Expert review of anti-infective therapy · 2026
Comparative effectiveness of ceftaroline plus vancomycin or daptomycin versus vancomycin or daptomycin monotherapy for MRSA bacteremia: an updated systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mohammad Shahd, Aljumaa Sarah Alhassan, Ghazal Haneen, Alnamous Alyamama, Al Dhaheri Reem, Almangour Thamer A, El-Dahiyat Faris
Аннотация
INTRODUCTION: MRSA bacteremia is associated with substantial clinical burden. Ceftaroline (CPT)-based combinations with vancomycin or daptomycin are increasingly utilized, but their added benefit remains uncertain. This meta-analysis compared the effectiveness and safety of CPT-based combination therapy versus vancomycin or daptomycin monotherapy.
METHODS: MEDLINE, Scopus, and Cochrane Central were systematically searched. Primary outcomes were all-cause mortality and microbiological recurrence. Data were pooled using Review Manager, and meta-regression analyses were performed in RStudio. Heterogeneity was assessed using the I2 statistic.
RESULTS: A total of 22,938 patients were included from 10 cohort studies and one randomized controlled trial, with mean age 53 years, Pitt bacteremia score 2.0, and Charlson Comorbidity Index 2.6. CPT-based combination therapy showed mortality comparable to monotherapy (17.2% vs. 17.2%; RR 1.13; 95% CI 0.80-1.59; p = 0.50; I2 = 4%), and the slight increase in microbiological recurrence (2.9% vs 1.4%; RR 0.86; 95% CI 0.51-1.47; p = 0.59; I2 = 17%) was not significant. Meta-regression identified no covariate significantly modifying treatment effect.
CONCLUSION: CPT-based combination therapy conferred no significant mortality benefit over vancomycin or daptomycin monotherapy in patients with MRSA bacteremia, and timing of initiation did not influence outcomes.
PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD420251084876.
METHODS: MEDLINE, Scopus, and Cochrane Central were systematically searched. Primary outcomes were all-cause mortality and microbiological recurrence. Data were pooled using Review Manager, and meta-regression analyses were performed in RStudio. Heterogeneity was assessed using the I2 statistic.
RESULTS: A total of 22,938 patients were included from 10 cohort studies and one randomized controlled trial, with mean age 53 years, Pitt bacteremia score 2.0, and Charlson Comorbidity Index 2.6. CPT-based combination therapy showed mortality comparable to monotherapy (17.2% vs. 17.2%; RR 1.13; 95% CI 0.80-1.59; p = 0.50; I2 = 4%), and the slight increase in microbiological recurrence (2.9% vs 1.4%; RR 0.86; 95% CI 0.51-1.47; p = 0.59; I2 = 17%) was not significant. Meta-regression identified no covariate significantly modifying treatment effect.
CONCLUSION: CPT-based combination therapy conferred no significant mortality benefit over vancomycin or daptomycin monotherapy in patients with MRSA bacteremia, and timing of initiation did not influence outcomes.
PROTOCOL REGISTRATION: www.crd.york.ac.uk/prospero identifier is CRD420251084876.