Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
April 12, 2026 · via Europe PMC
Association between β-lactam exposure and clearance of bacteraemia and acute kidney injury in patients with methicillin-resistant Staphylococcus aureus bloodstream infections-a post hoc analysis of the CAMERA2 trial.
Petersiel N, Legg A, Ong SWX, +7 more, Combination Antibiotics for Methicillin-Resistant Staphylococcus aureus (CAMERA2) Study Group.
AI summary — for doctors, generated from the abstract only
In a CAMERA2 post hoc analysis, brief empiric beta-lactam use sped clearance of MRSA bacteraemia without much added kidney injury, while longer use raised kidney injury sharply.
What was studied
A post hoc analysis of the CAMERA2 randomized trial examining how duration of beta-lactam therapy, including empiric treatment before randomization, related to clearance of MRSA bacteraemia and acute kidney injury, with exposure categorized as Early, Late, Throughout or None.
Key findings
- Versus no beta-lactam (n=74), adjusted hazard ratios for faster bacteraemia clearance were 1.59 (1.16-2.19) for Early (n=104), 1.62 (1.14-2.31) for Late (n=63) and 1.85 (1.36-2.52) for Throughout (n=111)
- For acute kidney injury versus None (n=61), adjusted odds ratios were 1.24 (0.27-6.60) for Early (n=81), 6.01 (1.61-29.60) for Late (n=52) and 7.93 (2.43-36.30) for Throughout (n=92)
Clinical relevance
The pattern suggests short empiric antistaphylococcal beta-lactam exposure may offer microbiological benefit at lower nephrotoxicity cost than a full 7-day course, but this is a post hoc observational analysis within a trial and not a basis for changing practice.
Who should care
Limitations
Post hoc, non-randomized comparison of exposure groups with wide confidence intervals and probable confounding by indication.
How long the beta-lactam is given seems to decide whether the benefit outweighs the kidney risk.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
In the Combination Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus (CAMERA2) trial, combination of vancomycin and 7 days of a β-lactam resulted in faster clearance of methicillin-resistant Staphylococcus aureus bacteraemia and higher rates of nephrotoxicity compared with monotherapy. Many participants received empirical β-lactam prior to enrolment. Whether the duration of β-lactam use, including the empiric treatment, impacts clinical and microbiological outcomes is unclear.
Methods
In a post hoc analysis of the CAMERA2 study, we investigated the impact of β-lactam therapy duration on the hazard ratio for clearance of bacteraemia and the odds ratio (OR) for development of acute kidney injury (AKI). β-Lactam use was categorized as 'Early' (any β-lactam for ≥24 hours from time of blood culture collection until trial randomization), 'Late' ([flu]cloxacillin or cefazolin for 7 days, only after randomization), 'Throughout' (Early + Late) or 'None' (<24 hours of any β-lactam). Participants requiring renal replacement therapy at baseline were excluded from assessment of AKI.
Results
Compared with no β-lactam treatment (n = 74), 'Early' (n = 104), 'Late' (n = 63) or 'Throughout' (n = 111) β-lactam receipt was associated with adjusted hazard ratios (95% CI) for faster clearance of bacteraemia of 1.59 (1.16-2.19), 1.62 (1.14-2.31) and 1.85 (1.36-2.52), respectively. Compared with 'None' (n = 61), 'Early' (n = 81), 'Late' (n = 52) and 'Throughout' (n = 92) groups had adjusted ORs of AKI of 1.24 (0.27-6.60), 6.01 (1.61-29.60) and 7.93 (2.43-36.30), respectively.
Conclusions
Combination treatment with a β-lactam was associated with a duration-dependent effect on clearance of bacteraemia and AKI. Short-duration antistaphylococcal β-lactam during the empiric treatment period was associated with faster clearance of methicillin-resistant S. aureus bacteraemia, and may not substantially increase the risk of nephrotoxicity.
DOI
10.1016/j.cmi.2026.04.006
PMID
41974351
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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