Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection : A Meta-Analysis with Trial Sequential Analysis
INTRODUCTION: Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections.
METHODS: We performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias.
RESULTS: After performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56-0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41-0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16-0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04-1.93, p = 0.03, I2 = 0%).
CONCLUSION: This meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence.
FUNDING: University of Florida Open Access Publishing Fund funded the Rapid Service Fees.
TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442).
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
Infectious diseases and therapy - 8(2019), 4 vom: 08. Dez., Seite 671-686 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Allen, John M [VerfasserIn] |
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| Links: |
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| Themen: |
Bacteremia |
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| Anmerkungen: |
Date Revised 22.04.2021 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s40121-019-00259-4 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM300032838 |
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| 100 | 1 | |a Allen, John M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection |b A Meta-Analysis with Trial Sequential Analysis |
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| 500 | |a Date Revised 22.04.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a INTRODUCTION: Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections | ||
| 520 | |a METHODS: We performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias | ||
| 520 | |a RESULTS: After performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56-0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41-0.74, p < 0.001, I2 = 0%), and antibiotic discontinuation due to adverse events (OR 0.25, 95% CI 0.16-0.39, p < 0.001, I2 = 23%). Infection recurrence was higher in the cefazolin patients (OR 1.41, 95% CI 1.04-1.93, p = 0.03, I2 = 0%) | ||
| 520 | |a CONCLUSION: This meta-analysis demonstrated that the use of cefazolin was associated with significant reductions in all-cause mortality, clinical failure, and discontinuation due to adverse events, but was associated with an increased risk of infection recurrence | ||
| 520 | |a FUNDING: University of Florida Open Access Publishing Fund funded the Rapid Service Fees | ||
| 520 | |a TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews (study ID: CRD42018106442) | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Bacteremia | |
| 650 | 4 | |a Cefazolin | |
| 650 | 4 | |a Infection | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Penicillins | |
| 650 | 4 | |a Staphylococcus aureus | |
| 700 | 1 | |a Bakare, Lolade |e verfasserin |4 aut | |
| 700 | 1 | |a Casapao, Anthony M |e verfasserin |4 aut | |
| 700 | 1 | |a Klinker, Ken |e verfasserin |4 aut | |
| 700 | 1 | |a Childs-Kean, Lindsey M |e verfasserin |4 aut | |
| 700 | 1 | |a Pomputius, Ariel F |e verfasserin |4 aut | |
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