Implementation of an Antimicrobial Stewardship Pathway with Daptomycin for Optimal Treatment of Methicillin-Resistant Staphylococcus aureus
 Bacteremia

Background: Methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) may fail to improve with standard monotherapy, particularly in patients with multifocal infection, incomplete source control, or persistent bacteremia. Synergy observed in vitro between ceftaroline (CPT) and daptomycin (DAP) or vancomycin (VAN) may translate into clinical benefit. Here, we describe our experience with DAP/CPT and VAN/CPT for complicated MRSA-B after monotherapy failure. Methods: Single-center, retrospective review of consecutive patients treated with DAP/CPT or VAN/CPT for MRSA-B after monotherapy failure from 1 January 2016 to 30 November 2018. Results: We identified 11 instances of combination therapy in 10 patients (DAP/CPT = 6, VAN/CPT = 5) with 1 patient receiving VAN/CPT followed by DAP/CPT. Rates of multifocal infection, incomplete source control, persistent bacteremia, and infective endocarditis were high (100%, 80%, 60%, and 60%, respectively). Combination therapy was initiated most commonly for persistent bacteremia (60%). When patients were persistently bacteremic, median preceding duration was 13 days and median time to clearance was 3 days. Total microbiologic cure rate was 100%. There were zero instances of bacteremia relapse at 30 days (30D) or 60 days (60D). All-cause 30D and 60D mortality rates were 11.1% and 33.3%, respectively. Conclusions: Combination therapy demonstrated success in diverse cases of refractory MRSA-B, including instances of persistent bacteremia paired with incomplete source control. Optimal timing and therapeutic cadence for combination therapy remain unclear. Our findings suggest that DAP/CPT and VAN/CPT can be considered for complicated MRSA bacteremia when other treatment options fail or are unavailable. We propose persistent bacteremia with incomplete source control to be a clinical niche particularly worthy of further investigation.

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A new simplified predictive model for mortality in methicillin-resistant Staphylococcus aureus bacteremia

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-018-03464-0 ◽

2019 ◽

Vol 38 (5) ◽

pp. 843-850 ◽

Cited By ~ 1

Author(s):

Sarah C. J. Jorgensen ◽

Abdalhamid M. Lagnf ◽

Sahil Bhatia ◽

Michael J. Rybak

Keyword(s):

Staphylococcus Aureus ◽

Predictive Model ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bacteremia

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Case report: Infected foot ulcer and methicillin-resistant staphylococcus aureus bacteremia in a diabetic patient

Case Reports in Internal Medicine ◽

10.5430/crim.v6n2p20 ◽

2019 ◽

Vol 6 (2) ◽

pp. 20

Author(s):

Margarita Goula ◽

Patricia Felix ◽

Meta-Celestine Mbuyamba ◽

Benoit Pirotte

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Patient ◽

Methicillin Resistant Staphylococcus Aureus ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Diagnostic Tools ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bacteremia ◽

Peripheral Arterial ◽

The Right

Diabetic foot ulcer is one of the most frequent complications affecting the diabetic patient. While there has been considerable progress regarding the diagnostic tools and the range of antibiotic choices, the outcome is often unsatisfactory, the presence of peripheral arterial occlusive disease being among the main factors influencing the evolution. This paper describes the management of a patient presenting with an infected foot ulcer and persistent methicillin-resistant Staphylococcus aureus bacteremia, furthercomplicated by spondylodiskitis and infectious endocarditis: the case gives an opportunity to review the literature in search of theoptimal care and the right treatment choices.

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