Articles producció científica> Medicina i Cirurgia

Cloxacillin plus fosfomycin versus cloxacillin alone for methicillin-susceptible Staphylococcus aureus bacteremia: a randomized trial

  • Datos identificativos

    Identificador: imarina:9330545
    Handle: https://hdl.handle.net/20.500.11797/imarina9330545
    Autores:
    Grillo, SPujol, MMiró, JMLópez-Contreras, JEuba, GGasch, OBoix-Palop, LGarcia-País, MJPérez-Rodríguez, MTGomez-Zorrilla, SOriol, ILópez-Cortés, LEPedro-Botet, MLSan-Juan, RAguado, JMGioia, FIftimie, SMorata, LJover-Sáenz, AGarcía-Pardo, GLoeches, BIzquierdo-Cárdenas, AGoikoetxea, AJGomila-Grange, ADietl, BBerbel, DVidela, SHereu, PPadulles, APallarès, NTebé, CCuervo, GCarratalà, JSAFO Study Grp
    Resumen:
    Treatment failure occurs in about 25% of patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We assessed whether cloxacillin plus fosfomycin achieves better treatment success than cloxacillin alone in hospitalized adults with MSSA bacteremia. We conducted a multicenter, open-label, phase III-IV superiority randomized clinical trial. We randomly assigned patients (1:1) to receive 2 g of intravenous cloxacillin alone every 4 h or with 3 g of intravenous fosfomycin every 6 h for the initial 7 days. The primary endpoint was treatment success at day 7, a composite endpoint with the following criteria: patient alive, stable or with improved quick Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA, adjudicated by an independent committee blinded to treatment allocation. We randomized 215 patients, of whom 105 received cloxacillin plus fosfomycin and 110 received cloxacillin alone. We analyzed the primary endpoint with the intention-to-treat approach in 214 patients who received at least 1 day of treatment. Treatment success at day 7 after randomization was achieved in 83 (79.8%) of 104 patients receiving combination treatment versus 82 (74.5%) of 110 patients receiving monotherapy (risk difference 5.3%; 95% confidence interval (CI), -5.95-16.48). Secondary endpoints, including mortality and adverse events, were similar in the two groups except for persistent bacteremia at day 3, which was less common in the combination arm. In a prespecified interim analysis, the independent committee recommended stopping recruitment for futility prior to meeting the planned randomization of 366 patients. Cloxacillin plus fosfomycin did not achieve better treatment success at day 7 of therapy than cloxacillin alone in MSSA b

  • Otros:

    Autor según el artículo: Grillo, S; Pujol, M; Miró, JM; López-Contreras, J; Euba, G; Gasch, O; Boix-Palop, L; Garcia-País, MJ; Pérez-Rodríguez, MT; Gomez-Zorrilla, S; Oriol, I; López-Cortés, LE; Pedro-Botet, ML; San-Juan, R; Aguado, JM; Gioia, F; Iftimie, S; Morata, L; Jover-Sáenz, A; García-Pardo, G; Loeches, B; Izquierdo-Cárdenas, A; Goikoetxea, AJ; Gomila-Grange, A; Dietl, B; Berbel, D; Videla, S; Hereu, P; Padulles, A; Pallarès, N; Tebé, C; Cuervo, G; Carratalà, J; SAFO Study Grp
    Departamento: Medicina i Cirurgia
    Autor/es de la URV: Garcia Pardo, Graciano / Iftimie Iftimie, Simona Mihaela / TEBÉ CORDOMÍ, CRISTIAN
    Resumen: Treatment failure occurs in about 25% of patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. We assessed whether cloxacillin plus fosfomycin achieves better treatment success than cloxacillin alone in hospitalized adults with MSSA bacteremia. We conducted a multicenter, open-label, phase III-IV superiority randomized clinical trial. We randomly assigned patients (1:1) to receive 2 g of intravenous cloxacillin alone every 4 h or with 3 g of intravenous fosfomycin every 6 h for the initial 7 days. The primary endpoint was treatment success at day 7, a composite endpoint with the following criteria: patient alive, stable or with improved quick Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA, adjudicated by an independent committee blinded to treatment allocation. We randomized 215 patients, of whom 105 received cloxacillin plus fosfomycin and 110 received cloxacillin alone. We analyzed the primary endpoint with the intention-to-treat approach in 214 patients who received at least 1 day of treatment. Treatment success at day 7 after randomization was achieved in 83 (79.8%) of 104 patients receiving combination treatment versus 82 (74.5%) of 110 patients receiving monotherapy (risk difference 5.3%; 95% confidence interval (CI), -5.95-16.48). Secondary endpoints, including mortality and adverse events, were similar in the two groups except for persistent bacteremia at day 3, which was less common in the combination arm. In a prespecified interim analysis, the independent committee recommended stopping recruitment for futility prior to meeting the planned randomization of 366 patients. Cloxacillin plus fosfomycin did not achieve better treatment success at day 7 of therapy than cloxacillin alone in MSSA bacteremia. Further trials should consider the intrinsic heterogeneity of the infection by using a more personalized approach. ClinicalTrials.gov registration: NCT03959345 .© 2023. The Author(s).
    Áreas temáticas: Psicología Medicine, research & experimental Medicine (miscellaneous) Medicine (all) Medicina veterinaria Medicina iii Medicina ii Medicina i General medicine General biochemistry,genetics and molecular biology Farmacia Enfermagem Ciências biológicas iii Ciências biológicas ii Ciências biológicas i Cell biology Biotecnología Biochemistry, genetics and molecular biology (miscellaneous) Biochemistry, genetics and molecular biology (all) Biochemistry & molecular biology
    Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
    Direcció de correo del autor: graciano.garcia@urv.cat simonamihaela.iftime@urv.cat
    Identificador del autor: 0000-0003-0714-8414
    Fecha de alta del registro: 2024-08-03
    Versión del articulo depositado: info:eu-repo/semantics/publishedVersion
    Enlace a la fuente original: https://www.nature.com/articles/s41591-023-02569-0#citeas
    URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
    Referencia al articulo segun fuente origial: Nature Medicine. 29 (10): 2518-2525
    Referencia de l'ítem segons les normes APA: Grillo, S; Pujol, M; Miró, JM; López-Contreras, J; Euba, G; Gasch, O; Boix-Palop, L; Garcia-País, MJ; Pérez-Rodríguez, MT; Gomez-Zorrilla, S; Oriol, I (2023). Cloxacillin plus fosfomycin versus cloxacillin alone for methicillin-susceptible Staphylococcus aureus bacteremia: a randomized trial. Nature Medicine, 29(10), 2518-2525. DOI: 10.1038/s41591-023-02569-0
    DOI del artículo: 10.1038/s41591-023-02569-0
    Entidad: Universitat Rovira i Virgili
    Año de publicación de la revista: 2023
    Tipo de publicación: Journal Publications

  • Palabras clave:

    Biochemistry & Molecular Biology,Biochemistry, Genetics and Molecular Biology (Miscellaneous),Cell Biology,Medicine (Miscellaneous),Medicine, Research & Experimental
    Psicología
    Medicine, research & experimental
    Medicine (miscellaneous)
    Medicine (all)
    Medicina veterinaria
    Medicina iii
    Medicina ii
    Medicina i
    General medicine
    General biochemistry,genetics and molecular biology
    Farmacia
    Enfermagem
    Ciências biológicas iii
    Ciências biológicas ii
    Ciências biológicas i
    Cell biology
    Biotecnología
    Biochemistry, genetics and molecular biology (miscellaneous)
    Biochemistry, genetics and molecular biology (all)
    Biochemistry & molecular biology

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