Comparison of Cefazolin versus Oxacillin for Treatment of Complicated Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus
Comparison of Cefazolin versus Oxacillin for Treatment of Complicated Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus
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DOI：
10.1128/aac.02800-14
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发表时间：
2014-09-01
影响因子：
4.9
通讯作者：
Lewis, James S., II
中科院分区：
文献类型：
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作者：
Li, Julius;Echevarria, Kelly L.;Lewis, James S., II
先前的病例报告描述了头孢唑林治疗甲氧西林敏感金黄色葡萄球菌（MSSA）感染的偶尔临床失败，最近的研究表明头孢唑林和抗葡萄球菌青霉素治疗MSSA菌血症的结果没有差异。虽然有希望，但这些研究描述了低频率的高接种感染，如心内膜炎。本回顾性研究比较了2008年1月至2012年6月在两家三级医院使用头孢唑林和奥西林治疗复杂的MSSA菌血症的临床结果。59例患者接受头孢唑林治疗，34例患者接受奥西林治疗。骨关节（41%）和血管内（20%）是主要的感染部位。头孢唑林和oxacillin治疗结束时的临床治愈率相似（95%对88%，P = 0.25），但oxacillin组90天的总体失败率更高（47%对24%，P = 0.04）。失败的患者更有可能接受手术干预（63%对40%，P = 0.05）和骨关节源（57%对33%，P = 0.04）。失败的菌血症持续时间也更长（7天vs 3天；P = 0.0002），这是失败的唯一预测因素。抗生素的选择不能预测失败。奥西林组的药物不良事件发生率更高（30%对3%，P = 0.0006），奥西林组更频繁地因药物不良事件而停药（21%对3%，P = 0.01）。头孢唑林在治疗复杂的MSSA菌血症方面与奥西林相似，但安全性显著提高。奥西林失败率较高可能与其他患者因素相混淆，值得进一步调查。
Contrary to prior case reports that described occasional clinical failures with cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infections, recent studies have demonstrated no difference in outcomes between cefazolin and antistaphylococcal penicillins for the treatment of MSSA bacteremia. While promising, these studies described low frequencies of high-inoculum infections, such as endocarditis. This retrospective study compares clinical outcomes of cefazolin versus oxacillin for complicated MSSA bacteremia at two tertiary care hospitals between January 2008 and June 2012. Fifty-nine patients treated with cefazolin and 34 patients treated with oxacillin were included. Osteoarticular (41%) and endovascular (20%) sources were the predominant sites of infection. The rates of clinical cure at the end of therapy were similar between cefazolin and oxacillin (95% versus 88%; P = 0.25), but overall failure at 90 days was higher in the oxacillin arm (47% versus 24%; P = 0.04). Failures were more likely to have received surgical interventions (63% versus 40%; P = 0.05) and to have an osteoarticular source (57% versus 33%; P = 0.04). Failures also had a longer duration of bacteremia (7 versus 3 days; P = 0.0002), which was the only predictor of failure. Antibiotic selection was not predictive of failure. Rates of adverse drug events were higher in the oxacillin arm (30% versus 3%; P = 0.0006), and oxacillin was more frequently discontinued due to adverse drug events (21% versus 3%; P = 0.01). Cefazolin appears similar to oxacillin for the treatment of complicated MSSA bacteremia but with significantly improved safety. The higher rates of failure with oxacillin may have been confounded by other patient factors and warrant further investigation.