Ceftaroline for bloodstream infections caused by methicillin-resistant Staphylococcus aureus: a multicentre retrospective cohort study.

Objectives: To evaluate the effectiveness of ceftaroline vs. vancomycin or daptomycin in the treatment of methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs).
Methods: This multicentre retrospective study conducted in 15 Spanish hospitals, included data from the first MRSA-BSIs of adult patients between January-2019 and December-2022. The ceftaroline group included patients who received ceftaroline for ≥72h within the first week of BSI onset; the standard of care (SOC) group included patients who received vancomycin or daptomycin ≥72h after BSI onset. Primary outcome was 30-day all-cause mortality; secondary outcomes included 90-day mortality and incidence of adverse events (AEs). Propensity-score (PS) matching and Cox proportional-hazards analyses were performed.
Results: A total of 429 MRSA-BSIs were included: 133 in the ceftaroline group and 296 in the SOC group. More patients in the ceftaroline group had a SOFA score>2 (51.1% vs. 36.5%; p<0.01), complicated-BSI (66.2% vs. 42.2%; p<0.01), infective endocarditis (18.8% vs. 6.4%; p<0.01) and prescribed in combination treatment (65.4% vs. 11.5%; p<0.01), with no statistically significant differences in 30-day mortality: 23.3% ceftaroline (95%CI 16.1%-30.5%) vs. 16.2% SOC (95%CI 12.0%-20.4%), p=0.08. There were no statistically significant differences in 90-day mortality (33.1% ceftaroline vs. 26.7% SOC; p=0.17). After PS matching, 105 patients treated with ceftaroline were matched with 105 controls: the 30-day mortality rates were 21.9% and 16.2% (p=0.38). Cox-regression analysis of the entire cohort (n=429) revealed that age (HR 1.05, 95%CI 1.03-1.07) and SOFA score>2 (HR 2.34, 95%CI 1.50-3.65) were associated with 90-day mortality risk, although ceftaroline treatment did not demonstrate a significant effect (HR 1.00, 95%CI 0.97-1.02). Incidence of AEs was 12.0% in ceftaroline vs. 4.4% in SOC group (p<0.01). Most AEs occurred when ceftaroline was used in combination vs. monotherapy (17.2% vs. 2.2%; p=0.01).
Conclusions: Ceftaroline was an effective treatment for MRSA-BSIs but was commonly prescribed in combination showing a higher incidence of AEs.
Competing Interests: Transparency declarations S.V. has received financial support from Pfizer(TM) for speaking engagements and attendance at conferences. L.B.P. has financial support for attending meetings from Menarini(TM) and Pfizer(TM). L.B. has received payment for consulting fees from Angelini(TM), Jannsen(TM) and Shionogi(TM) and for lecture fees and advisory boards from Jannsen(TM), ViiV(TM) and GILEAD(TM). All the rest authors reported no conflict of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
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