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首页> 美国卫生研究院文献>other >Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study
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Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study

机译：抗葡萄球菌青霉素与头孢菌素在甲氧西林敏感的金黄色葡萄球菌细菌血症中首周治疗的疗效比较：倾向评分回顾性研究

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The objective was to compare the prognostic impact of first week treatment with anti-staphylococcal penicillin (ASP) versus cephalosporin in methicillin-sensitive Staphylococcus aureus bacteremia (MS-SAB). Altogether 580 patients were retrospectively followed and categorized according to first week treatment; 84% (488) received ASP (cloxacillin) and 16% (92) cephalosporin (cefuroxime or ceftriaxone). SAB management was optimized with formal bedside infectious disease specialist consultation in 88%, deep infection foci diagnosed in 77% and adjunctive rifampicin therapy given to 61% of patients. The total case fatality in 580 patients was 12% at 28 days and 18% at 90 days. When comparing effectiveness of first week ASP versus cephalosporin treatment there were no significant differences in 28-days (11% vs. 12%, OR; 1.05, 95% CI, 0.53–2.09) or 90-days (17% vs. 21% OR; 1.25, 95% CI, 0.72–2.19) outcome. In univariate analysis no prognostic impact of either first week ASP or cephalosporin treatment was observed for 28-days (OR; 0.96, 95% CI, 0.48–1.90 and OR; 1.05, 95% CI, 0.53–2.09) or 90-days (OR; 0.80, 95% CI, 0.46–1.39 and OR; 1.25, 95% CI, 0.72–2.19) outcome. Propensity-score adjusted Cox proportional regression analysis for first week treatment with cephalosporin demonstrated no significant prognostic impact at 28-days (HR 1.54, 95% CI 0.72–3.23) or 90-days (HR 1.56, 95% CI 0.88–2.86). In conclusion: There is a comparable effectiveness with respect to 28- and 90-days outcome for first week treatment with ASP versus cephalosporin in MS-SAB. The results indicate that the difference in prognostic impact between first week ASP and cephalosporin may be non-significant in patient cohorts with SAB management optimized by infectious disease specialist consultation.
机译：目的是比较抗葡萄球菌青霉素（ASP）和头孢菌素对甲氧西林敏感的金黄色葡萄球菌菌血症（MS-SAB）的第一周治疗的预后影响。根据第一周的治疗，对580例患者进行了回顾性随访和分类。 84％（488）接受ASP（氯沙西林）和16％（92）头孢菌素（头孢呋辛或头孢曲松）。 SAB的管理得到了优化，其中有88％的患者接受了正规的床边传染病专家咨询，有77％的患者诊断为深层感染，有61％的患者接受了利福平辅助治疗。 580名患者的总病死率在28天时为12％，在90天时为18％。比较第一周ASP和头孢菌素治疗的有效性，在28天（11％比12％，或； 1.05、95％CI，0.53-2.09）或90天（17％比21％）没有显着差异。或； 1.25、95％CI，0.72-2.19）结果。在单变量分析中，未观察到28天（OR； 0.96、95％CI，0.48–1.90和OR； 1.05、95％CI，0.53–2.09）或90天（ASP；第一周ASP或头孢菌素治疗）的预后影响。或； 0.80、95％CI，0.46-1.39和或； 1.25、95％CI，0.72-2.19）。头孢菌素治疗第一周的倾向得分调整后的Cox比例回归分析显示，在28天（HR 1.54，95％CI 0.72–3.23）或90天（HR 1.56，95％CI 0.88–2.86）时，没有明显的预后影响。结论：对于MS-SAB，ASP与头孢菌素治疗首周治疗28天和90天的疗效相当。结果表明，通过传染病专家咨询对SAB管理进行优化的患者队列，第一周ASP与头孢菌素之间的预后影响差异可能不显着。

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