Caniff Kaylee E, Judd Chloe, Lucas Kristen, Goro Sandra, Orzol Caroline, Eshaya Mirna, Al Musawa Mohammed, Veve Michael P, Rybak Michael J
Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
Henry Ford Health System, Detroit, MI, USA.
Infect Dis Ther. 2024 Dec;13(12):2649-2662. doi: 10.1007/s40121-024-01068-0. Epub 2024 Nov 2.
Infective endocarditis (IE) due to methicillin-resistant Staphylococcus aureus (MRSA) is characterized by frequent treatment failure to first-line agents and high mortality, necessitating use of alternative management strategies. Ceftaroline fosamil (CPT) is a cephalosporin antibiotic with activity against MRSA but without regulatory approval for the indication of IE. This study describes clinical experience with CPT-based regimens utilized in MRSA-IE.
This is a retrospective, observational, descriptive analysis of patients from two major urban medical centers in Detroit, Michigan from 2011 to 2023. Included adult patients (≥ 18 years) had ≥ 1 positive blood culture for MRSA, met definitive clinical criteria for IE, and received CPT for ≥ 72 h. The primary outcome was treatment failure, defined as a composite of 30-day all-cause mortality from index culture or failure to improve or resolve infectious signs/symptoms after CPT initiation.
Seventy patients were included. The median (interquartile range [IQR]) age was 51 (34-63) years and 45.7% were male. Persons with injection drug use (PWID) made up 55.7% of the cohort and right-sided IE was the most prevalent subtype (50.0%). CPT was frequently employed second-line or later, often in combination with vancomycin (10.0%) or daptomycin (72.9%). Overall, 31.4% experienced treatment failure and 30-day all-cause mortality occurred in 15.7%.
These findings illustrate the challenges posed by MRSA-IE, including frequent treatment failures, and highlight the utilization of CPT as salvage therapy. Comparative studies are needed to more clearly define its role in MRSA-IE.
耐甲氧西林金黄色葡萄球菌（MRSA）引起的感染性心内膜炎（IE）的特点是对一线药物的治疗失败率高且死亡率高，因此需要采用替代管理策略。头孢洛林酯（CPT）是一种对MRSA有活性的头孢菌素抗生素，但尚未获得用于IE适应症的监管批准。本研究描述了在MRSA-IE中使用基于CPT的治疗方案的临床经验。
这是一项对2011年至2023年来自密歇根州底特律市两个主要城市医疗中心的患者进行的回顾性、观察性、描述性分析。纳入的成年患者（≥18岁）血培养MRSA≥1次阳性，符合IE的明确临床标准，并接受CPT治疗≥72小时。主要结局是治疗失败，定义为自首次培养起30天全因死亡率或开始使用CPT后感染体征/症状未改善或未缓解的综合情况。
共纳入70例患者。中位（四分位间距[IQR]）年龄为51（34-63）岁，45.7%为男性。注射吸毒者（PWID）占队列的55.7%，右侧IE是最常见的亚型（50.0%）。CPT经常作为二线或更晚使用，常与万古霉素（10.0%）或达托霉素（72.9%）联合使用。总体而言，31.4%的患者经历了治疗失败，15.7%的患者发生了30天全因死亡。
这些发现说明了MRSA-IE带来的挑战，包括频繁的治疗失败，并强调了CPT作为挽救治疗的应用。需要进行比较研究以更明确地界定其在MRSA-IE中的作用。
