Department of Pharmacy, University of California Irvine Health, Orange, CA; Department of Pharmacy, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL; Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL.
Int J Antimicrob Agents. 2019 Mar;53(3):225-233. doi: 10.1016/j.ijantimicag.2018.11.013. Epub 2018 Nov 23.
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.
一项系统的文献回顾和荟萃分析评估了头孢唑林与抗葡萄球菌青霉素（ASP）治疗甲氧西林敏感金黄色葡萄球菌（MSSA）血流感染（BSI）的疗效和耐受性。利用已发表的回归模型，将纳入的研究分为高和低死亡率预测概率亚组。与 ASP 治疗相比，头孢唑林治疗的治疗失败率显著降低（比值比 [OR]：0.70；95%置信区间 [CI]：0.61-0.82；P<0.001；I ² = 14%），粗死亡率（OR：0.69；95% CI：0.59-0.81；P<0.001；I ² = 18%）也显著降低。头孢唑林治疗相关药物不良反应的总体风险略低（OR：0.39；95% CI：0.15-1.00；P = 0.05）。在病情较轻的患者中进行的研究的亚组敏感性分析与合并分析结果相似。应前瞻性评估头孢唑林在 MSSA BSI 中最严重感染患者中的作用。
