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Pharmacotherapy. 2017 Nov;37(11):1347-1356. doi: 10.1002/phar.2034. Epub 2017 Nov 2.

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 information

1
Husson University School of Pharmacy, Bangor, Maine.
2
University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York.
3
Kingman Regional Medical Center, Kingman, Arizona.
4
University of Houston College of Pharmacy, Houston, Texas.
5
Department of Pharmacy, Wheaton Franciscan Healthcare - St. Francis Hospital, Milwaukee, Wisconsin.

Abstract

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.

KEYWORDS:

bacteremia; combination therapy; methicillin-resistant Staphylococcus aureus; vancomycin; β-lactam

PMID:
28949410
DOI:
10.1002/phar.2034
[Indexed for MEDLINE]

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