Health Research Methodology Program, McMaster University, Hamilton, Ontario, Canada.
Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
Int J Antimicrob Agents. 2021 Nov;58(5):106429. doi: 10.1016/j.ijantimicag.2021.106429. Epub 2021 Aug 29.
We compared the effectiveness of cefazolin and cloxacillin as definitive antibiotic therapy for methicillin-susceptible Staphylococcus aureus (MSSA) spinal epidural abscess (SEA).
This retrospective cohort study included patients with MSSA SEA from two academic hospitals in Hamilton, Ontario, Canada, between 2014 and 2020. Patients treated with cefazolin were compared to those treated with cloxacillin. Co-primary outcomes included 90-day mortality, antibiotic failure, adverse reactions and recurrence. Inverse probability of treatment weighting using propensity scores was used to balance important prognostic factors and to estimate an adjusted risk difference.
Of 98 patients with MSSA SEA, 50 and 48 patients were treated with cefazolin and cloxacillin, respectively. Mortality at 90 days was 8% and 13% in the cefazolin and cloxacillin groups, respectively (P = 0.52). The antibiotic failure rate was 12% and 19% in the cefazolin and cloxacillin groups, respectively (P = 0.41). The serious adverse reactions rate was 0% and 4% in the cefazolin and cloxacillin groups, respectively (P = 0.24). The recurrence rate was 2% and 8% in the cefazolin and cloxacillin groups, respectively (P = 0.20). The adjusted risk difference for mortality at 90 days was -1% [95% confidence interval (CI) -10% to 8%] favouring cefazolin. The adjusted risk differences for antibiotic failure, adverse reactions and recurrence were 1% (95% CI -12% to 14%), -5% (95% CI -11% to 2%) and -18% (-36% to -1%) respectively.
Cefazolin is likely as effective as an antistaphylococcal penicillin and may be considered as a first-line treatment for MSSA SEA.
我们比较了头孢唑林和氯唑西林作为治疗耐甲氧西林金黄色葡萄球菌（MSSA）脊柱硬膜外脓肿（SEA）的确定性抗生素治疗的效果。
这项回顾性队列研究纳入了 2014 年至 2020 年期间在加拿大安大略省汉密尔顿的两家学术医院就诊的 MSSA SEA 患者。比较了使用头孢唑林治疗的患者和使用氯唑西林治疗的患者。主要结局包括 90 天死亡率、抗生素失败、不良反应和复发。使用倾向评分进行逆概率治疗加权以平衡重要的预后因素，并估计调整后的风险差异。
在 98 例 MSSA SEA 患者中，分别有 50 例和 48 例患者接受了头孢唑林和氯唑西林治疗。头孢唑林组和氯唑西林组 90 天死亡率分别为 8%和 13%（P=0.52）。头孢唑林组和氯唑西林组的抗生素失败率分别为 12%和 19%（P=0.41）。头孢唑林组和氯唑西林组严重不良反应发生率分别为 0%和 4%（P=0.24）。头孢唑林组和氯唑西林组的复发率分别为 2%和 8%（P=0.20）。90 天死亡率的调整风险差异为-1%（95%置信区间（CI）-10%至 8%），有利于头孢唑林。抗生素失败、不良反应和复发的调整风险差异分别为 1%（95% CI-12%至 14%）、-5%（95% CI-11%至 2%）和-18%（-36%至-1%）。
头孢唑林可能与抗葡萄球菌青霉素一样有效，可考虑作为 MSSA SEA 的一线治疗药物。
