Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Patient Population
4.2. Inclusion Criteria
4.3. Exclusion Criteria
4.4. Data Collection
4.5. Hematological and Blood Chemistry Analyses
4.6. Microbiological Evaluation
4.7. Statistical Analysis
4.8. Ethical Considerations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | All Patients | SAM | CFZ | p-Value |
---|---|---|---|---|
N = 71 | N = 41 | N = 30 | ||
Mean age (years ± SD) | 69.8 ± 18.7 | 71.3 ± 2.9 | 67.7 ± 3.4 | 0.429 |
Median age (years, range) | 75 (18–97) | 76 (19–97) | 73.5 (18–91) | |
Male (n, %) | 51 (71.8) | 29 (70.7) | 22 (73.3) | 0.809 |
Body mass index (kg/cm2) | 25.0 ± 4.8 | 20.3 ± 0.6 | 21.6 ± 0.8 | 0.181 |
Hospital-acquired bacteremia | 31 (43.7) | 16 (39.0) | 15 (50.0) | 0.357 |
PS (mean ± SD) PS ≥ 3–4 (n, %) | 1.7 ± 1.4 27 (38.0) | 1.9 ± 0.2 18 (43.9) | 1.5 ± 0.3 9 (30.0) | 0.245 0.233 |
qSOFA ≥ 2 (n, %) | 14 (19.7) | 9 (22.0) | 5 (16.7) | 0.580 |
Septic shock (n, %) | 7 (9.9) | 4 (9.8) | 3 (10.0) | 0.972 |
Vasopressor use (n, %) | 1 (1.4) | 1 (2.4) | 0 (0) | 0.389 |
Developed disseminated intravascular coagulation (n, %) | 25 (35.2) | 17 (41.5) | 8 (26.7) | 0.197 |
Disease severity | ||||
SOFA ≥ 4 (n, %) | 17 (23.9) | 12 (29.2) | 5 (16.7) | 0.219 |
Underlying disease | ||||
Atopic dermatitis (n, %) | 13 (18.3) | 8 (19.5) | 5 (16.7) | 0.759 |
Diabetes mellitus (n, %) | 24 (33.8) | 14 (34.2) | 10 (33.3) | 0.943 |
Hemodialysis (n, %) | 8 (11.3) | 3 (7.3) | 5 (16.7) | 0.269 |
Cardiovascular disease (n, %) | 20 (28.2) | 11 (26.8) | 9 (30.0) | 0.769 |
Cerebrovascular disease (n, %) | 20 (28.2) | 13 (31.7) | 7 (23.3) | 0.438 |
Pulmonary disease (n, %) | 8 (11.3) | 3 (7.3) | 5 (16.7) | 0.269 |
Renal dysfunction (n, %) | 21 (29.6) | 13 (31.7) | 8 (26.7) | 0.645 |
Solid tumor (n, %) | 15 (21.1) | 6 (14.6) | 9 (30) | 0.117 |
Hematological malignancy (n, %) | 3 (4.2) | 1 (2.4) | 2 (6.7) | 0.569 |
Autoimmune disease (n, %) | 3 (4.2) | 3 (7.3) | 0 (0.0) | 0.257 |
Under chemotherapy (n, %) | 4 (5.6) | 1 (2.4) | 3 (10.0) | 0.303 |
Immunosuppressant (n, %) | 10 (14.1) | 6 (14.6) | 4 (13.3) | 0.876 |
Charlson Comorbidity Index ≥ 4 (n, %) | 25 (35.2) | 13 (31.7) | 12 (40) | 0.470 |
Laboratory data (mean ± SD) | ||||
White blood cell (μL) | 13,697 ± 6707 | 14,356.1 ± 1048.1 | 12,796.7 ± 1225.3 | 0.336 |
C-reactive protein (mg/dL) | 16.0 ± 9.2 | 16.9 ± 1.4 | 14.7 ± 1.7 | 0.324 |
Creatinine (U/L) | 1.6 ± 2.2 | 1.8 ± 0.3 | 1.4 ± 0.4 | 0.549 |
Albumin (g/dL) | 2.8 ± 0.6 | 2.7 ± 0.1 | 2.9 ± 0.1 | 0.325 |
Primary site of infection (n, %) | ||||
Primary bacteremia (entry sites were unknown) | 25 (35.2) | 13 (31.7) | 12 (40) | 0.469 |
Secondary bacteremia | ||||
Catheter-associated bloodstream infection | 14 (19.7) | 7 (17.1) | 7 (23.3) | 0.512 |
Skin and soft tissue infection | 13 (18.3) | 7 (17.1) | 6 (20) | 0.752 |
Urinary tract infection | 4 (5.6) | 2 (4.9) | 2 (6.7) | 0.746 |
Infective endocarditis | 3 (4.2) | 2 (4.9) | 1 (3.3) | 0.749 |
Pneumonia | 4 (5.6) | 4 (9.8) | 0 (0.0) | 0.132 |
Cholangitis | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Iliopsoas muscle abscess | 2 (2.8) | 2 (4.9) | 0 (0.0) | 0.505 |
Shunt infection | 2 (2.8) | 2 (4.9) | 0 (0.0) | 0.505 |
