Antistaphylococcal penicillins vs. cefazolin in the treatment of methicillin-susceptible Staphylococcus aureus infective endocarditis: a quasi-experimental monocentre study

• Published in: European journal of clinical microbiology & infectious diseases 2021-12, Vol.40 (12), p.2605-2616
• Main Authors: Lefèvre, B., Hoen, B., Goehringer, F., Sime, W. Ngueyon, Aissa, N., Alauzet, C., Jeanmaire, E., Hénard, S., Filippetti, L., Selton-Suty, C., Agrinier, N.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - administration & dosage; Antibiotics; Bilirubin; Biomedical and Life Sciences; Biomedicine; Cefazolin; Cefazolin - administration & dosage; Demography; Endocarditis; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - microbiology; Female; Humans; Internal Medicine; Liver; Male; Medical Microbiology; Methicillin; Methicillin - administration & dosage; Middle Aged; Mortality; Non-Randomized Controlled Trials as Topic; Observational studies; Original Article; Patients; Penicillin; Penicillins - administration & dosage; Prostheses; Quasi-experimental methods; Safety; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - genetics; Staphylococcus aureus - isolation & purification; Survival; Toxicity
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-021-04313-3

Whether cefazolin is as effective and safer than antistaphylococcal penicillins (ASPs) for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) is still debated in the absence of a randomized controlled trial. In this quasi-experimental study, we aimed to assess the effectiveness and safety of these two treatments in MSSA-IE, using the ASPs nationwide shortage in April 2016 as a unique opportunity to overcome the indication bias associated with observational studies. In this single-centre study, we compared patients with Duke-Li definite MSSA-IE treated with ASPs from January 2015 to March 2016 versus those treated with cefazolin from April 2016 to December 2018, when ASPs were not available. Effectiveness outcome was 90-day all-cause mortality. Safety outcomes included significant decrease in GFR and significant increase in serum liver enzymes. Logrank test was used to compare survival rates. Of 73 patients with MSSA-IE, 35 and 38 were treated with ASPs and cefazolin, respectively. Baseline patients’ characteristics (demography, native or prosthetic valve IE, clinical characteristics, cardiac and septic complications) were similar between groups. Ninety-day all-cause mortality was 28.6% and 21.1%, in patients treated with ASPs and cefazolin, respectively (logrank p  = 0.5727). There was no difference between groups for incident renal or liver toxicity events: acute kidney injury 45.7% vs. 44.7% ( p  = 0.933), increased ALT 5.7% vs. 13.2% ( p  = 0.432), bilirubin increase 5.7% vs. 10.5% ( p  = 0.676), in ASPs vs. cefazolin groups, respectively. In this quasi-experimental, effectiveness and safety did not statistically differ between ASPs and cefazolin for MSSA-IE treatment.