RT Journal Article
T1 Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial.
A1 Pujol, Miquel
A1 Miró, José-María
A1 Shaw, Evelyn
A1 Aguado, Jose-María
A1 San-Juan, Rafael
A1 Puig-Asensio, Mireia
A1 Pigrau, Carles
A1 Calbo, Esther
A1 Montejo, Miguel
A1 Rodriguez-Álvarez, Regino
A1 Garcia-Pais, María-Jose
A1 Pintado, Vicente
A1 Escudero-Sánchez, Rosa
A1 Lopez-Contreras, Joaquín
A1 Morata, Laura
A1 Montero, Milagros
A1 Andrés, Marta
A1 Pasquau, Juan
A1 Arenas, María-Del-Mar
A1 Padilla, Belén
A1 Murillas, Javier
A1 Jover-Sáenz, Alfredo
A1 López-Cortes, Luis-Eduardo
A1 García-Pardo, Graciano
A1 Gasch, Oriol
A1 Videla, Sebastian
A1 Hereu, Pilar
A1 Tebé, Cristian
A1 Pallarès, Natalia
A1 Sanllorente, Mireia
A1 Domínguez, María-Ángeles
A1 Càmara, Jordi
A1 Ferrer, Anna
A1 Padullés, Ariadna
A1 Cuervo, Guillermo
A1 Carratalà, Jordi
A1 MRSA Bacteremia (BACSARM) Trial Investigators, 
K1 MRSA
K1 bacteremia
K1 clinical trial
K1 daptomycin
K1 fosfomycin
AB We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93-1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018). Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events. NCT01898338.
YR 2021
FD 2021
LK https://hdl.handle.net/10668/26334
UL https://hdl.handle.net/10668/26334
LA en
DS RISalud
RD Apr 17, 2025