A large retrospective cohort study of cefazolin compared with flucloxacillin for methicillin-susceptible Staphylococcus aureus bacteraemia

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and objectives: Antistaphylococcal penicillins (ASPs) are recommended as first-line treatment for invasive infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cefazolin is an alternative option, but there is theoretical concern about its use as some MSSA strains produce beta-lactamases active against cefazolin. The study compared the outcomes in patients with MSSA infections treated with flucloxacillin and cefazolin. 

Methods: We analysed data from The Australia and New Zealand Co-operative Outcomes of Staphylococcal Sepsis (ANZCOSS) observational study, which included all consecutive unique episodes of Staphylococcus aureus bacteraemia from 27 hospital-based or independent microbiology laboratories from January 2007 to September 2013. In this retrospective analysis of prospectively collected data, we compared 30-day all-cause mortality in patients with MSSA bacteraemia treated with flucloxacillin to that in patients treated with cefazolin. 

Results: We included data from 7312 episodes of MSSA bacteremia and found no difference in 30-day mortality in those treated with flucloxacillin (731/6520 [11.2%, 95% CI 10.9–12.5%]) compared to cefazolin (83/792 [10.7%, 95% CI 8.4–12.8%]), OR 0.93 (95% CI 0.72–1.17). In a propensity-adjusted analysis, mortality remained non-significantly lower in the cefazolin group (aOR 0.86 [95% CI 0.65–1.14]). 

Conclusions: This study supports the results from previous observational studies from other regions, while extending them to Australasia and to a much larger number of patients. Although this observational study indicates cefazolin is likely to have equivalent or superior outcomes to ASPs for MSSA bacteraemia, this can only be convincingly proven by a properly designed randomised controlled trial.

LanguageEnglish
Pages297-300
Number of pages4
JournalInternational Journal of Antimicrobial Agents
Volume52
Issue number2
DOIs
StatePublished - Aug 2018

Fingerprint

Floxacillin
Cefazolin
Methicillin
Bacteremia
Staphylococcus aureus
Cohort Studies
Retrospective Studies
Observational Studies
Penicillins
Mortality
Australasia
beta-Lactamases
Microbiology
Infection
New Zealand
Sepsis
Randomized Controlled Trials
Outcome Assessment (Health Care)

Cite this

@article{c4c2533de84e448f9f5cd91fbcaabb08,
title = "A large retrospective cohort study of cefazolin compared with flucloxacillin for methicillin-susceptible Staphylococcus aureus bacteraemia",
abstract = "Background and objectives: Antistaphylococcal penicillins (ASPs) are recommended as first-line treatment for invasive infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cefazolin is an alternative option, but there is theoretical concern about its use as some MSSA strains produce beta-lactamases active against cefazolin. The study compared the outcomes in patients with MSSA infections treated with flucloxacillin and cefazolin. Methods: We analysed data from The Australia and New Zealand Co-operative Outcomes of Staphylococcal Sepsis (ANZCOSS) observational study, which included all consecutive unique episodes of Staphylococcus aureus bacteraemia from 27 hospital-based or independent microbiology laboratories from January 2007 to September 2013. In this retrospective analysis of prospectively collected data, we compared 30-day all-cause mortality in patients with MSSA bacteraemia treated with flucloxacillin to that in patients treated with cefazolin. Results: We included data from 7312 episodes of MSSA bacteremia and found no difference in 30-day mortality in those treated with flucloxacillin (731/6520 [11.2{\%}, 95{\%} CI 10.9–12.5{\%}]) compared to cefazolin (83/792 [10.7{\%}, 95{\%} CI 8.4–12.8{\%}]), OR 0.93 (95{\%} CI 0.72–1.17). In a propensity-adjusted analysis, mortality remained non-significantly lower in the cefazolin group (aOR 0.86 [95{\%} CI 0.65–1.14]). Conclusions: This study supports the results from previous observational studies from other regions, while extending them to Australasia and to a much larger number of patients. Although this observational study indicates cefazolin is likely to have equivalent or superior outcomes to ASPs for MSSA bacteraemia, this can only be convincingly proven by a properly designed randomised controlled trial.",
keywords = "Antistaphylococcal penicillins, Bacteraemia, Cefazolin, Flucloxacillin, Staphylococcus aureus",
author = "Davis, {J. S.} and J. Turnidge and Tong, {S. Y.C.}",
year = "2018",
month = "8",
doi = "10.1016/j.ijantimicag.2018.02.013",
language = "English",
volume = "52",
pages = "297--300",
journal = "International Journal of Antimicrobial Agents",
issn = "0924-8579",
publisher = "Elsevier",
number = "2",

}

TY - JOUR

T1 - A large retrospective cohort study of cefazolin compared with flucloxacillin for methicillin-susceptible Staphylococcus aureus bacteraemia

AU - Davis,J. S.

