2026 Eastern States Conference

Clinical outcomes of daptomycin and ceftaroline combination therapy in methicillin-resistant Staphylococcus aureus bacteremia
Bailey Coleman, PharmD; Meredith Todd, PharmD, BCPS, BCIDP; Brian Burton, MS
Learning Objective
Describe the risks of 30-day recurrence, in-hospital mortality, and readmission with combination daptomycin and ceftaroline versus early de-escalation in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.
Self Assessment Question
True or False: Early use of combination daptomycin and ceftaroline therapy may influence clinical outcomes in MRSA bacteremia.
Background
This study aims to evaluate clinical outcomes of combination daptomycin and ceftaroline therapy for MRSA bacteremia. Vancomycin or daptomycin are first-line agents, though the optimal timing and duration of combination therapy remain unclear.
Methods 
This retrospective observational study screened patients between September 14, 2016, and May 31, 2025. The primary outcome was a composite of clinical failure, including 30-day recurrence, in-hospital mortality, and 30-day readmission. Secondary outcomes included bacteremia duration and antibiotic exposure, including time to escalation, combination therapy duration, and monotherapy duration after de-escalation. Patients receiving more than 7 days of combination therapy were assigned to cohort 1, and those de-escalated within 7 days comprised cohort 2.
Results 
Among the 54 patients included in this study, there were n=46 patients in cohort 1 and n=8 patients in cohort 2. The primary outcome of 30-day recurrence occurred in 6.5% vs. 25% (p=0.15), in-hospital mortality in 4.3% vs. 0% (p=1.00), and 30-day readmission in 15.2% vs. 50% (p=0.05) in cohorts 1 and 2, respectively.
Conclusion
Based on data collected, there were no significant differences in 30-day recurrence, in-hospital mortality, or bacteremia duration between prolonged combination therapy and early de-escalation. However, 30-day readmission was higher among patients de-escalated within 7 days, suggesting daptomycin plus ceftaroline may be an acceptable alternative for MRSA bacteremia, though larger studies are needed to evaluate earlier use.