Journal article
Combination of Vancomycin and β-Lactam Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Pilot Multicenter Randomized Controlled Trial
Clinical Infectious Diseases, Vol.62(2), pp.173-180
2015
Abstract
Background. In vitro laboratory and animal studies demonstrate a synergistic role for the combination of vancomycin and antistaphylococcal β-lactams for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Prospective clinical data are lacking.
Methods. In this open-label, multicenter, clinical trial, adults with MRSA bacteremia received vancomycin 1.5 g intravenously twice daily and were randomly assigned (1:1) to receive intravenous flucloxacillin 2 g every 6 hours for 7 days (combination group) or no additional therapy (standard therapy group). Participants were stratified by hospital and randomized in permuted blocks of variable size. Randomization codes were kept in sealed, sequentially numbered, opaque envelopes. The primary outcome was the duration of MRSA bacteremia in days.
Results. We randomly assigned 60 patients to receive vancomycin (n = 29), or vancomycin plus flucloxacillin (n = 31). The mean duration of bacteremia was 3.00 days in the standard therapy group and 1.94 days in the combination group. According to a negative binomial model, the mean time to resolution of bacteremia in the combination group was 65% (95% confidence interval, 41%–102%; P = .06) that in the standard therapy group. There was no difference in the secondary end points of 28- and 90-day mortality, metastatic infection, nephrotoxicity, or hepatotoxicity.
Conclusions. Combining an antistaphylococcal β-lactam with vancomycin may shorten the duration of MRSA bacteremia. Further trials with a larger sample size and objective clinically relevant end points are warranted.
Details
- Title
- Combination of Vancomycin and β-Lactam Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Pilot Multicenter Randomized Controlled Trial
- Authors/Creators
- J.S. Davis (Author/Creator) - John Hunter HospitalA. Sud (Author/Creator) - The University of SydneyM.V.N. O'Sullivan (Author/Creator) - Westmead HospitalJ.O. Robinson (Author/Creator) - Fiona Stanley HospitalP.E. Ferguson (Author/Creator) - The University of SydneyH. Foo (Author/Creator) - Liverpool HospitalS.J. van Hal (Author/Creator) - Royal Prince Alfred HospitalA.P. Ralph (Author/Creator) - Menzies School of Health ResearchB.P. Howden (Author/Creator) - Peter Doherty InstituteP.M. Binks (Author/Creator) - Menzies School of Health ResearchA. Kirby (Author/Creator) - National Health and Medical Research CouncilS.Y.C. Tong (Author/Creator) - Menzies School of Health Research
- Publication Details
- Clinical Infectious Diseases, Vol.62(2), pp.173-180
- Publisher
- Oxford University Press
- Identifiers
- 991005541623807891
- Murdoch Affiliation
- School of Veterinary and Life Sciences
- Language
- English
- Resource Type
- Journal article
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Source: InCites
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- Collaboration types
- Domestic collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.23 Antibiotics & Antimicrobials
- 1.23.173 MRSA and VRE
- Web Of Science research areas
- Immunology
- Infectious Diseases
- Microbiology
- ESI research areas
- Immunology