Prediction Model to Identify Patients at Risk of 30-Day Treatment Failure in Patients With Staphylococcus aureus Bacteremia

ABSTRACTAbout 20% of methicillin-susceptibleStaphylococcus aureus(MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n= 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n= 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P> 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P> 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%;P= 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.

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PWE-065 Antibodies-to-infliximab post induction can help identify inflammatory bowel disease patients at risk of treatment failure

10.1136/gutjnl-2018-bsgabstracts.197 ◽

2018 ◽

Author(s):

Gloria Shwe Zin Tun ◽

Sister Laura Marshall ◽

Sister Kerry Robinson ◽

Sister Alison Wright ◽

Dr Alenka Brookes ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

At Risk ◽

Treatment Failure ◽

Bowel Disease ◽

Post Induction ◽

Patients At Risk ◽

Inflammatory Bowel ◽

Risk Of Treatment

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A Comparison of Cefazolin Versus Ceftriaxone for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia in a Tertiary Care VA Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy089 ◽

2018 ◽

Vol 5 (5) ◽

Cited By ~ 3

Author(s):

Dustin R Carr ◽

Usha Stiefel ◽

Robert A Bonomo ◽

Christopher J Burant ◽

Sharanie V Sims

Keyword(s):

Staphylococcus Aureus ◽

Treatment Failure ◽

Medical Center ◽

Tertiary Care ◽

Skilled Nursing Facility ◽

Suppressive Therapy ◽

Published Data ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Staphylococcus Aureus Bacteremia ◽

Population Potential

Abstract Background Cefazolin and ceftriaxone are frequently used to treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, especially in the realm of outpatient parenteral antimicrobial therapy. Both antimicrobials have been associated with favorable clinical outcomes for mixed MSSA infections. However, limited published data exist specifically comparing the use of these agents for the treatment of MSSA bacteremia. Methods We conducted a retrospective cohort study of Veteran patients with MSSA bacteremia who received ≥14 days of cefazolin or ceftriaxone between 2009 and 2014. Rates of treatment failure were compared between both groups. Treatment failure was defined as therapy extension, incomplete therapy, unplanned oral suppressive therapy, relapse of infection, or hospital admission or surgery within 90 days. Results Out of 71 patients, 38 received treatment with cefazolin and 33 with ceftriaxone. The overall rate of treatment failure was 40.8%, with significantly more failures among patients receiving ceftriaxone (54.5% versus 28.9%; P = .029). Factors associated with treatment failure included longer duration of parenteral therapy, heart failure, and treatment in an external skilled nursing facility as compared with treatment in the Department of Veterans Affairs attached Community Living Center. Conclusions Ceftriaxone had a higher rate of treatment failure than cefazolin for the treatment of MSSA bacteremia in a Veteran population. Potential reasons for this could include the higher protein binding of ceftriaxone, ultimately resulting in lower serum concentrations of free drug, or other unknown factors. Further studies are warranted to confirm these results.

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