Antimicrob Agents Chemother. 2021 Jun 14:AAC0034321. doi: 10.1128/AAC.00343-21. Online ahead of print.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia has a high case-fatality rate, but currently recommended antimicrobial therapies have many shortcomings. The efficacy and safety of lincosamide therapy for MRSA bacteraemia is incompletely defined. Materials and methods: A retrospective audit of the management of all adults with MRSA bacteraemia at an Australian tertiary-referral hospital between 1 January 2007 and 31 December 2020. Results: 176 patients were included. The case-fatality rate declined from 14/57 (25%) in the first half of the study to 12/119 (10%) in the second half (p=0.01). Of the 172 patients receiving antibiotics, 62 (36%) received a lincosamide-predominant regimen (lincosamide monotherapy for >50% of the intravenous course). The patients receiving lincosamide-predominant intravenous therapy had lower in-hospital mortality (odds ratio (OR): 0.07 (95% confidence interval (CI): 0.01-0.53), p=0.01) and a lower incidence of renal complications (OR (95% CI): 0.34 (0.15-0.75), p=0.008) than patients receiving an alternative regimen. In multivariate analysis that also considered age, disease severity, comorbidity, infectious diseases consultation, source control and the year of admission, patients receiving a lincosamide-predominant regimen were still less likely to die in hospital than those receiving an alternative regimen (OR (95% CI): 0.05 (0.00-0.65), p=0.02). Conclusions: Lincosamides appear to have utility - at least as stepdown therapy - in the treatment of MRSA bacteremia, particularly in young, clinically stable patients with few comorbidities in whom endocarditis has been excluded. Prospective studies will help define their optimal role.