The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

Vancomycin plus ceftaroline (V/C) therapy was found to be a potent salvage regimen against persistent methicillin-resistant Staphylococcus aureus bacteremia (pMRSAB), according to research presented at IDWeek, held virtually from September 29 to October 3, 2021.

Investigators performed a single-center, retrospective cohort study that included adult patients with MRSAB who received V/C salvage therapy between January 2016 and March 2021. Patients were included only if they had blood cultures positive for MRSA for at least 72 hours, and had initiated anti-MRSA monotherapy with subsequent V/C therapy for at least 24 hours. The primary outcome was time to blood culture clearance following V/C initiation; secondary outcomes were microbiologic cure (defined by blood culture clearance), 90-day all-cause mortality, 90-day MRSAB recurrence, and length of hospitalization.


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Although 178 patients with MRSAB were identified, only 20 met the inclusion criteria. The mean patient age was 38.5 (standard deviation [SD], 14.5) years, and the mean Pitt bacteremia score was 4.2 (SD 3.1). The most common cause of MRSA infection was intravenous drug use (55%), and the majority of patients had infective endocarditis (70%). Median time to blood culture clearance was 9.7 (interquartile range [IQR], 8.4-10.2) days from first positive blood culture and 2.4 (IQR, 1.5-3.1) days from V/C initiation. Microbiologic cure was achieved in 95% of patients in the cohort. Within 90 days of V/C initiation, all-cause mortality and MRSAB recurrence was reported in 35% and 5% of patients in the cohort, respectively. The median length of hospitalization was 25 (IQR, 14.5-32.0) days.

The study was limited by its single-center design and small sample size.

As microbiologic cure was achieved in nearly all patients, despite the complexity of patient cases, the investigators concluded that “V/C [therapy] may represent a potential salvage regimen for [patients with] pMRSAB.”

Reference

Kufel, WD, Parsels KA, Steele J, et al. Vancomycin plus ceftaroline salvage therapy for persistent methicillin-resistant Staphylococcus aureus bacteremia. Presented at: IDWeek; September 29 to October 3, 2021. Poster 187.

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