Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao Sung District, Kaohsiung, 833, Taiwan.
Chang Gung University College of Medicine, Kaohsiung, Taiwan.
BMC Infect Dis. 2021 May 12;21(1):437. doi: 10.1186/s12879-021-06111-w.
Many studies have shown that vancomycin is inferior to β-lactam antibiotics in terms of effectiveness in the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. However, limited data are available regarding the comparison of clinical outcomes between patients receiving initial teicoplanin and those receiving β-lactam antibiotics for MSSA bacteremia.
Eighty-four adults with MSSA bacteremia were included: initial teicoplanin treatment group (n = 28) and β-lactam treatment group (n = 56). The two groups were further stratified based on propensity score matching according to the outcome analysis using a logistic regression model. We investigated the clinical outcomes between the groups before and after propensity score matching after treatment completion.
Pittsburgh bacteremia score ≥ 4 (odds ratio, 60.6; 95%CI, 7.4-496.8) was an independent risk factor for unfavorable outcome. After propensity score matching, the initial teicoplanin treatment group and the β-lactam treatment group consisted of 28 patients each. No statistically significant differences were observed in the proportions of patients with favorable outcomes and 30-day overall mortality rates between the groups before and after propensity score matching after the completion of teicoplanin or β-lactam treatment. The Kaplan-Meier 30-day survival curve also showed no significant difference between the patients receiving initial teicoplanin treatment and those receiving β-lactam treatment before and after matching (hazard ratio, 1.84, 95%CI, 0.60-5.64; and 3.12, 95%CI, 0.98-9.99, respectively).
There were no significant difference in clinical outcomes between initial teicoplanin treatment and β-lactam treatment among patients with MSSA bacteremia. Pittsburgh bacteremia score ≥ 4 was a significant risk factor for mortality.
许多研究表明，万古霉素在治疗耐甲氧西林金黄色葡萄球菌（MSSA）菌血症方面的疗效不如β-内酰胺类抗生素。然而，关于初始使用替考拉宁与β-内酰胺类抗生素治疗 MSSA 菌血症的患者临床结局比较的数据有限。
纳入 84 例 MSSA 菌血症成人患者：初始替考拉宁治疗组（n=28）和β-内酰胺治疗组（n=56）。根据结局分析，使用逻辑回归模型进行倾向性评分匹配后，将两组进一步分层。我们研究了治疗完成后，在倾向性评分匹配前后两组之间的临床结局。
匹兹堡菌血症评分≥4（优势比，60.6；95%置信区间，7.4-496.8）是不良结局的独立危险因素。经过倾向性评分匹配后，替考拉宁初始治疗组和β-内酰胺治疗组各包含 28 例患者。在替考拉宁或β-内酰胺治疗完成后，倾向性评分匹配前后，两组患者的良好结局比例和 30 天总死亡率均无统计学差异。Kaplan-Meier 30 天生存曲线也显示，在匹配前后，接受初始替考拉宁治疗和接受β-内酰胺治疗的患者之间无显著差异（风险比，1.84，95%置信区间，0.60-5.64；和 3.12，95%置信区间，0.98-9.99）。
在 MSSA 菌血症患者中，初始替考拉宁治疗与β-内酰胺治疗的临床结局无显著差异。匹兹堡菌血症评分≥4 是死亡的显著危险因素。
