BACKGROUND: 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. METHODS: 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. RESULTS: In total, 7411 patients received vancomycin for MRSA BSI. Also, 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]: .25, .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: .69, 1.09). CONCLUSIONS: Switching to daptomycin within 3 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.
BACKGROUND: 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. METHODS: 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. RESULTS: In total, 7411 patients received vancomycin for MRSA BSI. Also, 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]: .25, .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: .69, 1.09). CONCLUSIONS: Switching to daptomycin within 3 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.
Authors: Richard E Nelson; Rachel B Slayton; Vanessa W Stevens; Makoto M Jones; Karim Khader; Michael A Rubin; John A Jernigan; Matthew H Samore Journal: Infect Control Hosp Epidemiol Date: 2017-06-01 Impact factor: 3.254
Authors: Spyridon Fortis; Amy M J O'Shea; Brice F Beck; Rajeshwari Nair; Michihiko Goto; Peter J Kaboli; Eli N Perencevich; Heather S Reisinger; Mary V Sarrazin Journal: J Crit Care Date: 2018-09-06 Impact factor: 3.425
Authors: Pamela A Moise; Darren L Culshaw; Annie Wong-Beringer; Joyce Bensman; Kenneth C Lamp; Winter J Smith; Karri Bauer; Debra A Goff; Robert Adamson; Kimberly Leuthner; Michael D Virata; James A McKinnell; Saira B Chaudhry; Romic Eskandarian; Thomas Lodise; Katherine Reyes; Marcus J Zervos Journal: Clin Ther Date: 2015-11-14 Impact factor: 3.393
Authors: Natalie Banniettis; Susan E Beekmann; Philip M Polgreen; Shubhi Kaushik; Stephan Kohlhoff; David Gilbert; John E Bennett; Margaret R Hammerschlag Journal: Open Forum Infect Dis Date: 2018-05-19 Impact factor: 3.835
Authors: Makoto Jones; John A Jernigan; Martin E Evans; Gary A Roselle; Kelly M Hatfield; Matthew H Samore Journal: MMWR Morb Mortal Wkly Rep Date: 2019-03-08 Impact factor: 17.586
Authors: Athena P Kourtis; Kelly Hatfield; James Baggs; Yi Mu; Isaac See; Erin Epson; Joelle Nadle; Marion A Kainer; Ghinwa Dumyati; Susan Petit; Susan M Ray; David Ham; Catherine Capers; Heather Ewing; Nicole Coffin; L Clifford McDonald; John Jernigan; Denise Cardo Journal: MMWR Morb Mortal Wkly Rep Date: 2019-03-08 Impact factor: 17.586
Authors: Evan J Zasowski; Trang D Trinh; Kimberly C Claeys; Abdalhamid M Lagnf; Sahil Bhatia; Kenneth P Klinker; Michael P Veve; Sandy J Estrada; Scott T Johns; Adam J Sawyer; Vanthida Huang; Brandi LaFrance; Donald P Levine; Keith S Kaye; Susan L Davis; Michael J Rybak Journal: Open Forum Infect Dis Date: 2021-12-23 Impact factor: 3.835