Comparable Effectiveness of Cefuroxime and Piperacillin-Tazobactam as Empirical Therapy for Methicillin-Susceptible Staphylococcus aureus Bacteremia

Bigseth, Robert Strengen; Sandholdt, Håkon; Petersen, Andreas; Østergaard, Christian Richter; Benfield, Thomas; Thorlacius-Ussing, Louise

doi:10.1128/spectrum.01530-21

Cited by 3 publications

(1 citation statement)

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“…Two recent retrospective studies compared cefuroxime with piperacillin/tazobactam and cloxacillin or cefazolin with β-lactam/β-lactamase inhibitor combinations, respectively. 14 , 15 In both studies, no difference in mortality was observed between treatment strategies (matched HR 0.82, 95% CI 0.47–1.46 and adjusted OR 0.53, 95% CI 0.18–1.51, respectively). Vancomycin was compared with β-lactams as empirical therapy in MSSA bacteraemia in an observational study.…”

Section: Discussionmentioning

confidence: 84%

Comparative effectiveness of β-lactams for empirical treatment of methicillin-susceptible Staphylococcus aureus bacteraemia: a prospective cohort study

Buis

Vaart

Prins

et al. 2023

Journal of Antimicrobial Chemotherapy

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Objectives Standard once-daily dosing of ceftriaxone may not lead to adequate antibiotic exposure in all cases of Staphylococcus aureus bacteraemia (SAB). Therefore, we compared clinical effectiveness of empirical antibiotic treatment with flucloxacillin, cefuroxime and ceftriaxone in adult patients with MSSA bacteraemia Methods We analysed data from the Improved Diagnostic Strategies in Staphylococcus aureus bacteraemia (IDISA) study, a multicentre prospective cohort study of adult patients with MSSA bacteraemia. Duration of bacteraemia and 30 day SAB-related mortality were compared between the three groups using multivariable mixed-effects Cox regression analyses. Results In total, 268 patients with MSSA bacteraemia were included in the analyses. Median duration of empirical antibiotic therapy was 3 (IQR 2–3) days in the total study population. Median duration of bacteraemia was 1.0 (IQR 1.0–3.0) day in the flucloxacillin, cefuroxime and ceftriaxone groups. In multivariable analyses, neither ceftriaxone nor cefuroxime was associated with increased duration of bacteraemia compared with flucloxacillin (HR 1.08, 95% CI 0.73–1.60 and HR 1.22, 95% CI 0.88–1.71). In multivariable analysis, neither cefuroxime nor ceftriaxone was associated with higher 30 day SAB-related mortality compared with flucloxacillin [subdistribution HR (sHR) 1.37, 95% CI 0.42–4.52 and sHR 1.93, 95% CI 0.67–5.60]. Conclusions In this study, we could not demonstrate a difference in duration of bacteraemia and 30 day SAB-related mortality between patients with SAB empirically treated with flucloxacillin, cefuroxime or ceftriaxone. Since sample size was limited, it is possible the study was underpowered to find a clinically relevant effect.

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Section: Discussionmentioning

confidence: 84%