Outcomes of Daptomycin Plus Ceftaroline Versus Alternative Therapy for Persistent Methicillin-resistant Staphylococcus aureus (MRSA) Bacteraemia

Objectives: This study aimed to evaluate both efficacy and safety of combination therapy with daptomycin plus ceftaroline (DAP/CPT) versus alternative therapy in the treatment of persistent methicillin-resistant Staphylococcus aureus bacteraemia (MRSAB).Methods: This retrospective, single-centre study investigated adult patients who underwent a change in antibiotic therapy for persistent MRSAB. Daptomycin plus ceftaroline was compared with alternative therapy after initial treatment with vancomycin or DAP monotherapy was modified. The primary outcome was in-hospital mortality, and several secondary efficacy and safety outcomes were evaluated. Results: A total of 68 patients with persistent MRSAB had initial therapy switched to DAP/CPT ( n = 43) or alternative therapy ( n = 25). In-hospital mortality was similar with DAP/CPT versus alternative ther-apy (16.3% vs. 16%; P = 1.0). On average, the total duration of bacteraemia was numerically 1 day less in patients switched to DAP/CPT (11.4 days vs. 12.5 days; P = 0.5). Daptomycin plus ceftaroline was de-escalated in 81% of patients after receiving combination therapy for an average of 12.5 days. Secondary outcomes, including rates of adverse events and emergence of antimicrobial resistance, were similar be-tween the two groups. Conclusions: Switching to DAP/CPT after approximately 1 week of persistent MRSA bacteraemia may re-sult in similar clinical outcomes when compared with alternative therapy. Rates of adverse events and emergence of antimicrobial resistance were low without a statistically significant difference observed be-tween DAP/CPT and alternative therapy. These findings, as well as the impact of earlier switch or pro-longed treatment with the combination, require further investigation.(c) 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.