Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study

Jennifer S McDanel; Mary-Claire Roghmann; Eli N Perencevich; Michael E Ohl; Michihiko Goto; Daniel J Livorsi; Makoto Jones; Justin P Albertson; Rajeshwari Nair; Amy M J O'Shea; Marin L Schweizer

doi:10.1093/cid/cix287

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Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study

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Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study

Jennifer S McDanel, Mary-Claire Roghmann, Eli N Perencevich, Michael E Ohl, Michihiko Goto, Daniel J Livorsi, Makoto Jones, Justin P Albertson, Rajeshwari Nair, Amy M J O'Shea, …

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol.65(1), pp.100-106

07/01/2017

DOI: 10.1093/cid/cix287

PMID: 28379314

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Abstract

To treat patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections, β-lactams are recommended for definitive therapy; however, the comparative effectiveness of individual β-lactams is unknown. This study compared definitive therapy with cefazolin vs nafcillin or oxacillin among patients with MSSA infections complicated by bacteremia. This retrospective study included patients admitted to 119 Veterans Affairs hospitals from 2003 to 2010. Patients were included if they had a blood culture positive for MSSA and received definitive therapy with cefazolin, nafcillin, or oxacillin. Cox proportional hazards regression and ordinal logistic regression were used to identify associations between antibiotic therapy and mortality or recurrence. A recurrent infection was defined as a MSSA blood culture between 45 and 365 days after the first MSSA blood culture. Of 3167 patients, 1163 (37%) patients received definitive therapy with cefazolin. Patients who received cefazolin had a 37% reduction in 30-day mortality (hazard ratio [HR], 0.63; 95% confidence interval [CI], .51-.78) and a 23% reduction in 90-day mortality (HR, 0.77; 95% CI, .66-.90) compared with patients receiving nafcillin or oxacillin, after controlling for other factors. The odds of recurrence (odds ratio, 1.13; 95% CI, .94-1.36) were similar among patients who received cefazolin compared with patients who received nafcillin or oxacillin, after controlling for other factors. In this large, multicenter study, patients who received cefazolin had a lower risk of mortality and similar odds of recurrent infections compared with nafcillin or oxacillin for MSSA infections complicated by bacteremia. Physicians might consider definitive therapy with cefazolin for these infections.

Staphylococcal Infections - drug therapy

Humans

Middle Aged

Bacteremia - complications

Bacteremia - drug therapy

Male

Treatment Outcome

Staphylococcal Infections - complications

Bacteremia - microbiology

Anti-Bacterial Agents - therapeutic use

Staphylococcal Infections - epidemiology

Bacteremia - epidemiology

Female

Aged

Retrospective Studies

Staphylococcal Infections - microbiology

beta-Lactams - therapeutic use

Staphylococcus aureus

Details

Title: Subtitle: Comparative Effectiveness of Cefazolin Versus Nafcillin or Oxacillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study
Creators: Jennifer S McDanel - Department of Epidemiology, College of Public Health, University of Iowa
Mary-Claire Roghmann - Veterans Affairs Maryland Health Care System, Baltimore
Eli N Perencevich - Department of Epidemiology, College of Public Health, University of Iowa
Michael E Ohl - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Michihiko Goto - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Daniel J Livorsi - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Makoto Jones - Veterans Affairs Salt Lake City Health Care System, Utah
Justin P Albertson - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Rajeshwari Nair - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Amy M J O'Shea - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
Marin L Schweizer - Department of Epidemiology, College of Public Health, University of Iowa
Resource Type: Journal article
Publication Details: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol.65(1), pp.100-106
DOI: 10.1093/cid/cix287
PMID: 28379314
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Publisher: United States
Grant note: IK2 HX001165 / HSRD VA
Language: English
Date published: 07/01/2017
Academic Unit: Psychiatry; Infectious Diseases; Epidemiology; Internal Medicine
Record Identifier: 9983779489502771

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