Search Results (1,066)

Background: Comorbidity is an important determinant of treatment selection and in-hospital complications in patients with head and neck cancer (HNC) and thyroid cancer (TC), yet population-based evidence on this relationship remains limited. Methods: We analyzed nationwide Diagnosis-Related Groups (DRG) data from 1,552,028 inpatient HNC and TC treatments of patients aged ≥30 years in Germany between 2005 and 2021. The aim was to characterize the association of comorbidity and severe treatment-related procedure-coded inpatient events (IEs) with gender, age, tumor subsite, and treatment type. Results: The largest proportion of treatments occurred in patients aged 60–69 years (33.5%). The most frequent tumor subsites were the oropharynx, thyroid gland, oral cavity, larynx, and hypopharynx, with 35.52, 33.84, 33.60, 26.12, and 15.76 treatments per 100,000 population per year, respectively. Overall, 38% of cases had a Charlson Comorbidity Index (CCI) ≥ 1, with the highest mean CCI observed for C14 (other sites of the lip, oral cavity and pharynx) and C12 (piriform sinus). IEs requiring additional in-hospital treatment occurred in 19.3% of cases. After adjustment for age, tumor location, and treatment type, men had a lower risk of IEs than women (OR 0.929; CI 0.919–0.939; p < 0.001). Increasing comorbidity was associated with a higher IE risk, reaching a plateau at CCI ≥ 4 (OR 2.135; CI 2.029–2.246; p < 0.001). IE risk was high during chemotherapy/immunotherapy (OR 29.527; CI 28.897–30.170; p < 0.001), followed by surgery (OR 3.465; CI 3.433–3.498; p < 0.001), whereas radiotherapy showed the lowest risk (OR 1.339; CI 1.313–1.366; p < 0.001). Conclusions: These findings highlight substantial heterogeneity in comorbidity and IE risk among patients with HNC or TC. Full article

Background/Objectives: Anorexia nervosa (AN) remains difficult to treat, and evidence for biological adjunctive interventions is limited. This study assessed the effectiveness of transcranial direct current stimulation (tDCS) as an adjunctive intervention in hospitalized patients with AN. Methods: In this double-blind, randomized, sham-controlled trial, 40 female inpatients with AN were allocated 1:1 to active tDCS or sham stimulation. Participants received 30 sessions over 3 weeks (2 mA, 25 min, twice daily on weekdays; anode F3, cathode F4), alongside standard inpatient treatment. Assessments were performed at baseline, post-intervention, and 2-week follow-up. Outcomes included eating disorder (ED) symptoms (EAT-26), depressive symptoms (BDI), perceived stress (PSS-10), self-esteem (SES), body mass index (BMI), and selected biological markers. Results: EAT-26 scores improved significantly from baseline to post-intervention in both groups; at the 2-week follow-up, scores remained significantly lower than baseline only in the active tDCS group. BMI and leptin increased significantly in both groups, while NT-3 decreased only in the active group. In multivariate analyses, higher leptin levels and greater perceived stress, adjusted for longer illness duration, were associated with greater improvement in ED symptoms; perceived stress predicted symptom improvement only in the active group. Conclusions: Active tDCS did not produce significantly greater short-term symptom reduction than sham in hospitalized patients with AN. However, findings observed at the 2-week follow-up and associations involving stress-related and metabolic measures require confirmation in studies with longer follow-up periods. Full article

Background/Objectives: While screening, brief intervention, and referral to treatment (SBIRT) is a widely recommended evidence-based approach for early detection and intervention for alcohol and other drug (AOD) use, limited guidance exists for implementing SBIRT among hospitalized adolescents with chronic medical conditions (A-CMCs). This exploratory qualitative study examined A-CMC and caregiver perspectives on factors that may shape the acceptability, feasibility, and equitable implementation of a proposed inpatient SBIRT approach for A-CMCs. Methods: Two separate focus groups were conducted in an urban pediatric hospital in 2023 with A-CMCs aged 13–18 (n = 7), who had a history of hospitalization for their medical condition, and their caregivers (n = 6). Data were coded using thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation Framework (HEIF), which captured implementation and equity-relevant determinants, respectively. Results: Although A-CMCs and caregivers recognized the importance of SBIRT within hospital settings, its acceptability hinged on the conditions of its delivery. The timing, relevance to current health needs, and modality of screening shaped an A-CMC’s willingness to disclose AOD use. Clinician communication style, including the use of a nonjudgmental tone and clear parameters for confidentiality, were also indicated as crucial for SBIRT delivery. Broadly, participants noted the significant impact that the sociopolitical context (e.g., stigma) and structural factors (e.g., financial burden) had on a family’s ability to benefit from SBIRT. Conclusions: In this exploratory qualitative study, participants identified confidentiality-forward, patient-centered workflows, and accessible follow-up supports as potentially important considerations for inpatient SBIRT among A-CMCs. These findings generate hypotheses for future co-design and implementation research across diverse pediatric inpatient settings. Full article