Subcutaneous abscess | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Spondylitis | 1 (1.4) | 0 (0.0) | 1 (3.3) | 0.422 |
Surgical site infection | 1 (1.4) | 0 (0.0) | 1 (3.3) | 0.422 |
Metastatic infection | 9 (12.7) | 6 (14.6) | 3 (10) | 0.724 |
Follow-up two sets of blood culture (n, %) | 54 (76.1) | 30 (73.2) | 24 (80) | 0.505 |
Continuous positive blood culture for > 7 days (n, %) | 4 (5.6) | 2 (4.8) | 2 (6.7) | 0.746 |
Duration of antibiotic treatment (mean ± SD) | 29.1 ± 47.4 | 33.5 ± 6.9 | 23.5 ± 8.1 | 0.351 |
Duration of intravenous treatment (mean ± SD) | 17.2 ± 10.7 | 18.2 ± 1.7 | 17.0 ± 2.0 | 0.630 |
Length of hospital stay of community-acquired MSSA infection (mean ± SD) | 36.4 ± 60.9 | 47.4 ± 10.3 | 28.3 ± 13.6 | 0.270 |
All-cause 30-day mortality (n, %) | 6 (8.5) | 4 (9.7) | 2 (6.6) | 0.643 |
Initial Antimicrobial Agents | All Patients (n, %) | SAM (n, %) | CFZ (n, %) | p-Value |
---|---|---|---|---|
N = 71 | N = 41 | N = 30 | ||
Ampicillin/sulbactam | 14 (19.7) | 11 (26.8) | 3 (10.0) | 0.129 |
Piperacillin/tazobactam | 12 (17.0) | 7 (17.1) | 5 (16.7) | 0.964 |
Cefazolin | 5 (7.0) | 0 (0.0) | 5 (16.7) | 0.010 |
Cefmetazole | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Ceftriaxone | 11 (15.5) | 7 (17.1) | 4 (13.3) | 0.749 |
Cefozopran/sulbactam | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Cefepime | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Doripenem | 1 (1.4) | 1 (2.4) | 0 (0.0) | 1.000 |
Meropenem | 8 (11.3) | 3 (7.3) | 5 (16.7) | 0.269 |
Vancomycin | 8 (11.3) | 5 (12.2) | 3 (10.0) | 1.000 |
Teicoplanin | 4 (5.6) | 3 (7.3) | 1 (3.3) | 0.632 |
Daptomycin | 4 (5.6) | 1 (2.4) | 3 (10.0) | 0.303 |
Levofloxacin | 1 (1.4) | 0 (0.0) | 1 (3.3) | 0.422 |
Variables | All Patients | SAM | CFZ | p-Value |
---|---|---|---|---|
N = 71 | N = 41 | N = 30 | ||
None (n, %) | 49 (69.0) | 24 (58.5) | 25 (83.3) | 0.026 |
Diarrhea (n, %) | 7 (9.8) | 6 (14.6) | 1 (3.3) | 0.115 |
Elevated eosinocyte levels (n, %) | 4 (5.6) | 2 (4.8) | 2 (6.6) | 0.747 |
Drug rush (n, %) | 4 (5.6) | 3 (7.3) | 1 (3.3) | 0.472 |
Liver dysfunction (n, %) | 13 (18.3) | 11 (26.8) | 2 (6.6) | 0.030 |
Thrombopenia (n, %) | 1 (1.4) | 0 | 1 (3.3) | 0.239 |
Complicated CDI | 0 | 0 | 0 | - |
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Hirai, J.; Asai, N.; Hagihara, M.; Kishino, T.; Kato, H.; Sakanashi, D.; Ohashi, W.; Mikamo, H. Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study. Antibiotics 2022, 11, 1505. https://doi.org/10.3390/antibiotics11111505
Hirai J, Asai N, Hagihara M, Kishino T, Kato H, Sakanashi D, Ohashi W, Mikamo H. Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study. Antibiotics. 2022; 11(11):1505. https://doi.org/10.3390/antibiotics11111505
Chicago/Turabian StyleHirai, Jun, Nobuhiro Asai, Mao Hagihara, Takaaki Kishino, Hideo Kato, Daisuke Sakanashi, Wataru Ohashi, and Hiroshige Mikamo. 2022. "Comparative Effectiveness of Ampicillin/Sulbactam versus Cefazolin as Targeted Therapy for Bacteremia Caused by Beta-Lactamase-Producing Methicillin-Sensitive Staphylococcus aureus: A Single-Center Retrospective Study" Antibiotics 11, no. 11: 1505. https://doi.org/10.3390/antibiotics11111505