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Methicillin-sensitive Staphylococcus aureus bacteremia: cefazolin may be better
Staphylococcus aureus is a common pathogen for community or hospital acquired infections. Current research is focused on methicillin-resistant Staphylococcus aureus (MRSA), while methicillin-sensitive Staphylococcus aureus (MSSA) reports are relatively relatively high. less. Despite this, MSSA-induced bloodstream infections have high morbidity and mortality, and the global medical burden is heavier and has received widespread attention.
At present, the relevant guidelines recommend oxacillin, cloxacillin and other anti-staphylococcus penicillin (ASP) and cefazolin for the treatment of MSSA bacteremia. However, the efficacy of ASP and cefazolin in the treatment of MSSA bacteremia is not clear. To this end, the team of Professor Lin Nengming from the First People's Hospital of Hangzhou University of Zhejiang Medical College, Shi Changcheng clinical pharmacist systematically evaluated the effectiveness and safety of both treatment of MSSA bacteremia, and the results were published in BMC in October 2018. Infectious disease.
The research system retrieved databases such as the PubMed, EMBAESE, and Cochrane libraries, and comprehensively collected the efficacy and safety of cefazolin and ASP in the treatment of MSSA bacteremia. The search time was from the establishment of the library to February 2018. The primary end point was mortality, and secondary endpoints included clinical failure rates, bacteremia recurrence rates, adverse events, and discontinuation due to adverse events.
A total of 10 observational studies were included in the study, totaling 4,779 patients. Meta-analysis showed a significant reduction in mortality in the cefazolin group compared with the ASP group. Sensitivity analysis and most subgroup analyses showed no significant changes, suggesting that the meta-analysis results were stable.
Secondary indicators: Compared with the ASP group, the clinical failure rate, hepatotoxicity, renal toxicity and discontinuation due to adverse events were significantly lower in the cefazolin group. There were no significant differences between the two groups in terms of bacteremia recurrence rate, adverse event rate, allergic reaction and hematological toxicity.
In summary, the efficacy and safety of cefazolin in the treatment of MSSA bacteremia is better than ASP, cefazolin can be described as "winning." However, it has been reported in the literature that cefazolin has an inoculation effect (meaning that the MIC of a certain bacteria increases significantly with the increase in the number of bacteria inoculated), which may lead to treatment failure. Therefore, the study suggests that cefazolin can be used as the drug of choice for MSSA bacteremia, but should be excluded from infective endocarditis and infection with high bacterial load.
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