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Clinical Outcomes with Penicillin Versus Alternative β‐Lactams in the Treatment of Penicillin‐Susceptible Staphylococcus aureus Bacteremia
Author(s) -
Shah Megan D.,
Wardlow Lynn C.,
Stevenson Kurt B.,
Coe Kelci E.,
Reed Erica E.
Publication year - 2018
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.2124
Subject(s) - nafcillin , cefazolin , medicine , penicillin , bacteremia , antibiotics , retrospective cohort study , surgery , microbiology and biotechnology , biology
Objectives To identify the impact of penicillin versus alternative β‐lactams on clinical outcomes in patients with penicillin‐susceptible Staphylococcus aureus ( PSSA ) bacteremia. Design Retrospective cohort study. Setting Academic medical center. Patients Adult patients with PSSA bacteremia treated with a β‐lactam as definitive therapy. Measurements The primary outcome was a composite end point of 30‐day clinical failure (change in PSSA therapy due to persistent or worsening signs and symptoms, PSSA bacteremia recurrence or persistence, and/or infection‐related mortality) in patients treated with penicillin versus alternative β‐lactams. Secondary outcomes included infection‐related and hospital length of stay ( LOS ), 90‐day recurrence, 90‐day infection‐related readmission, 30‐day all‐cause mortality, adverse drug events ( ADE s), and 30‐day change in PSSA therapy due to ADE s. A subgroup analysis comparing penicillin, nafcillin, and cefazolin was also conducted. Main Results For the 122 patients who were included, the most common definitive therapies were nafcillin (37%), cefazolin (29%), and penicillin (21%). No difference was found in 30‐day clinical failure (4% vs 11%, p=0.46), infection‐related LOS (12 days vs 11 days, p=0.39), hospital LOS (12.5 days vs 12 days, p=0.69), 90‐day recurrence (p=1.00), 90‐day infection‐related readmission (p=1.00), or 30‐day all‐cause mortality (p=0.45) between penicillin and other β‐lactams. The prevalence of ADE s was different among penicillin, nafcillin, and cefazolin (p=0.049), with nafcillin requiring more changes in therapy (p=0.005). Conclusions Definitive therapy with penicillin had similar efficacy compared with alternative β‐lactams for the treatment of PSSA bacteremia. However, nafcillin was associated with more ADE s requiring a change in therapy.