Meta‐analysis of trials comparing cefazolin to antistaphylococcal penicillins in the treatment of methicillin‐sensitive <scp>Staphylococcus aureus</scp> bacteraemia

Rindone, Joseph P.; Mellen, Chadwick K.

doi:10.1111/bcp.13554

Cited by 30 publications

(17 citation statements)

References 23 publications

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“…Two recent meta-analyses (both published after completion of our work) have compared the use of cefazolin and ASPs for the treatment of MSSA bacteremia [ 29 , 30 ]. The conclusions of these two meta-analyses were similar and consistent: the survival rates and safety profiles of cefazolin were superior to ASPs.…”

Section: Discussionmentioning

confidence: 99%

“…The meta-analysis conducted by Bidell et al concluded that cefazolin was associated with a significant reduction in all-cause 90-day mortality (OR, 0.63; 95% CI, 0.41 to 0.99; I 2 = 58%) and discontinuation due to AEs (OR, 0.25; 95% CI, 0.11 to 0.56; I 2 = 13%), when compared to ASPs [ 29 ]. Another meta-analysis conducted by Rindone et al demonstrated that the mortality (RR, 0.78; 95% CI, 0.69–0.88; I 2 = 51%) and withdrawals from AEs (RR, 0.27; 95% CI, 0.16 to 0.47; I 2 = 37%) were significantly lower in the cefazolin group than in the ASPs group [ 30 ]. These two meta-analyses had some differences compared with ours: (i) these two previous meta-analyses did not report the differences in AEs rates.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Shi

Xiao²,

Zhang

et al. 2018

BMC Infect Dis

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BackgroundAntistaphylococcal penicillins (ASPs) and cefazolin have become the most frequent choices for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, the best therapeutic agent to treat MSSA bacteremia remains to be established.MethodsWe conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these two regimens for the treatment of MSSA bacteremia. PubMed, EMBASE and the Cochrane Library from inception to February 2018 were searched. The primary outcome was mortality. The secondary outcomes included treatment failure, recurrence of bacteremia, adverse effects (AEs) and discontinuation due to AEs. Data were extracted and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.ResultsA total of ten observational studies met the inclusion criteria. The results indicate that compared to ASPs, cefazolin was associated with significant reduction in mortality (OR, 0.69; 95% CI, 0.58 to 0.82; I2 = 3.4%) and clinical failure (OR, 0.56; 95% CI, 0.37 to 0.85; I2 = 44.9%) without increasing the recurrence of bacteremia (OR, 1.12; 95% CI, 0.94 to 1.34; I2 = 0%). There were no significant differences for the risk of anaphylaxis (OR, 0.91; 95% CI, 0.36 to 2.99; I2 = 0%) or hematotoxicity (OR, 0.56; 95% CI, 0.17 to 1.88; I2 = 0%). However, nephrotoxicity (OR, 0.36; 95% CI, 0.16 to 0.81; I2 = 0%) and hepatotoxicity (OR, 0.12; 95% CI, 0.04 to 0.41; I2 = 0%) were significantly lower in the cefazolin group. Moreover, cefazolin was associated with lower probability of discontinuation due to AEs compared with the ASPs (OR, 0.24; 95% CI, 0.12 to 0.48; I2 = 18%).ConclusionThe results of present study favor the application of cefazolin and should be regarded as important evidence to help make clinical decisions in choosing a treatment option for treating MSSA bacteremia.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3418-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Shi

Xiao²,

Zhang

et al. 2018

BMC Infect Dis

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“…A variety of endpoints were used among these observational studies, making it difficult to truly evaluate their results in a uniform fashion. A recent meta-analysis of ten studies comparing cefazolin to antistaphylococcal penicillins for MSSA BSI revealed a lower mortality rate with cefazolin and a higher rate of clinical cure [14]. Antistaphylococcal penicillins were also more likely to be discontinued due to an adverse event.…”

Section: Discussionmentioning

confidence: 99%

Does the Beta-Lactam Matter? Nafcillin versus Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections

et al. 2018

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Background: Antistaphylococcal penicillins have historically been regarded as the drugs of choice for methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSI). However, recent outcomes data compared to cefazolin treatment are conflicting. Objective: This study compared treatment failure and adverse effects associated with nafcillin and cefazolin for MSSA BSI. Methods: Adult inpatients with MSSA BSI between January 1, 2009 and August 31, 2015 were included in this retrospective cohort study if they received ≥72 h of nafcillin or cefazolin as directed therapy after no more than 72 h of any empiric therapy. The primary composite endpoint was treatment failure defined by clinician documentation, 30-day recurrence of infection, all-cause 30-day in-hospital mortality, or loss to follow-up. Secondary outcomes included antibiotic-related acute kidney injury (AKI), acute interstitial nephritis (AIN), hepatotoxicity, and rash. Results: Among 157 patients, 116 (73.9%) received nafcillin and 41 (26.1%) received cefazolin. The baseline characteristics were similar except cefazolin-treated patients had higher APACHE II scores and more frequent renal dysfunction. No difference in the composite treatment failure outcome (28.4 vs. 31.7%; p = 0.69) was detected between the nafcillin and cefazolin groups, respectively. In a sensitivity analysis excluding patients without known follow-up, there was no significant difference of treatment failure. AKI, AIN, hepatotoxicity, and rash were all numerically more frequent among nafcillin-treated patients. Conclusions: Among nafcillin- or cefazolin-treated patients with MSSA BSI, there was no significant difference in treatment failure. Observing more frequent presumptive adverse effects associated with nafcillin receipt, future prospective studies evaluating cefazolin appear warranted.

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“…This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors. Our hypothesis was that, compared with ASPs, cefazolin would be associated with reduced mortality and have superior safety outcomes [7].…”

Section: Methodsmentioning

confidence: 99%

Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection: A Meta-Analysis with Trial Sequential Analysis

et al. 2019

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IntroductionMethicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections.MethodsWe performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias.ResultsAfter performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56–0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41–0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16–0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04–1.93, p = 0.03, I2 = 0%).ConclusionThis meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence.FundingUniversity of Florida Open Access Publishing Fund funded the Rapid Service Fees.Trial registrationPROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442).Electronic supplementary materialThe online version of this article (10.1007/s40121-019-00259-4) contains supplementary material, which is available to authorized users.

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Meta‐analysis of trials comparing cefazolin to antistaphylococcal penicillins in the treatment of methicillin‐sensitive Staphylococcus aureus bacteraemia

Cited by 30 publications

References 23 publications

Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis

Does the Beta-Lactam Matter? Nafcillin versus Cefazolin for Methicillin-Susceptible <b><i>Staphylococcus aureus</i></b> Bloodstream Infections

Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection: A Meta-Analysis with Trial Sequential Analysis

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