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Clin Infect Dis. 2015 Aug 1;61(3):361-7. doi: 10.1093/cid/civ308. Epub 2015 Apr 21.

Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals.

Author information

1
Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System.
2
Department of Internal Medicine, Carver College of Medicine, University of Iowa Department of Pathology, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics.
3
Department of Epidemiology, College of Public Health Department of Internal Medicine, Carver College of Medicine, University of Iowa Clinical Quality, Safety, and Performance Improvement, University of Iowa Hospitals and Clinics.
4
Department of Epidemiology, College of Public Health.
5
Department of Biostatistics, College of Public Health, University of Iowa, Iowa City.
6
Iowa City Veterans Affairs Health Care System.
7
Department of Internal Medicine, Carver College of Medicine, University of Iowa Iowa City Veterans Affairs Health Care System.

Abstract

BACKGROUND:

Previous studies indicate that vancomycin is inferior to beta-lactams for treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections. However, it is unclear if this association is true for empiric and definitive therapy. Here, we compared beta-lactams with vancomycin for empiric and definitive therapy of MSSA bloodstream infections among patients admitted to 122 hospitals.

METHODS:

This retrospective cohort study included all patients admitted to Veterans Affairs hospitals from 2003 to 2010 who had positive blood cultures for MSSA. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression. Empiric therapy was defined as starting treatment 2 days before and up to 4 days after the first MSSA blood culture was collected. Definitive therapy was defined as starting treatment between 4 and 14 days after the first positive blood culture was collected.

RESULTS:

Patients who received empiric therapy with a beta-lactam had similar mortality compared with those who received vancomycin (HR, 1.03; 95% CI, .89-1.20) after adjusting for other factors. However, patients who received definitive therapy with a beta-lactam had 35% lower mortality compared with patients who received vancomycin (HR, 0.65; 95% CI, .52-.80) after controlling for other factors. The hazard of mortality decreased further for patients who received cefazolin or antistaphylococcal penicillins compared with vancomycin (HR, 0.57; 95% CI, .46-.71).

CONCLUSIONS:

For patients with MSSA bloodstream infections, beta-lactams are superior to vancomycin for definitive therapy but not for empiric treatment. Patients should receive beta-lactams for definitive therapy, specifically antistaphylococcal penicillins or cefazolin.

KEYWORDS:

MSSA; beta-lactams; bloodstream infection; vancomycin

PMID:
25900170
DOI:
10.1093/cid/civ308
[Indexed for MEDLINE]

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