Chua Zheng Hong, Tan Sock Hoon, Mok Hoi Tong, Teng Christine B, Vasoo Shawn, Young Barnaby E
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
Division of Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore.
Sci Rep. 2025 Apr 9;15(1):12103. doi: 10.1038/s41598-025-96383-y.
In recent years, the incidence of penicillin-susceptible S. aureus (PSSA) bloodstream infection (BSI) has increased worldwide. However, the preferred antibiotic remains uncertain due to concerns of inducible resistance to benzylpenicillin. We compared outcomes associated with benzylpenicillin versus other antibiotics and investigated risk factors influencing treatment failure. Patients were grouped into benzylpenicillin and non-benzylpenicillin beta-lactam treatment groups (including anti-staphylococcal penicillins and cephalosporins). The primary outcome was overall treatment failure (30-day all-cause mortality and/or 90-day relapse). Of 335 patients, 74 (22.09%) received benzylpenicillin and 261 (77.91%) received a non-benzylpenicillin beta-lactam. While rates of overall treatment failure (13.51% vs. 17.24%; P = 0.45) and occurrence of adverse drug events (6.76% vs. 7.66%; P = 0.79) were comparable to non-benzylpenicillin beta-lactams, benzylpenicillin showed faster microbiological clearance [3.00 days (IQR, 2.00-4.00 days) vs. 4.00 days (IQR, 3.00-5.00 days); P = 0.03] and fewer persistent infections (22.97% vs. 36.02%; P = 0.04), suggesting potential to improve patient outcomes. We also found that unknown source (aOR 4.63, 95% CI 1.47-14.64; P < 0.01) was associated with treatment failure, while review by Infectious Disease (ID) specialists (aOR 0.30, 95% CI 0.12-0.73; P = 0.01) was protective, stressing the importance of early ID referral and thorough source identification. This study highlights benzylpenicillin as an effective treatment for PSSA BSI.
近年来，青霉素敏感金黄色葡萄球菌（PSSA）血流感染（BSI）的发病率在全球范围内有所上升。然而，由于担心对苄青霉素产生诱导性耐药，首选抗生素仍不确定。我们比较了苄青霉素与其他抗生素相关的治疗结果，并调查了影响治疗失败的危险因素。患者被分为苄青霉素治疗组和非苄青霉素β-内酰胺治疗组（包括抗葡萄球菌青霉素和头孢菌素）。主要结局是总体治疗失败（30天全因死亡率和/或90天复发率）。在335例患者中，74例（22.09%）接受了苄青霉素治疗，261例（77.91%）接受了非苄青霉素β-内酰胺治疗。虽然总体治疗失败率（13.51%对17.24%；P = 0.45）和药物不良事件发生率（6.76%对7.66%；P = 0.79）与非苄青霉素β-内酰胺类药物相当，但苄青霉素显示出更快的微生物清除速度[3.00天（四分位间距，2.00 - 4.00天）对4.00天（四分位间距，3.00 - 5.00天）；P = 0.03]和更少的持续性感染（22.97%对36.02%；P = 0.04），这表明有可能改善患者的治疗结果。我们还发现，感染源不明（调整后比值比4.63，95%置信区间1.47 - 14.64；P < 0.01）与治疗失败相关，而由感染病（ID）专科医生进行评估（调整后比值比0.30，95%置信区间0.12 - 0.73；P = 0.01）具有保护作用，这强调了早期ID转诊和彻底查明感染源的重要性。这项研究强调苄青霉素是治疗PSSA BSI的有效药物。
