A comparison of safety and outcomes with cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bloodstream infections

Miller, Matthew A.; Fish, Douglas N.; Barber, Gerard R.; Barron, Michelle A.; Goolsby, Tiffany; Moine, Pierre; Mueller, Scott W.

doi:10.1016/j.jmii.2018.07.006

Cited by 25 publications

(16 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In some instances, such as treatment of a patient with an acute life‐threatening infection, direct de‐labeling of the penicillin allergy may not be feasible or practical and favored approaches might be: (a) utilization of a nonpenicillin (structurally dissimilar beta‐lactam or non–beta‐lactam) or (b) desensitization. At the point of care, if an allergy label is present and an alternative antimicrobial is available with no drop in treatment efficacy, use of that alternative agent may be an acceptable practice, but this is not true for all infections . An avoidance of penicillin leading to use of bacteriostatic, overly broad‐spectrum antimicrobials or less effective antibiotic, rather than a similar spectrum cephalosporin, is of higher concern.…”

Section: Current Approaches To Penicillin Allergy Labels and Penicillmentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

181

160

View full text Add to dashboard Cite

Background Even though 8%‐25% of most populations studied globally are labeled as penicillin allergic, most diagnoses of penicillin allergy are made in childhood and relate to events that are either not allergic in nature, are low risk for immediate hypersensitivity, or are a potential true allergy that has waned over time. Penicillin allergy labels directly impact antimicrobial stewardship by leading to use of less effective and broader spectrum antimicrobials and are associated with antimicrobial resistance. They may also delay appropriate antimicrobial therapy and lead to increased risk of specific adverse healthcare outcomes. Operationalizing penicillin allergy de‐labeling into a new arm of antimicrobial stewardship programs (ASPs) has become an increasing global focus. Methods We performed an evidence‐based narrative review of the literature of penicillin allergy label carriage, the adverse effects of penicillin allergy labels, and current approaches and barriers to penicillin allergy de‐labeling. Over the period 1928‐2018 in Pubmed and Medline, search terms used included “penicillin allergy” or “penicillin hypersensitivity” alone or in combination with “adverse events,” “testing,” “evaluation,” “effects,” “label,” “de‐labeling,” “prick or epicutaneous,” and “intradermal” skin testing, “oral challenge or provocation,” “cross‐reactivity,” and “antimicrobial stewardship”. Results Penicillin allergy labels are highly prevalent, largely inaccurate and their carriage may lead to unnecessary treatment and inferior outcomes with alternative agents as well as adverse public health outcomes such as antibiotic resistance. Conclusions Operationalizing penicillin allergy de‐labeling as an aspect of ASP has become an increasing global focus. There is a need for validated approaches that optimally combine the use of history and ingestion challenge with or without proceeding formal skin testing to tackle penicillin allergy efficiently within complex healthcare systems. At the same time, there is great promise for penicillin allergy evaluation and de‐labeling as an individual and public health strategy to reduce adverse healthcare outcomes, improve antimicrobial stewardship, and decrease healthcare costs.

show abstract

Section: Current Approaches To Penicillin Allergy Labels and Penicillmentioning

confidence: 99%

The challenge of de‐labeling penicillin allergy

Stone

Trubiano

Coleman

et al. 2019

Allergy

181

160

View full text Add to dashboard Cite

show abstract

“…18 Another recent retrospective study evaluating 130 patients with MSSA bacteremia at a tertiary academic medical center reported a higher incidence of nephrotoxicity with nafcillin compared with cefazolin (25% vs 2%, respectively; relative risk = 1.31), utilizing an increase in SCr ≥1.5 times or by 0.5 mg/dL from baseline levels as nephrotoxicity criteria. 19 Burrelli et al 20 reported a higher incidence of AKI with nafcillin compared with cefazolin (29.1% vs 15.4%, respectively), utilizing a definition during hospital stay with an increase in SCr ≥0.5 mg/dL or 50% increase from baseline. In contrast, Youngster et al 11 reported nafcillin AKI rates of 11.4% when used for MSSA infections in the outpatient setting.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Analysis of Adverse Drug Events Between Nafcillin Versus Cefazolin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections

