Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia
Background: Anti-staphylococcal penicillins have long been the first-line treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Recent retrospective data comparing nafcillin and cefazolin report similar clinical efficacy despite concerns about high inoculum MSSA infec...
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doaj-94a6c47e22134182a077274e7bf00fe22020-11-25T00:14:30ZengElsevierJournal of Infection and Public Health1876-03412018-09-01115727731Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremiaMarguerite L. Monogue0Jessica K. Ortwine1Wenjing Wei2Khalid Eljaaly3Kavita P. Bhavan4University of Texas Southwestern Medical Center, Dallas, TX, United States; Corresponding author at: University of Texas Southwestern Medical Center, 6201 Harry Hines Blvd., Dallas, TX 75390, United States.Parkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United StatesParkland Hlth. and Hosp. System, Dallas, TX, United States; University of Texas Southwestern Medical School, Dallas, TX, United StatesDepartment of Clinical Pharmacy, King Abdulaziz University, Saudi Arabia; College of Pharmacy, University of Arizona, United StatesUniversity of Texas Southwestern Medical School, Dallas, TX, United States; University of Texas Southwestern Med. Ctr., Department of Medicine, Infectious Disease, Dallas, TX, United StatesBackground: Anti-staphylococcal penicillins have long been the first-line treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Recent retrospective data comparing nafcillin and cefazolin report similar clinical efficacy despite concerns about high inoculum MSSA infections. Methods: This was a retrospective, non-inferiority, cohort study comparing treatment failure rates between nafcillin and cefazolin in patients with MSSA bacteremia from any source, other than meningitis. Multiple logistic regression was used to adjust for confounding variables. Results: A total of 142 patients were included in the study. The overall treatment failure rate among patients receiving cefazolin was non-inferior to nafcillin (11.3% versus 8.5%; 90% confidence interval −5.2% to 10.8%). Rates of adverse drug events were significantly higher in the nafcillin arm (19.7% versus 7%; p = 0.046). After adjustment for confounding variables, no difference between treatment groups was found in treatment failure (adjusted odds ratio (OR) = 1.2; 95% CI, 0.3–4.5), but nafcillin was associated with significantly higher nephrotoxicity (adjusted odds ratio (OR) = 5.4; 95% CI, 1.1–26.8). Conclusion: Cefazolin was associated with lower nephrotoxicity and similar treatment failure rates compared to nafcillin suggesting that cefazolin is an appealing first line agent for most MSSA bloodstream infections. Keywords: Nafcillin, Cefazolin, Methicillin-susceptible Staphylococcus aureus, MSSA, Bacteremiahttp://www.sciencedirect.com/science/article/pii/S1876034118300297 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Marguerite L. Monogue Jessica K. Ortwine Wenjing Wei Khalid Eljaaly Kavita P. Bhavan |
spellingShingle |
Marguerite L. Monogue Jessica K. Ortwine Wenjing Wei Khalid Eljaaly Kavita P. Bhavan Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia Journal of Infection and Public Health |
author_facet |
Marguerite L. Monogue Jessica K. Ortwine Wenjing Wei Khalid Eljaaly Kavita P. Bhavan |
author_sort |
Marguerite L. Monogue |
title |
Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia |
title_short |
Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia |
title_full |
Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia |
title_fullStr |
Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia |
title_full_unstemmed |
Nafcillin versus cefazolin for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia |
title_sort |
nafcillin versus cefazolin for the treatment of methicillin-susceptible staphylococcus aureus bacteremia |
publisher |
Elsevier |
series |
Journal of Infection and Public Health |
issn |
1876-0341 |
publishDate |
2018-09-01 |
description |
Background: Anti-staphylococcal penicillins have long been the first-line treatment option for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Recent retrospective data comparing nafcillin and cefazolin report similar clinical efficacy despite concerns about high inoculum MSSA infections. Methods: This was a retrospective, non-inferiority, cohort study comparing treatment failure rates between nafcillin and cefazolin in patients with MSSA bacteremia from any source, other than meningitis. Multiple logistic regression was used to adjust for confounding variables. Results: A total of 142 patients were included in the study. The overall treatment failure rate among patients receiving cefazolin was non-inferior to nafcillin (11.3% versus 8.5%; 90% confidence interval −5.2% to 10.8%). Rates of adverse drug events were significantly higher in the nafcillin arm (19.7% versus 7%; p = 0.046). After adjustment for confounding variables, no difference between treatment groups was found in treatment failure (adjusted odds ratio (OR) = 1.2; 95% CI, 0.3–4.5), but nafcillin was associated with significantly higher nephrotoxicity (adjusted odds ratio (OR) = 5.4; 95% CI, 1.1–26.8). Conclusion: Cefazolin was associated with lower nephrotoxicity and similar treatment failure rates compared to nafcillin suggesting that cefazolin is an appealing first line agent for most MSSA bloodstream infections. Keywords: Nafcillin, Cefazolin, Methicillin-susceptible Staphylococcus aureus, MSSA, Bacteremia |
url |
http://www.sciencedirect.com/science/article/pii/S1876034118300297 |
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