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Early administration of adjuvant β-lactam therapy in combination with vancomycin among patients with methicillin-resistant Staphylococcus aureus bloodstream infection: a retrospective, multicenter analysis.
Pharmacotherapy. 2017 Sep 26;:
Authors: Casapao AM, Jacobs DM, Bowers DR, Beyda ND, Dilworth TJ, REACH-ID Study Group
Abstract
STUDY OBJECTIVE: To determine whether early administration of adjuvant β-lactam in combination with vancomycin (COMBO) affects clinical outcomes compared to standard vancomycin therapy alone (STAN) among patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection.
DESIGN: Retrospective, multicenter cohort study.
SETTING: Five academic or community hospitals throughout the United States.
PATIENTS: Adults with MRSA bloodstream infections treated with vancomycin (≥72 hours) ± an intravenous β-lactam (≥48 hours) initiated within 24 hours of initiating vancomycin.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was clinical failure, a composite endpoint including 30-day mortality, persistent bacteremia (≥7 days), bacteremia relapse, or change in antibiotic therapy during treatment due to clinical worsening. A multivariable logistic regression examined the impact of patient-, treatment-, and pathogen-level characteristics on clinical failure. A total of 201 patients were evaluated of whom 97 (48.3%) met the criteria for study inclusion; 40 (41.2%) in STAN and 57 (58.8%) in COMBO groups. Among patients in the STAN and COMBO groups, 30% and 24.6% experienced clinical failure, respectively (p=0.552). The median (IQR, interquartile range) duration of bacteremia in the STAN and COMBO groups was 4 days (2.5, 6.5) and 3 days (2, 5), respectively (p=0.048). In a multivariable analysis, receipt of COMBO therapy was inversely associated with clinical failure (adjusted odds ratio [aOR] 0.237, 95% confidence interval [CI] [0.057, 0.982]; p=0.047). Other independent predictors of clinical failure included complicated bacteremia (aOR 6.856, 95% CI [1.641, 28.649]; p=0.008) and antibiotic therapy not continued at discharge (aOR 45.404, 95% CI [9.383, 219.714]; p<0.001).
CONCLUSIONS: Receipt of COMBO therapy did not decrease the rate of clinical failure but was associated with expedited bacteremia clearance. Early adjuvant ß-lactam therapy deserves continued evaluation and clinical consideration. This article is protected by copyright. All rights reserved.
PMID: 28949410 [PubMed - as supplied by publisher]