A comparison of daptomycin alone and in combination with ceftaroline fosamil for methicillin-resistant Staphylococcus au
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BRIEF REPORT
A comparison of daptomycin alone and in combination with ceftaroline fosamil for methicillin-resistant Staphylococcus aureus bacteremia complicated by septic pulmonary emboli Taylor Morrisette 1
&
Abdalhamid M. Lagnf 1 & Sara Alosaimy 1 & Michael J. Rybak 1,2,3
Received: 18 February 2020 / Accepted: 2 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The use of daptomycin (DAP) in septic pulmonary emboli (SPE) remains controversial. We analyzed 29 cases of MRSA bacteremia complicated by SPE treated with DAP (n = 14) or DAP-ceftaroline fosamil (CPT; n = 15). Initial treatment with DAP monotherapy was found to have a success rate comparable with DAP-CPT (71% vs. 80%; p = 0.68). Keywords Daptomycin . Methicillin-resistant Staphylococcus aureus . Septic pulmonary emboli
Introduction The CDC currently recognizes MRSA as a serious public health threat [1]. Vancomycin (VAN) is the gold standard for invasive infections caused by MRSA; however, the literature is robust with evidence of VAN failures which may be due to a lack of attaining VAN pharmacodynamic targets due to varying levels of VAN resistance/concentrations and differences in site(s) of infection [2]. Despite the negative impact on patient outcomes, there are few alternative antibiotics to treat MRSA bacteremia. Additionally, cases complicated by septic pulmonary emboli (SPE) (embolization of microorganism-containing thrombi from a primary infectious site traveling from extrapulmonary circulation into the pulmonary vasculature) have been associated with further complications [3]. Daptomycin (DAP) is a lipopeptide antibiotic with rapid bactericidal activity but, similar to VAN, also has its limitations. A key disadvantage of DAP is that its utilization in pneumonia is not recommended * Michael J. Rybak [email protected] 1
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI 48201, USA
2
Division of Infectious Diseases, Department of Medicine, Wayne State University, Detroit, MI, USA
3
Department of Pharmacy, Detroit Medical Center, Detroit, MI, USA
due to sequestration by pulmonary surfactant [4]. Due to the lack of clinical utility DAP displays in treating pneumonia, questions have been raised regarding its use in SPE [5]. Ceftaroline (CPT) fosamil, the only commercially available beta-lactam with MRSA activity, is commonly used in tandem with DAP in cases of SPE. Theoretically, the lack of pulmonary surfactant within a hematogenous pulmonary infection should not lead to sequestration of DAP, in contrast to the bronchoalveoli [4]. Despite this pathophysiologic rationale, many clinicians will not use DAP for SPE due to lack of real-world evidence. Our primary objective was to evaluate the outcomes of patients with MRSA bacteremia complicated with SPE treated initially with DAP monotherapy versus DAP-CPT combination therapy.
Materials and methods Retrospective cohort of adult patients
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