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Ceftaroline fosamil successfully treats gram-positive infective endocarditis

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February 8, 2019

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Keith S. Kaye

Researchers found that patients with gram-positive infective endocarditis, including those with infections caused by MRSA, were successfully treated with ceftaroline fosamil, according to study findings published in the International Journal of Antimicrobial Agents.

“This study addressed treatment of one of the most serious and challenging infections: endocarditis,” said Infectious Disease News Editorial Board member Keith S. Kaye, MD, MPH, professor of internal medicine and director of clinical research in the division of infectious diseases at the University of Michigan Medical School. “Both left-sided and right-sided gram-positive infective endocarditis cases were included [in this study]. The majority of isolates were MRSA, which is particularly problematic to treat.”

In the retrospective CAPTURE study, Kaye and colleagues reviewed patient charts between September 2013 and February 2015 to collect data on patient demographics, medical history, risk factors, microbiological etiology and clinical outcomes.

They determined that 55 patients with gram-positive endocarditis received ceftaroline fosamil (CPT-F) therapy. Intravascular devices (43.6%), diabetes mellitus (40%) and injection drug use (38.2%) were the most common risk factors. MRSA was the most commonly isolated pathogen (80%), followed by methicillin-susceptible S aureus (MSSA) and coagulase-negative Staphylococci, at 7.3% each.

CPT-F was a first-line treatment in less than 7.3% of patients and a second-line or later treatment with prior antibiotic treatment administered in the rest. CPT-F was given as monotherapy in 41.8% of patients and as concurrent therapy with another antibiotic in 58.2%.

More than 82% of patients treated with CPT-F monotherapy achieved clinical success, whereas 75% of patients treated with CPT-F as first-line therapy and 70.6% of patients treated for second-line therapy achieved success, as well.

The majority of patients with MRSA (77.3%) and 25% of patients with MSSA achieved clinical success, the researchers reported.

“The clinical success rate with CPT-F therapy was high among patients with [gram-positive infective endocarditis] regardless of location of care (ICU vs. general hospital ward), location of infection (left- vs. right-sided), or presence of risk factors, including [injection drug use] and [intravascular device],” the researchers concluded.

“Although not FDA-approved for endocarditis,” Kaye added, “ceftaroline might be a viable treatment option for gram-positive infective endocarditis, and for MRSA in particular.” – by Bruce Thiel

Disclosures: Kaye reports having served as consultant for Allergan, for which he received consulting fees. Allergan supported the study. Please see the study for all other authors’ relevant financial disclosures.

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