Antimicrobial resistance poses a critical challenge to global public health. Urinary tract infections are one of the leading causes of morbidity in Mexico. This study aimed to identify the most prevalent bacterial pathogens in urinary bacterial isolates and to determine their antimicrobial and selected multidrug-resistance pattern profiles in outpatient and inpatient isolates at a tertiary care hospital in Mexico City. In this retrospective laboratory-based surveillance study, a census of 3434 urine samples collected between January and December 2023 was analyzed. Bacterial identification and antimicrobial susceptibility testing were performed using a VITEK 2 XL automated system. Escherichia coli was the predominant uropathogen in both groups, followed by Enterococcus spp. and Klebsiella spp. A significant disparity was observed in the resistance profiles: E. coli resistance to third-generation cephalosporins and fluoroquinolones was higher in inpatient isolates than in outpatient isolates. The selected multidrug-resistance patterns were generally higher in the inpatient isolates than in the outpatient isolates. Although common enteric pathogens with lower resistance levels predominated in the outpatient isolates, inpatient isolates required coverage targeting higher resistance. These findings reflect the need to tailor the treatment to the patients’ clinical context, launch awareness campaigns for the strategic use of antibiotics, and strengthen epidemiological surveillance. Full article

Background: Oral cavity cancer is a clinically relevant subgroup of head and neck malignancies and is associated with substantial treatment burden and healthcare utilization. Hospital length of stay (LOS) is an important indicator of inpatient resource use and complexity of care, yet large multicenter data from Germany are limited. Methods: This retrospective multicenter analysis used anonymized inpatient administrative data from 49 German hospitals; eligible oral cavity cancer hospitalizations were contributed by 34 of these hospitals. Adult inpatient hospitalizations (≥18 years) with malignant neoplasms of the oral cavity, defined using ICD-10-GM codes C00–C06, recorded between January 1 2019 and 31 December 2024 were included. The primary outcome was hospital LOS in days. Multimorbidity was quantified using the van Walraven-weighted Elixhauser Comorbidity Score. Prolonged hospitalization was defined as LOS ≥ 7 days and LOS ≥ 14 days. Associations between demographic, clinical, and treatment-related variables and LOS were examined using multivariable Poisson regression models. Because overdispersion was present, a negative binomial mixed model was additionally fitted as a sensitivity analysis. To account for inter-hospital variability, hospital was included as a random intercept in all multivariable models. Associations with prolonged LOS were analyzed using multivariable logistic regression models. All analyses were performed at the hospitalization level. Results: A total of 3957 inpatient hospitalizations for oral cavity cancer were included. Mean age was 65.6 years, and 66.2% of hospitalizations involved male patients. The median LOS was 6 days (interquartile range [IQR] 3–13; mean 10.2 days, standard deviation 11.8). Overall, 49.4% of hospitalizations had an LOS ≥ 7 days and 23.5% had an LOS ≥ 14 days. Older age, particularly >80 years, and higher comorbidity burden were associated with longer LOS (adjusted Poisson rate ratio [RR] for age > 80 years 1.17, 95% CI 1.13–1.21; high comorbidity burden RR 1.58, 95% CI 1.54–1.63). Several treatment-related variables, including surgical procedures in the oral and facial region, lymphatic system operations, blood transfusions, and complex intensive care treatment, were associated with prolonged hospitalization (e.g., blood transfusion RR 1.80, 95% CI 1.76–1.85; complex intensive care RR 1.70, 95% CI 1.65–1.75). Chemotherapy-related hospitalizations were associated with shorter LOS. Conclusions: LOS varied substantially across inpatient hospitalizations for oral cavity cancer in Germany. Older age, higher comorbidity burden, and markers of more complex inpatient treatment were associated with extended hospital stay. These findings may help identify hospitalizations at increased risk of prolonged LOS and inform inpatient planning and resource allocation. Full article

