回顾性比较头孢曲松与苯唑西林治疗耐甲氧西林金黄色葡萄球菌引起的骨和关节感染。
A retrospective comparison of ceftriaxone versus oxacillin for osteoarticular infections due to methicillin-susceptible Staphylococcus aureus.
机构信息
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri 63110, USA.
出版信息
Clin Infect Dis. 2012 Mar 1;54(5):585-90. doi: 10.1093/cid/cir857. Epub 2011 Dec 5.
BACKGROUND
Antistaphylococcal penicillins are the treatment of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infection. Ceftriaxone can be dosed once daily and is less expensive for outpatient therapy than oxacillin. We compared patient outcomes of MSSA osteoarticular infections treated with ceftriaxone versus oxacillin.
METHODS
We conducted a retrospective cohort study of patients with MSSA osteoarticular infections at a tertiary care hospital from January 2005 to April 2010. We collected demographic, clinical, and outcome data including treatment-related adverse events. Successful treatment (clinical improvement; improved follow-up markers and imaging; no readmission for treatment) was compared at 3-6 months and >6 months after completion of intravenous antibiotics.
RESULTS
In total, 124 patients had an MSSA osteoarticular infection; 64 (52%) had orthopedic hardware involvement. Of those patients, 74 (60%) received ceftriaxone and 50 (40%) received oxacillin. Oxacillin was more often discontinued due to toxicity (9 of 50 [18%] oxacillin vs 3 of 74 [4%] ceftriaxone; P = .01). At 3-6 and >6 months, data for 97 and 88 patients, respectively, were available for analysis. Treatment success was similar at 3-6 months (50 of 60 [83%] ceftriaxone vs 32 of 37 [86%] oxacillin; P = .7) and >6 months (43 of 56 [77%] ceftriaxone vs 26 of 32 [81%] oxacillin; P = .6). After intravenous antibiotics, 56 (45%) patients received long-term suppression with oral antibiotics (31 of 74 [42%] ceftriaxone vs 25 of 50 [50%] oxacillin; P = .4).
CONCLUSIONS
In this comparison of ceftriaxone versus oxacillin for MSSA osteoarticular infections, there was no difference in treatment success at 3-6 and >6 months following the completion of intravenous antibiotics. Patients receiving oxacillin were more likely to have it discontinued due to toxicity.
背景
耐甲氧西林金黄色葡萄球菌（MSSA）感染的治疗选择是抗葡萄球菌青霉素。头孢曲松可每日一次给药，且用于门诊治疗时比苯唑西林更便宜。我们比较了头孢曲松与苯唑西林治疗 MSSA 骨关节感染的患者结局。
方法
我们对 2005 年 1 月至 2010 年 4 月在一家三级保健医院就诊的 MSSA 骨关节感染患者进行了回顾性队列研究。我们收集了人口统计学、临床和结局数据，包括治疗相关的不良事件。在静脉用抗生素治疗完成后 3-6 个月和>6 个月时比较了临床改善、随访标志物和影像学改善、无因治疗再入院的治疗成功情况。
结果
共有 124 例患者发生 MSSA 骨关节感染，64 例（52%）有骨科硬件参与。其中，74 例（60%）患者接受了头孢曲松治疗，50 例（40%）接受了苯唑西林治疗。由于毒性（50 例中的 9 例[18%]苯唑西林 vs 74 例中的 3 例[4%]头孢曲松；P =.01），苯唑西林更常被停用。在 3-6 个月和>6 个月时，分别有 97 例和 88 例患者的数据可用于分析。3-6 个月时治疗成功率相似（60 例中的 50 例[83%]头孢曲松 vs 37 例中的 32 例[86%]苯唑西林；P =.7），>6 个月时也相似（56 例中的 43 例[77%]头孢曲松 vs 32 例中的 26 例[81%]苯唑西林；P =.6）。静脉用抗生素后，56 例（45%）患者接受了口服抗生素的长期抑制治疗（74 例中的 31 例[42%]头孢曲松 vs 50 例中的 25 例[50%]苯唑西林；P =.4）。
结论
在这项头孢曲松与苯唑西林治疗 MSSA 骨关节感染的比较中，静脉用抗生素治疗完成后 3-6 个月和>6 个月时，治疗成功率无差异。由于毒性，接受苯唑西林治疗的患者更有可能停药。
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