Clinical Outcomes with Penicillin Vs. Alternative Β-Lactams in the Treatment of Penicillin-Susceptible Staphylococcus aureus Bacteremia. (4th October 2017)

• Record Type: Journal Article
• Authors: Shah, Megan; Wardlow, Lynn; Stevenson, Kurt; Haydocy, Kelci; Reed, Erica
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S558
• Page End: S558
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1453
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The prevalence of penicillin-susceptible S. aureus (PSSA) has increased in recent years. However, non-penicillin β-lactams (BLs) are often utilized for the treatment of PSSA bacteremia. To date, there are limited data on the management of PSSA bacteremia and its associated outcomes. The aim of this study is to identify the impact of penicillin (PCN) vs. alternative BLs on clinical outcomes in patients with PSSA bacteremia. Methods: Patients admitted to The Ohio State University Wexner Medical Center between July 2011 and June 2016 with PSSA bacteremia who were treated with an intravenous BL as definitive therapy were evaluated. Data collected included baseline characteristics, Pitt Bacteremia score, definitive BL selected, and time to microbiological clearance. The primary outcome was a composite end point of 30-day clinical failure (i.e., change in PSSA therapy due to persistent or worsening signs and symptoms, PSSA bacteremia recurrence or persistence, and/or infection-related mortality) in patients treated with PCN vs. alternative BLs. Secondary outcomes included 90-day recurrence, 90-day infection-related readmission, 30-day all-cause mortality, adverse drug events (ADEs), and 30-day change in PSSA therapy due to ADEs. A sub-analysis comparing PCN to nafcillin and cefazolin was also conducted. The Student's t-test, Pearson chi-squared test, Fisher's exact test, and one-way ANOVA were utilized as appropriate. Results: Among 174 patients with PSSA bacteremia during the study timeframe, 122 patients met inclusion criteria. The most common definitive therapies were nafcillin (37%), cefazolin (29%), and PCN (21%). The median time to microbiological clearance was 2 days. There was no difference in 30-day clinical failure with PCN vs. other BLs (4% vs. 11%, P = 0.46). There was also no difference in 90-day recurrence ( P = 1.00), 90-day infection-related readmission ( P = 1.00), or 30-day all-cause mortality ( P = 0.45) between PCN and other BLs. ADEs were similar, except nafcillin required more changes in therapy due to ADEs compared with PCN and cefazolin (48% vs. 0% vs. 0%, P = 0.005). Conclusion: Definitive therapy with PCN had similar efficacy and tolerability compared with alternative BLs for the treatment of PSSA bacteremia; however, nafcillin may be associated with more ADEs. Disclosures: All authors: No reported disclosures.