Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia

S. Weis, M. Kesselmeier, J. S. Davis, A. M. Morris, S. Lee, A. Scherag, S. Hagel, M. W. Pletz

    Research output: Contribution to journalReview articleResearchpeer-review

    7 Downloads (Pure)

    Abstract

    Background: For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect.

    Objectives: To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB).

    Methods: We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I 2 . The primary endpoint was 90-day all-cause mortality. The Newcastle–Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment.

    Results: Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence).

    Conclusions: Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.

    Original languageEnglish
    Pages (from-to)818-827
    Number of pages10
    JournalClinical Microbiology and Infection
    Volume25
    Issue number7
    Early online date27 Mar 2019
    DOIs
    Publication statusPublished - Jul 2019

    Fingerprint

    Cefazolin
    Bacteremia
    Penicillins
    Staphylococcus aureus
    Methicillin
    Therapeutics
    Meta-Analysis
    Mortality
    Endocarditis
    Treatment Failure
    MEDLINE
    Abscess
    Publications
    Language
    Databases
    Confidence Intervals
    Recurrence

    Cite this

    Weis, S. ; Kesselmeier, M. ; Davis, J. S. ; Morris, A. M. ; Lee, S. ; Scherag, A. ; Hagel, S. ; Pletz, M. W. / Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. In: Clinical Microbiology and Infection. 2019 ; Vol. 25, No. 7. pp. 818-827.
    @article{1344d1206a3f4fe9adb8c04aad16128c,
    title = "Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia",
    abstract = "Background: For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect. Objectives: To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB). Methods: We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95{\%} confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I 2 . The primary endpoint was 90-day all-cause mortality. The Newcastle–Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment. Results: Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence). Conclusions: Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.",
    keywords = "Anti-staphylococcal penicillins, Antimicrobial therapy, Bacteraemia, Cefazolin, Flucloxacillin, Meta-analysis, Staphylococcus aureus",
    author = "S. Weis and M. Kesselmeier and Davis, {J. S.} and Morris, {A. M.} and S. Lee and A. Scherag and S. Hagel and Pletz, {M. W.}",
    year = "2019",
    month = "7",
    doi = "10.1016/j.cmi.2019.03.010",
    language = "English",
    volume = "25",
    pages = "818--827",
    journal = "Clinical Microbiology and Infection",
    issn = "1198-743X",
    publisher = "Wiley-Blackwell",
    number = "7",

    }

    Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. / Weis, S.; Kesselmeier, M.; Davis, J. S.; Morris, A. M.; Lee, S.; Scherag, A.; Hagel, S.; Pletz, M. W.

    In: Clinical Microbiology and Infection, Vol. 25, No. 7, 07.2019, p. 818-827.

    Research output: Contribution to journalReview articleResearchpeer-review

    TY - JOUR

    T1 - Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia

    AU - Weis, S.

    AU - Kesselmeier, M.

    AU - Davis, J. S.

    AU - Morris, A. M.

    AU - Lee, S.

    AU - Scherag, A.

    AU - Hagel, S.

    AU - Pletz, M. W.

    PY - 2019/7

    Y1 - 2019/7

    N2 - Background: For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect. Objectives: To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB). Methods: We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I 2 . The primary endpoint was 90-day all-cause mortality. The Newcastle–Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment. Results: Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence). Conclusions: Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.

    AB - Background: For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect. Objectives: To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB). Methods: We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I 2 . The primary endpoint was 90-day all-cause mortality. The Newcastle–Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment. Results: Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence). Conclusions: Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.

    KW - Anti-staphylococcal penicillins

    KW - Antimicrobial therapy

    KW - Bacteraemia

    KW - Cefazolin

    KW - Flucloxacillin

    KW - Meta-analysis

    KW - Staphylococcus aureus

    UR - http://www.scopus.com/inward/record.url?scp=85064621590&partnerID=8YFLogxK

    U2 - 10.1016/j.cmi.2019.03.010

    DO - 10.1016/j.cmi.2019.03.010

    M3 - Review article

    VL - 25

    SP - 818

    EP - 827

    JO - Clinical Microbiology and Infection

    JF - Clinical Microbiology and Infection

    SN - 1198-743X

    IS - 7

    ER -