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Early Administration of Adjuvant β‐Lactam Therapy in Combination with Vancomycin among Patients with Methicillin‐Resistant Staphylococcus aureus Bloodstream Infection: A Retrospective, Multicenter Analysis
Author(s) -
Casapao Anthony M.,
Jacobs David M.,
Bowers Dana R.,
Beyda Nicholas D.,
Dilworth Thomas J.
Publication year - 2017
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2034
Subject(s) - medicine , vancomycin , staphylococcus aureus , methicillin resistant staphylococcus aureus , staphylococcal infections , microbiology and biotechnology , adjuvant , bloodstream infection , intensive care medicine , bacteria , biology , genetics
Study Objective To determine whether early administration of adjuvant β‐lactam in combination with vancomycin ( COMBO ) affects clinical outcomes compared to standard vancomycin therapy alone ( STAN ) among patients with methicillin‐resistant Staphylococcus aureus ( MRSA ) bloodstream infection. Design Retrospective, multicenter cohort study. Setting Five academic or community hospitals throughout the United States. Patients Adults with MRSA bloodstream infections treated with vancomycin (≥ 72 hrs) with or without an intravenous β‐lactam (≥ 48 hrs) initiated within 24 hours of initiating vancomycin. Measurements and Main Results The primary outcome was clinical failure, a composite endpoint including 30‐day mortality, persistent bacteremia (≥ 7 days), bacteremia relapse, or change in antibiotic therapy during treatment due to clinical worsening. A multivariable logistic regression examined the impact of patient‐, treatment‐, and pathogen‐level characteristics on clinical failure. A total of 201 patients were evaluated of whom 97 (48.3%) met the criteria for study inclusion; 40 (41.2%) in STAN and 57 (58.8%) in COMBO groups. Among patients in the STAN and COMBO groups, 30% and 24.6% experienced clinical failure, respectively (p=0.552). The median (interquartile range) duration of bacteremia in the STAN and COMBO groups was 4 days (2.5–6.5) and 3 days (2–5), respectively (p=0.048). In a multivariable analysis, receipt of COMBO therapy was inversely associated with clinical failure (adjusted odds ratio [ aOR ] 0.237, 95% confidence interval [ CI ] [0.057–0.982]; p=0.047). Other independent predictors of clinical failure included complicated bacteremia ( aOR 6.856, 95% CI [1.641–28.649]; p=0.008) and antibiotic therapy not continued at discharge ( aOR 45.404, 95% CI [9.383–219.714]; p<0.001). Conclusions Receipt of COMBO therapy did not decrease the rate of clinical failure but was associated with expedited bacteremia clearance. Early adjuvant β‐lactam therapy deserves continued evaluation and clinical consideration.