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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

PurposeMethicillin-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. MethodsThrough 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. ResultsOverall, 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. ConclusionsTreatment 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.