Hammond Jennifer, Benigno Michael, Bleibdrey Nataly, Ansari Wajeeha, Nguyen Jennifer L
Pfizer, Collegeville, PA, USA.
Pfizer Biopharmaceutical Group, Pfizer Inc., 66 Hudson Blvd East, New York, NY, 10001, USA.
Drugs Real World Outcomes. 2024 Jun;11(2):273-283. doi: 10.1007/s40801-024-00422-5. Epub 2024 Apr 2.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia results in substantial morbidity and mortality. As current treatments often lead to unsatisfactory outcomes, evidence guiding alternative treatment options is needed. This study evaluated real-world clinical outcomes of ceftaroline fosamil for the treatment of MRSA bacteremia.
This retrospective study included adults hospitalized with MRSA bacteremia between 2011 and 2019. Patients were classified according to treatment with ceftaroline fosamil (ceftaroline), vancomycin, or daptomycin: Group 1, ceftaroline; Group 2, vancomycin or daptomycin (without ceftaroline); Group 3, combination therapy with ≥ 2 of these three agents. Clinical outcomes were compared using propensity-score-adjusted odds ratios (ORs) from logistic regression models.
Overall, 24,479 patients were included (Group 1, n = 532; Group 2, n = 21,555; Group 3, n = 2392). Mean age was 59.6, 60.8, and 57.4 years in Groups 1, 2, and 3, respectively. Mean post-index treatment length of stay was 8.8, 8.8, and 8.0 days, respectively. The most frequent line of therapy was ceftaroline first-line (42.1%), vancomycin or daptomycin first-line (95.4%), and combination therapy third-line or later (67.8%) in Groups 1, 2, and 3, respectively. Compared with Group 2, Groups 1 and 3 had similar favorable clinical responses {odds ratio [OR] = 1.18 [95% confidence interval (CI) 0.98-1.44], p = 0.08; OR = 1.20 [95% CI 0.97-1.47], p = 0.09, respectively} and were less likely to switch treatment (both p < 0.001). Compared with Group 2, Group 1 was more likely to undergo 30-day all-cause readmission [OR = 1.38 (95% CI 1.06-1.80), p = 0.02], whereas this was less likely for Group 3 [OR = 0.77 (95% CI 0.58-1.00), p = 0.05].
Patients receiving ceftaroline more often had favorable clinical responses than those receiving vancomycin or daptomycin monotherapy. In the absence of large-scale randomized controlled trials, these real-world data provide insights into the potential role of ceftaroline for treating MRSA bacteremia.
耐甲氧西林金黄色葡萄球菌（MRSA）菌血症会导致严重的发病和死亡。由于目前的治疗方法往往导致不尽人意的结果，因此需要有指导替代治疗方案的证据。本研究评估了头孢洛林酯治疗MRSA菌血症的真实世界临床疗效。
这项回顾性研究纳入了2011年至2019年间因MRSA菌血症住院的成年人。根据使用头孢洛林酯（头孢洛林）、万古霉素或达托霉素进行治疗，将患者分为：第1组，头孢洛林；第2组，万古霉素或达托霉素（不使用头孢洛林）；第3组，这三种药物中至少两种的联合治疗。使用逻辑回归模型的倾向评分调整比值比（OR）比较临床疗效。
总体而言，共纳入24479例患者（第1组，n = 532；第2组，n = 21555；第3组，n = 2392）。第1、2和3组的平均年龄分别为59.6岁、60.8岁和57.4岁。索引治疗后的平均住院时间分别为8.8天、8.8天和8.0天。第1、2和3组最常见的治疗线分别是头孢洛林一线治疗（42.1%）、万古霉素或达托霉素一线治疗（95.4%）以及联合治疗三线及更晚治疗（67.8%）。与第2组相比，第1组和第3组有相似的良好临床反应{比值比[OR]=1.18[95%置信区间（CI）0.98 - 1.44]，p = 0.08；OR = 1.20[95%CI 0.97 - 1.47]，p = 0.09}，且更换治疗的可能性较小（p均<0.001）。与第2组相比，第1组更有可能在30天内因任何原因再次入院[OR = 1.38（95%CI 1.06 - 1.80），p = 0.02]，而第3组则不太可能[OR = 0.77（95%CI 0.58 - 1.
