Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis

Amy Legg; Matthew A Roberts; Jane Davies; Alan Cass; Niamh Meagher; Archana Sud; Vered Daitch; Yael Dishon Benattar; Dafna Yahav; Mical Paul; Chen Xinxin; Yeo He Ping; David Lye; Russel Lee; J Owen Robinson; Hong Foo; Adrian R Tramontana; Narin Bak; Adelaide Grenfell; Benjamin Rogers; Ying Li; Neela Joshi; Matthew O’Sullivan; Genevieve McKew; Niladri Ghosh; Kellie Schneider; Natasha E Holmes; Ravindra Dotel; Timothy Chia; Sophia Archuleta; Simon Smith; Morgyn S Warner; Christina Titin; Shirin Kalimuddin; Jason A Roberts; Steven Y C Tong; Joshua S Davis; the CAMERA2 study group

doi:10.1093/ofid/ofad337

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Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis

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Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis

Amy Legg, Matthew A Roberts, Jane Davies, Alan Cass, Niamh Meagher, Archana Sud, Vered Daitch, Yael Dishon Benattar, Dafna Yahav, Mical Paul, …

Open forum infectious diseases, Vol.10(7), ofad337

2023

DOI: https://doi.org/10.1093/ofid/ofad337

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Abstract

AcademicSubjects

acute kidney injury

Major

MED00290

nephrotoxicity

Staphylococcus aureus bacteremia

Background The Combination Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus (CAMERA2) trial ceased recruitment in July 2018, noting that a higher proportion of patients in the intervention arm (combination therapy) developed acute kidney injury (AKI) compared to the standard therapy (monotherapy) arm. We analyzed the long-term outcomes of participants in CAMERA2 to understand the impact of combination antibiotic therapy and AKI. Methods Trial sites obtained additional follow-up data. The primary outcome was all-cause mortality, censored at death or the date of last known follow-up. Secondary outcomes included kidney failure or a reduction in kidney function (a 40% reduction in estimated glomerular filtration rate to <60 mL/minute/1.73 m2). To determine independent predictors of mortality in this cohort, adjusted hazard ratios were calculated using a Cox proportional hazards regression model. Results This post hoc analysis included extended follow-up data for 260 patients. Overall, 123 of 260 (47%) of participants died, with a median population survival estimate of 3.4 years (235 deaths per 1000 person-years). Fifty-five patients died within 90 days after CAMERA2 trial randomization; another 68 deaths occurred after day 90. Using univariable Cox proportional hazards regression, mortality was not associated with either the assigned treatment arm in CAMERA2 (hazard ratio [HR], 0.84 [95% confidence interval [CI], .59–1.19]; P = .33) or experiencing an AKI (HR at 1 year, 1.04 [95% CI, .64–1.68]; P = .88). Conclusions In this cohort of patients hospitalized with methicillin-resistant S aureus bacteremia, we found no association between either treatment arm of the CAMERA2 trial or AKI (using CAMERA2 trial definition) and longer-term mortality.

Details

Title: Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Trial: A Post Hoc Analysis
Authors/Creators: Amy Legg - Menzies School of Health Research
Matthew A Roberts - Eastern Health
Jane Davies - Royal Darwin Hospital
Alan Cass - Charles Darwin University
Niamh Meagher - Peter Doherty Institute
Archana Sud - Nepean Hospital
Vered Daitch - Rabin Medical Center
Yael Dishon Benattar - , ,
Dafna Yahav - Sheba Medical Center
Mical Paul - Technion – Israel Institute of Technology
Chen Xinxin - ,
Yeo He Ping - ,
David Lye - National University of Singapore
Russel Lee - National Centre for Infectious Diseases
J Owen Robinson - , , ,
Hong Foo - New South Wales Department of Health
Adrian R Tramontana - Footscray Hospital
Narin Bak - Royal Adelaide Hospital
Adelaide Grenfell - Monash Health
Benjamin Rogers - Monash Health
Ying Li - , ,
Neela Joshi - Westmead Hospital
Matthew O’Sullivan - , , , , , ,
Genevieve McKew - Concord Repatriation General Hospital
Niladri Ghosh - , ,
Kellie Schneider - John Hunter Hospital
Natasha E Holmes - Austin Health
Ravindra Dotel - Blacktown & Mount Druitt Hospital
Timothy Chia - ,
Sophia Archuleta - National University Health System
Simon Smith - Cairns Hospital
Morgyn S Warner - South Australia Pathology
Christina Titin - Singapore General Hospital
Shirin Kalimuddin - Singapore General Hospital
Jason A Roberts - Royal Brisbane and Women's Hospital
Steven Y C Tong - The Royal Melbourne Hospital
Joshua S Davis - Charles Darwin University
the CAMERA2 study group
Publication Details: Open forum infectious diseases, Vol.10(7), ofad337
Publisher: Oxford University Press on behalf of Infectious Diseases Society of America.
Grant note: 1145033; 1160331
Identifiers: 991005598469807891
Murdoch Affiliation: Murdoch University
Language: English
Resource Type: Journal article

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Collaboration types: Domestic collaboration; International 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