1738. Use of Ceftaroline for Treatment of Methicillin Resistant Staphylococcus aureus Bacteremia (MRSAB) After Failure of the Initial Regimen
Session: Poster Abstract Session: Treatment of Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

The use of ceftaroline for treatment of MRSAB is appealing given the superiority of beta-lactam therapy for treating S. aureus infections. We investigated of the use of ceftaroline-containing salvage regimens for treatment of MRSAB. 

Methods:

Retrospective study of adult patients with MRSAB treated with ceftaroline after failing or developing intolerance to initial therapy at the Johns Hopkins Hospital from 8/11 to 2/13. Bacteremia source, duration of blood culture positivity, adverse events and outcomes were assessed. Patients were treatment successes if they had follow up information in the medical record indicating clinical cure at least 6 weeks after the end of therapy. 

Results:

Of 21 patients with MRSAB switched to ceftaroline, 16 had infective endocarditis or cardiac device infection, 4 had soft tissue infections, and 1 had pneumonia. 15 (71%) patients were switched to ceftaroline due to persistent positive blood cultures; 10 of these had positive blood cultures when ceftaroline was started. 3 of these had a vancomycin minimum inhibitory concentration > 1µg/ml. 4 (19%) patients had adverse events to primary therapy. In one patient ceftaroline was used for better CNS penetration and another was switched from linezolid to avoid side effects.  In the 10 patients with positive blood cultures at the time of switch to ceftaroline, blood cultures cleared at a median 3.5 days (IQR 1.5, 5.5) after the start of ceftaroline. TMP/SMX was used in combination with ceftaroline in 5 of these patients.   One patient cleared blood cultures with ceftaroline despite inadequate source control. 16 (76%) patients in the whole cohort survived to discharge with no evidence of treatment failure; 8 of these were treatment successes.  Of the 15 patients with persistent MRSAB, 11 (73%) were alive at discharge with no evidence of treatment failure; 5 of these were treatment successes. No patients in the cohort had adverse events associated with ceftaroline

Conclusion:

Using strict criteria, 38% of all patients with MRSAB and 33% of patients with persistent MRSAB had treatment success on ceftaroline. An additional 38% and 40% in each group had no evidence of failure at discharge. In our cohort, ceftaroline appeared effective and safe for salvage therapy of MRSAB.

Valeria Fabre, MD, Infectious Diseases, Johns Hopkins Hospital, Baltimore, MD, Marcela Ferrada, MD, Johns Hopkins Hospital, Baltimore, MD, Edina Avdic, PharmD, MBA, The Johns Hopkins University School of Medicine, Baltimore, MD, Sara Cosgrove, MD, MS, FIDSA, FSHEA, The Johns Hopkins Medical Institutions, Baltimore, MD and Whitney Redding, PharmD, Department of Pharmacy, Intermountain Medical Center, Murray, UT

Disclosures:

V. Fabre, None

M. Ferrada, None

E. Avdic, None

S. Cosgrove, Novartis: Consultant, Consulting fee
Cubist: Grant Investigator, Research grant
AdvanDx: Grant Investigator, Research grant
Pfizer/The Joint Commission: Grant Investigator, Grant recipient

W. Redding, None

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