Department I of Internal Medicine, Infectious Diseases, Medical Faculty, University Hospital of Cologne, University of Cologne, Cologne, Germany.
Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt am Main, Germany.
Infection. 2024 Jun;52(3):1159-1163. doi: 10.1007/s15010-023-02168-8. Epub 2024 Jan 31.
Antistaphylococcal penicillins and cefazolin have been used as first line therapy in Methicillin-susceptible Staphylococcus aureus bloodstream infection. While efficacy of both regimens seems to be similar, the compounds may differ with regard to tolerability. This study aims to describe the clinical use of cefazolin and flucloxacillin, focussing on discontinuation or change of anti-infective agent due to adverse events.
This observational prospective study was conducted at two German tertiary care centres with an internal recommendation of flucloxacillin for MSSA-BSI in one, and of cefazolin in the other centre. Adverse events were registered weekly under treatment and at a 90-day follow-up. Descriptive analysis was complemented by a propensity score analysis comparing adverse events (stratified rank-based test applied to the sum of Common Terminology Criteria for adverse events ratings per patient).
Of 71 patients included, therapy was initiated with flucloxacillin in 56 (79%), and with cefazolin in 15 (21%). The propensity score analysis indicates a statistically significant difference concerning the severity of adverse events between the treatment groups in favour of cefazolin (p = 0.019). Adverse events led to discontinuation of flucloxacillin in 7 individuals (13% of all patients receiving flucloxacillin). Clinical outcome was not different among treatment groups.
Using cefazolin rather than flucloxacillin as a first line agent for treatment of MSSA-BSI is supported by these clinical data.
耐甲氧西林金黄色葡萄球菌（MSSA）血流感染的一线治疗药物通常为抗葡萄球菌青霉素类和头孢唑林。虽然这两种方案的疗效似乎相似，但在耐受性方面，这些药物可能存在差异。本研究旨在描述头孢唑林和氟氯西林的临床应用，重点关注因不良事件而停止或改变抗感染药物的情况。
这是一项在德国两家三级保健中心进行的观察性前瞻性研究，其中一家中心内部推荐使用氟氯西林治疗 MSSA-BSI，另一家中心则推荐使用头孢唑林。在治疗期间和 90 天随访时每周都会登记不良事件。描述性分析补充了倾向评分分析，该分析比较了不良事件（对每个患者的不良事件通用术语标准评级之和应用分层秩检验）。
共纳入 71 例患者，其中 56 例（79%）接受氟氯西林治疗，15 例（21%）接受头孢唑林治疗。倾向评分分析表明，治疗组之间不良事件的严重程度存在统计学差异，头孢唑林组更有利（p=0.019）。氟氯西林组有 7 例（所有接受氟氯西林治疗患者的 13%）因不良事件而停止治疗。治疗组之间的临床结局无差异。
这些临床数据支持将头孢唑林而非氟氯西林作为治疗 MSSA-BSI 的一线药物。
