4CPS-255 Clinical experience of ceftaroline use in a third level hospital

Background and importance Ceftaroline is approved for the treatment of complicated skin and soft tissue infections (cSSSI), and community acquired pneumonia (CAP). However, the most specific aspect of the drug is that it is a beta-lactam with activity against methicillin resistant Staphylococcus aureus (MRSA). These characteristics mean that a large part of its use in clinical practice is in off-label indications. Aim and objectives To determine the use of ceftaroline in the clinical practice of a third level hospital, and its effectiveness and safety. Material and methods An observational retrospective study was conducted that included all patients treated with ceftaroline in the hospital from May 2016 to September 2020. Variables studied were: age, sex, indication, dose, microorganism, clinical and microbiological cure, and adverse effects. Results 57 patients received treatment with ceftaroline, 75.4% men, with a median age of 69 years (28–89). In 11/57 patients it was used as empirical treatment (for suspected multiresistant germ) and in 46/57 as directed treatment, for the following indications: 13 bacteraemia, 14 endocarditis (with bacteraemia), 15 pneumonia (11 with bacteraemia, 1 with CNS infection and 2 with cSSSI), 2 cSSSI and 2 CNS infection. Infections were caused by MRSA in 23/46 patients, 15/46 by methicillin resistant coagulase negative Staphylococcus, 5/46 methicillin sensitive Staphylococcus aureus (MSAS), 2/46 Streptococcus pneumoniae and in 1 patient due to MSAS and Streptococcus pneumoniae. Methicillin resistant microorganisms caused the infections in 38/46 patients. The median duration of treatment was 7 days (1–42). Posology: 600 mg/8 hours was used in bacteraemia, endocarditis and in CNS infection, and 600 mg/12 hours in cSSSI. The regimen used in pneumonia was 600 mg/12 hours in 6/15 patients and 600 mg/8 hours in 9/15 patients (8 of whom had bacteraemia and one had concomitant CNS infection). The dosage used in the empirical treatment was 600 mg/12 hours in eight patients and 600 mg/8 hours in three. In six patients it was adjusted for renal function. 78.7% of the patients presented with clinical resolution (82.9% microbiological). Thrombopenia was detected in two patients, probably associated with treatment with the drug. Conclusion and relevance Our results suggested that ceftaroline was effective in severe cases of methicillin resistant gram positive infections. In most cases, ceftaroline was used for off-label indications. In these cases, higher dosages are being recommended, which are usually prolonged in time, so it is advisable to evaluate the profile of adverse effects. References and/or acknowledgements Conflict of interest No conflict of interest