Daptomycin does not shorten duration of MSSA bacteremia
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The use of adjunctive daptomycin therapy among patients with methicillin-susceptible Staphylococcus aureus bloodstream infections does not shorten the duration of bacteremia, researchers reported.
The finding was from a randomized, double-blind, placebo-controlled trial published in Clinical Infectious Disease.
Matthew P. Cheng, MD, assistant professor in McGill University’s divisions of infectious diseases and medical microbiology, told Healio that the study showed that daptomycin “was not synergistic” with antistaphylococcal beta-lactams when treating methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections, and noted that the combination “should not be used routinely in clinical practice.”
“One key take-home message is the importance of performing well-constructed randomized control trials — just because there is biological plausibility for something to work doesn’t mean it will translate into a meaningful clinical effect,” Cheng said. “Another key message is that small teams with limited budgets can answer important questions, and that performing a robust clinical trial was key to obtaining quality evidence on the subject.”
Cheng and colleagues conducted the trial at two hospitals in Montreal. They included 115 patients with MSSA bloodstream infections who were receiving either cefazolin or cloxacillin monotherapy and were given either a 5-day regimen of daptomycin or a placebo. The primary outcome was MSSA bloodstream infection.
The average participant age was 67 years, and 34.5% were female. The researchers found that the average bacteremia duration was 2.04 days in the daptomycin group and 1.65 days in the placebo group for an absolute difference of 0.39 days (P = 0.4). A secondary analysis of patients who remained bacteremic at enrollment showed an average bacteremia duration of 3.06 in the daptomycin group and 3 days in the placebo group (absolute difference = 0.06 days; P = .77). Additionally, the 90-day mortality rate was 18.9% in the daptomycin group and 17.7% in the placebo group.
“I was admittedly disappointed there was not a shortened duration of bacteremia among those who received combination therapy, as there was biological plausibility to support synergistic activity,” Cheng said.
Cheng said that because there was no indication of a decrease in duration of bacteremia, the researchers are not planning a larger study.
“Combination therapy has not been shown to be beneficial to date in the treatment of S. aureus bacteremia,” he said. “We emphasized the need for robust clinical trials and ongoing research to improve outcomes in this disease.”
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