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Abstract：
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is associated with high mortality rates. Despite antibiotic therapy, persistent bacteremia is challenging to treat. Combination therapy with ceftaroline has emerged as a potential treatment option; however, the optimal duration and clinical implications after bacteremia clearance are unknown.
METHODS: This retrospective cohort study examined patients with high-grade or persistent MRSA bacteremia who were treated with ceftaroline combination therapy at the University of New Mexico Hospital between January 2014 and June 2021. Patients were categorized into short- (<7 days) or long-duration (≥7 days) groups based on the duration of combination therapy after bacteremia clearance. Outcomes included 30-day all-cause mortality, bacteremia recurrence, post-bacteremia clearance length of stay, and adverse events.
RESULTS: A total of 32 patients were included in this study. The most common sources of bacteremia were bone/joint and endovascular (28.1%, 9/32 each). The median duration of combination therapy after clearance was seven days (IQR 2.8, 11). Patients in the long-duration group had a lower Charlson comorbidity index (1.0 vs 5.5, p = 0.017) than those in the short-duration group. After adjusting for confounders, there was no significant difference in the 30-day all-cause mortality between the groups (AOR 0.17, 95% CI 0.007-1.85, p = 0.18). No association was found between combination therapy duration and recurrence (OR 2.53, 95% CI 0.19-inf, p = 0.24) or adverse drug events (OR 3.46, 95% CI 0.39-74.86, p = 0.31). After controlling for total hospital length of stay, there was no significant difference in the post-bacteremia clearance length of stay between the two groups (p = 0.37).
CONCLUSIONS: Prolonging ceftaroline combination therapy after bacteremia clearance did not significantly improve outcomes in patients with persistent or high-grade MRSA bacteremia. The limitations of this study warrant cautious interpretation of its results. Larger studies are needed to determine the optimal duration and role of combination therapy for this difficult-to-treat infection.
METHODS: This retrospective cohort study examined patients with high-grade or persistent MRSA bacteremia who were treated with ceftaroline combination therapy at the University of New Mexico Hospital between January 2014 and June 2021. Patients were categorized into short- (<7 days) or long-duration (≥7 days) groups based on the duration of combination therapy after bacteremia clearance. Outcomes included 30-day all-cause mortality, bacteremia recurrence, post-bacteremia clearance length of stay, and adverse events.
RESULTS: A total of 32 patients were included in this study. The most common sources of bacteremia were bone/joint and endovascular (28.1%, 9/32 each). The median duration of combination therapy after clearance was seven days (IQR 2.8, 11). Patients in the long-duration group had a lower Charlson comorbidity index (1.0 vs 5.5, p = 0.017) than those in the short-duration group. After adjusting for confounders, there was no significant difference in the 30-day all-cause mortality between the groups (AOR 0.17, 95% CI 0.007-1.85, p = 0.18). No association was found between combination therapy duration and recurrence (OR 2.53, 95% CI 0.19-inf, p = 0.24) or adverse drug events (OR 3.46, 95% CI 0.39-74.86, p = 0.31). After controlling for total hospital length of stay, there was no significant difference in the post-bacteremia clearance length of stay between the two groups (p = 0.37).
CONCLUSIONS: Prolonging ceftaroline combination therapy after bacteremia clearance did not significantly improve outcomes in patients with persistent or high-grade MRSA bacteremia. The limitations of this study warrant cautious interpretation of its results. Larger studies are needed to determine the optimal duration and role of combination therapy for this difficult-to-treat infection.
摘要：
背景：耐甲氧西林金黄色葡萄球菌（MRSA）与高死亡率相关。尽管有抗生素治疗,持续性菌血症治疗具有挑战性.与头孢洛林联合治疗已成为一种潜在的治疗选择;然而，菌血症清除后的最佳持续时间和临床意义尚不清楚.
方法：这项回顾性队列研究检查了2014年1月至2021年6月在新墨西哥大学医院接受头孢洛林联合治疗的高级别或持续性MRSA菌血症患者。根据菌血症清除后联合治疗的持续时间，将患者分为短期（<7天）或长期（≥7天）组。结果包括30天全因死亡率，菌血症复发，菌血症清除后住院时间，和不良事件。
结果：本研究共纳入32例患者。最常见的菌血症来源是骨/关节和血管内（28.1%，每个9/32）。清除后联合治疗的中位持续时间为7天（IQR2.8，11）。长期组患者的Charlson合并症指数（1.0vs5.5，p=0.017）低于短期组。在调整了混杂因素后，两组间30天全因死亡率无显著差异(AOR0.17,95%CI0.007-1.85,p=0.18).在联合治疗持续时间和复发之间没有发现关联(OR2.53，95%CI0.19-inf，p=0.24）或药物不良事件（OR3.46，95％CI0.39-74.86，p=0.31）。控制住院总时间后，两组间菌血症清除后住院时间无显著差异(p=0.37).
结论：菌血症清除后延长头孢洛林联合治疗并不能显著改善持续性或高级别MRSA菌血症患者的预后。这项研究的局限性值得谨慎解释其结果。需要更大规模的研究来确定联合治疗这种难以治疗的感染的最佳持续时间和作用。
方法：这项回顾性队列研究检查了2014年1月至2021年6月在新墨西哥大学医院接受头孢洛林联合治疗的高级别或持续性MRSA菌血症患者。根据菌血症清除后联合治疗的持续时间，将患者分为短期（<7天）或长期（≥7天）组。结果包括30天全因死亡率，菌血症复发，菌血症清除后住院时间，和不良事件。
结果：本研究共纳入32例患者。最常见的菌血症来源是骨/关节和血管内（28.1%，每个9/32）。清除后联合治疗的中位持续时间为7天（IQR2.8，11）。长期组患者的Charlson合并症指数（1.0vs5.5，p=0.017）低于短期组。在调整了混杂因素后，两组间30天全因死亡率无显著差异(AOR0.17,95%CI0.007-1.85,p=0.18).在联合治疗持续时间和复发之间没有发现关联(OR2.53，95%CI0.19-inf，p=0.24）或药物不良事件（OR3.46，95％CI0.39-74.86，p=0.31）。控制住院总时间后，两组间菌血症清除后住院时间无显著差异(p=0.37).
结论：菌血症清除后延长头孢洛林联合治疗并不能显著改善持续性或高级别MRSA菌血症患者的预后。这项研究的局限性值得谨慎解释其结果。需要更大规模的研究来确定联合治疗这种难以治疗的感染的最佳持续时间和作用。
