Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is a major cause of morbidity and mortality in the hospitalized patients. Treatment failure with vancomycin or daptomycin is common in MRSA BSI complicated by endocarditis, implanted devices, or metastatic sites of infection. Ceftaroline fosamil is the first beta-lactam antibiotics with in vitro and in vivo activity against MRSA. Recent studies show that ceftaroline is effective in various MRSA infections; however, there is currently limited clinical experience with ceftaroline in complicated MRSA BSI. We report a series of 10 patients in which ceftaroline monotherapy was used as salvage therapy for complicated MRSA BSI.
Using records from the antimicrobial stewardship program, 44 ceftaroline-treated patients were identified between February 2012 to September 2014 at Robert Wood Johnson University Hospital in New Brunswick, NJ, USA. All cases were reviewed and 10 patients received ceftaroline for complicated MRSA BSI due to refractory bacteremia after at least 4 days of treatment with vancomycin or daptomycin.
All 10 patients had clearance of MRSA BSI after initiation of ceftaroline without further surgical intervention. Of the 10 patients with complicated MRSA BSI, 4 were related to implanted devices, 4 to endocarditis, and 3 to metastatic sites of infection. Two isolates were vancomycin-intermediate and daptomycin non-susceptible Staphylococcus aureus. The average time to clearance after initiation of ceftaroline was 6 days. 9 patients were discharged from the hospital to complete 6 weeks of ceftaroline treatment. At 6-month follow-up, there was no re-admission for MRSA related infections. One patient died of aspiration pneumonia during the course of treatment.
Ceftaroline may be effective in clearance of refractory MRSA BSI related to implanted devices, endocarditis, or metastatic sites of infection- conditions with high rates of treatment failure. Further study is needed to compare ceftaroline monotherapy versus current MRSA BSI treatment standards, daptomycin and vancomycin.
R. Sharma, None
T. Bhowmick, None
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