Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-Resistant Staphylococcus aureus Bacteremia: Does β-Lactam Class Matter?

Thomas J. Dilworth; Anthony M. Casapao; Omar M. Ibrahim; David M. Jacobs; Dana R. Bowers; Nicholas D. Beyda; Renee-Claude Mercier

doi:10.1128/AAC.02211-18

DOI: 10.1128/AAC.02211-18

Article Figures & Data

Tables

TABLE 1

Treatment assignment and persistent bacteremia, univariable analyses

Characteristic	Treatment assignment^a			Bacteremia duration^a
Characteristic	Combo^b (n = 90)	VAN (n = 66)	P value	<5 days (n = 103)	≥5 days (n = 53)	P value
Age (yr, mean ± SD)	58 ± 16	61 ± 17	0.317	58 ± 16	60 ± 17	0.539
Male	50 (55.6)	35 (53.0)	0.871	57 (53.3)	28 (52.8)	0.865
Race/ethnicity			0.417			0.392
Caucasian	55 (61.1)	36 (54.5)		63 (61.2)	28 (52.8)
Other	35 (38.9)	30 (45.5)		40 (38.8)	25 (47.2)
Diabetes mellitus	43 (47.8)	27 (40.9)	0.419	45 (43.7)	25 (47.2)	0.735
Cancer	16 (17.8)	15 (22.7)	0.543	18 (17.5)	13 (24.5)	0.299
Lung disease	20 (22.2)	10 (15.2)	0.309	17 (16.5)	13 (24.5)	0.284
Congestive heart failure	14 (15.6)	8 (12.1)	0.644	16 (15.5)	6 (11.3)	0.628
End-stage renal disease	27 (30.0)	20 (30.3)	>0.999	32 (31.1)	15 (28.3)	0.854
Hemodialysis	15 (16.7)	15 (22.7)	0.412	19 (18.5)	11 (20.8)	0.831
PITT bacteremia score ≥4	19 (12.2)	12 (18.8)	0.690	23 (22.1)	8 (15.4)	0.397
Intensive care unit admission	41 (45.6)	22 (33.3)	0.140	43 (41.8)	20 (37.7)	0.731
Bacteremia source			0.167			0.156
Primary endovascular	27 (30.0)	24 (36.4)		32 (31.1)	19 (35.9)
Secondary	50 (55.6)	27 (40.9)		56 (54.4)	21 (39.6)
Catheter related	13 (14.4)	15 (22.7)		15 (15.0)	13 (24.5)
Prosthesis	14 (15.6)	18 (27.3)	0.107	20 (19.4)	12 (22.6)	0.678
VAN MIC ≤1 mg/liter	74 (82.2)	57 (86.4)	0.517	84 (81.6)	47 (88.6)	0.357
Initial VAN level (mg/liter; median [IQR])	17.8 (14.0–23.4)	15.7 (11.3–20.2)	0.041	17.5 (14.0–23.0)	15.0 (11.1–23.2)	0.108
VAN therapy duration (days [range])	12 (8–26)	11.5 (7–22)	0.773	12 (7–31)	13 (9–19)	0.990
Persistent bacteremia	24 (26.7)	29 (43.9)	0.027
In-hospital mortality	14 (15.6)	9 (13.6)	0.822	14 (13.6)	9 (17.0)	0.636
Acute kidney injury	17 (18.9)	5 (7.6)	0.062	13 (12.6)	9 (17.0)	0.474

↵a Data presented as n (%) unless noted otherwise.
↵b Piperacillin-tazobactam (60.0%), cefepime (15.6%), ceftriaxone (12.2%), meropenem (4.4%), imipenem-cilastatin (3.3%), ampicillin-sulbactam (2.2%), cefazolin (1.1%), and doripenem (1.1%).

TABLE 2

Rates of persistent bacteremia and acute kidney injury by β-lactam class

Characteristic	Rate (n [%]) with:
Characteristic	Carbapenem (n = 8)	Cephalosporin (n = 25)	Penicillin (n = 56)	Vancomycin^a (n = 66)
Persistent bacteremia	0 (0)	8 (32)	15 (26.8)	29 (43.9)
Acute kidney injury	1 (12.5)	4 (16)	12 (21.4)	5 (7.6)