ArticleInfectious diseases and therapy2023
The Combination of Daptomycin with Fosfomycin is More Effective than Daptomycin Alone in Reducing Mortality of Vancomycin-Resistant Enterococcal Bloodstream Infections: A Retrospective, Comparative Cohort Study.
Article in Infectious diseases and therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 17 citations in OpenAlex.
- Antimicrobial Resistance in Major Gram-Positive Pathogens: Beyond the Vancomycin Border.Antibiotics (Basel, Switzerland) · 2026Review
- ManagingEClinicalMedicine · 2026Article
- Intravenous Fosfomycin for Gram-Negative and Gram-Positive Bacterial Infections: A Systematic Review of the Clinical Evidence.Antibiotics (Basel, Switzerland) · 2025Review
- Therapeutic approach to difficult-to-treat multidrug-resistant enterococcal infections.Antimicrobial agents and chemotherapy · 2025Review
- Real-World Use, Effectiveness, and Safety of Intravenous Fosfomycin: The FORTRESS Study.Infectious diseases and therapy · 2025Article
- Review
- Comparative Efficacy of High-Dose Daptomycin Monotherapy versus Combination Therapy for Daptomycin-ResistantInfection and drug resistance · 2025Article
- Overcoming the drug resistance barrier: progress in fosfomycin combination therapy against multidrug-resistant pathogens.Frontiers in microbiology · 2025Review
- Machine learning in causal inference for epidemiology.European journal of epidemiology · 2024Article
- Antibiotics with antibiofilm activity - rifampicin and beyond.Frontiers in microbiology · 2024Review
- New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended.Journal of clinical medicine · 2023Review
- Fosfomycin for Non-Urinary Tract Infections: a systematic review.Le infezioni in medicina · 2023Review
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
introductionHigh-dose daptomycin-based combinations are recommended for vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI). Preclinical data have shown a synergistic effect of daptomycin/fosfomycin combinations against VRE. However, clinical studies comparing daptomycin monotherapy with daptomycin/fosfomycin combinations are unavailable.
methodsAn observational study of VRE-BSI was performed between 2010-2021 on patients receiving daptomycin monotherapy (≥ 8 mg/kg) or daptomycin combined with intravenous fosfomycin. Patients treated with concomitant β-lactam combinations were excluded. The primary outcome was in-hospital mortality. Outcomes were analyzed using multivariable logistic regression and augmented inverse probability weighting (AIPW) analyses.
resultsAmong 224 patients, 176 received daptomycin monotherapy, and 48 received fosfomycin combinations. The median daptomycin and fosfomycin doses were 9.8 mg/kg and 12 g/day, respectively. In-hospital mortality was 77.3% and 47.9% in the daptomycin monotherapy and fosfomycin combination groups (P < 0.001), respectively. Multivariable logistic regression analysis predicted lower mortality with fosfomycin combination treatment (adjusted odds ratio, 0.35; 95% confidence interval (CI), 0.17-0.73; P = 0.005). AIPW demonstrated a 17.8% reduced mortality with fosfomycin combinations (95% CI, - 30.6- - 4.9%; P = 0.007). The survival benefit was significant, especially among patients with a lower Pitt bacteremia score or fosfomycin minimum inhibitory concentration (MIC) ≤ 64 mg/l. Fosfomycin combination resulted in higher hypernatremia (10.4% vs. 2.8%, P = 0.04) and hypokalemia (33.3% vs. 15.3%, P = 0.009) compared to daptomycin monotherapy.
conclusionThe combination of high-dose daptomycin with fosfomycin improved the survival rate of patients with VRE-BSI compared to daptomycin alone. The benefit of the combination was most pronounced for VRE with fosfomycin MIC ≤ 64 mg/l and for patients with a low Pitt bacteremia score.
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