title: Ceftaroline fosamil monotherapy for methicillin-resistant Staphylococcus aureus bacteremia: a comparative clinical outcomes study.
abstract: OBJECTIVE
  Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia; however, its use has been subject to scrutiny due to failure in severe infections. Ceftaroline fosamil (CPT-F) is approved for MRSA acute bacterial skin and skin structure infections, but not for bloodstream infections. The clinical outcomes of treatment with CPT-F in patients with MRSA bacteremia were evaluated.
  
  
  METHODS
  Patients diagnosed with MRSA bacteremia at Henry Ford Hospital in Detroit, Michigan, USA, involving isolates with a vancomycin minimum inhibitory concentration ≥1.0mg/l and susceptible in vitro to CPT-F, were systematically reviewed retrospectively. Ceftaroline fosamil-treated patients were matched with at least two vancomycin- and/or one daptomycin-treated control patient based on age-patients age 65 years or greater or less than 65 years of age. Outcomes evaluated included the duration of hospitalization, duration of therapy, adverse events, relapse, hospital readmission, and death.
  
  
  RESULTS
  Thirty consecutive cases of MRSA bacteremia treated with CPT-F during the period May 2011 to June 2013 were identified; these patients were matched to 56 MRSA bacteremia patients treated with vancomycin and 46 MRSA bacteremia patients treated with daptomycin. The primary source of MRSA bacteremia in the cohort treated with CPT-F was endocarditis (n=7, 23%), skin/wound (n=9, 30%), and bone/joint (n=8, 27%). The MRSA bacteremia in those treated with CPT-F was community-acquired in 43% of cases, healthcare-associated in 43%, and hospital-acquired in 13%. The mean length of hospital stay for these patients was 22 days. The overall 30-day mortality rate was 13% (n=4) in CPT-F patients versus 24% (n=11) in daptomycin patients and 11% (n=6) in vancomycin patients (p=0.188).
  
  
  CONCLUSIONS
  CPT-F demonstrated comparable clinical outcomes in MRSA bacteremia patients compared with the other agents, especially as salvage therapy.
authors.affiliation: Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, CFP 314, Detroit, MI 48202, USA. Electronic address: sarshad1@hfhs.org.
authors.forename: Samia
authors.initials: S
authors.lastname: Arshad
authors.affiliation: Midwestern University College of Pharmacy-Glendale, Glendale, Arizona, USA.
authors.forename: Vanthida
authors.initials: V
authors.lastname: Huang
authors.affiliation: Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, CFP 314, Detroit, MI 48202, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Hartman
authors.affiliation: Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, CFP 314, Detroit, MI 48202, USA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Perri
authors.affiliation: Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, CFP 314, Detroit, MI 48202, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Moreno
authors.affiliation: Division of Infectious Diseases, Henry Ford Hospital, 2799 West Grand Blvd, CFP 314, Detroit, MI 48202, USA; Wayne State University, School of Medicine, Detroit, Michigan, USA.
authors.forename: Marcus J
authors.initials: MJ
authors.lastname: Zervos
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use*; D017576:Daptomycin / Q000494:pharmacology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008824:Michigan; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use; D000097583:Ceftaroline
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017576:Daptomycin; D014640:Vancomycin; D000097583:Ceftaroline
keywords: Bacteremia; Bloodstream infection; Ceftaroline fosamil; Methicillin-resistant Staphylococcus aureus