Abstract
(1) Background: Ceftriaxone is a potential alternative for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in acute care and outpatient parenteral antimicrobial therapy (OPAT) settings. We evaluated the effectiveness and safety of ceftriaxone for the treatment of MSSA BSIs. (2) Method: We searched PubMed, Embase, and Cochrane Library from their inception to October 30th 2021. Our outcomes included clinical cure, microbiological cure, 30- and 90-day mortality, 90-day hospital readmission, and adverse drug reactions (ADRs). We compared ceftriaxone against standard of care (SOC) therapy. We used the random-effects model for the meta-analysis, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals (CI). (3) Results: Twelve retrospective cohort studies were included, comprising 1037 patients in the ceftriaxone arms and 2088 patients in the SOC arms. The clinical cure rate of the ceftriaxone regimen was not statistically different from SOC: OR 0.65 (95% CI: 0.29–1.45). Ceftriaxone was also not statistically different from SOC in microbiological cure: OR 1.48 (95% CI: 0.29–7.51); 30-day mortality: OR 0.79 (95% CI: 0.14–4.65); 90-day mortality: OR 0.82 (95% CI: 0.38–1.80); 90-day hospital readmission: OR 1.20 (95% CI: 0.92–1.56); and ADRs: OR 0.92 (95% CI: 0.39–2.18). (4) Conclusion: Ceftriaxone could provide an alternative for the treatment of MSSA BSIs in acute care and OPAT settings (except in patients whose BSIs were due to infective endocarditis).
Highlights
The objective of this study is to evaluate the evidence for the effectiveness and safety of ceftriaxone for methicillinsusceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in acute care and outpatient parenteral antimicrobial therapy (OPAT) settings qualitatively utilizing a systematic review and quantitatively by meta-analysis
We evaluated clinical and microbiological cures, 30- and 90-day mortality, 90-day hospital readmission, and adverse drug reactions (ADRs) and found that ceftriaxone use was non-inferior to standard of care (SOC) in clinical effectiveness and safety outcomes that were evaluated
Our findings suggest that ceftriaxone could provide an alternative treatment for MSSA BSI, and this is consistent with several studies
Summary
Staphylococcus aureus is one of the most common pathogenic Gram-positive bacteria, and it causes a wide range of community-acquired and hospital-acquired infections [1,2]. S. aureus expresses several virulence mechanisms and can cause serious infections associated with mortality that can be as high as 22–48% [3,4]. In the United States (U.S.), S. aureus accounts for 23% of bloodstream infections (BSIs) [1,5].
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