Adjunctive daptomycin in the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a randomized, controlled trial.
Adjunctive daptomycin in the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a randomized, controlled trial.
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DOI：
10.1093/cid/ciaa1000
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发表时间：
2020-01-01
影响因子：
11.8
通讯作者：
Lee, T. C.
中科院分区：
文献类型：
--
作者：
Cheng, Matthew P.;Lawandi, Alexander;Lee, T. C.
背景资料：甲氧西林敏感金黄色葡萄球菌（MSSA）的血流感染（BSI）与显著的发病率和死亡率相关。本研究的目的是确定达托霉素与头孢唑林或氯唑西林联合治疗MSSA BSI的疗效。方法：在加拿大蒙特利尔的2家学术医院进行了一项随机、双盲、安慰剂对照试验。考虑纳入接受头孢唑林或氯唑西林单药治疗的年龄≥18岁MSSA BSI患者。除了标准治疗外，参与者还接受了为期5天的连续达托霉素或安慰剂治疗。主要结局是MSSA BSI的持续时间（天）。结果在筛选的318名参与者中，115名入组，104名被纳入意向治疗分析（中位年龄67岁; 34.5%为女性）。接受达托霉素治疗的患者中位菌血症持续时间为2.04天，而接受安慰剂治疗的患者为1.65天（绝对差异为0.39天; P = 0.40）。在一项修改的意向治疗分析中，涉及在入组时仍保持菌血症的参与者，我们发现接受达托霉素的患者菌血症的中位持续时间为3.06天，而接受安慰剂的患者为3.0天（绝对差异为0.06天; P = 0.77）。达托霉素组的90天死亡率为18.9%，安慰剂组为17.7%（P = 1.0）。结论：在MSSA BSI患者中，将达托霉素治疗与标准治疗相结合并不能缩短菌血症的持续时间，因此不应常规考虑。
Background: Bloodstream infections (BSIs) with methicillin-susceptible Staphylococcus aureus (MSSA) are associated with significant morbidity and mortality. Our objective in this study was to determine the efficacy of synergistic treatment with daptomycin when given with either cefazolin or cloxacillin for the treatment of MSSA BSI. Methods: A randomized, double-blind, placebo-controlled trial was performed at 2 academic hospitals in Montreal, Canada. Patients aged ≥18 years with MSSA BSI receiving either cefazolin or cloxacillin monotherapy were considered for inclusion. In addition to the standard-of-care treatment, participants received a 5-day course of adjunctive daptomycin or placebo. The primary outcome was the duration of MSSA BSI in days. Results Of 318 participants screened, 115 were enrolled and 104 were included in the intention-to-treat analysis (median age, 67 years; 34.5% female). The median duration of bacteremia was 2.04 days among patients who received daptomycin vs 1.65 days in those who received placebo (absolute difference, 0.39 days; P =.40). In a modified intention-to-treat analysis that involved participants who remained bacteremic at the time of enrollment, we found a median duration of bacteremia of 3.06 days among patients who received daptomycin vs 3.0 days in those who received placebo (absolute difference, 0.06 days; P =.77). Ninety-day mortality in the daptomycin arm was 18.9% vs 17.7% in the placebo arm (P = 1.0). Conclusions: Among patients with MSSA BSIs, the administration of adjunctive daptomycin therapy to standard-of-care treatment did not shorten the duration of bacteremia and should not be routinely considered.