The Ulutas Medical Journal p-ISSN 2149-0430 e-ISSN 2149-388X

The Ulutas Medical Journal · ISSN 2149-0430 (print), 2149-388X (online) · https://www.ulutasmedicaljournal.com/?mno=106884

Letter to the Editor · Open access

Daptomycin or Vancomycin Plus Ceftaroline for Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections

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  1. Department of Nursing, Kaohsiung Municipal United Hospital, Taiwan ROR
  2. Department of Intensive Care Medicine, Chi-Mei Medical Center, Liouying, Taiwan ROR
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Abstract

The clinical outcomes of patients with MRSA bacteremia treated with ceftaroline plus vancomycin or daptomycin were similar to those treated with monotherapy with vancomycin or daptomycin. However, this analysis has limited case and study numbers; larger-scale studies are warranted to confirm these findings.

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To the Editor

Recently, one randomized clinical trial (RCT) by Tong et al showed that addition of an anti-staphylococcal β-lactam to daptomycin or vancomycin alone was not associated with improve outcome of patients with MRSA bacteremia (1). Moreover, more acute kidney injury occurred in combination group than monotherapy group in this RCT (1). However, another recent retrospectivestudyby Jorgensen et al which investigated the effect of addition of a β-lactam to daptomycin in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection and found that the combination of a β-lactam and daptomycin was associated with a better outcome than daptomycin monotherapy (2). In addition to different study design between these two studies (1, 2), the choice of β-lactam in each of them was significant different. In Jorgensen et al’s study (2), 87.5% (63/72) of combination therapy used cephalosporin, but most of the patents treated with combining flucloxacillin or cloxacillin (1). Therefore, we wonder whether cephalosporin, especially the ceftaroline, which exhibits potent in vitro anti-MRSA activity can be the better choice of daptomycin-based combination therapy to improve the outcome of patients with MRSA bloodstream infections. To clarify this issue, we conducted this metaanalysis to compare the effect of adding ceftaroline to vancomycin or daptomycin and monotherapy in the treatment of MRSA bacteremia.

Four studies (3–6) which compared the effect of combining ceftaroline and vancomycin/daptomycin and standard therapy were identified from the literature search. Table 1 summarized the characteristics of these studies. One study was RCT (4) and other three were retrospective studies (3, 5, 6). Each two studies were single(3, 6) and multicenter studies (4, 5). Primary outcomes as 28-day mortality was recorded for analysis. Secondary outcome including 90-day mortality, microbiological relapse and the risk of acute kidney injury were extracted from the enrolled studies.

Table 1. Characteristics of Included Studies
Table 1: Characteristics of Included Studies

Overall, 94 and 156 patients received combination therapy with daptomycin plus ceftaroline and monotherapy - vancomycin or daptomycin, respectively. Although 28-day mortality rate of combination therapy group was numerically than monotherapy group (7.4% [7/94] vs 14.7% [23/156]), this difference did not reach statistical significance (risk difference, -0.07; 95% confidence interval [CI], -0.21 ~ 0.08). The similarity between combination therapy and monotherapy was also observed regarding the 90-day mortality (risk difference, 0.08; 95%CI, -0.77 ~ 0.94). In addition, combination therapy was similar to monotherapy (risk difference, -0.06; 95%CI, -0.22 ~ 0.1) in terms of micro biological relapse. Finally, the risk of acute kidney injury was similar between combination therapy and monotherapy (risk difference,-0.21; 95% CI,-0.62~0.2).

Based on the above findings, the clinical outcome of patients with MRSA bacteremia treated by the combination of ceftaroline and vancomycin or daptomycin was similar to those by monotherapy of vancomycin or daptomycin. However, the case and study number are limited in this analysis, further large-scale study is warrant to confirm these findings.

Declarations

Author contributions (CRediT)
All authors contributed equally to all 14 CRediT roles (Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing).
Funding

Funding information was not reported in the published version of this article.

Conflicts of interest
The author declared no conflict of interest.
Ethics approval
Ethics approval details were not reported in the published version of this article.
Data availability
Data sharing is not applicable to this article as no new data were created or analysed in this study.

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How to cite this article

Lee GM, Chao CM. Daptomycin or Vancomycin Plus Ceftaroline for Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections. Ulutas Med J. 2020;6(3):185-187. doi:10.5455/umj.20200513022718

Lee, G. M., & Chao, C. M. (2020). Daptomycin or Vancomycin Plus Ceftaroline for Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections. The Ulutas Medical Journal, 6(3), 185–187. https://doi.org/10.5455/umj.20200513022718

Lee, G.M. and Chao, C.M. (2020) 'Daptomycin or Vancomycin Plus Ceftaroline for Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections', The Ulutas Medical Journal, 6(3), pp. 185–187. doi: 10.5455/umj.20200513022718.

@article{umj106884,
  title = {Daptomycin or Vancomycin Plus Ceftaroline for Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections},
  author = {Lee, Guang-Mao and Chao, Chien-Ming},
  journal = {The Ulutas Medical Journal},
  year = {2020},
  volume = {6},
  number = {3},
  pages = {185--187},
  doi = {10.5455/umj.20200513022718},
  url = {https://www.ulutasmedicaljournal.com/?mno=106884},
  issn = {2149-388X}
}
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