Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study

A. Henderson, P. Harris, G. Hartel, D. Paterson, J. Turnidge, J. S. Davis, S. Y.C. Tong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

In clinical practice, differing opinions exists regarding the optimal management of patients with penicillin-susceptible Staphylococcus aureus (PSSA) bloodstream infection (BSI). The aim of this study was to compare the 30-day mortality of patients treated with benzylpenicillin or flucloxacillin for PSSA BSI from a large prospectively collected data set from Australia and New Zealand. A logistic regression model and propensity score treatment analysis using inverse probability of treatment weighting were used. A total of 915 patients were included in the study, with an overall mortality rate of 12.9% (118/915) [benzylpenicillin 10.5% (33/315) and flucloxacillin 14.2% (85/600)]. Endocarditis was associated with benzylpenicillin treatment choice, whereas skin and soft-tissue infection was associated with flucloxacillin treatment choice. In the multivariate analysis, increased 30-day mortality was associated with flucloxacillin compared with benzylpenicillin [odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.0–2.5; P = 0.05). When adjusted for treatment choice in the propensity score analysis, flucloxacillin was again associated with increased 30-day mortality (OR = 1.06, 95% CI 1.01–1.1; P = 0.03). An increase in 30-day mortality associated with flucloxacillin use suggests a potential benefit for benzylpenicillin therapy in patients with PSSA BSI.

Original languageEnglish
Pages (from-to)491-495
Number of pages5
JournalInternational Journal of Antimicrobial Agents
Volume54
Issue number4
Early online date7 Jun 2019
DOIs
Publication statusPublished - Oct 2019

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Floxacillin
Penicillin G
Penicillins
Staphylococcus aureus
Cohort Studies
Retrospective Studies
Infection
Mortality
Propensity Score
Therapeutics
Logistic Models
Odds Ratio
Confidence Intervals
Soft Tissue Infections
Endocarditis
New Zealand
Multivariate Analysis
Skin

Cite this

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title = "Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study",
abstract = "In clinical practice, differing opinions exists regarding the optimal management of patients with penicillin-susceptible Staphylococcus aureus (PSSA) bloodstream infection (BSI). The aim of this study was to compare the 30-day mortality of patients treated with benzylpenicillin or flucloxacillin for PSSA BSI from a large prospectively collected data set from Australia and New Zealand. A logistic regression model and propensity score treatment analysis using inverse probability of treatment weighting were used. A total of 915 patients were included in the study, with an overall mortality rate of 12.9{\%} (118/915) [benzylpenicillin 10.5{\%} (33/315) and flucloxacillin 14.2{\%} (85/600)]. Endocarditis was associated with benzylpenicillin treatment choice, whereas skin and soft-tissue infection was associated with flucloxacillin treatment choice. In the multivariate analysis, increased 30-day mortality was associated with flucloxacillin compared with benzylpenicillin [odds ratio (OR) = 1.6, 95{\%} confidence interval (CI) 1.0–2.5; P = 0.05). When adjusted for treatment choice in the propensity score analysis, flucloxacillin was again associated with increased 30-day mortality (OR = 1.06, 95{\%} CI 1.01–1.1; P = 0.03). An increase in 30-day mortality associated with flucloxacillin use suggests a potential benefit for benzylpenicillin therapy in patients with PSSA BSI.",
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Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study. / Henderson, A.; Harris, P.; Hartel, G.; Paterson, D.; Turnidge, J.; Davis, J. S.; Tong, S. Y.C.

In: International Journal of Antimicrobial Agents, Vol. 54, No. 4, 10.2019, p. 491-495.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study

AU - Henderson, A.

AU - Harris, P.

AU - Hartel, G.

AU - Paterson, D.

AU - Turnidge, J.

AU - Davis, J. S.

AU - Tong, S. Y.C.

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