Clinical Use of Ceftaroline Fosamil for the Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Abstract

Background. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are both associated with substantial morbidity and mortality. This analysis examined the clinical experience of patients with HAP/VAP treated with ceftaroline fosamil and extracted from CAPTURE, a retrospective multicenter phase 4 study. Methods. Data including patient demographics, medical history and risk factors, disease characteristics, antibiotic use, location of care, pathogens isolated and clinical outcome were collected between March 2014 and January 2015 by review of randomly ordered patient charts from participating sites in the United States. Clinical success was defined as discontinuation of ceftaroline fosamil following clinical cure with no further need for antibiotic or clinical improvement with switch to another antibiotic. Results. There were 85 patients from 27 study centers with HAP/VAP who were treated with ceftaroline fosamil; 82.4% (70/85) of whom received a 600 mg dose. Ceftaroline fosamil was dosed every 12 hours in 89.4% (76/85) of patients and every 8 hours in 11.8% (10/85) of patients. Risk factors included history of smoking (49.4%; 42/85), structural lung disease (41.2%; 35/85), and ventilator use (36.5%; 31/85). The pathogens most commonly isolated were methicillin-resistant S. aureus (MRSA; 42.4% [36/85]) and methicillin-susceptible S. aureus (MSSA; 5.9% [5/85]). Antibiotics were administered before ceftaroline fosamil treatment in 89.4% (76/85) of the patients, with vancomycin being the most common prior therapy (68.2% [58/85]). The mean (SD) duration of ceftaroline fosamil therapy was 6.9 (4.0) days. Overall clinical success was 82.4% (70/85). Clinical success in those with a history of smoking was 78.6% (33/42), structural lung disease was 85.7% (30/35), and ventilator use was 71.0% (22/31). The success rate was 84.2% (64/76) among recipients of antibiotics prior to receiving ceftaroline. The success rate was 72.2% (26/36) in patients with bacteremia due to MRSA and 60.0% (3/5) due to MSSA. Two patients (2.3%) discontinued ceftaroline fosamil therapy because of adverse events. Conclusion. Clinical success rates with ceftaroline fosamil were high in patients with HAP/VAP, including those with infections caused by MRSA.