Safety and Efficacy of Ceftriaxone in the Treatment of Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections: A Noninferiority Retrospective Cohort Study. Issue 4 (April 2023)

• Record Type: Journal Article
• Authors: Ganguly, Anisha; de la Flor, Carolina; Alvarez, Kristin; Brown, L. Steven; Mang, Norman S.; Smartt, Jillian; King, Helen; Perl, Trish M.; Filizola, Hector; Bhavan, Kavita P.
• Is Part Of: Annals of pharmacotherapy. Volume 57:Issue 4(2023)
• Page Start: 425
• Page End: 431
• Publication Date: 2023-04
• Subjects: ceftriaxone -- cefazolin -- MSSA -- bloodstream infections -- noninferiority study; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1177/10600280221115460
• Languages: English
• ISSNs: 1060-0280

Abstract

Background: Antistaphylococcal penicillins and cefazolin are the treatments of choice for methicillin-susceptible Staphylococcus aureus (MSSA) infections, requiring multiple doses daily. At Parkland, eligible uninsured patients with MSSA bloodstream infections (BSI) receive self-administered outpatient parenteral antimicrobial therapy (S-OPAT). Ceftriaxone was used in a cohort of S-OPAT patients for ease of once-daily dosing. Objective: A retrospective study was conducted to evaluate clinical outcomes for patients discharged with ceftriaxone versus cefazolin to treat MSSA BSI. Methods: A retrospective cohort noninferiority study design was used to assess treatment efficacy of ceftriaxone versus cefazolin among Parkland S-OPAT patients treated from April 2012 to March 2020. Demographic, clinical, and treatment-related adverse events data were collected. Clinical outcomes included treatment failure as defined by repeat positive blood culture or retreatment within 6 months, all-cause 30-day readmission rates, and central line–associated bloodstream infection (CLABSI) rates. Results: Of 368 S-OPAT patients with MSSA BSI, 286 (77.7%) received cefazolin, and 82 (22.3%) received ceftriaxone. Demographics and comorbidities were similar for both groups. There were no treatment failures in the ceftriaxone group compared with 4 (1%) in the cefazolin group ( P = 0.58). No difference in 30-day readmission rate between groups was found. The CLABSI rates were lower in ceftriaxone group (2%) compared with cefazolin (11%; P = 0.02). Limitations include retrospective cohort design. Conclusions: Ceftriaxone was found to be noninferior to cefazolin in this study. Our findings suggest that ceftriaxone is a safe and effective treatment of MSSA BSI secondary to osteoarticular or skin and soft tissue infections when used in the S-OPAT setting. Poster abstract: OFID on 2018 Nov; 5(Suppl 1): S316: doi:10.1093/ofid/ofy210.894.