Evidence map›Paper›PMID 29859132›Full record

Trial reportTrials2018

A randomized phase 2B trial of vancomycin versus daptomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteremia due to isolates with high vancomycin minimum inhibitory concentrations - results of a prematurely terminated study.

Shirin Kalimuddin, Yvonne F Z Chan, Rachel Phillips, Siew Pei Ong, Sophia Archuleta, David Chien Lye, Thuan Tong Tan, Jenny G H Low

Registry-linked trialOpen access · goldAbstract readClinical Trial, Phase IIComparative StudyRandomized Controlled Trial
In one paragraph

Trial report in Trials, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01975662 (A Multi-centre Open Label Randomized Controlled Phase IIB Trial Comparing Vancomycin Versus Daptomycin for the Treatment of MRSA Bacteremia Due to Isolates With High Vancomycin Minimum Inhibitory Concentrations), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
0.9field-weighted citation impact, top 28% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01975662 phase2terminatednot on this map

A Multi-centre Open Label Randomized Controlled Phase IIB Trial Comparing Vancomycin Versus Daptomycin for the Treatment of MRSA Bacteremia Due to Isolates With High Vancomycin Minimum Inhibitory Concentrations

TypeinterventionalSponsorSingapore General HospitalRan2014 to 2015Enrolled14ConditionsBacteremia Due to Staphylococcus AureusArmsDaptomycin, Vancomycin
3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Article
  8. Clinical Practice Variation Among Adult Infectious Disease Physicians in the Management of Staphylococcus aureus Bacteremia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2019
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 2 countries.

Shirin KalimuddinDepartment of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore. shirin.kalimuddin@singhealth.com.sg.
Yvonne F Z ChanDepartment of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
Rachel PhillipsSchool of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, Guy's Campus, London, SE1 1UL, UK.
Siew Pei OngGeriatric Education and Research Institute, 2 Yishun Central 2, Singapore, 768024, Singapore.
Sophia ArchuletaDivision of Infectious Diseases, National University Health System, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore.
David Chien LyeDepartment of Infectious Diseases, Communicable Disease Centre, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Thuan Tong TanDepartment of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
Jenny G H LowDepartment of Infectious Diseases, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.
Singapore General Hospital · SGGeriatric Education and Research Institute · SGKing's College London · GBNational University of Singapore · SGTan Tock Seng Hospital · SG

Funding

Ministry of Health -Singapore SIDI/2013/007
6 · The paper itself

Abstract

backgroundStudies have suggested the reduced effectiveness of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections with high vancomycin minimum inhibitory concentrations. Alternative agents such as daptomycin may be considered. We conducted a randomized controlled study comparing daptomycin against vancomycin in the treatment of MRSA bloodstream infections with high vancomycin minimum inhibitory concentrations.

methodsPatients were randomized to receive vancomycin or daptomycin for a minimum of 14 days. The primary end point was the rate of all-cause mortality at day 60.

resultsA total of 14 patients were randomized in this study, with 7 patients in each treatment arm. The study was terminated early due to slow patient accrual. At day 60, there was one death in the vancomycin arm and none in the daptomycin arm. The median time to microbiological clearance was 4 days in both arms (IQR 3-5 days in the vancomycin arm and 3-7 days in daptomycin arm). Only one patient in the vancomycin arm had recurrence of bacteremia. Rates of adverse events were similar in both arms. There was one case of musculoskeletal toxicity and one case of drug-related nephrotoxicity - both events occurred in the daptomycin arm. None of the patients in either treatment arm required cessation of study treatment or addition of a second anti-MRSA agent because of worsening infection.

conclusionBased on the limited number of patients evaluated in this study, it remains unclear if alternative, more expensive agents such as daptomycin are superior to vancomycin in the treatment of high vancomycin minimum inhibitory concentration MRSA bloodstream infections. More studies are urgently needed but investigators may wish to consider employing novel, alternative trial methodologies to ensure a greater chance of success.

trial registrationClinicalTrials.gov, NCT01975662 . Registered on 5 November 2013.

Indexed as

AgedAnti-Bacterial AgentsBacteremiaCause of DeathDaptomycinDrug Resistance, BacterialEarly Termination of Clinical TrialsFemaleHumansMaleMethicillin-Resistant Staphylococcus aureusMicrobial Sensitivity TestsMiddle AgedPredictive Value of TestsRecurrenceSingaporeAnti-Bacterial AgentsDaptomycinVancomycinBacteremiaDaptomycinMethicillin-resistant Staphylococcus aureusMinimum inhibitory concentrationVancomycin

Identifiers

PMID29859132
PMCPMC5984763
OpenAlexW2807625228

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.