Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective StudyReportar como inadecuado




Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

The objective was to compare the prognostic impact of first week treatment with anti-staphylococcal penicillin ASP versus cephalosporin in methicillin-sensitive Staphylococcus aureus bacteremia MS-SAB. Altogether 580 patients were retrospectively followed and categorized according to first week treatment; 84% 488 received ASP cloxacillin and 16% 92 cephalosporin cefuroxime or ceftriaxone. SAB management was optimized with formal bedside infectious disease specialist consultation in 88%, deep infection foci diagnosed in 77% and adjunctive rifampicin therapy given to 61% of patients. The total case fatality in 580 patients was 12% at 28 days and 18% at 90 days. When comparing effectiveness of first week ASP versus cephalosporin treatment there were no significant differences in 28-days 11% vs. 12%, OR; 1.05, 95% CI, 0.53–2.09 or 90-days 17% vs. 21% OR; 1.25, 95% CI, 0.72–2.19 outcome. In univariate analysis no prognostic impact of either first week ASP or cephalosporin treatment was observed for 28-days OR; 0.96, 95% CI, 0.48–1.90 and OR; 1.05, 95% CI, 0.53–2.09 or 90-days OR; 0.80, 95% CI, 0.46–1.39 and OR; 1.25, 95% CI, 0.72–2.19 outcome. Propensity-score adjusted Cox proportional regression analysis for first week treatment with cephalosporin demonstrated no significant prognostic impact at 28-days HR 1.54, 95% CI 0.72–3.23 or 90-days HR 1.56, 95% CI 0.88–2.86. In conclusion: There is a comparable effectiveness with respect to 28- and 90-days outcome for first week treatment with ASP versus cephalosporin in MS-SAB. The results indicate that the difference in prognostic impact between first week ASP and cephalosporin may be non-significant in patient cohorts with SAB management optimized by infectious disease specialist consultation.



Autor: Erik Forsblom , Eeva Ruotsalainen, Asko Järvinen

Fuente: http://plos.srce.hr/



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