Longer-term Mortality and Kidney Outcomes of Participants in the Combination Antibiotics for Methicillin-Resistant (CAMERA2) Trial: A Post Hoc Analysis

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2023 Jul 27

PMID 37496601

Authors

Amy Legg

Matthew A Roberts

Jane Davies

Alan Cass

Niamh Meagher

Archana Sud

Vered Daitch

Yael Dishon Benattar

Dafna Yahav

Mical Paul

Chen Xinxin

Yeo He Ping

David Lye

Russel Lee

J Owen Robinson

Hong Foo

Adrian R Tramontana

Narin Bak

Adelaide Grenfell

Benjamin Rogers

Ying Li

Neela Joshi

Matthew OSullivan

Genevieve McKew

Niladri Ghosh

Kellie Schneider

Natasha E Holmes

Ravindra Dotel

Timothy Chia

Sophia Archuleta

Simon Smith

Morgyn S Warner

Christina Titin

Shirin Kalimuddin

Jason A Roberts

Steven Y C Tong

Joshua S Davis

Affiliations

Soon will be listed here.

Abstract

Background: The Combination Antibiotic Therapy for Methicillin-Resistant (CAMERA2) trial ceased recruitment in July 2018, noting that a higher proportion of patients in the intervention arm (combination therapy) developed acute kidney injury (AKI) compared to the standard therapy (monotherapy) arm. We analyzed the long-term outcomes of participants in CAMERA2 to understand the impact of combination antibiotic therapy and AKI.

Methods: Trial sites obtained additional follow-up data. The primary outcome was all-cause mortality, censored at death or the date of last known follow-up. Secondary outcomes included kidney failure or a reduction in kidney function (a 40% reduction in estimated glomerular filtration rate to <60 mL/minute/1.73 m). To determine independent predictors of mortality in this cohort, adjusted hazard ratios were calculated using a Cox proportional hazards regression model.

Results: This post hoc analysis included extended follow-up data for 260 patients. Overall, 123 of 260 (47%) of participants died, with a median population survival estimate of 3.4 years (235 deaths per 1000 person-years). Fifty-five patients died within 90 days after CAMERA2 trial randomization; another 68 deaths occurred after day 90. Using univariable Cox proportional hazards regression, mortality was not associated with either the assigned treatment arm in CAMERA2 (hazard ratio [HR], 0.84 [95% confidence interval [CI], .59-1.19]; = .33) or experiencing an AKI (HR at 1 year, 1.04 [95% CI, .64-1.68]; = .88).

Conclusions: In this cohort of patients hospitalized with methicillin-resistant bacteremia, we found no association between either treatment arm of the CAMERA2 trial or AKI (using CAMERA2 trial definition) and longer-term mortality.

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