Ceftaroline as good as daptomycin for primary treatment for MRSA bloodstream infection

USA: In a new study, it was found that there was no difference in treatment failure or death between methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) treated with ceftaroline versus MRSA BSI treated with daptomycin. This study was conducted by Evan J Zasowski and the team, the results of which were published in the journal Open Forum Infectious Diseases. 

Ceftaroline appears to be efficacious for MRSA BSI, although there are few comparable data with a standard of treatment. The results of MRSA BSI treated with ceftaroline versus daptomycin are compared in this study.

From 2010 to 2017, this was a multicenter, retrospective, observational cohort study of adult patients with MRSA BSI. Patients who had been given ceftaroline or daptomycin for less than 72 hours were included in the study. Those who cleared BSI before taking the trial medicine, as well as those who had a pneumonia cause, were excluded. The major outcome was composite treatment failure, which was defined as 30-day death, BSI duration of fewer than seven days on study medication, and MRSA BSI recurrence within 60 days. A 15% non-inferiority margin was applied to the inverse likelihood of treatment weighted risk difference in composite failure between the daptomycin and ceftaroline groups.

The results of this study state as follow:

1. There were 270 patients in all, with 83 receiving ceftaroline and 187 receiving daptomycin.

2. In terms of composite failure, ceftaroline was non-inferior to daptomycin [39% daptomycin, 32.5% ceftaroline].

3. There were no changes in 30-day mortality or any secondary efficacy outcomes between treatment groups.

4. Creatine phosphokinase increase was shown to be more prevalent in daptomycin patients (5.3% vs. 0%).

5. Ceftaroline patients had a considerably higher rate of rash (10.8 vs. 1.1%).

In conclusion, these findings encourage further research into ceftaroline as a main MRSA BSI therapy, as well as its existing use as an alternate to vancomycin and daptomycin.

Reference:

Zasowski EJ, Trinh TD, Claeys KC, Casapao AM, Sabagha N, Lagnf AM, Klinker KP, Davis SL, Rybak MJ. Multicenter Observational Study of Ceftaroline Fosamil for Methicillin-Resistant Staphylococcus aureus Bloodstream Infections. Antimicrob Agents Chemother. 2017 Jan 24;61(2):e02015-16. doi:10.1128/AAC.02015-16.