CAMERA2-combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial

Tong, Steven Y. C., Nelson, Jane, Paterson, David L., Fowler, Vance G., Jr., Howden, Benjamin P., Cheng, Allen C., Chatfield, Mark, Lipman, Jeffrey, Van Hal, Sebastian, O'Sullivan, Matthew, Robinson, James O., Yahav, Dafna, Lye, David and Davis, Joshua S. (2016) CAMERA2-combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial. Trials, 17 . doi:10.1186/s13063-016-1295-3


Author Tong, Steven Y. C.
Nelson, Jane
Paterson, David L.
Fowler, Vance G., Jr.
Howden, Benjamin P.
Cheng, Allen C.
Chatfield, Mark
Lipman, Jeffrey
Van Hal, Sebastian
O'Sullivan, Matthew
Robinson, James O.
Yahav, Dafna
Lye, David
Davis, Joshua S.
Title CAMERA2-combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial
Formatted title
CAMERA2-combination antibiotic therapy for methicillin-resistant Staphylococcus aureus infection: study protocol for a randomised controlled trial
Journal name Trials   Check publisher's open access policy
ISSN 1745-6215
1468-6708
Publication date 2016-03-31
Year available 2016
Sub-type Article (original research)
DOI 10.1186/s13063-016-1295-3
Open Access Status DOI
Volume 17
Total pages 15
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2017
Language eng
Formatted abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a serious infection resulting in 20–50 %
90-day mortality. The limitations of vancomycin, the current standard therapy for MRSA, make treatment difficult. The only other approved drug for treatment of MRSA bacteraemia, daptomycin, has not been shown to be superior to vancomycin. Surprisingly, there has been consistent in-vitro and in-vivo laboratory data demonstrating synergy between vancomycin or daptomycin and an anti-staphylococcal β-lactam antibiotic. There is also growing clinical data to support such combinations, including a recent pilot randomised controlled trial (RCT) that demonstrated a trend towards a reduction in the duration of bacteraemia in patients treated with vancomycin plus flucloxacillin compared to vancomycin alone. Our aim is to determine whether the addition of an anti-staphylococcal penicillin to standard therapy results in improved clinical outcomes in MRSA bacteraemia.

Methods/Design: We will perform an open-label, parallel-group, randomised (1:1) controlled trial at 29 sites in Australia, New Zealand, Singapore, and Israel. Adults (aged 18 years or older) with MRSA grown from at least one blood culture and able to be randomised within 72 hours of the index blood culture collection will be eligible for inclusion. Participants will be randomised to vancomycin or daptomycin (standard therapy) given intravenously or to standard therapy plus 7 days of an anti-staphylococcal β-lactam (flucloxacillin, cloxacillin, or cefazolin). The primary endpoint will be a composite outcome at 90 days of (1) all-cause mortality, (2) persistent bacteraemia at day 5 or beyond, (3) microbiological relapse, or (4) microbiological treatment failure. The recruitment target of 440 patients is based on an expected failure rate for the primary outcome of 30 % in the control arm and the ability to detect a clinically meaningful absolute decrease of 12.5 %, with a two-sided alpha of 0.05, a power of 80 %, and assuming 10 % of patients will not be evaluable for the primary endpoint.

Discussion: Key potential advantages of adding anti-staphylococcal β-lactams to standard therapy for MRSA bacteraemia
include their safety profile, low cost, and wide availability.

Trial registration: ClinicalTrials.gov Identifier: NCT02365493. Registered 24 February 2015.
Keyword Staphylococcus aureus
Methicillin-resistant
MRSA
Vancomycin
Combination
Randomised controlled trial
Daptomycin
Flucloxacillin
Cloxacillin
Cefazolin
Nafcillin
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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