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Title: | Daptomycin plus Fosfomycin versus Daptomycin Alone for Methicillin-Resistant Staphylococcus 2 aureus Bacteremia and Endocarditis. A Randomized Clinical Trial |
Author: | Pujol, Miquel Miró Meda, José M. Shaw, Evelyn Aguado, José María San Juan, Rafael Puig Asensio, Mireia Pigrau, Carles Calbo, Esther Montejo, Miguel Rodriguez Álvarez, Regino Garcia Pais, María Jose Pintado, Vicente Escudero Sánchez, Rosa López Contreras, Joaquín Morata, Laura Montero, Milagros Andrés, Marta Pasquau, Juan Arenas, María del Mar Padilla, Belén Murillas, Javier Jover Sáenz, Alfredo López Cortés, Luis Eduardo García Pardo, Graciano Gasch, Oriol Videla, Sebastian Hereu, Pilar Tebé, Cristian Pallarès, Natàlia Sanllorente, Mireia Domínguez Luzón, Ma. Ángeles (María Ángeles) Càmara, Jordi Ferrer, Anna Padullés Zamora, Ariadna Cuervo Requena, Guillermo Carratalà, Jordi MRSA Bacteremia (BACSARM) Trial Investigators |
Keywords: | Assaigs clínics Bacteris Antibiòtics Endocarditis Malalties infeccioses Clinical trials Bacteria Antibiotics Endocarditis Communicable diseases |
Issue Date: | 29-Jul-2020 |
Publisher: | Oxford University Press |
Abstract: | 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. |
Note: | Reproducció del document publicat a: https://doi.org/10.1093/cid/ciaa1081 |
It is part of: | Clinical Infectious Diseases, 2020, vol. 72, num. 9, p. 1517-1525 |
URI: | http://hdl.handle.net/2445/183825 |
Related resource: | https://doi.org/10.1093/cid/ciaa1081 |
ISSN: | 1058-4838 |
Appears in Collections: | Articles publicats en revistes (Patologia i Terapèutica Experimental) Articles publicats en revistes (Ciències Clíniques) Articles publicats en revistes (Medicina) Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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