Cefazolin vs. anti-staphylococcal penicillins for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections in acutely ill adult patients: Results of a systematic review and meta-analysis.

A systematic literature review and meta-analysis was conducted to evaluate the comparative efficacy and tolerability of cefazolin vs. anti-staphylococcal penicillins (ASPs) for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI). Utilizing published regression models, included studies were stratified into subgroups of high and low pre-probability of mortality. Cefazolin was associated with significantly lower rates of treatment failure (odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.61-0.82; P<0.001; I = 14%) and crude, all-cause mortality (OR: 0.69; 95% CI: 0.59-0.81; P<0.001; I = 18%) compared with ASP therapy. Overall risk of treatment-related adverse drug reactions was numerically lower with cefazolin (OR: 0.39; 95% CI: 0.15-1.00; P = 0.05). Subgroup sensitivity analyses of studies conducted in less severely ill patients were similar to the combined analysis. The role of cefazolin in the most severely ill patients with MSSA BSI should be prospectively evaluated.