Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 13;24(1):3.
doi: 10.1186/s12941-025-00773-z.

Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia

Addison S Hicks  1 , Mackenzie A Dolan  2 , Megan D Shah  2 , Sarah E Elwood  3 , James A Platts-Mills  3 , Gregory R Madden  3 , Zachary S Elliott  2 , Joshua C Eby  4
Affiliations

Early initiation of ceftaroline-based combination therapy for methicillin-resistant Staphylococcus aureus bacteremia

Addison S Hicks et al. Ann Clin Microbiol Antimicrob. .

Abstract

Purpose: Monotherapy with vancomycin or daptomycin remains guideline-based care for methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) despite concerns regarding efficacy. Limited data support potential benefit of combination therapy with ceftaroline as initial therapy. We present an assessment of outcomes of patients initiated on early combination therapy for MRSA-B.

Methods: This was a single-center, retrospective study of adult patients admitted with MRSA-B between July 1, 2017 and April 31, 2023. During this period, there was a change in institutional practice from routine administration of monotherapy to initial combination therapy for most patients with MRSA-B. Combination therapy included vancomycin or daptomycin plus ceftaroline within 72 h of index blood culture and monotherapy was vancomycin or daptomycin alone. The primary outcome was a composite of persistent bacteremia, 30-day all-cause mortality, and 30-day bacteremia recurrence. Time to microbiological cure and safety outcomes were assessed. All outcomes were assessed using propensity score-weighted logistic regression.

Results: Of 213 patients included, 118 received monotherapy (115 vancomycin, 3 daptomycin) and 95 received combination therapy with ceftaroline (76 vancomycin, 19 daptomycin). The mean time from MRSA-positive molecular diagnostic blood culture result to combination therapy was 12.1 h. There was no difference between groups for the primary composite outcome (OR 1.58, 95% CI 0.60, 4.18). Time to microbiological cure was longer with combination therapy (mean difference 1.50 days, 95% CI 0.60, 2.41). Adverse event rates were similar in both groups.

Conclusions: Early initiation of ceftaroline-based combination therapy did not improve outcomes for patients with MRSA-B in comparison to monotherapy therapy.

Keywords: Ceftaroline; Combination therapy; Daptomycin; Methicillin-resistant Staphylococcus aureus bacteremia; Vancomycin.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The research protocol received an Exempt approval by the Institutional Review Board (IRB) for Health Sciences Research at the University of Virginia. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study population and analysis cohort. Abbreviations: CPT, ceftaroline; DAP, daptomycin; MRSA-B, Methicillin-resistant Staphylococcus aureus bacteremia; VAN, vancomycin
See this image and copyright information in PMC

Update of

References

    1. Naber CK. Staphylococcus aureus Bacteremia: Epidemiology, Pathophysiologymanagementgstrategiestegies. Clin Infect Dis. 2009;48(s4):S231–7. - PubMed
    1. Hornak JP, Anjum S, Reynoso D. Adjunctive ceftaroline in combination with daptomycin or Vancomycin for complicated methicillin-resistant Staphylococcus aureus bacteremia after monotherapy failure. Therapeutic Adv Infect. 2019;6:204993611988650. - PMC - PubMed
    1. Van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev. 2012;25(2):362–86. - PMC - PubMed
    1. Tong SYC, Lye DC, Yahav D, Sud A, Robinson JO, Nelson J, et al. Effect of Vancomycin or Daptomycin with vs without an antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or treatment failure in patients with MRSA Bacteremia: a Randomized Clinical Trial. JAMA. 2020;323(6):527. - PMC - PubMed
    1. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: Epidemiology, Pathophysiology, Clinical manifestations, and management. Clin Microbiol Rev. 2015;28(3):603–61. - PMC - PubMed

MeSH terms

LinkOut - more resources