No published clinical trials have investigated ceftaroline (CPT) use for treatment (tx) of deep-seated methicillin-resistant Staphylococcus aureus (MRSA) infections; however, limited publications document successful use of CPT as salvage therapy for these infections.
We conducted a case series at Northwestern Memorial Hospital of all patients (pts) who received CPT from Aug. 2012 to Sept. 2014. Cases were obtained from the pharmacy database. Electronic medical records were reviewed to identify cases of CPT as salvage therapy for deep-seated MRSA infection. The following data were collected: demographics; co-morbid conditions; antimicrobial allergies; site of infection; concurrent anti-staphylococcal antimicrobial use; CPT MIC testing, dose and duration; adverse reactions to CPT, and clinical outcome.
7 cases occurred during the study. Sites of infection included: endocarditis (n=2), bone & joint (n=3), endocarditis plus bone (n=1) and septic thrombophlebitis (n=1). All pts previously received standard anti-MRSA antimicrobials and experienced failure of standard tx (n=6) and/or a serious adverse reaction (n=3). 4 pts (57%) were successfully tx’d with salvage regimens that included CPT; of these pts 1 received CPT in conjunction with other agents and 1 completed tx with standard agents. 3 pts (43%) experienced tx failure; however, one had received only 1 dose of CPT before death and another died after electing to pursue palliative care. 4 pts (57%) required procedures for source control in conjunction with antimicrobial tx.
CPT-containing MRSA salvage therapy was used successfully either alone or in conjunction with other antimicrobials at our institution. Our cases represent realistic scenarios requiring MRSA salvage therapy. The high proportion of pts who received concurrent antimicrobial agents, warranted procedures for source control, and completed tx with standard agents limits the ability to assess the direct impact of CPT salvage therapy on the clinical outcomes.
Our findings as well as the literature suggest that CPT should be considered in instances where MRSA salvage therapy is required. Further studies are needed to determine the specific role of CPT in MRSA salvage therapy.
J. Esterly, None
S. Sutton, None
T. Zembower, None
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