Birrell Michael T, Fuller Andrew
Department of Infectious Diseases, Alfred Health, 55 Commercial Road, Melbourne, Victoria, 3004, Australia.
Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.
Ther Adv Infect Dis. 2019 Dec 9;6:2049936119882847. doi: 10.1177/2049936119882847. eCollection 2019 Jan-Dec.
The use of cefazolin for infections caused by has been demonstrated to be effective, and associated with fewer adverse effects compared with anti-staphylocccal penicillins; however, use of cefazolin on outpatient parenteral antimicrobial therapy (OPAT) programs often requires the use of continuous infusions. We report the outcomes of patients with serious infections caused by methicillin-sensitive (MSSA) treated using twice daily cefazolin by a large tertiary hospital OPAT program. The aim of this study was to evaluate the safety, efficacy and outcomes after 90 days of follow up for patients with serious infections caused by MSSA treated with twice daily cefazolin by our OPAT program.
A retrospective analysis of clinical outcomes of cases treated for a serious infection proven to be caused by MSSA treated with cefazolin monotherapy on the OPAT program at a tertiary hospital between January 2010 and July 2016 (6.5 years). Outcome measures included readmission rate, adverse drug reactions and clinical cure.
A total of 111 cases of serious MSSA infection were treated with cefazolin in the OPAT service during the study period, including 52 with peripheral or vertebral osteomyelitis and 13 with infective endocarditis; 56 patients had bacteraemia. Median duration of intravenous antibiotic therapy was 41 days, and the median proportion of intravenous therapy administered OPAT was 69%. Two patients had recurrence of infection within 90 days, but were in the setting of retained prosthetic material. A total of 4% of patients experienced an adverse drug reaction. No cases of antibiotic failure were identified.
The use of twice daily cefazolin for serious MSSA infection on an OPAT program is safe and effective. Further study is needed to assess for noninferiority to conventional treatment regimes.
已证明使用头孢唑林治疗由[具体病菌名称缺失]引起的感染是有效的，且与抗葡萄球菌青霉素相比不良反应更少；然而，在门诊胃肠外抗菌治疗（OPAT）项目中使用头孢唑林通常需要持续输注。我们报告了一家大型三级医院OPAT项目使用每日两次头孢唑林治疗耐甲氧西林[具体病菌名称缺失]（MSSA）引起的严重感染患者的结果。本研究的目的是评估我们的OPAT项目使用每日两次头孢唑林治疗MSSA引起的严重感染患者在90天随访后的安全性、有效性和结果。
对2010年1月至2016年7月（6.5年）期间在一家三级医院的OPAT项目中接受头孢唑林单药治疗且经证实由MSSA引起的严重感染病例的临床结果进行回顾性分析。结果指标包括再入院率、药物不良反应和临床治愈情况。
在研究期间，OPAT服务中共有111例严重MSSA感染患者接受了头孢唑林治疗，其中52例患有外周或脊椎骨髓炎，13例患有感染性心内膜炎；56例患者发生菌血症。静脉抗生素治疗的中位持续时间为41天，在OPAT进行静脉治疗的中位比例为69%。两名患者在90天内感染复发，但均存在人工假体材料留存的情况。共有4%的患者出现药物不良反应。未发现抗生素治疗失败的病例。
在OPAT项目中使用每日两次头孢唑林治疗严重MSSA感染是安全有效的。需要进一步研究以评估其与传统治疗方案相比是否不劣。
