Anthony D Bai1, Adrienne Showler2, Lisa Burry3, Marilyn Steinberg4, Daniel R Ricciuto5, Tania Fernandes6, Anna Chiu6, Sumit Raybardhan7, Michelle Science8, Eshan Fernando1, George Tomlinson9, Chaim M Bell10, Andrew M Morris11. 1. Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada. 3. Mount Sinai Hospital, Toronto, Ontario, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada. 4. Mount Sinai Hospital, Toronto, Ontario, Canada. 5. Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada Lakeridge Health, Oshawa, Ontario, Canada. 6. Trillium Health Partners, Mississauga, Ontario, Canada. 7. North York General Hospital, Toronto, Ontario, Canada. 8. Hospital for Sick Children, Toronto, Ontario, Canada. 9. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 10. Department of Medicine, University of Toronto, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 11. Department of Medicine, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada amorris@mtsinai.on.ca.
Abstract
OBJECTIVES: We compared the effectiveness of cefazolin versus cloxacillin in the treatment of MSSA bacteraemia in terms of mortality and relapse. METHODS: A retrospective cohort study examined consecutive patients with Staphylococcus aureus bacteraemia from six academic and community hospitals between 2007 and 2010. Patients with MSSA bacteraemia who received cefazolin or cloxacillin as the predominant definitive antibiotic therapy were included in the study. Ninety-day mortality was compared between the two groups matched by propensity scores. RESULTS: Of 354 patients included in the study, 105 (30%) received cefazolin and 249 (70%) received cloxacillin as the definitive antibiotic therapy. In 90 days, 96 (27%) patients died: 21/105 (20%) in the cefazolin group and 75/249 (30%) in the cloxacillin group. Within 90 days, 10 patients (3%) had a relapse of S. aureus infection: 6/105 (6%) in the cefazolin group and 4/249 (2%) in the cloxacillin group. All relapses in the cefazolin group were related to a deep-seated infection. Based on the estimated propensity score, 90 patients in the cefazolin group were matched with 90 patients in the cloxacillin group. In the propensity score-matched groups, cefazolin had an HR of 0.58 (95% CI 0.31-1.08, P = 0.0846) for 90 day mortality. CONCLUSIONS: There was no significant clinical difference between cefazolin and cloxacillin in the treatment of MSSA bacteraemia with respect to mortality. Cefazolin was associated with non-significantly more relapses compared with cloxacillin, especially in deep-seated S. aureus infections.
OBJECTIVES: We compared the effectiveness of cefazolin versus cloxacillin in the treatment of MSSA bacteraemia in terms of mortality and relapse. METHODS: A retrospective cohort study examined consecutive patients with Staphylococcus aureus bacteraemia from six academic and community hospitals between 2007 and 2010. Patients with MSSA bacteraemia who received cefazolin or cloxacillin as the predominant definitive antibiotic therapy were included in the study. Ninety-day mortality was compared between the two groups matched by propensity scores. RESULTS: Of 354 patients included in the study, 105 (30%) received cefazolin and 249 (70%) received cloxacillin as the definitive antibiotic therapy. In 90 days, 96 (27%) patients died: 21/105 (20%) in the cefazolin group and 75/249 (30%) in the cloxacillin group. Within 90 days, 10 patients (3%) had a relapse of S. aureus infection: 6/105 (6%) in the cefazolin group and 4/249 (2%) in the cloxacillin group. All relapses in the cefazolin group were related to a deep-seated infection. Based on the estimated propensity score, 90 patients in the cefazolin group were matched with 90 patients in the cloxacillin group. In the propensity score-matched groups, cefazolin had an HR of 0.58 (95% CI 0.31-1.08, P = 0.0846) for 90 day mortality. CONCLUSIONS: There was no significant clinical difference between cefazolin and cloxacillin in the treatment of MSSA bacteraemia with respect to mortality. Cefazolin was associated with non-significantly more relapses compared with cloxacillin, especially in deep-seated S. aureus infections.
Authors: G Sasson; A D Bai; A Showler; L Burry; M Steinberg; D R Ricciuto; T Fernandes; A Chiu; S Raybardhan; M Science; E Fernando; A M Morris; C M Bell Journal: Eur J Clin Microbiol Infect Dis Date: 2017-03-01 Impact factor: 3.267
Authors: S Pollett; S M Baxi; G W Rutherford; S B Doernberg; P Bacchetti; H F Chambers Journal: Antimicrob Agents Chemother Date: 2016-07-22 Impact factor: 5.191
Authors: Maya Beganovic; Jaclyn A Cusumano; Vrishali Lopes; Kerry L LaPlante; Aisling R Caffrey Journal: Open Forum Infect Dis Date: 2019-06-06 Impact factor: 3.835
Authors: B Lefèvre; B Hoen; F Goehringer; W Ngueyon Sime; N Aissa; C Alauzet; E Jeanmaire; S Hénard; L Filippetti; C Selton-Suty; N Agrinier Journal: Eur J Clin Microbiol Infect Dis Date: 2021-08-12 Impact factor: 3.267