Ceftaroline vs. Vancomycin in the Treatment of Acute Pulmonary Exacerbation of Cystic Fibrosis

Study Methodology and Objectives, Study Population

The retrospective observational study included a total of 55 adult patients (average age 23.5 years) with cystic fibrosis hospitalized between January 2011 and 2020 at the University of Texas Southwestern Medical Center for acute pulmonary exacerbation with methicillin-resistant Staphylococcus aureus (MRSA) etiology. They were treated for ≥ 7 days with ceftaroline at a dose of 600 mg i.v. every 8 hours (n = 22) or vancomycin according to pharmacokinetic parameters (n = 33).

The primary parameter monitored was the improvement in lung function, specifically the one-second vital capacity (FEV₁) to at least 90% of the baseline value (maximum measured FEV₁ in the 6 months prior to hospitalization). Secondary parameters included length of hospital stay, the rate of 30-day rehospitalization and mortality, length of treatment, and the incidence of adverse events (acute renal failure, neutropenia, Clostridium difficile infection).

All patients had a positive MRSA sputum culture within 90 days before admission to the hospital or 21 days after. Exclusion criteria were:

• lung transplantation
• alternative MRSA therapy ≥ 48 hours (vancomycin, linezolid, ceftaroline)
• renal replacement therapy
• acute pulmonary exacerbation caused by fungal or mycobacterial infection

Results

The majority of patients were homozygous for the Phe508del mutation of the cystic fibrosis gene CFTR (73% of patients treated with ceftaroline and 61% treated with vancomycin). A total of 19 (41%) patients in the ceftaroline group and 10 (30%) in the vancomycin group were using CFTR modulators. There was no significant difference in the baseline FEV₁ between the two groups. A total of 30 patients (13 in the ceftaroline group and 17 in the vancomycin group) had a culture positive for Pseudomonas aeruginosa.

Improvement in FEV₁ to 90% of the baseline value was achieved by 13 (59%) patients treated with ceftaroline and 24 (73%) treated with vancomycin (p = 0.38). FEV₁ values measured in the 6 months before hospitalization, at admission, and at discharge did not significantly differ between the groups.

The median length of hospital stay was 14 days for patients treated with ceftaroline and 9 days for patients on vancomycin (p = 0.01). No significant differences were observed between the groups in the remaining secondary parameters.

Conclusion

Ceftaroline is an effective and safe alternative for the treatment of acute pulmonary exacerbation of cystic fibrosis caused by MRSA in adult patients.

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Source: Esquivel M. D., Monogue M. L., Smith G. S. et al. Ceftaroline versus vancomycin for treatment of acute pulmonary exacerbations of cystic fibrosis in adults. J Glob Antimicrob Resist 2022; 28: 67–70, doi: 10.1016/j.jgar.2021.12.008.