Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea
- 주제(키워드) Bacteraemia , Cefazolin , Inoculum effect , Nafcillin , Staphylococcus aureus
- 주제(기타) Infectious Diseases; Microbiology
- 설명문(일반) [Lee, S.; Lee, S. H.] Pusan Natl Univ, Sch Med, Dept Internal Med, Busan, South Korea; [Lee, S.; Lee, S. H.] Pusan Natl Univ Hosp, Med Res Inst, Busan, South Korea; [Song, K. -H.; Park, W. B.; Kim, E. S.; Kim, N. J.; Kim, H. B.] Seoul Natl Univ, Coll Med, Dept Internal Med, 173 Gumi Ro, Seongnam, South Korea; [Song, K. -H.; Kim, E. S.; Kim, H. B.] Seoul Natl Univ, Bundang Hosp, 173 Gumi Ro, Seongnam, South Korea; [Jung, S. -I.; Park, K. -H.] Chonnam Natl Univ, Med Sch, Dept Infect Dis, Gwangju, South Korea; [Park, W. B.; Kim, N. J.] Seoul Natl Univ Hosp, Seoul, South Korea; [Kim, Y. -S.] Chungnam Natl Univ, Chungnam Natl Univ Hosp, Sch Med, Div Infect Dis, Daejeon, South Korea; [Jang, H. -C.] Chonnam Natl Univ, Hwasun Hosp, Dept Internal Med, Hwasun, Jeollanam Do, South Korea; [Kwak, Y. G.] Inje Univ, Ilsan Paik Hosp, Dept Internal Med, Goyang, South Korea; [Kim, Y. K.] Yonsei Univ, Med Sch, Dept Internal Med, Wonju, South Korea; [Kiem, S. M.] Inje Univ, Coll Med, Dept Internal Med, Busan, South Korea; [Kim, H. -I.] Daegu Fatima Hosp, Dept Internal Med, Daegu, South Korea
- 등재 SCIE, SCOPUS
- 발행기관 ELSEVIER SCI LTD
- 발행년도 2018
- URI http://www.dcollection.net/handler/ewha/000000160580
- 본문언어 영어
- Published As http://dx.doi.org/10.1016/j.cmi.2017.07.001
초록/요약
Objectives: No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Methods: A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (>= 15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. Results: Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. Conclusions: Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE. (c) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
more