Comparison of Clinical Outcomes for Glycopeptides and Beta-Lactams in Methicillin-Susceptible Staphylococcus Aureus Bloodstream Infections

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Authors: Yeon Ju La ; Hye Rim Kim ; Dong Hyun Oh ; Jin Young Ahn ; Yong Chan Kim

MeSH: Anti-Bacterial Agents / therapeutic use ; Bacteremia* / drug therapy ; Cefazolin / adverse effects ; Glycopeptides / therapeutic use ; Humans ; Methicillin / therapeutic use ; Nafcillin / adverse effects ; Retrospective Studies ; Sepsis* / complications ; Staphylococcal Infections* / complications ; Staphylococcal Infections* / drug therapy ; Staphylococcus aureus ; Teicoplanin / therapeutic use ; Vancomycin / therapeutic use ; beta-Lactams / therapeutic use

Keywords: Methicillin-susceptible Staphylococcus aureus ; beta-lactams ; bloodstream infection ; glycopeptides ; inverse probability of treatment weighting

Abstract: Purpose: This study aimed to provide compelling evidence of anti-staphylococcal beta-lactam use for methicillin-susceptible Staphylococcus aureus bloodstream infection (MSSA BSI).

Materials and methods: We retrospectively collected data on patients with MSSA BSI who were admitted to two academic tertiary-care hospitals from 2010 to 2018. Only patients who received nafcillin, cefazolin, vancomycin, or teicoplanin as definitive therapy were included. The primary outcome was 28-day mortality. To perform unbiased comparisons between both treatments, we used inverse probability of treatment weighting (IPTW) analysis.

Results: A total of 359 patients were divided into two groups based on the definitive therapy used: beta-lactams (n=203), including nafcillin or cefazolin; and glycopeptides (n=156), including vancomycin or teicoplanin. In the IPTW analysis, glycopeptides were associated with significantly increased odds of 28-day mortality (adjusted odds ratio, 3.37; 95% confidence interval, 1.71-6.61; p<0.001). The rate of primary outcome in prespecified subgroups was largely consistent with the main analysis.

Conclusion: Definitive therapy with beta-lactams in patients with MSSA BSI was associated with lower 28-day mortality compared to definitive therapy with glycopeptides.