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Tytuł:
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Cefazolin versus cloxacillin as definitive antibiotic therapy for methicillin-susceptible Staphylococcus aureus spinal epidural abscess: a retrospective cohort study.
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Autorzy:
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Bai AD; Health Research Methodology Program, McMaster University, Hamilton, Ontario, Canada. Electronic address: .
Findlater A; Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
Irfan N; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Singhal N; Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
Loeb M; Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada.
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Źródło:
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International journal of antimicrobial agents [Int J Antimicrob Agents] 2021 Nov; Vol. 58 (5), pp. 106429. Date of Electronic Publication: 2021 Aug 29.
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Typ publikacji:
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Comparative Study; Journal Article; Multicenter Study
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Język:
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English
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Imprint Name(s):
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Original Publication: Amsterdam : Elsevier Science Publishers, c1991-
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MeSH Terms:
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Anti-Bacterial Agents/*therapeutic use
Cefazolin/*therapeutic use
Cloxacillin/*therapeutic use
Epidural Abscess/*drug therapy
Staphylococcal Infections/*drug therapy
Staphylococcus aureus/*drug effects
Aged ; Anti-Bacterial Agents/adverse effects ; Canada ; Cefazolin/adverse effects ; Cloxacillin/adverse effects ; Epidural Abscess/microbiology ; Female ; Humans ; Male ; Methicillin/pharmacology ; Middle Aged ; Recurrence ; Retrospective Studies ; Staphylococcal Infections/mortality ; Treatment Outcome
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Contributed Indexing:
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Keywords: Antistaphylococcal penicillin; Cefazolin; MSSA; Methicillin-susceptible; Spinal epidural abscess; Staphylococcus aureus
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Substance Nomenclature:
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0 (Anti-Bacterial Agents)
IHS69L0Y4T (Cefazolin)
O6X5QGC2VB (Cloxacillin)
Q91FH1328A (Methicillin)
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Entry Date(s):
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Date Created: 20210901 Date Completed: 20220126 Latest Revision: 20220126
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Update Code:
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20240105
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DOI:
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10.1016/j.ijantimicag.2021.106429
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PMID:
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34469802
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Objectives: We compared the effectiveness of cefazolin and cloxacillin as definitive antibiotic therapy for methicillin-susceptible Staphylococcus aureus (MSSA) spinal epidural abscess (SEA).
Methods: This retrospective cohort study included patients with MSSA SEA from two academic hospitals in Hamilton, Ontario, Canada, between 2014 and 2020. Patients treated with cefazolin were compared to those treated with cloxacillin. Co-primary outcomes included 90-day mortality, antibiotic failure, adverse reactions and recurrence. Inverse probability of treatment weighting using propensity scores was used to balance important prognostic factors and to estimate an adjusted risk difference.
Results: Of 98 patients with MSSA SEA, 50 and 48 patients were treated with cefazolin and cloxacillin, respectively. Mortality at 90 days was 8% and 13% in the cefazolin and cloxacillin groups, respectively (P = 0.52). The antibiotic failure rate was 12% and 19% in the cefazolin and cloxacillin groups, respectively (P = 0.41). The serious adverse reactions rate was 0% and 4% in the cefazolin and cloxacillin groups, respectively (P = 0.24). The recurrence rate was 2% and 8% in the cefazolin and cloxacillin groups, respectively (P = 0.20). The adjusted risk difference for mortality at 90 days was -1% [95% confidence interval (CI) -10% to 8%] favouring cefazolin. The adjusted risk differences for antibiotic failure, adverse reactions and recurrence were 1% (95% CI -12% to 14%), -5% (95% CI -11% to 2%) and -18% (-36% to -1%) respectively.
Conclusion: Cefazolin is likely as effective as an antistaphylococcal penicillin and may be considered as a first-line treatment for MSSA SEA.
(Copyright © 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.)