et al. 2019

View full text Add to dashboard Cite

Background: Nafcillin or cefazolin are drugs of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections. Prior studies indicate a higher incidence of acute kidney injury (AKI) with nafcillin, although AKI classification and time to occurrence is not well described. Objective: To characterize the incidence and time to adverse drug events for nafcillin versus cefazolin in the inpatient setting. Methods: A retrospective cohort study evaluated hospitalized, adult patients receiving intravenous nafcillin or cefazolin for treatment of MSSA infection. Incidence and time to AKI based on RIFLE criteria were measured. Secondary end points included antibiotic discontinuation and incidence of neutropenia, thrombocytopenia, elevated transaminases, and Clostridioides difficile infection (CDI). Results: Of 324 patients who received nafcillin (n = 119) or cefazolin (n = 205), higher rates of AKI were found for nafcillin versus cefazolin (19% vs 2%, respectively; P < 0.0001). Median time to AKI with nafcillin was 6.5 days (range, 3-14 days). The majority of patients were classified as RIFLE “Risk” stratum. Nafcillin treatment discontinuations were more frequent than for cefazolin (17.6% vs 0.9%, respectively; P < 0.0001). Nafcillin was an independent predictor of AKI (odds ratio = 12.4; 95% CI = 4.14-47.60, P < 0.0001). No differences in neutropenia, thrombocytopenia, elevated transaminases, or CDI were observed. Conclusion and Relevance: Nafcillin displayed higher rates of AKI at a median of 1 week of therapy, which provides a framework for clinician monitoring and consideration of antibiotic modification. Most patients developed “Risk” class AKI (RIFLE classification), which may be reversible with prompt intervention.

show abstract

“…Antagonism with FLZ was not a universal attribute among penicillin antibiotics but was evident for oxacillin and methicillin (Figure 5M). We also tested a first-generation cephalosporin, cefazolin, that is often prescribed in place of nafcillin (Letourneau, 2019;Miller et al, 2018) and a second-generation cephalosporin, cefonicid. We found that both of these molecules also antagonize FLZ (Figure 5M).…”

Section: Exposure To Beta-lactam Antibiotics Increases Ergosterol Levels and Antagonizes Fluconazole Activitymentioning

confidence: 99%

Faculty Opinions recommendation of Synergistic and antagonistic drug interactions in the treatment of systemic fungal infections.

Pagano

2020

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature

View full text Add to dashboard Cite

Invasive fungal infections cause 1.6 million deaths annually, primarily in immunocompromised individuals. Mortality rates are as high as 90% due to limited treatments. The azole class antifungal, fluconazole, is widely available and has multi-species activity but only inhibits growth instead of killing fungal cells, necessitating long treatments. To improve treatment, we used our novel high-throughput method, the overlap 2 method (O2M) to identify drugs that interact with fluconazole, either increasing or decreasing efficacy. We identified 40 molecules that act synergistically (amplify activity) and 19 molecules that act antagonistically (decrease efficacy) when combined with fluconazole. We found that critical frontline beta-lactam antibiotics antagonize fluconazole activity. A promising fluconazole-synergizing anticholinergic drug, dicyclomine, increases fungal cell permeability and inhibits nutrient intake when combined with fluconazole. In vivo, this combination doubled the time-to-endpoint of mice with Cryptococcus neoformans meningitis. Thus, our ability to rapidly identify synergistic and antagonistic drug interactions can potentially alter the patient outcomes.

show abstract

A comparison of safety and outcomes with cefazolin versus nafcillin for methicillin-susceptible Staphylococcus aureus bloodstream infections

Abstract: CFZ was associated with less nephrotoxicity and no difference in clinical success compared to NAF for MSSA BSI. A prospective study comparing NAF to CFZ for MSSA BSI should be conducted to elucidate differences in therapies.

Cited by 25 publications

References 18 publications

The challenge of de‐labeling penicillin allergy

The challenge of de‐labeling penicillin allergy

Retrospective Analysis of Adverse Drug Events Between Nafcillin Versus Cefazolin for Treatment of Methicillin-Susceptible Staphylococcus aureus Infections

Faculty Opinions recommendation of Synergistic and antagonistic drug interactions in the treatment of systemic fungal infections.

Contact Info

Product

Resources

About