Ceftaroline fosamil for treatment of methicillin-resistant staphylococcus aureus hospital-acquired pneumonia and health care–associated pneumonia: A 5-year matched case-control evaluation of epidemiology and outcomes

Purpose: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia patients treated with current antibiotic therapies have exhibited poor outcomes, increased hospital length of stay, and higher costs of care. Twenty-eight-day mortality rate of 32% was reported with vancomycin therapy for MRSA hospital-acquired pneumonia (HAP) and MRSA health care-associated pneumonia (HCAP) from the same institution. The purpose of this study was to compare the epidemiology and effectiveness of ceftaroline versus alternative antibiotic therapies: linezolid, vancomycin, and/or cefepime, in hospitalized patients with MRSA HAP or HCAP based on clinical outcomes. Methods: Through retrospective matched case-control study design, the Infectious Diseases Society of America- and Centers for Disease Control and Prevention-defined MRSA HCAP or HAP consecutive hospitalized subjects treated with either ceftaroline fosamil (CPT-F) or alternative antibiotics were compared. Primary outcomes were 28-day mortality and 14-day clinical evaluation. Secondary outcomes included duration of hospitalization, complications with treatment, and clinical response to therapy switches. Results: Overall, 40 cases of MRSA HAP or HCAP treated with CPT-F were matched to 109 control subjects treated with either vancomycin or linezolid based on age, intensive care unit status, and type of pneumonia infection. The CPT-F cohort had a 10% (n = 4) 28-day mortality rate, and 91% (n = 32) had 14-day clinical success/cure (+/-1 day) from diagnosis of pneumonia for the 35 evaluable cases. Of the 4 patients who died, 3 had debilitating comorbid conditions and an overall APACHE (Acute Physiology and Chronic Health Evaluation) II score greater than 20. Of those failing on standard antibiotic therapy, 50% (n = 20) were switched to CPT-F; subsequently, all (n = 20) switched patients cleared pneumonia. The overall success rate with CPT-F was 90% versus 75% for comparators. Conclusions: Treatment of MRSA pneumonia with CPT-F is associated with overall lower 28-day mortality than earlier studies with other agents. These data suggest a possible benefit in the use of CPT-F for therapy of MRSA hospital-acquired and health care-associated pneumonia