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Impact of beta-lactam and daptomycin combination therapy on clinical outcomes in methicillin-susceptible Staphylococcus aureus bacteremia: A propensity score-matched analysis.
Clin Infect Dis. 2019 Jan 07;:
Authors: Grillo S, Cuervo G, Carratalà J, Grau I, Pallarès N, Tebé C, Guillem Tió L, Murillo O, Ardanuy C, Domínguez MA, Shaw E, Gudiol C, Pujol M
Abstract
Background: Mortality rates from Staphylococcus aureus bacteremia are high and have only modestly improved in recent decades. We compared the efficacies of beta-lactam in combination with daptomycin (BL/D-C) and beta-lactam monotherapy (BL-M) in improving clinical outcomes in methicillin-susceptible S. aureus (MSSA) bacteremia.
Methods: A retrospective cohort study of MSSA bacteremia was performed in a tertiary hospital from January 2011 to December 2017. Patients receiving BL/D-C and BL-M were compared to assess 7-, 30- and 90-day mortality rates. A 1:2 propensity score matching was performed. Differences were assessed using Cox regression models.
Results: Of the 514 patients with MSSA bacteremia, 164 were excluded as they had received combination therapies other than BL/D-C, had pneumonia or had died within 48 h of admission. Of the remaining 350 patients, 136 and 214 received BL/D-C and BL-M, respectively. BL/D-C patients had higher Pitt scores and persistent bacteremia more often than BL-M patients. In the raw analysis, there were no differences in mortality rates between groups. After propensity score matching, there were no significant differences between the BL/D-C (110 patients) and BL-M (168 patients) groups for all-cause mortality rates at 7 (8.18% vs. 7.74%, P = 1.000), 30 (17.3% vs. 16.1%, P = 0.922) and 90 days (22.7% vs. 23.2%, P = 1.000), even in a sub-analysis of patients with high-risk source of infection and in a subgroup excluding catheter-related bacteremia.
Conclusions: BL/D-C failed to reduce mortality rates in patients with MSSA bacteremia. Treatment strategies to improve survival in MSSA bacteremia are urgently needed.
PMID: 30615122 [PubMed - as supplied by publisher]