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

Laura Herrera-Hidalgo1, Patricia Muñoz2, Ana Álvarez-Uría3

  • 1Department of Pharmacy, University Hospital Virgen del Rocío, Seville, Spain; Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|November 5, 2023
PubMed
Abstract

Insights

Cefazolin is an effective treatment for methicillin-susceptible Staphylococcus aureus infective endocarditis (MSSA IE), showing similar outcomes to cloxacillin. This study found no significant differences in mortality or relapse rates between the two antibiotics for MSSA IE.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Pharmacology

Background:

  • Methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) requires effective antibiotic treatment.
  • Cefazolin and antistaphylococcal penicillins (ASPs) like cloxacillin are used, but real-world comparative data is limited.

Purpose of the Study:

  • To evaluate the effectiveness and safety of cefazolin compared to cloxacillin for treating MSSA IE.
  • To analyze treatment outcomes including mortality, relapse, and renal toxicity within the Spanish National Endocarditis Database (GAMES).

Main Methods:

  • Prospective cohort study with retrospective analysis of 631 MSSA IE episodes.
  • Patients were treated with cloxacillin, cefazolin, or both.
  • Outcomes included intra-hospital, overall, and IE-related mortality, relapse rates, and adverse events, with a specific evaluation of renal toxicity.

Main Results:

  • Cefazolin-treated patients had more comorbidities and prior renal failure.
  • Cloxacillin-treated patients experienced higher rates of septic shock, new/worsening renal failure, and in-hospital mortality.
  • One-year IE-related mortality and relapse rates were similar between cefazolin and cloxacillin groups.

Conclusions:

  • Cefazolin is a viable treatment option for MSSA IE.
  • Cefazolin demonstrated comparable efficacy to cloxacillin regarding mortality and relapse rates.
  • No significant differences in outcomes suggest cefazolin can be considered equally effective as cloxacillin for MSSA IE.
Keywords:
Antistaphylococcal penicillinCefazolinInfective endocarditisMethicillin-susceptible Staphylococcus aureus

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