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.
Highlights
Methicillin-susceptible Staphylococcus aureus (MSSA) is a pathogen that causes serious nosocomial and community-acquired infections [1], with high morbidity and mortality [2]
The aim of this study was to assess the clinical outcomes of cefazolin delivered daily vs. every two days for MSSA infections in Outpatient parenteral antimicrobial therapy (OPAT) programs
Of the 1595 patients included in the OPAT program, 149 had MSSA infections treated with cefazolin as a continuation regimen
Summary
Methicillin-susceptible Staphylococcus aureus (MSSA) is a pathogen that causes serious nosocomial and community-acquired infections [1], with high morbidity and mortality [2]. The standard therapy for MSSA infections is anti-staphylococcal penicillin (oxacillin, flucloxacillin, or nafcillin), several studies have reported similar efficacy with cefazolin with fewer adverse events [3,4]. Outpatient parenteral antimicrobial therapy (OPAT) allows patients to complete the antimicrobial treatment at home. The safety and effectiveness of OPAT have been extensively demonstrated [5]. Most of the studies have shown that these programs are cost-effective [6] and associated with greater comfort for the patient and a lower risk of nosocomial complications [7]. Patients with MSSA infections often involve long-term inpatient antimicrobial therapy; OPAT is a highly attractive alternative for these patients
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