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Int J Antimicrob Agents. 2014 Dec;44(6):557-63. doi: 10.1016/j.ijantimicag.2014.07.024. Epub 2014 Sep 16.

Use of ceftaroline after glycopeptide failure to eradicate meticillin-resistant Staphylococcus aureus bacteraemia with elevated vancomycin minimum inhibitory concentrations.

Author information

1
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 213 Kapoor Hall, Buffalo, NY 14214, USA; CPL Associates, LLC, 73 High St., Buffalo, NY 14203, USA; Erie County Medical Center, 462 Grider St., Buffalo, NY 14215, USA. Electronic address: paladino@buffalo.edu.
2
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 213 Kapoor Hall, Buffalo, NY 14214, USA; CPL Associates, LLC, 73 High St., Buffalo, NY 14203, USA.
3
University of Pittsburgh, Department of Medicine, 3601 Fifth Ave., Falk Medical Building, Suite 3A, Pittsburgh, PA 15213, USA.
4
Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239, USA.
5
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, 213 Kapoor Hall, Buffalo, NY 14214, USA.
6
CPL Associates, LLC, 73 High St., Buffalo, NY 14203, USA.
7
Erie County Medical Center, 462 Grider St., Buffalo, NY 14215, USA; University at Buffalo School of Medicine, 326 Biomedical Research Building, 3435 Main St., Buffalo, NY 14214, USA.

Abstract

Elevated minimum inhibitory concentrations (MICs) of vancomycin against meticillin-resistant Staphylococcus aureus (MRSA) and the emergence of heteroresistant S. aureus strains have led to increased use of anti-MRSA antibiotics other than vancomycin. Ceftaroline fosamil is a novel cephalosporin with activity against MRSA, but there are limited clinical data on its use for MRSA bacteraemia (MRSAB) and against strains exhibiting high vancomycin MICs (2-4 μg/mL). This multicentre, retrospective, case-control study compared the microbiological and clinical effectiveness of ceftaroline used after vancomycin failure with that of vancomycin-treated controls for the treatment of MRSA with vancomycin MICs ≥ 2 μg/mL. In total, 32 patients were matched 1:1 with respect to vancomycin MIC, age and origin of bacteraemia. In the ceftaroline group, patients received prior MRSA therapy for a median of 5 days [interquartile range (IQR), 3-15.8 days] prior to switching to ceftaroline. Median time to eradication of MRSA was significantly less after treatment with ceftaroline compared with vancomycin [4 days (IQR, 3-7.5 days) vs. 8 days (IQR, 5.8-19.5 days); P=0.02]. Both clinical success at the end of treatment and recurrence of MRSA at Day 7 were trending towards being inferior in the vancomycin group, although the results did not attain statistical significance [81% vs. 44% (P=0.06) and 6% vs. 38% (P=0.08), respectively]. Ceftaroline added at the point of vancomycin failure resolves MRSAB more rapidly and with a higher rate of clinical success, therefore ceftaroline should be considered as an alternative for these difficult-to-treat infections.

KEYWORDS:

Ceftaroline fosamil; MRSA bacteraemia; Vancomycin

[Indexed for MEDLINE]

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