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  3. Ceftaroline for bloodstream infections caused by methicillin-resistant Staphylococcus aureus: a multicentre retrospective cohort study.

Ceftaroline for bloodstream infections caused by methicillin-resistant Staphylococcus aureus: a multicentre retrospective cohort study.

Fecha de publicación: Fecha Ahead of Print:

Autores de IDIVAL

Autores ajenos al IDIVAL

  • De La Villa S
  • Escrihuela-Vidal F
  • Fernández-Hidalgo N
  • Escudero-Sánchez R
  • Boix-Palop L
  • Díaz-Pollán B
  • Goikoetxea AJ
  • García-País MJ
  • Pérez-Rodríguez MT
  • Crespo Á
  • Buzón-Martín L
  • Sanz-Peláez O
  • Ramos-Merino L
  • Silvante F
  • Muñoz P
  • Ceftaroline MRSA Group Spain GEIRAS-SEIMC

Unidades

Abstract

OBJECTIVES: To evaluate the effectiveness of ceftaroline vs. vancomycin or daptomycin in the treatment of methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs). METHODS: This multicentre retrospective study conducted in 15 Spanish hospitals, included data from the first MRSA-BSIs of adult patients between January-2019 and December-2022. The ceftaroline group included patients who received ceftaroline for =72h within the first week of BSI onset; the standard of care (SOC) group included patients who received vancomycin or daptomycin =72h after BSI onset. Primary outcome was 30-day all-cause mortality; secondary outcomes included 90-day mortality and incidence of adverse events (AEs). Propensity-score (PS) matching and Cox proportional-hazards analyses were performed. RESULTS: A total of 429 MRSA-BSIs were included: 133 in the ceftaroline group and 296 in the SOC group. More patients in the ceftaroline group had a SOFA score>2 (51.1% vs. 36.5%; p<0.01), complicated-BSI (66.2% vs. 42.2%; p<0.01), infective endocarditis (18.8% vs. 6.4%; p<0.01) and prescribed in combination treatment (65.4% vs. 11.5%; p<0.01), with no statistically significant differences in 30-day mortality: 23.3% ceftaroline (95%CI 16.1%-30.5%) vs. 16.2% SOC (95%CI 12.0%-20.4%), p=0.08. There were no statistically significant differences in 90-day mortality (33.1% ceftaroline vs. 26.7% SOC; p=0.17). After PS matching, 105 patients treated with ceftaroline were matched with 105 controls: the 30-day mortality rates were 21.9% and 16.2% (p=0.38). Cox-regression analysis of the entire cohort (n=429) revealed that age (HR 1.05, 95%CI 1.03-1.07) and SOFA score>2 (HR 2.34, 95%CI 1.50-3.65) were associated with 90-day mortality risk, although ceftaroline treatment did not demonstrate a significant effect (HR 1.00, 95%CI 0.97-1.02). Incidence of AEs was 12.0% in ceftaroline vs. 4.4% in SOC group (p<0.01). Most AEs occurred when ceftaroline was used in combination vs. monotherapy (17.2% vs. 2.2%; p=0.01). CONCLUSIONS: Ceftaroline was an effective treatment for MRSA-BSIs but was commonly prescribed in combination showing a higher incidence of AEs.

Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
1198-743X, 1469-0691

CLINICAL MICROBIOLOGY AND INFECTION  WILEY-BLACKWELL

Tipo:
Article
Páginas:
793-801
PubMed:
39581546

Citas Recibidas en Web of Science: 3

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Keywords

  • Bloodstream-infection; MRSA; Staphylococcus aureus; ceftaroline; combination therapy; mortality

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