血症的首选方法包括静脉用抗葡萄球菌β-内酰胺（ASBL）抗生素进行明确治疗。达托霉素（DAP）已被确定为β-内酰胺过敏或不耐受患者的可行替代品。
这项单中心回顾性队列研究评估了 DAP 与 ASBL 抗生素[萘夫西林（NAF）或头孢唑林（CFZ）]治疗 2011 年 11 月 1 日至 2018 年 10 月 31 日住院的 MSSA 菌血症患者的临床结局。主要结局是以下方面的复合结果：临床失败、MSSA 复发和 MSSA 持续存在或住院感染相关死亡率。次要结局包括 MSSA 菌血症持续时间、感染相关住院时间、感染相关 90 天再入院、30 天全因死亡率以及需要改变治疗的不良事件。
在 89 例 MSSA 菌血症患者中，29 例接受 DAP 治疗，30 例接受 NAF 治疗，30 例接受 CFZ 治疗。与 ASBL 相比，接受 DAP 治疗的患者复合主要结局无差异（10%对 5%，P=0.39）。与 ASBL 组相比，DAP 组的住院时间更长（20 天对 11.5 天，P=0.0007）。其他次要结局之间无差异。
这项研究表明，DAP 可能是治疗 MSSA 菌血症的 ASBL 的一种可替代方法，因为在临床结局方面没有差异。需要更大的研究来证实这些发现。
