Updates on Combination Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia
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Updates on Combination Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia Alison L. Blackman 1 & Ellen C. Rubin 1 & Eleanor K. Broadbent 1 & Karrine D. Brade 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with a large clinical burden and high rates of treatment failure with first-line treatment options. Literature for combination antimicrobial therapies for initial treatment or salvage therapy in the setting of persistent bacteremia is developing. Recent Findings Various combination strategies have emerged for the treatment of MRSA bacteremia, including vancomycin or daptomycin in combination with either anti-staphylococcal penicillins, early- and late-generation cephalosporins, ceftaroline, trimethoprim-sulfamethoxazole, or fosfomycin. When used as second-line or salvage therapy, evidence suggests use of these combinations shorten the duration of bacteremia. More recently, data have emerged evaluating this strategy for initial therapy, although results are conflicting. Summary Use of combination therapy for MRSA bacteremia may shorten bacteremia duration, but the optimal combination, doses, timing of use, and exact impact on clinical outcomes are still evolving. Keywords Methicillin-resistant Staphylococcus aureus . Daptomycin . Vancomycin . Combination antibiotic therapy . Ceftaroline . Bacteremia
Introduction Staphylococcus aureus is a leading cause of bacteremia in the USA and is associated with mortality rates of approximately 20% [1, 2]. Compared with methicillin-susceptible S. aureus, methicillin-resistant S. aureus (MRSA) is associated with worse outcomes and can be more challenging to treat, often This article is part of the Topical Collection on Antimicrobial Development and Drug Resistance * Karrine D. Brade [email protected] Alison L. Blackman [email protected] Ellen C. Rubin [email protected] Eleanor K. Broadbent [email protected] 1
Boston Medical Center, 850 Harrison Avenue, Boston, MA 02118, USA
with a slower response to first- and second-line therapies [1–3]. In 2017, MRSA was associated with an estimated 323,700 hospitalizations and 10,600 deaths, which led to its inclusion in the Center for Disease Control and Prevention’s (CDC) 2019 US antibiotic resistance report as a serious resistance threat [4]. The Infectious Diseases Society of America (IDSA) guidelines for MRSA infections in Adults and Children recommend either vancomycin or daptomycin as first-line therapy for MRSA bacteremia [5]. Even when these recommendations are followed, treatment failure occurs in up to 50% of cases, leaving clinicians seeking salvage treatment options [6, 7]. Additionally, although rare, development of vancomycin and daptomycin resistance during therapy, including vancomycin-intermediate S. aureus (VISA), heterogenous vancomycin-intermediate S. aureus (hVISA), vancomycinresistant S. aureus (VRSA), and daptomycin non-susceptible (DNS) S. aureus, makes
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