Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark.
J Antimicrob Chemother. 2014 Feb;69(2):506-14. doi: 10.1093/jac/dkt375. Epub 2013 Sep 26.
The objective of the present study was to compare the efficacy of cefuroxime with that of dicloxacillin as definitive antimicrobial therapy in methicillin-susceptible Staphylococcus aureus bacteraemia (MS-SAB) using a Danish bacteraemia database, information on the indication for antimicrobial therapy, multivariate adjustment and propensity score (PS) matching.
This was a retrospective cohort study. MS-SAB cases from 1 January 2006 to 31 December 2008 were included from a total of seven hospitals in the greater Copenhagen area and seven hospitals in the North Denmark Region. Information including demographics, antimicrobial therapy and clinical condition was obtained. The physician's note detailing the indication for starting empirical antimicrobial therapy was given special attention. Hazard ratios (HRs) and 95% CIs for 30 day and 90 day mortality were calculated using PS-adjusted Cox proportional hazards regression analyses. In addition, PS matching was performed.
A total of 691 patients with MS-SAB received either dicloxacillin (n = 368) or cefuroxime (n = 323) as definitive antimicrobial therapy. Twenty-eight different indications for empirical antimicrobial therapy were identified and grouped into eight categories. There was no statistically significant difference in 30 day mortality between the two groups (HR 1.02, 95% CI 0.68-1.52). Definitive antimicrobial therapy with cefuroxime was associated with increased 90 day mortality in a PS-adjusted multivariate analysis (HR 1.43, 95% CI 1.03-1.98) and in the PS matching (OR 1.65, 95% CI 1.06-2.56). Antimicrobial therapy for an indication of 'severe infection' was independently associated with 90 day mortality (HR 1.97, 95% CI 1.19-3.28).
Definitive antimicrobial therapy with cefuroxime was associated with significantly higher 90 day mortality than was dicloxacillin therapy in patients with MS-SAB.
本研究旨在通过丹麦菌血症数据库、抗菌治疗适应证信息、多变量调整和倾向评分（PS）匹配，比较头孢呋辛与双氯西林作为耐甲氧西林金黄色葡萄球菌菌血症（MS-SAB）确定性抗菌治疗的疗效。
这是一项回顾性队列研究。纳入了 2006 年 1 月 1 日至 2008 年 12 月 31 日来自哥本哈根大都市区的 7 家医院和北丹麦地区的 7 家医院的 MS-SAB 病例。收集了人口统计学、抗菌治疗和临床状况等信息。特别关注详细说明开始经验性抗菌治疗适应证的医生笔记。使用 PS 调整的 Cox 比例风险回归分析计算 30 天和 90 天死亡率的风险比（HR）和 95%置信区间。此外，还进行了 PS 匹配。
共 691 例 MS-SAB 患者接受了双氯西林（n=368）或头孢呋辛（n=323）作为确定性抗菌治疗。确定了 28 种不同的经验性抗菌治疗适应证，并分为 8 类。两组 30 天死亡率无统计学差异（HR 1.02，95%CI 0.68-1.52）。在 PS 调整的多变量分析中，头孢呋辛确定性抗菌治疗与 90 天死亡率增加相关（HR 1.43，95%CI 1.03-1.98），且在 PS 匹配中也存在相关性（OR 1.65，95%CI 1.06-2.56）。针对“严重感染”的适应证进行抗菌治疗与 90 天死亡率独立相关（HR 1.97，95%CI 1.19-3.28）。
与双氯西林治疗相比，头孢呋辛确定性抗菌治疗与 MS-SAB 患者的 90 天死亡率显著升高相关。
