Comparison of Clinical Outcomes for Glycopeptides and Beta-Lactams in Methicillin-Susceptible Staphylococcus Aureus Bloodstream Infections
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Purpose: This study aimed to provide compelling evidence of anti-staphylococcal beta-lactam use for methicillin-susceptibleStaphylococcus aureus bloodstream infection (MSSA BSI). Materials and Methods: We retrospectively collected data on patients with MSSA BSI who were admitted to two academic tertia ry-care hospitals from 2010 to 2018. Only patients who received nafcillin, cefazolin, vancomycin, or teicoplanin as definitive ther apy were included. The primary outcome was 28-day mortality. To perform unbiased comparisons between both treatments, weused inverse probability of treatment weighting (IPTW) analysis. Results: A total of 359 patients were divided into two groups based on the definitive therapy used: beta-lactams (n=203), includ ing nafcillin or cefazolin; and glycopeptides (n=156), including vancomycin or teicoplanin. In the IPTW analysis, glycopeptideswere associated with significantly increased odds of 28-day mortality (adjusted odds ratio, 3.37; 95% confidence interval, 1.71–6.61; p<0.001). The rate of primary outcome in prespecified subgroups was largely consistent with the main analysis. Conclusion: Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality com pared to definitive therapy with glycopeptides.
Abstract
Purpose: This study aimed to provide compelling evidence of anti-staphylococcal beta-lactam use for methicillin-susceptibleStaphylococcus aureus bloodstream infection (MSSA BSI). Materials and Methods: We retrospectively collected data on patients with MSSA BSI who were admitted to two academic tertia ry-care hospitals from 2010 to 2018. Only patients who received nafcillin, cefazolin, vancomycin, or teicoplanin as definitive ther apy were included. The primary outcome was 28-day mortality. To perform unbiased comparisons between both treatments, weused inverse probability of treatment weighting (IPTW) analysis. Results: A total of 359 patients were divided into two groups based on the definitive therapy used: beta-lactams (n=203), includ ing nafcillin or cefazolin; and glycopeptides (n=156), including vancomycin or teicoplanin. In the IPTW analysis, glycopeptideswere associated with significantly increased odds of 28-day mortality (adjusted odds ratio, 3.37; 95% confidence interval, 1.71–6.61; p<0.001). The rate of primary outcome in prespecified subgroups was largely consistent with the main analysis. Conclusion: Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality com pared to definitive therapy with glycopeptides.
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