Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Herrera Hidalgo, Laura; Muñoz, Patricia; Álvarez-Uría, Ana; Alonso-Menchén, David; Luque Márquez, Rafael; Gutiérrez Carretero, Encarnación; Fariñas, Mari Carmen; Miró, José María; Goenaga, Miguel Angel; López-Cortés, Luis E.; Angulo-Lara, Basilio; Boix Palop, Lucía; Alarcón, Arístides de; Grupo de Apoyo al Manejo de la Endocarditis Infecciosa en España (GAMES) Cohort Investigators

doi:http://dx.doi.org/10.1016/j.ijid.2023.10.019

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

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Citació

Herrera-Hidalgo L, Muñoz P, Álvarez-Uría A, Alonso-Menchén D, Luque-Marquez R, et al. Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort. Int J Infect Dis. 2023 Dec;137:134-43. DOI: 10.1016/j.ijid.2023.10.019

Resum

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors.Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective.