Daptomycin plus fosfomycin versus daptomycin alone for methicillin-resistant staphylococcus aureus bacteremia and endocarditis: a randomized clinical trial
Autor/a
Pujol, Miquel
Miró, José-María
Shaw, Evelyn
Aguado, Jose-María
San-Juan, Rafael
Puig-Asensio, Mireia
Pigrau, Carles
Calbo Sebastián, Esther
Montejo, Miguel
Rodriguez-Álvarez, Regino
Garcia-Pais, María-Jose
Pintado, Vicente
Escudero-Sánchez, Rosa
Lopez-Contreras, Joaquín
Fecha de publicación
2021ISSN
1058-4838
Resumen
Background: We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. Methods: A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. Results: Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93–1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018). Conclusions: Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events.
Tipo de documento
Artículo
Versión del documento
Versión publicada
Lengua
Inglés
Materias (CDU)
61 - Medicina
Palabras clave
Endocarditis
Bacterèmia
Daptomicina
Fosfomicina
Estafilococ aureus resistent a la meticil·lina
Endocarditis
Bacteremia
Daptomicina
Fosfomicina
Estafilococo aureus resistente a la meticilina
Endocarditis
Bacteremia
Daptomycin
Fosfomycin
Methicillin-resistant staphylococcus aureus
Páginas
9
Publicado por
Oxford University Press
Colección
72;9
Publicado en
Clinical Infectious Diseases
Citación
Pujol, Miquel; Miró, José-María; Shaw, Evelyn [et al.]. Daptomycin plus fosfomycin versus daptomycin alone for methicillin-resistant staphylococcus aureus bacteremia and endocarditis: a randomized clinical trial. Clinical Infectious Diseases, 2021, 72(9), p. 1517-1525. Disponible en: <https://academic.oup.com/cid/article/72/9/1517/5877897>. Fecha de acceso: 6 sep. 2021. DOI: 10.1093/cid/ciaa1081
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