Shah Megan D, Wardlow Lynn C, Stevenson Kurt B, Coe Kelci E, Reed Erica E
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Pharmacotherapy. 2018 Jul;38(7):769-775. doi: 10.1002/phar.2124. Epub 2018 Jun 25.
To identify the impact of penicillin versus alternative β-lactams on clinical outcomes in patients with penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia.
Retrospective cohort study.
Academic medical center.
Adult patients with PSSA bacteremia treated with a β-lactam as definitive therapy.
The primary outcome was a composite end point of 30-day clinical failure (change in PSSA therapy due to persistent or worsening signs and symptoms, PSSA bacteremia recurrence or persistence, and/or infection-related mortality) in patients treated with penicillin versus alternative β-lactams. Secondary outcomes included infection-related and hospital length of stay (LOS), 90-day recurrence, 90-day infection-related readmission, 30-day all-cause mortality, adverse drug events (ADEs), and 30-day change in PSSA therapy due to ADEs. A subgroup analysis comparing penicillin, nafcillin, and cefazolin was also conducted.
For the 122 patients who were included, the most common definitive therapies were nafcillin (37%), cefazolin (29%), and penicillin (21%). No difference was found in 30-day clinical failure (4% vs 11%, p=0.46), infection-related LOS (12 days vs 11 days, p=0.39), hospital LOS (12.5 days vs 12 days, p=0.69), 90-day recurrence (p=1.00), 90-day infection-related readmission (p=1.00), or 30-day all-cause mortality (p=0.45) between penicillin and other β-lactams. The prevalence of ADEs was different among penicillin, nafcillin, and cefazolin (p=0.049), with nafcillin requiring more changes in therapy (p=0.005).
Definitive therapy with penicillin had similar efficacy compared with alternative β-lactams for the treatment of PSSA bacteremia. However, nafcillin was associated with more ADEs requiring a change in therapy.
确定青霉素与其他β-内酰胺类药物对青霉素敏感金黄色葡萄球菌（PSSA）菌血症患者临床结局的影响。
回顾性队列研究。
学术医疗中心。
接受β-内酰胺类药物作为确定性治疗的成年PSSA菌血症患者。
主要结局是接受青霉素与其他β-内酰胺类药物治疗的患者30天临床失败的复合终点（因持续或恶化的体征和症状、PSSA菌血症复发或持续以及/或感染相关死亡率而改变PSSA治疗方案）。次要结局包括感染相关住院时间（LOS）和总住院时间、90天复发率、90天感染相关再入院率、30天全因死亡率、不良药物事件（ADEs）以及因ADEs导致的30天内PSSA治疗方案的改变。还进行了一项比较青霉素、萘夫西林和头孢唑林的亚组分析。
纳入的122例患者中，最常用的确定性治疗药物为萘夫西林（37%）、头孢唑林（29%）和青霉素（21%）。青霉素与其他β-内酰胺类药物在30天临床失败率（4%对11%，p = 0.46）、感染相关LOS（12天对11天，p = 0.39）、总住院时间（12.5天对12天，p = 0.69）、90天复发率（p = 1.00）、90天感染相关再入院率（p = 1.00）或30天全因死亡率（p = 0.45）方面未发现差异。青霉素、萘夫西林和头孢唑林的ADEs发生率不同（p = 0.049），萘夫西林需要更多的治疗方案改变（p = 0.005）。
对于PSSA菌血症的治疗，青霉素作为确定性治疗与其他β-内酰胺类药物具有相似的疗效。然而萘夫西林与更多需要改变治疗方案的ADEs相关。
