title: Combination Therapy With Vancomycin and Ceftaroline for Refractory Methicillin-resistant Staphylococcus aureus Bacteremia: A Case Series.
abstract: Although vancomycin has been the mainstay of therapy for methicillin-resistant Staphylococcus aureus (MRSA) infections, its effectiveness has been challenged. Combination therapy may be used for patients with persistent MRSA bacteremia refractory to initial therapy. Studies have reported in vitro synergy between vancomycin and ceftaroline; however, clinical experience with this therapy is limited. Here, we report our experience with 5 cases of vancomycin-refractory MRSA bacteremia treated with the combination of vancomycin and ceftaroline.
  
  
  
  Between January 2014 and August 2016, 5 patients were identified who received vancomycin and ceftaroline combination therapy due to persistent bacteremia or deterioration of their clinical status on vancomycin alone (despite a vancomycin MIC within the susceptible range).
  
  
  
  Five patients presented with MRSA bacteremia secondary to endocarditis (n = 2), epidural abscess (n = 2), or left iliopsoas abscess (n = 1). Four of the 5 patients experienced microbiologic cure, and 1 patient transitioned to palliative care.
  
  
  
  This case series serves to describe additional clinical experience with vancomycin and ceftaroline combination therapy. This combination may be considered when vancomycin monotherapy does not lead to microbiological and/or clinical improvement in patients with metastatic MRSA bacteremia. Additional studies are warranted to further define its role in salvage therapy for persistent MRSA bacteremia.
authors.affiliation: Department of Pharmacy, Mount Sinai Beth Israel, New York, New York; Touro College of Pharmacy, New York, New York. Electronic address: diana.gritsenko@gmail.com.
authors.forename: Diana
authors.initials: D
authors.lastname: Gritsenko
authors.affiliation: Department of Pharmacy, Mount Sinai Beth Israel, New York, New York.
authors.forename: Marianna
authors.initials: M
authors.lastname: Fedorenko
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Mount Sinai Beth Israel, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Jorg J
authors.initials: JJ
authors.lastname: Ruhe
authors.affiliation: Department of Pharmacy, Mount Sinai Beth Israel, New York, New York.
authors.forename: Jerry
authors.initials: J
authors.lastname: Altshuler
mesh_terms: D000038:Abscess / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy*; D002511:Cephalosporins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D016879:Salvage Therapy; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014640:Vancomycin / Q000627:therapeutic use*; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D014640:Vancomycin; D000097583:Ceftaroline
keywords: MRSA; Staphylococcus aureus; bacteremia; ceftaroline; synergy; vancomycin