头孢唑林在耐甲氧西林金黄色葡萄球菌感染治疗中用于不耐青霉素钠患者的耐受性。
Tolerability of Cefazolin in Nafcillin-Intolerant Patients for the Treatment of Methicillin-Susceptible Staphylococcus aureus Infections.
机构信息
Department of Pharmacy, University of Virginia Health, Charlottesville, Virginia, USA.
National Institutes of Health, Bethesda, Maryland, USA.
出版信息
Clin Infect Dis. 2021 Nov 2;73(9):1650-1655. doi: 10.1093/cid/ciab368.
BACKGROUND
Non-immunoglobulin E (IgE)-mediated hypersensitivity reactions (HSRs) to nafcillin are commonly reported, but scarce data are available to guide appropriate antibiotic change following these reactions. Although cefazolin is an attractive therapeutic alternative in methicillin-susceptible Staphylococcus aureus (MSSA) infections when patients experience an HSR to nafcillin, more data are needed to evaluate the tolerability of cefazolin after switching from nafcillin. The purpose of this study was to describe the tolerability of cefazolin in patients who develop a suspected non-IgE-mediated HSR to nafcillin.
METHODS
This was a retrospective, descriptive case series of patients who received nafcillin for an MSSA infection, experienced a suspected non-IgE-mediated HSR, and were switched to cefazolin between October 2015 and November 2019 at a single academic medical center. The primary objective was to identify the percentage of patients who completed cefazolin after experiencing a suspected non-IgE-mediated HSR to nafcillin.
RESULTS
There were 80 patients with 87 prespecified non-IgE-mediated HSRs during the study period. Seventy-one (89%) patients completed cefazolin, with 53 (75%) of these patients completing at least 2 weeks of therapy. One patient was ultimately switched from cefazolin to daptomycin due to concern for treatment failure. Eight patients (10%) did not tolerate cefazolin after switching from nafcillin. Of these, 3 patients experienced an unrelated HSR, whereas 5 patients experienced the same non-IgE-mediated HSR that was attributed to nafcillin and discontinued cefazolin within 7 days. The most common HSR cited was immune-mediated nephritis; however, the majority were clinically presumed but did not meet objective diagnostic criteria.
CONCLUSIONS
Treatment with cefazolin after experiencing a suspected non-IgE-mediated HSR to nafcillin appears to be safe, even for patients requiring a prolonged duration of cefazolin.
背景
非免疫球蛋白 E（IgE）介导的过敏反应（HSR）对萘夫西林很常见，但缺乏指导这些反应后适当抗生素更换的数据。虽然头孢唑林在耐甲氧西林金黄色葡萄球菌（MSSA）感染中是一种有吸引力的治疗替代药物，当患者对萘夫西林发生 HSR 时，但需要更多的数据来评估从萘夫西林转换后头孢唑林的耐受性。本研究的目的是描述对疑似非 IgE 介导的 HSR 对萘夫西林的患者使用头孢唑林的耐受性。
方法
这是一项回顾性、描述性病例系列研究，纳入了 2015 年 10 月至 2019 年 11 月期间在一家学术医疗中心接受奈夫西林治疗 MSSA 感染、发生疑似非 IgE 介导的 HSR 并转换为头孢唑林的患者。主要目的是确定在经历疑似非 IgE 介导的 HSR 对萘夫西林后完成头孢唑林治疗的患者比例。
结果
在研究期间，有 80 例患者出现了 87 例预设的非 IgE 介导的 HSR。71 例（89%）患者完成了头孢唑林治疗，其中 53 例（75%）患者完成了至少 2 周的治疗。1 例患者因担心治疗失败最终从头孢唑林转换为达托霉素。8 例（10%）患者在从萘夫西林转换后不能耐受头孢唑林。其中 3 例患者发生了无关的 HSR，而 5 例患者发生了归因于萘夫西林的相同非 IgE 介导的 HSR，并在 7 天内停用了头孢唑林。最常见的 HSR 是免疫介导的肾炎；然而，大多数是临床推测的，但不符合客观诊断标准。
结论
在经历疑似非 IgE 介导的 HSR 对萘夫西林后使用头孢唑林治疗似乎是安全的，即使是需要长时间使用头孢唑林的患者也是如此。
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