Background/Objectives: Unilateral Spatial Neglect (USN) is a disabling attentional syndrome occurring after cortical or subcortical stroke, including thalamic lesions. EEG-based neurofeedback (EEG-NF) may support cortical self-regulation, but evidence in spatial neglect remains limited. This case report describes the clinical, neuropsychological, functional, and electrophysiological (quantitative EEG, qEEG) evolution of a patient with USN after a right thalamic hemorrhagic stroke who underwent multidisciplinary rehabilitation including EEG-NF. Methods: A 70-year-old patient underwent a 3-week inpatient multidisciplinary rehabilitation program including physiotherapy, speech and swallowing therapy, conventional cognitive stimulation, and 15 adjunctive EEG-NF sessions. Baseline and post-treatment assessments included clinical, neuropsychological, neglect-specific, functional, affective, and resting-state qEEG measures. Individual change was examined using the Reliable Change Index when suitable psychometric parameters were available, together with published normative and clinical thresholds. Results: After rehabilitation, the Montreal Cognitive Assessment total raw score increased from 20 to 24, reaching the published minimal clinically important difference but not the minimal detectable change. The Frontal Assessment Battery increased from 8 to 12; after adjustment for age and education according to Italian normative data, both scores remained below the normative cut-off. Neglect-specific measures showed reduced spatial asymmetry, increased contralesional target detection, and a Catherine Bergego Scale reduction from 17 to 5, indicating a shift from moderate to mild ecological neglect. Functional independence improved, with reliable change in Functional Independence Measure (FIM) total and cognitive scores and Modified Barthel Index scores. Exploratory qEEG analyses showed condition-dependent spectral and connectivity changes, but findings were heterogeneous and hypothesis-generating. EEG-NF was completed without adverse events. Conclusions: The adjunctive EEG-NF protocol was completed as planned, with no adverse events. Clinical improvement cannot be attributed specifically to neurofeedback because all rehabilitation components were delivered concurrently. Controlled studies are needed to clarify its specific contribution and the durability of the observed improvements in post-stroke spatial neglect. Full article

Aims: International diabetes guidelines recommend inpatient glycaemic management protocols for bolus enteral feeding in people with diabetes to improve clinical outcomes. This study aims to evaluate before and after hospital-wide implementation of an inpatient bolus enteral feeding protocol: (1) the incidence of hyperglycaemia (>13.9 mmol/L) and hypoglycaemia (<4.0 mmol/L), (2) medication prescribing practices and capillary blood glucose monitoring and (3) health care professionals’ knowledge and confidence levels. Methods: We implemented an inpatient glycaemic management protocol for bolus enteral feeding developed by a multidisciplinary team of diabetes nurse educators and endocrinologists and approved by the institutional medical board in July 2024. This before-and-after quality improvement study was conducted over 3 months across eight inpatient wards. Adult inpatients were consecutively enrolled if they met the inclusion criteria: (1) a documented diagnosis of diabetes mellitus, (2) receiving bolus enteral feeding and (3) treatment with glucose-lowering medication. Patients listed as critically ill were excluded. Nurses working in the pilot wards were also recruited. Before implementing the protocol, diabetes nurse educators trained inpatient nurses on understanding and executing the protocol for administering capillary blood glucose monitoring and medications for patients with diabetes on enteral feeding. Nurses’ pre- and post-knowledge levels and perceived confidence were assessed using a structured questionnaire. Electronic medical records were reviewed to evaluate the incidence rates of hypoglycaemia and hyperglycaemia before and during the 3 months following protocol implementation. We also assessed adherence to protocol-recommended capillary blood glucose monitoring frequencies based on the diabetes medication regimen. Results: A total of 31 patients were observed during the 6-week baseline period and 28 patients following protocol implementation. A total of 192 clinical care episodes were audited, comprising 78 in the pre-intervention phase and 114 in the post-intervention phase. The incidence of hyperglycaemia decreased from 43.6% to 10.5%, while hypoglycaemia decreased from 3.8% to 2.6%. After adjusting for protocol adoption rates, protocol implementation was associated with significantly lower odds of hyperglycaemia (odds ratio [OR] 0.22, 95% CI [0.07, 0.65], p = 0.006). A significant increase in appropriate nursing practices was observed post-intervention (p < 0.001). Adoption of the protocol by nurses decreased the odds of hyperglycaemia by 70% (p = 0.014). Nurses’ knowledge scores improved significantly from baseline to 3 months post-implementation (p < 0.001). Conclusions: Implementation of a standardised inpatient glycaemic management protocol for PWD receiving bolus enteral feeding was associated with reduced rates of hyperglycaemia and hypoglycaemia. Larger-scale studies are warranted to evaluate the effectiveness and sustainability of wider implementation in improving clinical outcomes. Full article

