CAMERA2 (original research)
Trial question
What is the role of combining anti-staphylococcal β-lactam and standard therapy in MRSA bacteremia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
34.0% female
66.0% male
N = 352
352 patients (121 female, 231 male).
Inclusion criteria: hospitalized adult patients with MRSA bacteremia.
Key exclusion criteria: history of type 1 hypersensitivity reaction to β-lactams; polymicrobial bacteremia; pregnancy; currently receiving β-lactam therapy that could not be ceased or substituted for a non-β-lactam antibiotic; death expected in the next 48 hours; treatment limitations precluding the use of antibiotics.
Interventions
N=174 combination therapy (an antistaphylococcal β-lactam [intravenous flucloxacillin, cloxacillin, or cefazolin] plus intravenous vancomycin or daptomycin).
N=178 standard therapy (intravenous vancomycin or daptomycin).
Primary outcome
Death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days
35%
39%
39.0 %
29.3 %
19.5 %
9.8 %
0.0 %
Combination
therapy
Standard
therapy
No significant
difference ↔
No significant difference in death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days (35% vs. 39%; AD -4.2%, 95% CI -14.3 to 6).
Secondary outcomes
No significant difference in all-cause mortality at 90 days (21% vs. 16%; AD 4.5%, 95% CI -3.7 to 12.7).
Significant decrease in persistent bacteremia at day 5 (11% vs. 20%; AD -8.9%, 95% CI -16.6 to -1.2).
Significant increase in AKI (excluding patients receiving dialysis at baseline) (23% vs. 6%; AD 17.2%, 95% CI 9.3 to 25.2).
Safety outcomes
No significant difference in microbiological treatment failure or microbiological relapse.
Significant differences in adverse events (13.2% vs. 3.9%), AKI (7.5% vs. 0.6%).
Conclusion
In hospitalized adult patients with MRSA bacteremia, combination therapy was not superior to standard therapy with respect to death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days.
Reference
Steven Y C Tong, David C Lye, Dafna Yahav et al. Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial. JAMA. 2020 Feb 11;323(6):527-537.
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