Introduction: Since the last century, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has become a major global and public health concern not only in terms of morbidity and mortality, but also the duration of hospital stay, healthcare cost, and antimicrobial choices. Especially alarming is the growing antimicrobial resistance due to their misuse and overuse, which has led the world to be exhausted of its effective antibiotic resources. In this review article, we sought to figure out the most efficacious antimicrobial agents to treat MRSA-related bloodstream infections.
Methods: Information sources, keyword search and the following items were used in Elsevier searches to find relevant articles: (treatment of MRSA bacteremia), (methicillin-resistant Staphylococcus aureus or MRSA), (MRSA bacteremia). We compared the data from reviewing reports summarizing their comparative efficacy. We focused on vancomycin and daptomycin, which are the current Infectious Disease Society Of America (IDSA)-recommended antibiotics for MRSA bacteremia treatment. A deep dive into the newer agents revealed better efficacy and treatment outcome in the combination of ceftaroline (β-lactam) with daptomycin compared to traditional standard monotherapy (vancomycin/daptomycin monotherapy). Also, the IDSA recommended high-dose daptomycin (8-10 mg/kg) therapy for MRSA bacteremia treatment to be more effective in cases with vancomycin-reduced susceptibility.
Results: The upshot is that we need more large-scale clinical trials exploring in-depth effectiveness and adverse effects to decide on newer agents like β-lactams to use as routine therapy for MRSA bacteremia.
Conclusion: Treatment of methicillin-resistant Staphylococcus bacteremia is a growing challenge that physicians continue to face as it can lead to life-threatening conditions. Although IDSA has recommended VAN and DAP as first-line treatment options for MRSA, multiple drawbacks warrant the advent of alternatives that will increase clinical success rates with fewer adverse effects. Many studies demonstrated that combining DAP/VAN with β-lactams can result in faster bacterial clearance and a lower risk of 30-day mortality - making it a promising choice. But these studies concerning ceftaroline were underpowered to detect clinically significant differences due to bias or smaller study groups. We need to conduct more head-to-head comparative studies with larger cohorts to replicate the results discussed here so that physicians can employ a comprehensive strategy against MRSA that will ensure increased clinical success with decreased mortality and morbidity, lower hospital stay, and reduced financial burden. Moreover, we did not find any trial or study describing the use of ceftaroline as a monotherapy to compare its efficacy in MRSA bacteremia with the current standard therapy.