Psychotropic medication is widely used in the treatment of severe mental illness, yet its impact on spirituality—understood as relating to the transcendent—remains underexplored. This qualitative study examines how individuals who have reduced or discontinued medication experience and navigate spirituality. In-depth, semi-structured interviews were conducted with seven former inpatients, and data were analyzed thematically within an existential–phenomenological framework. Participants described diverse spiritual and extraordinary experiences intertwined with symptoms and medication use. They navigated these by managing medication as a double-edged sword that both protected and numbed spirituality; by attempting, with varying degrees of success, to make sense of their experiences within “illness” or “spirituality” frameworks; and by seeking relational support. The findings suggest that tapering psychotropic medication may be not only a pharmaceutical process but also an existential and spiritual one. Mental health services may enhance recovery by acknowledging spirituality, engaging with patients’ meaning-making around extraordinary experiences, and recognizing the complex role of medication while making room for ambiguity, uncertainty, and mystery as sources of existential hope. Full article

Background: Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal. Methods: This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed. Results: The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted p = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; p = 0.010). Conclusions: Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions. Full article

Background/Objective: Ovarian hyperstimulation syndrome (OHSS) is a severe complication during controlled ovarian hyperstimulation. Ascites and consecutive hemoconcentration may lead to potentially life-threatening complications like thromboembolic events and the need for intensive care. The use of diuretics is widely used to treat ascites in non-OHSS patients. The aim of this study was to assess whether the use of furosemide in the treatment of OHSS was associated with a higher rate of complications compared to the literature. Methods: In this retrospective cohort study, 502 cases treated from January 2005 to June 2023 for OHSS at the Medical University of Vienna were evaluated regarding the distribution of OHSS severity, average duration of treatment, types and frequency of complications associated with antidiuretic treatment, and predictive factors for paracentesis. Results: The median AMH levels were 5.7 ng/mL. An antagonist protocol was used in 80% of stimulations. Human Chorionic Gonadotropin trigger was used in 80% of stimulations, with 71.7% of cases being early-onset. The incidence dropped from 8.4% (2006 to 2016) to 3.3% (from 2015 to 2023). The median duration of inpatient treatment was seven days, with about 75% of patients receiving furosemide as a diuretic treatment. Ascites drainage was necessary in 27.9%. None of our patients developed a thromboembolic complication following the furosemide treatment. Conclusions: During the study period, the incidence of OHSS declined, most probably as a result of advances in ovarian stimulation protocols and freezing strategies. In moderate to severe OHSS, standardized diuretic treatment with furosemide was not associated with additional thromboembolic complications as long as patients remain normovolemic. Full article

Postoperative atrial fibrillation (POAF) after cardiac surgery is often managed as a transient inpatient arrhythmia, yet recurrent or silent atrial fibrillation (AF) after discharge may identify persistent atrial vulnerability. This issue is particularly relevant in cancer survivors, whose thrombotic and bleeding risks vary according to cancer activity, treatment exposure, thrombocytopenia, frailty and planned procedures. For this narrative review, PubMed/MEDLINE and Scopus were searched from inception to 16 June 2026, with Google Scholar used for supplementary citation tracking. A total of 50 publications were included in the final narrative synthesis. Direct evidence at the intersection of cancer, cardiac surgery, POAF and digital monitoring remains limited. Accordingly, the proposed “Digital Cancer-POAF Survivorship Pathway” is presented as a conceptual, hypothesis-generating framework, rather than a validated clinical algorithm. Its distinctive contribution is to connect cancer-state phenotyping and treatment-specific arrhythmic risk with post-discharge rhythm surveillance, electrocardiogram (ECG) confirmation, multidisciplinary interpretation, data governance and outcomes for prospective validation. Digital monitoring may increase AF detection; however, whether it reduces stroke, bleeding, readmission, or healthcare utilisation in this population is unknown. Neither a low detected AF burden nor the absence of AF during finite monitoring has been validated as an independent basis for anticoagulation decisions. Full article

