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Observational Study
. 2021 Dec;40(12):2605-2616.
doi: 10.1007/s10096-021-04313-3. Epub 2021 Aug 12.

Antistaphylococcal penicillins vs. cefazolin in the treatment of methicillin-susceptible Staphylococcus aureus infective endocarditis: a quasi-experimental monocentre study

B Lefèvre  1   2   3 , B Hoen  4 , F Goehringer  4 , W Ngueyon Sime  5 , N Aissa  6 , C Alauzet  6   7 , E Jeanmaire  4 , S Hénard  4 , L Filippetti  8 , C Selton-Suty  8 , N Agrinier  9   5 ; for AEPEI study group (Association pour l’Etude et la Prévention de l’Endocardite Infectieuse)
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Observational Study

Antistaphylococcal penicillins vs. cefazolin in the treatment of methicillin-susceptible Staphylococcus aureus infective endocarditis: a quasi-experimental monocentre study

B Lefèvre et al. Eur J Clin Microbiol Infect Dis. 2021 Dec.

Abstract

Whether cefazolin is as effective and safer than antistaphylococcal penicillins (ASPs) for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) is still debated in the absence of a randomized controlled trial. In this quasi-experimental study, we aimed to assess the effectiveness and safety of these two treatments in MSSA-IE, using the ASPs nationwide shortage in April 2016 as a unique opportunity to overcome the indication bias associated with observational studies. In this single-centre study, we compared patients with Duke-Li definite MSSA-IE treated with ASPs from January 2015 to March 2016 versus those treated with cefazolin from April 2016 to December 2018, when ASPs were not available. Effectiveness outcome was 90-day all-cause mortality. Safety outcomes included significant decrease in GFR and significant increase in serum liver enzymes. Logrank test was used to compare survival rates. Of 73 patients with MSSA-IE, 35 and 38 were treated with ASPs and cefazolin, respectively. Baseline patients' characteristics (demography, native or prosthetic valve IE, clinical characteristics, cardiac and septic complications) were similar between groups. Ninety-day all-cause mortality was 28.6% and 21.1%, in patients treated with ASPs and cefazolin, respectively (logrank p = 0.5727). There was no difference between groups for incident renal or liver toxicity events: acute kidney injury 45.7% vs. 44.7% (p = 0.933), increased ALT 5.7% vs. 13.2% (p = 0.432), bilirubin increase 5.7% vs. 10.5% (p = 0.676), in ASPs vs. cefazolin groups, respectively. In this quasi-experimental, effectiveness and safety did not statistically differ between ASPs and cefazolin for MSSA-IE treatment.

Keywords: Antistaphylococcal penicillins; Cefazolin; Cloxacillin; Infective endocarditis; Methicillin-susceptible Staphylococcus aureus; Oxacillin.

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References

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