Comparison of cefazolin versus oxacillin for the treatment of complicated bacteremia caused by methicillin-susceptible Staphylococcus aureus.
Antimicrob Agents Chemother. 2014 Jun 16;
Authors: Li J, Echevarria KL, Hughes DW, Cadena JA, Bowling JE, Lewis JS
Contrary to prior case reports describing occasional clinical failures with cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infections, recent studies demonstrated no difference in outcomes between cefazolin and antistaphylococcal penicillins for the treatment of MSSA bacteremia. While promising, these studies had low frequencies of high inoculum infections, such as endocarditis. This retrospective study compares clinical outcomes of cefazolin to 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 sources (20%) were the predominant sites of infection. Clinical cure at the end of therapy was 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 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 in 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 warrants further investigation.
PMID: 24936596 [PubMed - as supplied by publisher]