Tong SYC

Nelson J

Paterson DL

Fowler VG

Howden BP

Cheng AC

Chatfield M

Lipman J

Van Hal S

O'Sullivan M

Robinson JO

Yahav D

Lye D

Davis JS

2016-03-31

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20-50 % 90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia. We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint. Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia include their safety profile, low cost, and wide availability. ClinicalTrials.gov Identifier: NCT02365493 . Registered 24 February 2015.

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.. Royal Darwin Hospital, Darwin, NT, Australia..

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia..

University of Queensland, Centre for Clinical Research, Herston, QLD, Australia..

Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA.. Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA..

Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne, at The Doherty Institute, Melbourne, VIC, Australia..

Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia.. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia..

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia..

Burns, Trauma Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.. Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia..

Department of Microbiology and Infectious Disease Royal Prince Alfred Hospital, Sydney, NSW, Australia..

Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia.. Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia..

Department of Microbiology and Infectious Diseases, Pathwest Laboratory Medicine WA, Royal Perth Hospital and Fiona Stanley Hospital, Perth, WA, Australia.. Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia..

Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.. Rabin Medical Center, Petah Tikvah, Israel..

Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore..

Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia. Joshua.Davis@menzies.edu.au.. John Hunter Hospital, Newcastle, NSW, Australia. Joshua.Davis@menzies.edu.au..

Trials . 2016 Mar 31:17:170. doi: 10.1186/s13063-016-1295-3.

0000-0001-9864-5699

https://pubmed.ncbi.nlm.nih.gov/27029920/?otool=iaurydwlib

https://hdl.handle.net/10137/5362

Cefazolin

Cloxacillin

Combination

Daptomycin

Flucloxacillin

MRSA

Methicillin-resistant

Nafcillin

Randomised controlled trial

Staphylococcus aureus

Vancomycin

Anti-Bacterial Agents

Australia

Cefazolin

Clinical Protocols

Cloxacillin

Daptomycin

Drug Therapy, Combination

Floxacillin

Humans

Israel

Methicillin-Resistant Staphylococcus aureus

New Zealand

Research Design

Singapore

Staphylococcal Infections

Time Factors

Treatment Outcome

Vancomycin

beta-Lactams

Methicillin Resistance

CAMERA2 - combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial.

Journal Article

Publication