Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Chemotherapy. 2018;63(6):345-351. doi: 10.1159/000499033. Epub 2019 Apr 9.
Antistaphylococcal penicillins have historically been regarded as the drugs of choice for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI). However, recent outcomes data compared to cefazolin treatment are conflicting.
This study compared treatment failure and adverse effects associated with nafcillin and cefazolin for MSSA BSI.
Adult inpatients with MSSA BSI between January 1, 2009 and August 31, 2015 were included in this retrospective cohort study if they received ≥72 h of nafcillin or cefazolin as directed therapy after no more than 72 h of any empiric therapy. The primary composite endpoint was treatment failure defined by clinician documentation, 30-day recurrence of infection, all-cause 30-day in-hospital mortality, or loss to follow-up. Secondary outcomes included antibiotic-related acute kidney injury (AKI), acute interstitial nephritis (AIN), hepatotoxicity, and rash.
Among 157 patients, 116 (73.9%) received nafcillin and 41 (26.1%) received cefazolin. The baseline characteristics were similar except cefazolin-treated patients had higher APACHE II scores and more frequent renal dysfunction. No difference in the composite treatment failure outcome (28.4 vs. 31.7%; p = 0.69) was detected between the nafcillin and cefazolin groups, respectively. In a sensitivity analysis excluding patients without known follow-up, there was no significant difference of treatment failure. AKI, AIN, hepatotoxicity, and rash were all numerically more frequent among nafcillin-treated patients.
Among nafcillin- or cefazolin-treated patients with MSSA BSI, there was no significant difference in treatment failure. Observing more frequent presumptive adverse effects associated with nafcillin receipt, future prospective studies evaluating cefazolin appear warranted.
抗葡萄球菌青霉素在历史上一直被认为是治疗耐甲氧西林金黄色葡萄球菌（MSSA）血流感染（BSI）的首选药物。然而，最近的结果数据与头孢唑林治疗相比存在矛盾。
本研究比较了耐甲氧西林金黄色葡萄球菌 BSI 患者使用萘夫西林和头孢唑林治疗的治疗失败和不良反应。
本回顾性队列研究纳入了 2009 年 1 月 1 日至 2015 年 8 月 31 日期间接受至少 72 小时奈夫西林或头孢唑林治疗的成人 MSSA BSI 患者，如果在任何经验性治疗后不超过 72 小时内接受了至少 72 小时的指导治疗。主要复合终点是临床医生记录的治疗失败、30 天内感染复发、全因 30 天住院死亡率或失访。次要结局包括抗生素相关急性肾损伤（AKI）、急性间质性肾炎（AIN）、肝毒性和皮疹。
在 157 名患者中，116 名（73.9%）接受了萘夫西林治疗，41 名（26.1%）接受了头孢唑林治疗。两组患者的基线特征相似，但头孢唑林治疗组患者的 APACHE II 评分更高，肾功能不全更常见。萘夫西林组和头孢唑林组的复合治疗失败结局（28.4%与 31.7%；p=0.69）无显著差异。在排除无已知随访患者的敏感性分析中，治疗失败无显著差异。AKI、AIN、肝毒性和皮疹在萘夫西林治疗组中更为常见。
在接受萘夫西林或头孢唑林治疗的 MSSA BSI 患者中，治疗失败无显著差异。鉴于萘夫西林治疗相关不良反应更为常见，未来需要开展前瞻性研究评估头孢唑林。
