Hicks Addison S, Dolan Mackenzie A, Shah Megan D, Elwood Sarah E, Platts-Mills James A, Madden Gregory R, Elliott Zachary S, Eby Joshua C
University of Virginia Health System.
Res Sq. 2024 Mar 15:rs.3.rs-4095478. doi: 10.21203/rs.3.rs-4095478/v1.
Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We present an assessment of outcomes of patients initiated on early combination therapy for MRSA-B.
This was a single-center, retrospective study of adult patients admitted with MRSA-B between July 1, 2017 and April 31, 2023. During this period, there was a change in institutional practice from routine administration of monotherapy to initial combination therapy for most patients with MRSA-B. Combination therapy included vancomycin or daptomycin plus ceftaroline within 72 hours of index blood culture and monotherapy was vancomycin or daptomycin alone. The primary outcome was a composite of persistent bacteremia, 30-day all-cause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were assessed. All outcomes were assessed using propensity score-weighted logistic regression.
Of 213 patients included, 118 received monotherapy (115 vancomycin, 3 daptomycin) and 95 received combination therapy with ceftaroline (76 vancomycin, 19 daptomycin). The mean time from MRSA-positive molecular diagnostic blood culture result to combination therapy was 12.1 hours. There was no difference between groups for the primary composite outcome (OR 1.58, 95% CI 0.60, 4.18). Time to microbiological cure was longer with combination therapy (mean difference 1.50 days, 95% CI 0.60, 2.41). Adverse event rates were similar in both groups.
Early initiation of ceftaroline-based combination therapy did not improve outcomes for patients with MRSA-B in comparison to monotherapy therapy.
尽管对万古霉素或达托霉素单药治疗耐甲氧西林菌血症（MRSA-B）的疗效存在担忧，但基于指南的治疗方案仍是使用这两种药物进行单药治疗。有限的数据支持以头孢洛林作为初始治疗进行联合治疗可能带来的益处。我们对开始接受早期联合治疗的MRSA-B患者的治疗结果进行了评估。
这是一项针对2017年7月1日至2023年4月31日期间因MRSA-B入院的成年患者的单中心回顾性研究。在此期间，机构治疗方案发生了变化，大多数MRSA-B患者从常规的单药治疗改为初始联合治疗。联合治疗包括在首次血培养后72小时内使用万古霉素或达托霉素加头孢洛林，单药治疗则仅使用万古霉素或达托霉素。主要结局是持续性菌血症、30天全因死亡率和30天菌血症复发的综合结果。评估了微生物治愈时间和安全性结局。所有结局均使用倾向评分加权逻辑回归进行评估。
纳入的213例患者中，118例接受单药治疗（115例使用万古霉素，3例使用达托霉素），95例接受头孢洛林联合治疗（76例使用万古霉素，19例使用达托霉素）。从MRSA阳性分子诊断血培养结果到联合治疗的平均时间为12.1小时。两组在主要综合结局方面无差异（比值比1.58，95%置信区间0.60，4.18）。联合治疗的微生物治愈时间更长（平均差异1.50天，95%置信区间0.60，2.41）。两组的不良事件发生率相似。
与单药治疗相比，早期开始基于头孢洛林的联合治疗并未改善MRSA-B患者的治疗结局。
