Cargando…

1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia

BACKGROUND: Vancomycin (VAN) monotherapy is regarded as first-line treatment of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA). However, in vitro and clinical evidence indicate synergy is achieved against MRSA when certain beta-lactam antibiotics are combined...

Descripción completa

Detalles Bibliográficos
Autores principales: Caniff, Kaylee E, Kunz Coyne, Ashlan J, Rybak, Michael J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678159/
http://dx.doi.org/10.1093/ofid/ofad500.064
_version_ 1785150296655134720
author Caniff, Kaylee E
Kunz Coyne, Ashlan J
Rybak, Michael J
author_facet Caniff, Kaylee E
Kunz Coyne, Ashlan J
Rybak, Michael J
author_sort Caniff, Kaylee E
collection PubMed
description BACKGROUND: Vancomycin (VAN) monotherapy is regarded as first-line treatment of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA). However, in vitro and clinical evidence indicate synergy is achieved against MRSA when certain beta-lactam antibiotics are combined with VAN. In 2016, a MRSA BSI treatment pathway was implemented at the Detroit Medical Center (DMC) which incorporates early use of combination therapy with VAN and cefazolin (CFZ). This study assesses clinical outcomes among patients receiving VAN vs. combination therapy with VAN + CFZ in MRSA BSI. METHODS: This is a retrospective, observational cohort study of patients hospitalized with MRSA BSI at the DMC from 2006-2021. Included patients were initiated on VAN within 72 hours of the index culture. Patients were excluded if they received < 5 days of VAN, transferred to an outside hospital, received an alternative anti-MRSA antibiotic, received > 5 days of non-CFZ beta-lactam, or initiated on CFZ > 120 hours after index culture. Patients were compared by VAN therapy (no receipt of CFZ during treatment course) to VAN + CFZ combination therapy (CFZ initiated within 120 hours of index culture). Multivariable logistic regression was performed to identify independent predictors of 30-day mortality. RESULTS: Overall, 359 patients were included; 145 received VAN + CFZ and 214 received VAN. There were no significant differences between groups when comparing baseline demographics, infectious source, comorbid conditions, MRSA risk factors, or illness severity. However, VAN + CFZ patients were more likely to have an infectious diseases consult (98.6% vs. 82.7%, p < 0.001). VAN + CFZ was associated a lower 30-day mortality rate (3.4% vs. 9.8%, p = 0.022) and shorter duration of bacteremia (49.0 [35.0-74.0] hours vs. 62.0 [42.0-95.8] hours, p = 0.005). After adjusting for confounders, VAN + CFZ receipt was independently associated with reduced 30-day mortality (aOR 0.31, 95% CI 0.11-0.93). CONCLUSION: In patients with MRSA BSI, the addition of CFZ to VAN within 120 hours of index culture was associated with improved outcomes. To our knowledge, this is the first study specifically examining VAN + CFZ in this population. Further research is warranted to determine the utility of this therapy combination in MRSA BSI. DISCLOSURES: Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant
format Online
Article
Text
id pubmed-10678159
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-106781592023-11-27 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia Caniff, Kaylee E Kunz Coyne, Ashlan J Rybak, Michael J Open Forum Infect Dis Abstract BACKGROUND: Vancomycin (VAN) monotherapy is regarded as first-line treatment of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA). However, in vitro and clinical evidence indicate synergy is achieved against MRSA when certain beta-lactam antibiotics are combined with VAN. In 2016, a MRSA BSI treatment pathway was implemented at the Detroit Medical Center (DMC) which incorporates early use of combination therapy with VAN and cefazolin (CFZ). This study assesses clinical outcomes among patients receiving VAN vs. combination therapy with VAN + CFZ in MRSA BSI. METHODS: This is a retrospective, observational cohort study of patients hospitalized with MRSA BSI at the DMC from 2006-2021. Included patients were initiated on VAN within 72 hours of the index culture. Patients were excluded if they received < 5 days of VAN, transferred to an outside hospital, received an alternative anti-MRSA antibiotic, received > 5 days of non-CFZ beta-lactam, or initiated on CFZ > 120 hours after index culture. Patients were compared by VAN therapy (no receipt of CFZ during treatment course) to VAN + CFZ combination therapy (CFZ initiated within 120 hours of index culture). Multivariable logistic regression was performed to identify independent predictors of 30-day mortality. RESULTS: Overall, 359 patients were included; 145 received VAN + CFZ and 214 received VAN. There were no significant differences between groups when comparing baseline demographics, infectious source, comorbid conditions, MRSA risk factors, or illness severity. However, VAN + CFZ patients were more likely to have an infectious diseases consult (98.6% vs. 82.7%, p < 0.001). VAN + CFZ was associated a lower 30-day mortality rate (3.4% vs. 9.8%, p = 0.022) and shorter duration of bacteremia (49.0 [35.0-74.0] hours vs. 62.0 [42.0-95.8] hours, p = 0.005). After adjusting for confounders, VAN + CFZ receipt was independently associated with reduced 30-day mortality (aOR 0.31, 95% CI 0.11-0.93). CONCLUSION: In patients with MRSA BSI, the addition of CFZ to VAN within 120 hours of index culture was associated with improved outcomes. To our knowledge, this is the first study specifically examining VAN + CFZ in this population. Further research is warranted to determine the utility of this therapy combination in MRSA BSI. DISCLOSURES: Michael J. Rybak, PharmD, PhD, MPH, Abbvie, Merck, Paratek, Shionogi, Entasis, La Jolla, T2 Biosystems: Advisor/Consultant Oxford University Press 2023-11-27 /pmc/articles/PMC10678159/ http://dx.doi.org/10.1093/ofid/ofad500.064 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstract
Caniff, Kaylee E
Kunz Coyne, Ashlan J
Rybak, Michael J
1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title_full 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title_fullStr 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title_full_unstemmed 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title_short 1033. Unexpected Allies: Vancomycin and Cefazolin Combination Therapy in Methicillin-Resistant Staphylococcus aureus Bacteremia
title_sort 1033. unexpected allies: vancomycin and cefazolin combination therapy in methicillin-resistant staphylococcus aureus bacteremia
topic Abstract
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10678159/
http://dx.doi.org/10.1093/ofid/ofad500.064
work_keys_str_mv AT caniffkayleee 1033unexpectedalliesvancomycinandcefazolincombinationtherapyinmethicillinresistantstaphylococcusaureusbacteremia
AT kunzcoyneashlanj 1033unexpectedalliesvancomycinandcefazolincombinationtherapyinmethicillinresistantstaphylococcusaureusbacteremia
AT rybakmichaelj 1033unexpectedalliesvancomycinandcefazolincombinationtherapyinmethicillinresistantstaphylococcusaureusbacteremia