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

RCT (n=352) found no significant difference in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure for addition of an antistaphylococcal β-lactam to standard antibiotic therapy (vancomycin or daptomycin) vs standard therapy alone.

SPS commentary:

Authors highlight that early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favour of the intervention should be considered when interpreting the findings.

 

A related editorial states that the challenge of suboptimal treatments for MRSA bacteraemia is not unique, and a common thread exists among all other resistant pathogens. Similar to MRSA bacteremia, treatment of most antibiotic-resistant infections is more often guided by small observational studies and expert opinion rather than high-quality clinical trial data. This report not only guides treatment of individual patients but also serves as a model for the types of high-resource, multicenter studies needed to close these gaps.

Journal of the American Medical Association

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Editorial