Updates on Combination Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with a large clinical burden and high rates of treatment failure with first-line treatment options. Literature for combination antimicrobial therapies for initial treatment or salvage therapy in the setting of persistent bacteremia is developing. Various combination strategies have emerged for the treatment of MRSA bacteremia, including vancomycin or daptomycin in combination with either anti-staphylococcal penicillins, early- and late-generation cephalosporins, ceftaroline, trimethoprim-sulfamethoxazole, or fosfomycin. When used as second-line or salvage therapy, evidence suggests use of these combinations shorten the duration of bacteremia. More recently, data have emerged evaluating this strategy for initial therapy, although results are conflicting. Use of combination therapy for MRSA bacteremia may shorten bacteremia duration, but the optimal combination, doses, timing of use, and exact impact on clinical outcomes are still evolving.