6/28/23, 12:02 AM CAMERA2 Pathway Feedback Search Clinical Topics Home Studies CAMERA2 CAMERA2 Disease Disease Disease Catheter-related bloodstream in Cellulitis Commu Trial question What is the role of combining antistaphylococcal -lactam and standard therapy in MRSA bacteremia? Study design Multi-center Open label RCT Population Characteristics of study participants 34.0% female N = 352 66.0% male 352 patients (121 female, 231 male) Inclusion criteria: hospitalized adults with MRSA bacteremia Key exclusion criteria: history of type 1 hypersensitivity reaction to -lactams; polymicrobial bacteremia; pregnancy; currently receiving -lactam therapy that could not be ceased or substituted for a non- -lactam antibiotic; death expected in the next 48 hours; treatment limitations precluding the use of antibiotics Interventions N=174 combination therapy (an antistaphylococcal -lactam [intravenous flucloxacillin, cloxacillin, or cefazolin] plus intravenous vancomycin or daptomycin) N=178 standard therapy (intravenous vancomycin or daptomycin) Primary outcome https://web.pathway.md/studies/rec6xfIbWNkELBpX0 1/2 6/28/23, 12:02 AM CAMERA2 Pathway Death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days 39.0 % 39 35 29.3 % 19.5 % 9.8 % No significant difference 0.0 % Combination therapy Standard therapy No significant difference in death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days (35% vs. 39%; AD -4.2%, 95% CI -14.3 to 6) Secondary outcomes No significant difference in death from all causes at 90 days (21% vs. 16%; AD 4.5%, 95% CI -3.7 to 12.7) Significant decrease in persistent bacteremia at day 5 (11% vs. 20%; AD -8.9%, 95% CI -16.6 to -1.2) Significant increase in AKI (excluding patients receiving dialysis at baseline) (23% vs. 6%; AD 17.2%, 95% CI 9.3 to 25.2) Safety outcomes No significant difference in microbiological treatment failure or microbiological relapse. Significant differences in adverse events (13.2% vs. 3.9%), AKI (7.5% vs. 0.6%). Conclusion In hospitalized adults with MRSA bacteremia, combination therapy was not superior to standard therapy with respect to death, persistent bacteremia at day 5, microbiological relapse, or microbiological treatment failure at 90 days. Reference Steven Y C Tong, David C Lye, Dafna Yahav et al. Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal -Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial. JAMA. 2020 Feb 11;323(6):527-537. Open reference URL https://web.pathway.md/studies/rec6xfIbWNkELBpX0 2/2