Treatment Outcomes of Cefazolin versus Oxacillin for Deep-Seated Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections.
Antimicrob Agents Chemother. 2015 Jun 15;
Authors: Rao SN, Rhodes NJ, Lee BJ, Scheetz MH, Hanson AP, Segreti J, Crank CW, Wang SK
Abstract
Clinical preference of a semisynthetic penicillin (oxacillin or nafcillin) over cefazolin for deep-seated methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI) perseveres despite limited data to support this approach. A retrospective, cohort study of patients treated for MSSA BSI with either oxacillin or cefazolin across two medical centers in Chicago, Illinois. Outcome measures included documented in-hospital treatment failure, all cause in-hospital mortality, duration of MSSA BSI, and incidence of documented adverse events. Of 161 patients with MSSA BSI, 103 (64%) received cefazolin and 58 (36%) oxacillin. Identified sources of BSI were central line (37.9%), osteoarticular (18%), and skin and soft tissue (17.4%). Patients with endocarditis (n=29/52; 44.2%) and other deep-seated infections (n=23/52; 55.8%) were classified under the subset of deep-seated infections (n=52/161; 32.3%). Multivariate models found deep-seated infection (aOR=4.52, 95% CI: 1.23-16.6; P=0.023), metastatic disease (aOR=4.21, 95% CI: 1.13-15.7; P=0.033), and ICU onset of infection (aOR = 4.80, 95% CI: 1.26-18.4; P=0.022) to be independent risk factors for in-hospital treatment failure. Treatment group was not an independent predictor of failure (aOR=3.76, 95% CI: 0.98-14.4; P=0.053). Treatment failure was similar among cefazolin (n=5/32; 15.6%) and oxacillin (n=4/20; 20.0%) treated patients (P=0.72) in the subset of deep-seated infections. Mortality was observed in 1 (1%) and 3 (5.2%) cases of cefazolin and oxacillin treated patients, respectively (P=0.13). Cefazolin was not associated with higher rates of treatment failure and appears to be an effective alternative to oxacillin for deep-seated MSSA BSI.
PMID: 26077253 [PubMed - as supplied by publisher]