Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France.
Infectious Diseases Department, Pitié-Salpêtrière University Hospital, Paris, France.
Eur J Clin Microbiol Infect Dis. 2024 Aug;43(8):1569-1577. doi: 10.1007/s10096-024-04851-6. Epub 2024 May 28.
To compare the effectiveness and safety of cefazolin versus cloxacillin for the treatment of infective endocarditis (IE) due to methicillin-sensitive Staphylococci (MSS).
Data were retrospectively collected on patients treated for a definite MSS endocarditis who received cefazolin or cloxacillin for at least 10 consecutive days in six French hospitals between January-1 2014 and December-31 2020. The primary endpoint was treatment failure defined as a composite of death within 90 days of starting antibiotherapy, or embolic event during antibiotherapy, or relapse of IE within 90 days of stopping antibiotherapy. We used Cox regression adjusted for the inverse probability of treatment weighting of receiving cefazolin.
192 patients were included (median age 67.8 years). IE was caused by S.aureus in 175 (91.1%) and by coagulase-negative staphylococci in 17 (8.9%). Ninety-four patients (48.9%) received cefazolin, and 98 (51%) received cloxacillin. 34 patients (34.7%) with cefazolin and 26 (27.7%) with cloxacillin met the composite primary endpoint, with no significant differences between groups (adjusted HR = 1.13, 95% CI 0.63 to 2.03). There were no significant differences in secondary efficacy endpoints or biological safety events.
The effectiveness of cefazolin did not significantly differ from cloxacillin for the treatment of MSS endocarditis.
比较头孢唑林与氯唑西林治疗耐甲氧西林金黄色葡萄球菌（MSS）引起的感染性心内膜炎（IE）的疗效和安全性。
在六家法国医院，从 2014 年 1 月 1 日至 2020 年 12 月 31 日，回顾性收集了至少连续 10 天接受头孢唑林或氯唑西林治疗的确诊 MSS 心内膜炎患者的数据。主要终点是治疗失败，定义为抗生素治疗开始后 90 天内死亡、抗生素治疗期间发生栓塞事件或停止抗生素治疗后 90 天内 IE 复发的复合事件。我们使用 Cox 回归调整了接受头孢唑林治疗的逆概率治疗权重。
共纳入 192 例患者（中位年龄 67.8 岁）。IE 由金黄色葡萄球菌引起的有 175 例（91.1%），凝固酶阴性葡萄球菌引起的有 17 例（8.9%）。94 例（48.9%）患者接受头孢唑林治疗，98 例（51%）患者接受氯唑西林治疗。头孢唑林组有 34 例（34.7%）和氯唑西林组有 26 例（27.7%）患者符合复合主要终点，两组间无显著差异（调整 HR=1.13，95%CI 0.63 至 2.03）。次要疗效终点或生物学安全性事件无显著差异。
头孢唑林治疗 MSS 心内膜炎的疗效与氯唑西林无显著差异。
