MRSA death rates remain high⚠️. Combo daptomycin+ceftaroline may reduce mortality: 0 deaths vs 6 in monotherapy in a 40-patient trial🧪. More studies needed🔎.
Death rates due to Staphylococcus aureus remain unacceptably high [1]. Despite a recent surge in S. aureus bacteremia trials, ongoing uncertainties and gaps in optimal management are reflected in wide practice variation in antibiotic selection [2]. For methicillin-resistant S. aureus (MRSA) bacteremia, one point of contention is whether combination therapy, particularly with daptomycin plus a β-lactam antibiotic, improves outcomes and, if so, when this strategy should be deployed. Multiple in vitro studies have defined the mechanisms of synergy between daptomycin and β-lactams and have propelled clinical studies to determine if capitalizing on this phenomenon will help improve outcomes [3–5]. One common drawback to many of these investigations is that the studied β-lactams lack intrinsic MRSA activity. In clinical practice, clinicians most often reach for dual therapy with vancomycin or daptomycin plus a cephalosporin with MRSA activity, such as ceftaroline or ceftobiprole, as salvage treatment in the setting of persistently positive blood cultures [6, 7]. Small observational studies have suggested the possibility of a clinical benefit of ceftaroline plus daptomycin, though the benefit has not been universally described [8–10]. A single-center pilot trial randomized forty participants with MRSA bacteremia to open-label monotherapy with vancomycin or daptomycin compared with dual therapy with daptomycin plus ceftaroline [11]. The investigators halted the study early after noting an imbalance in mortality with 6 deaths in the monotherapy group compared with none in the combination therapy group, a statistically significant, though fragile, finding which requires additional confirmation.
