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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Infectious Diseases 1/2018

Comparison of the efficacy of nafcillin and glycopeptides as definitive therapy for patients with methicillin-susceptible Staphylococcus aureus bacteremia: a retrospective cohort study

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2018
Autoren:
Dong Hyun Oh, Jung Ju Kim, Jinnam Kim, Hye Seong, Se Ju Lee, Yong Chan Kim, Eun Jin Kim, In Young Jung, Woo Yong Jeong, Su Jin Jeong, Nam Su Ku, Sang Hoon Han, Jun Yong Choi, Young Goo Song, June Myung Kim
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12879-018-2978-z) contains supplementary material, which is available to authorized users.

Abstract

Background

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. 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.

Methods

Patients 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.

Results

A 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).

Conclusion

In 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.
Zusatzmaterial
Additional file 1: Supplement 1. Antibiotic resistance rate of identified Staphylococcus aureus. (DOCX 21 kb)
12879_2018_2978_MOESM1_ESM.docx
Additional file 2: Multivariate analysis of prognostic factors for predicting mortality in patients with MSSA bacteremia, with adjustments for prevalence of malignancy, healthcare-associated infections, and CRP. (DOCX 13 kb)
12879_2018_2978_MOESM2_ESM.docx
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