Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals

Jennifer S McDanel; Eli N Perencevich; Daniel J Diekema; Loreen A Herwaldt; Tara C Smith; Elizabeth A Chrischilles; Jeffrey D Dawson; Lan Jiang; Michihiko Goto; Marin L Schweizer

doi:10.1093/cid/civ308

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Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals

Journal article

Open access

Peer reviewed

Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals

Jennifer S McDanel, Eli N Perencevich, Daniel J Diekema, Loreen A Herwaldt, Tara C Smith, Elizabeth A Chrischilles, Jeffrey D Dawson, Lan Jiang, Michihiko Goto and Marin L Schweizer

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol.61(3), pp.361-367

08/01/2015

DOI: 10.1093/cid/civ308

PMID: 25900170

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Abstract

Previous studies indicate that vancomycin is inferior to beta-lactams for treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. However, it is unclear if this association is true for empiric and definitive therapy. Here, we compared beta-lactams with vancomycin for empiric and definitive therapy of MSSA bloodstream infections among patients admitted to 122 hospitals. This retrospective cohort study included all patients admitted to Veterans Affairs hospitals from 2003 to 2010 who had positive blood cultures for MSSA. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. Empiric therapy was defined as starting treatment 2 days before and up to 4 days after the first MSSA blood culture was collected. Definitive therapy was defined as starting treatment between 4 and 14 days after the first positive blood culture was collected. Patients who received empiric therapy with a beta-lactam had similar mortality compared with those who received vancomycin (HR, 1.03; 95% CI, .89-1.20) after adjusting for other factors. However, patients who received definitive therapy with a beta-lactam had 35% lower mortality compared with patients who received vancomycin (HR, 0.65; 95% CI, .52-.80) after controlling for other factors. The hazard of mortality decreased further for patients who received cefazolin or antistaphylococcal penicillins compared with vancomycin (HR, 0.57; 95% CI, .46-.71). For patients with MSSA bloodstream infections, beta-lactams are superior to vancomycin for definitive therapy but not for empiric treatment. Patients should receive beta-lactams for definitive therapy, specifically antistaphylococcal penicillins or cefazolin.

Staphylococcal Infections - drug therapy

Humans

Methicillin-Resistant Staphylococcus aureus - drug effects

Middle Aged

Male

Cross Infection - drug therapy

Vancomycin - adverse effects

Anti-Bacterial Agents - therapeutic use

beta-Lactams - pharmacology

Staphylococcal Infections - epidemiology

Vancomycin - therapeutic use

Cross Infection - microbiology

Vancomycin - pharmacology

beta-Lactams - adverse effects

Female

Aged

Anti-Bacterial Agents - adverse effects

Anti-Bacterial Agents - pharmacology

Staphylococcal Infections - microbiology

beta-Lactams - therapeutic use

Cross Infection - epidemiology

Details

Title: Subtitle: Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals
Creators: Jennifer S McDanel - Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
Eli N Perencevich - Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
Daniel J Diekema - Department of Internal Medicine, Carver College of Medicine, University of Iowa Department of Pathology, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics
Loreen A Herwaldt - Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics
Tara C Smith - Department of Epidemiology, College of Public Health
Elizabeth A Chrischilles - Department of Epidemiology, College of Public Health
Jeffrey D Dawson - Department of Biostatistics, College of Public Health, University of Iowa, Iowa City
Lan Jiang - Iowa City Veterans Affairs Health Care System
Michihiko Goto - Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
Marin L Schweizer - Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System
Resource Type: Journal article
Publication Details: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol.61(3), pp.361-367
DOI: 10.1093/cid/civ308
PMID: 25900170
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Publisher: United States
Grant note: name: VA Health Services Research and Development (HSR&D) Career Development, award: CDA, 11-211; name: VA HSR&D CDA, award: (11-211
Language: English
Date published: 08/01/2015
Academic Unit: Pharmacy; Public Health Administration; Infectious Diseases; Epidemiology; Pathology; Biostatistics; Internal Medicine
Record Identifier: 9983779293502771

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