Abstract
Cefazolin is an essential antibiotic used for treating bacteremia; in particular, it is recommended as a first-line agent for infections caused by methicillin-susceptible Staphylococcus aureus (MSSA). In March 2019, problems with a major antibiotic supplier caused a critical shortage of cefazolin in Japan; however, the impact of the cefazolin shortage on clinical outcomes remains unknown. This study aimed to evaluate the effect of the cefazolin shortage in patients with MSSA bacteremia. Data from 75 patients were compared between the pre-shortage (March 2018–January 2019, n = 39) and post-shortage (March 2019–January 2020, n = 36) periods. There were no significant differences in the demographic characteristics between the two groups, and the cefazolin shortage did not worsen clinical outcomes such as adverse drug reactions, treatment failure, and 30-day mortality. In the post-shortage group, ampicillin/sulbactam and benzylpenicillin were more frequently administered as alternative antibiotics for empirical and definitive therapy (10% vs. 31%, p = 0.042; 0% vs. 19%, p = 0.004, respectively). Multivariate analysis revealed that the broad-spectrum antibiotics for definitive therapy, such as antipseudomonal penicillin, were associated with treatment failure in patients with MSSA bacteremia (OR = 17, p = 0.003). Hence, narrow-spectrum antibiotics should be prescribed for MSSA bacteremia as alternatives during a cefazolin shortage.
Highlights
We extracted data on all patients with bacteremia caused by pathogens including Methicillin-susceptible Staphylococcus aureus (MSSA)
No significant differences were observed between the two groups with respect to sex, age, hospitalization ward, hospital stay before bacteremia onset, previous immunosuppression, recent surgery, hemodialysis, invasive device use, vasopressor use, quick sequential organ failure assessment score ≥2, or altered mental status
We identified that piperacillin/tazobactam for definitive therapy was associated with treatment failure for MSSA bacteremia
Summary
Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of hospitalacquired infections and is associated with poor clinical outcomes [1]. Anti-staphylococcal penicillins (such as nafcillin, oxacillin, cloxacillin, and flucloxacillin) and the cephalosporin cefazolin should be used for treating MSSA [2,3,4]. Anti-staphylococcal penicillins are unavailable locally in Japan. Cefazolin, which is a narrow-spectrum first-generation cephalosporin, is used as the first choice for treating
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