AU - Turnidge,J.

AU - Tong,S. Y.C.

PY - 2018/8

Y1 - 2018/8

N2 - Background and objectives: Antistaphylococcal penicillins (ASPs) are recommended as first-line treatment for invasive infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cefazolin is an alternative option, but there is theoretical concern about its use as some MSSA strains produce beta-lactamases active against cefazolin. The study compared the outcomes in patients with MSSA infections treated with flucloxacillin and cefazolin. Methods: We analysed data from The Australia and New Zealand Co-operative Outcomes of Staphylococcal Sepsis (ANZCOSS) observational study, which included all consecutive unique episodes of Staphylococcus aureus bacteraemia from 27 hospital-based or independent microbiology laboratories from January 2007 to September 2013. In this retrospective analysis of prospectively collected data, we compared 30-day all-cause mortality in patients with MSSA bacteraemia treated with flucloxacillin to that in patients treated with cefazolin. Results: We included data from 7312 episodes of MSSA bacteremia and found no difference in 30-day mortality in those treated with flucloxacillin (731/6520 [11.2%, 95% CI 10.9–12.5%]) compared to cefazolin (83/792 [10.7%, 95% CI 8.4–12.8%]), OR 0.93 (95% CI 0.72–1.17). In a propensity-adjusted analysis, mortality remained non-significantly lower in the cefazolin group (aOR 0.86 [95% CI 0.65–1.14]). Conclusions: This study supports the results from previous observational studies from other regions, while extending them to Australasia and to a much larger number of patients. Although this observational study indicates cefazolin is likely to have equivalent or superior outcomes to ASPs for MSSA bacteraemia, this can only be convincingly proven by a properly designed randomised controlled trial.

AB - Background and objectives: Antistaphylococcal penicillins (ASPs) are recommended as first-line treatment for invasive infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). Cefazolin is an alternative option, but there is theoretical concern about its use as some MSSA strains produce beta-lactamases active against cefazolin. The study compared the outcomes in patients with MSSA infections treated with flucloxacillin and cefazolin. Methods: We analysed data from The Australia and New Zealand Co-operative Outcomes of Staphylococcal Sepsis (ANZCOSS) observational study, which included all consecutive unique episodes of Staphylococcus aureus bacteraemia from 27 hospital-based or independent microbiology laboratories from January 2007 to September 2013. In this retrospective analysis of prospectively collected data, we compared 30-day all-cause mortality in patients with MSSA bacteraemia treated with flucloxacillin to that in patients treated with cefazolin. Results: We included data from 7312 episodes of MSSA bacteremia and found no difference in 30-day mortality in those treated with flucloxacillin (731/6520 [11.2%, 95% CI 10.9–12.5%]) compared to cefazolin (83/792 [10.7%, 95% CI 8.4–12.8%]), OR 0.93 (95% CI 0.72–1.17). In a propensity-adjusted analysis, mortality remained non-significantly lower in the cefazolin group (aOR 0.86 [95% CI 0.65–1.14]). Conclusions: This study supports the results from previous observational studies from other regions, while extending them to Australasia and to a much larger number of patients. Although this observational study indicates cefazolin is likely to have equivalent or superior outcomes to ASPs for MSSA bacteraemia, this can only be convincingly proven by a properly designed randomised controlled trial.

KW - Antistaphylococcal penicillins

KW - Bacteraemia

KW - Cefazolin

KW - Flucloxacillin

KW - Staphylococcus aureus

UR - http://www.scopus.com/inward/record.url?scp=85048757758&partnerID=8YFLogxK

U2 - 10.1016/j.ijantimicag.2018.02.013

DO - 10.1016/j.ijantimicag.2018.02.013

M3 - Article

VL - 52

SP - 297

EP - 300

JO - International Journal of Antimicrobial Agents

T2 - International Journal of Antimicrobial Agents

JF - International Journal of Antimicrobial Agents

SN - 0924-8579

IS - 2

ER -