ABSTRACT
Background
Traditionally, the antibiotic of choice for Methicillin-susceptible Staphylococcus aureus related blood stream infections (MSSA-BSI) are the antistaphylococcal penicillins.
Cefazolin is considered an alternative agent, with recent evidence showing similar
clinical efficacy. This study further evaluates the utility of nafcillin versus cefazolin
in MSSA bacteremia including high disease burden sources of infection and its impact
on treatment failure.
Methods
This retrospective study included patients admitted to Methodist LeBonheur Healthcare
adult hospitals from 2011 to 2016. Patients were included if they received at least
3 days of either nafcillin or cefazolin and had a positive blood culture for MSSA.
The primary objective was to evaluate rates of treatment failure between groups. Secondary
outcomes included clinical and microbiological cure, MSSA-BSI associated readmissions,
identification of risk factors for treatment failure including disease burden, in-hospital
and 90 day mortality.
Results
A total of 277 patients were included (nafcillin n = 126; cefazolin n = 151). Treatment failure and microbiologic cure were similar between nafcillin and
cefazolin (20.6% vs. 16.6%; 91.2% vs. 87.2%, respectively). Clinical cure was significantly
higher in the cefazolin treatment arm (93.4 vs. 83.3%; P = 0.012). However, the total number of patients with high disease burden was greater
in the nafcillin group (54.8% vs. 39.1%; P = 0.011). Higher rates of in-hospital mortality were observed in the nafcillin group
(15.1% vs. 6%; P = 0.016).
Conclusions
Our study observed significantly higher rates of clinical cure and reduced in-hospital
mortality in patients who received cefazolin. Further analysis is warranted to evaluate
the effectiveness of these agents and identifying predictors of treatment failure.
Key Indexing Terms
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Article info
Publication history
Published online: April 16, 2020
Accepted:
April 8,
2020
Received:
December 4,
2019
Footnotes
Disclosure: The authors have nothing to disclose.
Funding: No funding was received for this research.
Identification
Copyright
© 2020 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
