Daptomycin plus Fosfomycin versus Daptomycin Alone for Methicillin-Resistant Staphylococcus 2 aureus Bacteremia and Endocarditis. A Randomized Clinical Trial

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 tria...

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Detalles Bibliográficos
Autores: Pujol Rojo, Miquel, Miró Meda, José M. (José María), 1956-, 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, Sebastià, Hereu, Pilar, Tebé, Cristian, Pallarès, Natàlia, Sanllorente, Mireia, Domínguez Luzón, Ma. Ángeles (María Ángeles), Càmara Mas, Jordi, Ferrer, Anna, Padullés Zamora, Ariadna, Cuervo Requena, Guillermo, Carratalà, Jordi, MRSA Bacteremia (BACSARM) Trial Investigators
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2020
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/183825
Acceso en línea:https://hdl.handle.net/2445/183825
Access Level:acceso abierto
Palabra clave:Assaigs clínics
Bacteris
Antibiòtics
Endocarditis
Malalties infeccioses
Clinical trials
Bacteria
Antibiotics
Communicable diseases
Descripción
Sumario: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.

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