Background/Objective: Avoidant/Restrictive Food Intake Disorder (ARFID) is increasingly recognized among hospitalized pediatric patients with malnutrition; however, optimal nutritional management strategies remain poorly defined. Many programs utilize protocols developed for anorexia nervosa (AN). This study examined patterns of nasogastric tube (NGT) use and weight trajectories in pediatric patients with ARFID and AN/atypical AN (AAN) treated under the same inpatient refeeding protocol. Methods: We conducted a retrospective study of pediatric patients admitted for medical stabilization of malnutrition at a tertiary care children’s hospital (n = 160; ARFID subgroup n = 34). Data included NGT utilization and weight change during hospitalization. Longitudinal change in BMI z-scores during hospitalization was modeled using multivariable analysis. Results: Patients with ARFID were more likely to require NGT than those with AN/AAN (p < 0.001), despite similar BMI z-scores at admission and discharge. Patients with ARFID requiring NGT were younger and had lower BMI z-scores at admission than ARFID patients without NGT (p < 0.05). Conclusions: In this study, pediatric patients with ARFID undergoing inpatient nutrition rehabilitation achieved comparable weight gain during hospitalization to patients with AN/AAN but required higher enteral nutrition support to do so. Among patients with ARFID who required NGT support, anthropometric measures suggested higher baseline nutritional severity and likely confounding by indication. Because NGT use was determined clinically rather than randomly assigned, the observed association between NGT use and higher weight gain should not be interpreted as evidence of a causal treatment effect. Interpretation is also limited by variability in clinical practice and the relatively small ARFID subgroup. This study supports diagnosis-specific considerations during medical stabilization and underscores the need for further ARFID-specific protocols and research. Full article

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Background and Objectives: Urinary tract infections are common in clinical practice, but in hospital settings, especially among older and catheterized patients, the microbial ecology and resistance burden may differ substantially from community-acquired infections. Local surveillance is therefore essential to support appropriate empirical treatment and antimicrobial stewardship. The objective is to describe the microbiological epidemiology of urinary isolates in a tertiary hospital and evaluate temporal trends in antimicrobial resistance among the most frequently isolated microorganisms. Materials and Methods: This retrospective observational study analyzed microbiology laboratory data from Tor Vergata University Hospital, Rome, Italy, collected from January 2022 to June 2025. After WHONET-based deduplication using a 30-day repeat-isolate rule, 5788 deduplicated urinary isolates and 85,888 microorganism–drug associations were included. Descriptive analyses, cumulative antibiograms/antimycograms, and quarterly resistance trends were assessed using univariable and multivariable regression analyses. Results: The population was predominantly elderly, inpatient, and catheter-exposed. Gram-negative organisms predominated, followed by Gram-positive bacteria and fungi. The most frequent isolates were E. coli, K. pneumoniae, E. faecalis, and C. albicans. Although microorganism distribution remained broadly stable over time, resistance increased in several clinically relevant organism–drug combinations, especially among major Enterobacterales. Conclusions: In this high-complexity hospital population, urinary isolates showed a relatively stable microorganism distribution but progressive changes in susceptibility among selected urinary isolates. These findings support setting-specific microbiological surveillance and stewardship-informed empirical treatment strategies. Full article

Background/Objectives: In methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, randomized evidence indicates comparable efficacy of cefazolin and antistaphylococcal penicillins with less nephrotoxicity; whether this extends to bone and joint infection (BJI) is unknown. We compared both agents in MSSA BJI. Methods: We retrospectively analyzed all adults at a single center with culture-confirmed, monomicrobial MSSA BJI treated with inpatient intravenous cefazolin or flucloxacillin monotherapy (January 2022–January 2025)—a selected population excluding rifampicin-based combination therapy, outpatient parenteral therapy, polymicrobial infection, and concurrent bacteremia/endocarditis. Endpoints, a priori exploratory, comprised effectiveness (mortality; clinical success) and renal safety (peri-treatment acute kidney injury [AKI]); the AKI comparison was additionally adjusted for confounders. Results: Among 110 patients (64 cefazolin, 46 flucloxacillin), baseline characteristics were comparable except for more frequent nephrotoxic co-medication with cefazolin (56.2% vs. 26.1%; p = 0.002). No statistically significant differences in effectiveness were detected: 30-day clinical success was 89.1% versus 80.4% (ARD 8.6 percentage points, 95% CI −4.7 to +23.3) and one-year clinical success 79.7% versus 65.2% (ARD 14.5, 95% CI −2.2 to +31.0); these imprecise estimates are compatible with effects ranging from no difference to a clinically relevant benefit of cefazolin. Peri-treatment AKI occurred in 19.0% versus 30.4% (ARD 11.4, 95% CI −4.7 to +27.7; adjusted odds ratio 2.27, 95% CI 0.87–5.91); the difference was confined to stage 1. Conclusions: In this selected inpatient monotherapy cohort, cefazolin was associated with numerically fewer AKI events, without statistically significant differences in any comparison. These exploratory findings support cefazolin as a rational targeted option for MSSA BJI, pending prospective confirmation. Full article