Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
Pharmacy Service, Oklahoma City Veterans Affairs Health Care System, Oklahoma City, Oklahoma, USA.
Int J Antimicrob Agents. 2023 Apr;61(4):106743. doi: 10.1016/j.ijantimicag.2023.106743. Epub 2023 Feb 2.
Ticagrelor may improve the outcomes in Staphylococcus aureus bacteraemia (SAB). However, treatment outcome data for these patients remain limited. The primary objective of this study was to characterize the outcomes of patients with SAB who received ticagrelor compared with a cohort who received clopidogrel.
This was a retrospective, nationwide propensity-matched analysis of patients with SAB who were prescribed ticagrelor or clopidogrel concomitantly with antistaphylococcal therapy. The primary outcome was the comparative all-cause 30-day mortality rate between propensity-matched groups.
In total, 1509 patients were prescribed concomitantly with ticagrelor or clopidogrel during treatment of S. aureus bacteraemia; of these, 194 patients were excluded from this study due to an inadequate number of antiplatelet doses within the first week of therapy (n=171) or non-admission to hospital (n=23). Of the remaining 1315 patients, 74 patients received ticagrelor and 1241 patients received clopidogrel. There was no significant difference in all-cause 30-day mortality between the groups [6/74 (8.1%) in the ticagrelor group vs 10/74 (13.5%) in the clopidogrel group; P=0.29]. Multi-variate logistic regression demonstrated that elevated aspartate aminotransferase, systolic blood pressure <90 mmHg, elevated serum creatinine and neurological comorbidity were independently associated with all-cause 30-day mortality.
This study found no difference in all-cause 30-day mortality between the two groups, although overall mortality appeared to be lower compared with other reports. Randomized controlled trials of P2Y12 inhibitors as adjunctive agents to antibiotic therapy for the treatment of serious S. aureus infections are warranted.
替格瑞洛可能改善金黄色葡萄球菌菌血症（SAB）的结局。然而，此类患者的治疗结局数据仍然有限。本研究的主要目的是描述接受替格瑞洛治疗的 SAB 患者与接受氯吡格雷治疗的患者的结局。
这是一项回顾性、全国性倾向匹配分析，纳入了同时接受替格瑞洛或氯吡格雷与抗葡萄球菌治疗的 SAB 患者。主要结局是倾向匹配组间的全因 30 天死亡率比较。
共 1509 例患者在金黄色葡萄球菌菌血症治疗期间同时接受替格瑞洛或氯吡格雷治疗；其中 194 例因治疗的前 7 天内抗血小板药物剂量不足（n=171）或未住院（n=23）而被排除出本研究。在其余 1315 例患者中，74 例接受替格瑞洛治疗，1241 例接受氯吡格雷治疗。两组间全因 30 天死亡率无显著差异[替格瑞洛组 6/74（8.1%）vs 氯吡格雷组 10/74（13.5%）；P=0.29]。多变量逻辑回归表明，天门冬氨酸氨基转移酶升高、收缩压<90mmHg、血清肌酐升高和神经合并症与全因 30 天死亡率独立相关。
本研究发现两组间全因 30 天死亡率无差异，尽管总体死亡率似乎低于其他报道。需要进行随机对照试验，以评估 P2Y12 抑制剂作为抗生素治疗金黄色葡萄球菌严重感染的辅助药物的效果。
