Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea

The Korea INfectious Diseases (KIND) study group

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objectives: No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Methods: A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. Results: Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. Conclusions: Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.

Original languageEnglish
Pages (from-to)152-158
Number of pages7
JournalClinical Microbiology and Infection
Volume24
Issue number2
DOIs
Publication statusPublished - 2018 Feb

Fingerprint

Nafcillin
Cefazolin
Methicillin
Korea
Bacteremia
Multicenter Studies
Staphylococcus aureus
Cohort Studies
Treatment Failure
Anti-Bacterial Agents
Propensity Score
Mortality
Sepsis
Observational Studies
Randomized Controlled Trials
Joints
Bone and Bones
Recurrence

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{732ae027b4f44220ad527781deb0c96f,
title = "Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective multicentre cohort study in Korea",
abstract = "Objectives: No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Methods: A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. Results: Among the 242 included cases, the bones and joints (36.8{\%}) were the most common sites of infection and 60.7{\%} of the patients had sepsis. The overall treatment failure rate was 43.8{\%} (106/242). All-cause mortality within 1 month was 6.2{\%} (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4{\%} (24/79) vs. 49.4{\%} (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22{\%} (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. Conclusions: Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.",
author = "{The Korea INfectious Diseases (KIND) study group} and S. Lee and Song, {K. H.} and Jung, {S. I.} and Park, {W. B.} and Lee, {S. H.} and Kim, {Y. S.} and Kwak, {Y. G.} and Kim, {Y. K.} and Kiem, {S. M.} and Kim, {H. I.} and Kim, {E. S.} and Park, {K. H.} and Kim, {N. J.} and Jang, {H. C.} and Kim, {H. B.} and Choi, {S. M.} and Park, {K. U.} and Kim, {C. J.} and Cho, {J. E.} and Choi, {Y. J.} and {In Park}, J. and Kim, {T. S.} and Choe, {P. G.} and Park, {W. B.} and Kim, {N. H.} and Lee, {M. J.} and Choi, {S. J.} and Jeon, {J. H.} and Kim, {D. K.} and Song, {S. A.} and Kang, {M. J.} and Shin, {J. G.} and J. Yi and S. Park and Choi, {H. K.} and Han, {M. S.} and Cho, {C. R.} and Song, {H. S.} and Lee, {Y. S.} and Kang, {S. J.} and Hwang, {H. J.} and S. Cheon and Hwang, {J. H.} and Yun, {S. J.} and Kwon, {K. T.} and Shin, {S. M.}",
year = "2018",
month = "2",
doi = "10.1016/j.cmi.2017.07.001",
language = "English",
volume = "24",
pages = "152--158",
journal = "Clinical Microbiology and Infection",
issn = "1198-743X",
publisher = "Elsevier Limited",
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Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia : a prospective multicentre cohort study in Korea. / The Korea INfectious Diseases (KIND) study group.

In: Clinical Microbiology and Infection, Vol. 24, No. 2, 02.2018, p. 152-158.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bacteraemia

T2 - a prospective multicentre cohort study in Korea

AU - The Korea INfectious Diseases (KIND) study group

AU - Lee, S.

AU - Song, K. H.

AU - Jung, S. I.

AU - Park, W. B.

AU - Lee, S. H.

AU - Kim, Y. S.

AU - Kwak, Y. G.

AU - Kim, Y. K.

AU - Kiem, S. M.

AU - Kim, H. I.

AU - Kim, E. S.

AU - Park, K. H.

AU - Kim, N. J.

AU - Jang, H. C.

AU - Kim, H. B.

AU - Choi, S. M.

AU - Park, K. U.

AU - Kim, C. J.

AU - Cho, J. E.

AU - Choi, Y. J.

AU - In Park, J.

AU - Kim, T. S.

AU - Choe, P. G.

AU - Park, W. B.

AU - Kim, N. H.

AU - Lee, M. J.

AU - Choi, S. J.

AU - Jeon, J. H.

AU - Kim, D. K.

AU - Song, S. A.

AU - Kang, M. J.

AU - Shin, J. G.

AU - Yi, J.

AU - Park, S.

AU - Choi, H. K.

AU - Han, M. S.

AU - Cho, C. R.

AU - Song, H. S.

AU - Lee, Y. S.

AU - Kang, S. J.

AU - Hwang, H. J.

AU - Cheon, S.

AU - Hwang, J. H.

AU - Yun, S. J.

AU - Kwon, K. T.

AU - Shin, S. M.

PY - 2018/2

Y1 - 2018/2

N2 - Objectives: No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Methods: A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. Results: Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. Conclusions: Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.

AB - Objectives: No randomized controlled trials have evaluated the comparative outcomes of cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. Methods: A prospective observational cohort study including all S. aureus bacteraemia was conducted at 10 hospitals. Patients (≥15 years) with MSSA bacteraemia who received cefazolin or nafcillin as definitive antibiotics were included. The rates of treatment failure (premature discontinuation of antibiotics because of adverse effects, switching of antibiotics because of clinical failure, all-cause mortality within 1 month, or recurrence) were compared between the cefazolin and nafcillin groups. Propensity score matching analyses were performed to balance the factors influencing the selection of antibiotics. Results: Among the 242 included cases, the bones and joints (36.8%) were the most common sites of infection and 60.7% of the patients had sepsis. The overall treatment failure rate was 43.8% (106/242). All-cause mortality within 1 month was 6.2% (15/242). After propensity score matching, the treatment failure rate of cefazolin was lower than that of nafcillin (30.4% (24/79) vs. 49.4% (39/79), p 0.015) because of a higher rate of discontinuation caused by adverse events. When the data were limited to patients with sepsis, the treatment failure rates of both groups were not significantly different. Approximately 22% (24/110) of MSSA isolates exhibited a cefazolin-inoculum effect (CIE) that had significant impact on the failure rate and mortality of the cefazolin group. Conclusions: Cefazolin might be recommended as an adequate and better-tolerated treatment for MSSA bacteraemia in the absence of CIE.

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U2 - 10.1016/j.cmi.2017.07.001

DO - 10.1016/j.cmi.2017.07.001

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SN - 1198-743X

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