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Clin Infect Dis. 2019 Jan 7. doi: 10.1093/cid/ciz018. [Epub ahead of print]

Impact of beta-lactam and daptomycin combination therapy on clinical outcomes in methicillin-susceptible Staphylococcus aureus bacteremia: A propensity score-matched analysis.

Grillo S1,2, Cuervo G1,2,3, Carratalà J1,2,3,4, Grau I1,2,5,4, Pallarès N6,7, Tebé C6,8, Guillem Tió L1, Murillo O1,2,3,4, Ardanuy C2,9,5,4, Domínguez MA2,9,3,4, Shaw E1,2,3, Gudiol C1,2,3,4, Pujol M1,2,3.

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Department of Infectious Diseases, H. Bellvitge, Barcelona, Spain.
Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain.
Red Española de Investigación en Patología Infecciosa, Seville, Spain.
University of Barcelona (UB), Barcelona, Spain.
CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain.
Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Spain.
Basic Clinical Practice Department, University of Barcelona, Barcelona, Spain.
Basic Clinical Practice Department, Rovira Virgili University, Reus, Spain.
Department of Microbiology, H. Bellvitge, Barcelona, Spain.



Mortality rates from Staphylococcus aureus bacteremia are high and have only modestly improved in recent decades. We compared the efficacies of beta-lactam in combination with daptomycin (BL/D-C) and beta-lactam monotherapy (BL-M) in improving clinical outcomes in methicillin-susceptible S. aureus (MSSA) bacteremia.


A retrospective cohort study of MSSA bacteremia was performed in a tertiary hospital from January 2011 to December 2017. Patients receiving BL/D-C and BL-M were compared to assess 7-, 30- and 90-day mortality rates. A 1:2 propensity score matching was performed. Differences were assessed using Cox regression models.


Of the 514 patients with MSSA bacteremia, 164 were excluded as they had received combination therapies other than BL/D-C, had pneumonia or had died within 48 h of admission. Of the remaining 350 patients, 136 and 214 received BL/D-C and BL-M, respectively. BL/D-C patients had higher Pitt scores and persistent bacteremia more often than BL-M patients. In the raw analysis, there were no differences in mortality rates between groups. After propensity score matching, there were no significant differences between the BL/D-C (110 patients) and BL-M (168 patients) groups for all-cause mortality rates at 7 (8.18% vs. 7.74%, P = 1.000), 30 (17.3% vs. 16.1%, P = 0.922) and 90 days (22.7% vs. 23.2%, P = 1.000), even in a sub-analysis of patients with high-risk source of infection and in a subgroup excluding catheter-related bacteremia.


BL/D-C failed to reduce mortality rates in patients with MSSA bacteremia. Treatment strategies to improve survival in MSSA bacteremia are urgently needed.


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