Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT

Abstract

Cefazolin is a recommended treatment for methicillin-susceptible Staphylococcus aureus (MSSA) infections that has been successfully used in outpatient parenteral antibiotic therapy (OPAT) programs. The aim of this study was to assess the clinical outcomes of cefazolin delivered each day (Group 24) vs. every two days (Group 48) for MSSA infections in OPAT programs. It was a prospective observational study with retrospective analysis of a cohort of MSSA infections attended in OPAT. The primary outcome was treatment success, defined as completing the antimicrobial regimen without death, treatment discontinuation, or readmission during treatment and follow-up. A univariate and multivariate logistic regression model was built. A two-sided p < 0.05 was considered statistically significant. Of the 149 MSSA infections treated with cefazolin 2 g/8 h in OPATs, 94 and 55 patients were included in the delivery Group 24 and Group 48, respectively. Treatment failure and unplanned readmission rates were similar in both groups (11.7% vs. 7.3% p = 0.752 and 8.5% vs. 5.5% p = 0.491). There was a significant increase in vascular access complications in Group 24 (33.0%) with respect to Group 48 (7.3%) (p < 0.001). Treating uncomplicated MSSA infection with cefazolin home-delivered every two days through an OPAT program is not associated with an increased risk of treatment failure and entails a significant reduction in resource consumption compared to daily delivery.

Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort

“…Due to the limited number of patients in the OPAT group, patients with SAB treated in the DOMUS OPAT program, a service provided by the Virgen del Rocio and Virgen Macarena University Hospitals (both in Seville, Spain) from 2012 to 2021, were also considered eligible. The specific features of the DOMUS OPAT program have been extensively described in previous publications [28,32,33]. Patients undergoing hemodialysis after a period of conventional hospitalization were included in the full hospitalization therapy group as part of our objective to explore the effectiveness of OPAT versus standard practice.…”

“…The lack of evidence could be partly explained by the fact that clinical management of SAB is challenging due to its high virulence, the need for close clinical follow-up to prevent or detect early complications such as endocarditis, distant metastatic foci or relapse, or by the adverse events of first-line antibiotics [19,20,22,23,26,27]. Nevertheless, interest in the use of OPAT programs to reduce costs is growing in light of new evidence on the effectiveness and safety of intravenous therapies with a good pharmacokinetic profile, such as cefazoline or ceftriaxone [28][29][30][31]. By defining the characteristics of patients who can properly be managed with oral therapy or in an OPAT program, the management of SAB could be modified in the coming years as a way of improving the patient's quality of life.…”