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Comparison of the efficacy of nafcillin and glycopeptides as definitive therapy for patients with methicillin-susceptible Staphylococcus aureus bacteremia: a retrospective cohort study

 Dong Hyun Oh  ;  Jung Ju Kim  ;  Jinnam Kim  ;  Hye Seong  ;  Se Ju Lee  ;  Yong Chan Kim  ;  Eun Jin Kim  ;  In Young Jung  ;  Woo Yong Jeong  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Sang Hoon Han  ;  Jun Yong Choi  ;  Young Goo Song  ;  June Myung Kim 
 BMC Infectious Diseases, Vol.18(1) : 60, 2018 
Journal Title
 BMC Infectious Diseases 
Issue Date
Adult ; Aged ; Anti-Bacterial Agents/pharmacology/*therapeutic use ; Bacteremia/drug therapy ; C-Reactive Protein/analysis ; Cohort Studies ; Cross Infection/complications ; Female ; Glycopeptides/*therapeutic use ; Hospital Mortality ; Humans ; Intensive Care Units ; Male ; Methicillin/pharmacology ; Middle Aged ; Nafcillin/*therapeutic use ; Proportional Hazards Models ; Retrospective Studies ; Staphylococcal Infections/complications/*drug therapy/microbiology/mortality ; Staphylococcus aureus/drug effects/isolation & purification ; Tertiary Care Centers
Antistaphylococcal penicillin ; Glycopeptides ; Methicillin-susceptible Staphylococcus aureus ; Nafcillin
BACKGROUND: Studies have shown that the prognosis of the treatment of methicillin-susceptible S. aureus (MSSA) with glycopeptides is inferior compared to treatment with beta-lactam. However, there are only few studies comparing treatment with antistaphylococcal penicillin alone to glycopeptide treatment. The aim of this study was to compare the efficacy of nafcillin, an antistaphylococcal penicillin, with that of glycopeptides as a definitive therapy for MSSA bacteremia. METHODS: Patients with MSSA bacteremia recruited from a tertiary referral hospital were enrolled in this retrospective cohort study. Demographic characteristics, laboratory data, and clinical outcome of the treatment were compared between a group receiving nafcillin and a group receiving glycopeptides. RESULTS: A total of 188 patients with MSSA bacteremia were included in this study. The glycopeptide group had a higher rate of malignancy (28.6 vs. 60.8%, p < 0.001) and proportion of healthcare-associated infections (47.3 vs. 72.2%, p < 0.001) compared to the nafcillin group. The ratio of skin and soft tissue infections (30.0 vs. 16.7%, p = 0.037) and bone and joint infections (17.8 vs. 6.3%, p = 0.022), as well as levels of C-reactive protein (139.60 vs. 107.61 mg/dL, p = 0.022) were higher in the nafcillin group. All-cause 28-day mortality was significantly high in the glycopeptide group (7.7 vs. 20.6%, p = 0.013). CONCLUSION: In patients with MSSA bacteremia, all-cause 28-day mortality rate was higher in a group treated with glycopeptides than in a group treated with nafcillin. Therefore, the use of nafcillin should be considered as a definitive therapy for MSSA bacteremia.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
구남수(Ku, Nam Su) ORCID logo https://orcid.org/0000-0002-9717-4327
김정주(Kim, Jung Ju)
김준명(Kim, June Myung)
김진남(Kim, Jin Nam)
송영구(Song, Young Goo) ORCID logo https://orcid.org/0000-0002-0733-4156
정수진(Jeong, Su Jin) ORCID logo https://orcid.org/0000-0003-4025-4542
정우용(Jeong, Wooyong)
정인영(Jung, In Young)
최준용(Choi, Jun Yong) ORCID logo https://orcid.org/0000-0002-2775-3315
한상훈(Han, Sang Hoon) ORCID logo https://orcid.org/0000-0002-4278-5198
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