Abstract
BackgroundStudies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with β-lactam. However, there are only few studies comparing treatment with antistaphylococcal penicillin alone to glycopeptide treatment. The aim of this study was to compare the efficacy of nafcillin, an antistaphylococcal penicillin, with that of glycopeptides as a definitive therapy for MSSA bacteremia.MethodsPatients with MSSA bacteremia recruited from a tertiary referral hospital were enrolled in this retrospective cohort study. Demographic characteristics, laboratory data, and clinical outcome of the treatment were compared between a group receiving nafcillin and a group receiving glycopeptides.ResultsA total of 188 patients with MSSA bacteremia were included in this study. The glycopeptide group had a higher rate of malignancy (28.6 vs. 60.8%, p < 0.001) and proportion of healthcare-associated infections (47.3 vs. 72.2%, p < 0.001) compared to the nafcillin group. The ratio of skin and soft tissue infections (30.0 vs. 16.7%, p = 0.037) and bone and joint infections (17.8 vs. 6.3%, p = 0.022), as well as levels of C-reactive protein (139.60 vs. 107.61 mg/dL, p = 0.022) were higher in the nafcillin group. All-cause 28-day mortality was significantly high in the glycopeptide group (7.7 vs. 20.6%, p = 0.013).ConclusionIn patients with MSSA bacteremia, all-cause 28-day mortality rate was higher in a group treated with glycopeptides than in a group treated with nafcillin. Therefore, the use of nafcillin should be considered as a definitive therapy for MSSA bacteremia.
Highlights
Studies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with β-lactam
Many studies comparing the efficacy of β-lactam antibiotics, including antistaphylococcal penicillin and glycopeptides, as empirical therapy for MSSA bacteremia have been conducted, and β-lactam agents have been found to be superior in the treatment of MSSA bacteremia compared with glycopeptides in these studies [5,6,7,8]
Laboratory tests showed that the median C-reactive protein (CRP) level was significantly higher in the nafcillin group than in the glycopeptide group (139.60 vs. 107.61 mg/dL, p = 0.022)
Summary
Studies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with β-lactam. The aim of this study was to compare the efficacy of nafcillin, an antistaphylococcal penicillin, with that of glycopeptides as a definitive therapy for MSSA bacteremia. Many clinicians use glycopeptides such as vancomycin as their first choice of antibiotics for empirical treatment of S. aureus bacteremia to cover both MRSA and methicillin-susceptible S. aureus (MSSA) before confirming antibiotic susceptibility. There were few studies comparing glycopeptides and antistaphylococcal penicillin such as nafcillin alone as a treatment for MSSA bacteremia. This study aimed to compare the efficacy of nafcillin, an antistaphylococcal antibiotic, with that of glycopeptides including vancomycin and teicoplanin, as definitive therapy for patients with MSSA bacteremia
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