Comparative Effectiveness of Switching to Daptomycin Versus Remaining on Vancomycin Among Patients With Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infections.
Comparative Effectiveness of Switching to Daptomycin Versus Remaining on Vancomycin Among Patients With Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infections.
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DOI：
10.1093/cid/ciaa1572
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发表时间：
2021-01-29
期刊：
影响因子：
--
通讯作者：
Perencevich EN
中科院分区：
文献类型：
--
作者：
Schweizer ML;Richardson K;Vaughan Sarrazin MS;Goto M;Livorsi DJ;Nair R;Alexander B;Beck BF;Jones MP;Puig-Asensio M;Suh D;Ohl M;Perencevich EN
耐甲氧西林金黄色葡萄球菌血流感染（MRSA BSI）的患者通常接受万古霉素的初始治疗，但可能转为达托霉素进行确定性治疗，特别是如果怀疑治疗失败。我们的目的是评价MRSA BSI患者从万古霉素转换为达托霉素与继续使用万古霉素的有效性。纳入了在2007-2014年期间在124家退伍军人事务医院接受MRSA BSI治疗并接受万古霉素治疗的患者。使用考克斯回归模型评估转换为达托霉素与30天死亡率之间的相关性。建立了单独的模型，用于在首次住院期间的任何时间转换为达托霉素，以及在接受万古霉素后3天内转换。7，411例患者接受万古霉素治疗MRSA BSI。606例（8.2%）患者在首次住院期间从万古霉素转换为达托霉素，108例（1.5%）患者在开始万古霉素治疗后3天内从万古霉素转换为达托霉素。在多变量分析中，3天内转换为达托霉素与30天死亡率降低显著相关（风险比[HR]=0.48; 95%置信区间[CI]：0.25，0.92）。然而，在首次住院期间的任何时间转换为达托霉素与30天死亡率无显著相关性（HR：0.87; 95% CI：0.69，1.09）。在首次接受万古霉素治疗后3天内改用达托霉素与MRSA BSI患者的30天死亡率降低相关。这种好处在后来发生的转换中没有看到。未来的研究应该前瞻性地评估早期从万古霉素转换为其他抗MRSA抗生素的益处。在124家医院收治的MRSA血流感染患者的队列研究中，与继续使用万古霉素相比，在治疗的前三天从万古霉素转换为达托霉素与死亡率降低之间存在相关性。
Patients with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) usually receive initial treatment with vancomycin but may be switched to daptomycin for definitive therapy, especially if treatment failure is suspected. Our objective was to evaluate the effectiveness of switching from vancomycin to daptomycin compared with remaining on vancomycin among patients with MRSA BSI. Patients admitted to 124 Veterans Affairs Hospitals who experienced MRSA BSI and were treated with vancomycin during 2007–2014 were included. The association between switching to daptomycin and 30-day mortality was assessed using Cox regression models. Separate models were created for switching to daptomycin any time during the first hospitalization and for switching within 3 days of receiving vancomycin. 7,411 patients received vancomycin for MRSA BSI. 606 (8.2%) patients switched from vancomycin to daptomycin during the first hospitalization, and 108 (1.5%) switched from vancomycin to daptomycin within 3 days of starting vancomycin. In the multivariable analysis, switching to daptomycin within 3-days was significantly associated with lower 30-day mortality (hazards ratio [HR]=0.48; 95% confidence interval [CI]: 0.25, 0.92). However, switching to daptomycin at any time during the first hospitalization was not significantly associated with 30-day mortality (HR: 0.87; 95% CI: 0.69, 1.09). Switching to daptomycin within three days of initial receipt of vancomycin is associated with lower 30-day mortality among patients with MRSA BSI. This benefit was not seen when the switch occurred later. Future studies should prospectively assess the benefit of early switching from vancomycin to other anti-MRSA antibiotics. In a cohort study of patients with MRSA bloodstream infections admitted to 124 hospitals, there was an association between switch from vancomycin to daptomycin in the first three days of treatment and reduced mortality compared with remaining on vancomycin.
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影响因子：
33.9
作者：
Kourtis, Athena P.;Hatfield, Kelly;Cardo, Denise
通讯作者：
Cardo, Denise
金黄色葡萄球菌菌血症的临床管理：评论。
影响因子：
120.7
作者：
Holland, Thomas L.;Arnold, Christopher;Fowler, Vance G., Jr.
通讯作者：
Fowler, Vance G., Jr.
影响因子：
3.3
作者：
Sohn MW;Arnold N;Maynard C;Hynes DM
通讯作者：
Hynes DM
DOI：
10.1186/cc11454
发表时间：
2013-02-04
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kellum JA;Lameire N;KDIGO AKI Guideline Work Group
通讯作者：
KDIGO AKI Guideline Work Group
影响因子：
2.5
作者：
Kalimuddin S;Chan YFZ;Phillips R;Ong SP;Archuleta S;Lye DC;Tan TT;Low JGH
通讯作者：
Low JGH