Antistaphylococcal Penicillin vs Cefazolin for the Treatment of Methicillin-SusceptibleStaphylococcus aureusSpinal Epidural Abscesses

Abstract

Cefazolin is commonly used as an alternative to anti-staphylococcal penicillins (ASPs) in treating methicillin-susceptible Staphylococcus aureus (MSSA) infections; however, no study has compared these agents in MSSA spinal epidural abscess (SEA). We describe our experience in managing MSSA SEA and compare the clinical efficacy of cefazolin with ASPs. This retrospective multi-center study reviewed 79 adult patients diagnosed with SEA between January 2006 and July 2020 using data collected from electronic health records and clinical microbiology laboratory databases. Forty-five patients received cefazolin, while thirty-four received ASPs. The total antibiotic duration was longer in the ASPs group but not statistically significant. There were no significant differences in treatment failure at week six and week twelve, 30-day and overall mortality, and 90-day recurrence rates between the treatment groups. Cefazolin was equally as effective as ASPs, and our findings suggest it can be an alternative to ASPs in the treatment of MSSA SEA.

Epidural Abscesses as a Complication of Interleukin-6 Inhibitor and Dexamethasone Treatment in a Patient with COVID-19 Pneumonia: A Case Report

“…The duration of antibiotic therapy for epidural abscesses is not well defined. Sources cite 4 to 12 weeks as adequate durations [13]. A relatively long antibiotic duration was chosen in this patient to reduce the risk of recurrence because she was managed conservatively with no drainage of the abscesses [14].…”

Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

“…When compared to nafcillin for treatment of MSSA infections, cefazolin is reported to be better tolerated, with fewer adverse and cessation of therapy events [ 216 ]. However, there is an ongoing clinical impasse on the utility of cefazolin in the presence of high inoculum infection (e.g., highly invasive presentation) causing inducible resistance with the potential of treatment failure, while several reports indicate no difference in treatment outcomes [ 216 , 217 , 218 ].…”

Targeted Therapy of Severe Infections Caused by Staphylococcus aureus in Critically Ill Adult Patients: A Multidisciplinary Proposal of Therapeutic Algorithms Based on Real-World Evidence

“…Conversely, a recent large multicentric retrospective study including 7312 patients with MSSA BSIs (ICU admission 13.5%) showed no difference in the 30-day mortality rate between cefazolin and flucloxacillin at propensity adjusted analysis (aOR 0.86; 95%CI 0.65–1.14) [ 18 ]. Likewise, no difference between cefazolin and antistaphylococcal penicillins (ASPs) was documented in several retrospective observational studies (ICU admission ranging from 5.2% to 41.8%) in terms of mortality rate, clinical cure rate, and relapse or recurrence rate of MSSA BSIs [ 19 , 20 , 21 , 22 , 23 ]. In a multicentric retrospective cohort study including 93 patients with complicated MSSA BSIs (41% related to bone and joint infections and 20% IE) [ 24 ], cefazolin showed a significantly lower clinical failure rate at 90-day (24% vs. 47%; p = 0.04) and AE rate (3% vs. 30%; p < 0.001) compared to oxacillin.…”