Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Clin Microbiol Infect. 2018 Feb;24(2):152-158. doi: 10.1016/j.cmi.2017.07.001. Epub 2017 Jul 8.
No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia.
A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics.
Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group.
Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.
尚无随机对照试验评估头孢唑林与萘夫西林治疗甲氧西林敏感金黄色葡萄球菌（MSSA）菌血症的疗效比较。
在 10 家医院进行了一项前瞻性观察性队列研究，纳入所有金黄色葡萄球菌菌血症患者。将接受头孢唑林或萘夫西林作为明确抗生素治疗的 MSSA 菌血症患者纳入研究。比较头孢唑林组和萘夫西林组的治疗失败率（因不良反应提前停药、因临床失败换用抗生素、1 个月内全因死亡率或复发）。采用倾向评分匹配分析平衡影响抗生素选择的因素。
在纳入的 242 例病例中，最常见的感染部位是骨骼和关节（36.8%），60.7%的患者患有败血症。总的治疗失败率为 43.8%（106/242）。1 个月内的全因死亡率为 6.2%（15/242）。经倾向评分匹配后，头孢唑林的治疗失败率低于萘夫西林（30.4%（24/79）vs. 49.4%（39/79），p=0.015），原因是不良反应导致停药率较高。当数据仅限于败血症患者时，两组的治疗失败率无显著差异。大约 22%（24/110）的 MSSA 分离株存在头孢唑林接种效应（CIE），这对头孢唑林组的失败率和死亡率有显著影响。
在不存在 CIE 的情况下，头孢唑林可能被推荐为 MSSA 菌血症的充分且更耐受的治疗选择。
