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Heartfelt Impact: A Descriptive Analysis of Ceftaroline-Containing Regimens in Endocarditis due to
Kaylee E Caniff1, Chloe Judd1, Kristen Lucas1
1Anti-Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Detroit, MI, 48201, USA.
Introduction:
Infective endocarditis (IE) due to methicillin-resistant Staphylococcus aureus (MRSA) is characterized by frequent treatment failure to first-line agents and high mortality, necessitating use of alternative management strategies. Ceftaroline fosamil (CPT) is a cephalosporin antibiotic with activity against MRSA but without regulatory approval for the indication of IE. This study describes clinical experience with CPT-based regimens utilized in MRSA-IE.
Methods:
This is a retrospective, observational, descriptive analysis of patients from two major urban medical centers in Detroit, Michigan from 2011 to 2023. Included adult patients (≥ 18 years) had ≥ 1 positive blood culture for MRSA, met definitive clinical criteria for IE, and received CPT for ≥ 72 h. The primary outcome was treatment failure, defined as a composite of 30-day all-cause mortality from index culture or failure to improve or resolve infectious signs/symptoms after CPT initiation.
Results:
Seventy patients were included. The median (interquartile range [IQR]) age was 51 (34-63) years and 45.7% were male. Persons with injection drug use (PWID) made up 55.7% of the cohort and right-sided IE was the most prevalent subtype (50.0%). CPT was frequently employed second-line or later, often in combination with vancomycin (10.0%) or daptomycin (72.9%). Overall, 31.4% experienced treatment failure and 30-day all-cause mortality occurred in 15.7%.
Conclusions:
These findings illustrate the challenges posed by MRSA-IE, including frequent treatment failures, and highlight the utilization of CPT as salvage therapy. Comparative studies are needed to more clearly define its role in MRSA-IE.
Insights
Ceftaroline fosamil (CPT) shows promise as salvage therapy for methicillin-resistant Staphylococcus aureus infective endocarditis (MRSA-IE), despite high treatment failure rates. Further studies are needed to define its role in managing this challenging infection.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) presents significant treatment challenges, including high mortality and frequent failure of first-line therapies.
- Ceftaroline fosamil (CPT), an antibiotic with demonstrated MRSA activity, is being explored for IE management despite lacking specific regulatory approval for this indication.
Purpose of the Study:
- To describe the clinical experience and outcomes of using ceftaroline fosamil-based regimens in patients with MRSA-IE.
- To evaluate treatment failure rates and mortality associated with CPT utilization in this patient population.
Main Methods:
- A retrospective, observational, descriptive analysis was conducted on adult patients diagnosed with MRSA-IE at two urban medical centers between 2011 and 2023.
- Patients receiving CPT for at least 72 hours were included. Treatment failure was defined as 30-day all-cause mortality or lack of clinical improvement.
Main Results:
- The study included 70 patients, with a median age of 51 years; 55.7% were persons who inject drugs (PWID), and 50.0% had right-sided IE.
- CPT was often used as second-line or later therapy, frequently in combination with daptomycin (72.9%).
- Overall treatment failure occurred in 31.4% of patients, and 30-day all-cause mortality was 15.7%.
Conclusions:
- Ceftaroline fosamil (CPT) is utilized as a salvage therapy for MRSA-IE, reflecting the difficulties in treating this condition.
- The findings underscore the need for comparative studies to better establish the role and efficacy of CPT in MRSA-IE treatment regimens.
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