Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA; Department of Pharmacy, Rush University Medical Center, Chicago, IL, USA.
Int J Antimicrob Agents. 2017 May;49(5):650-654. doi: 10.1016/j.ijantimicag.2016.12.021. Epub 2017 Mar 6.
Methicillin-susceptible Staphylococcus aureus (MSSA) infections have been successfully treated both with cefazolin and antistaphylococcal penicillins; cefazolin appears effective in MSSA bloodstream infections (BSIs). Thus, our antimicrobial stewardship programme (ASP) implemented a clinical pathway supporting cefazolin use in MSSA-BSIs and restricting oxacillin use to infectious diseases (ID) consultation due to cefazolin's lower cost and more convenient dosing. This before and after quasi-experimental study was conducted to describe the impact on outcomes and process of care measures associated with implementing this pathway among patients with MSSA-BSI. Definitive treatment with cefazolin increased over the study period from 17.3% to 69.8% post-implementation. Clinical failure (5.8% vs. 2.3%; P = 0.62) and in-hospital mortality (3.8% vs. 0%; P = 0.50) were rare pre- and post-implementation. Median hospital length of stay among survivors was similar between pre- and post-implementation periods (P = 0.31). Duration of bacteraemia [median (IQR) 3 (2-4) days vs. 2 (2-3) days; P = 0.002] and rates of re-infection after culture clearance (9.6% vs. 0%; P = 0.06) were reduced post-implementation. Frequency of source control (P = 0.71) and time to source control (P = 0.52) were similar between study periods. Significant increases in ID consultations (33.3% [3/9] vs. 73.3% [22/30]; P = 0.047) and median (IQR) 24-h daily doses [2 (1-3) g vs. 6 (3-6) g; P < 0.01] were seen for patients treated with cefazolin post-implementation. ASPs may find implementation of a similar pathway to be an effective means of improving the care of patients infected with MSSA.
耐甲氧西林金黄色葡萄球菌（MSSA）感染已成功用头孢唑林和抗葡萄球菌青霉素治疗；头孢唑林似乎对 MSSA 血流感染（BSI）有效。因此，我们的抗菌药物管理计划（ASP）实施了一项临床途径，支持头孢唑林在 MSSA-BSI 中的使用，并由于头孢唑林成本更低且给药更方便而限制使用苯唑西林，仅限于传染病（ID）咨询。这项前后准实验研究旨在描述在 MSSA-BSI 患者中实施该途径对结果和护理措施的影响。在研究期间，确定治疗的头孢唑林使用率从实施前的 17.3%增加到实施后的 69.8%。临床失败（5.8%对 2.3%；P=0.62）和住院死亡率（3.8%对 0%；P=0.50）在实施前后均罕见。幸存者的中位住院时间在实施前后相似（P=0.31）。血培养清除后再感染的发生率（9.6%对 0%；P=0.06）和持续时间[中位数（IQR）3（2-4）天对 2（2-3）天；P=0.002]均降低。源控制的频率（P=0.71）和源控制的时间（P=0.52）在两个研究期间相似。头孢唑林治疗的患者的 ID 咨询次数显著增加（33.3%[3/9]对 73.3%[22/30]；P=0.047），且 24 小时每日剂量的中位数（IQR）[2（1-3）g 对 6（3-6）g；P<0.01]也增加。ASP 可能会发现实施类似途径是改善 MSSA 感染患者护理的有效手段。
