[A new era in the treatment ofStaphylococcus aureusbacteremia: cefazolin becomes first choice]

Investigate whether cefazolin is as effective as flucloxacillin in the treatment of Staphylococcus aureus bacteremia (SAB). In the Netherlands, SAB is typically treated with flucloxacillin, with cefazolin as an alternative.

The international adaptive platform trial SNAP compared cefazolin to (flu)cloxacillin in adults with methicillin-susceptible S. aureus (MSSA) bacteremia.

Primary outcome was 90-day all-cause mortality; secondary outcomes included acute kidney injury (AKI).

Between February 2022 and June 2024, 1,287 patients from eight countries were enrolled. Ninety-day mortality was 15.0% with cefazolin versus 17.0% with (flu)cloxacillin (aOR 0.81; 95%CrI 0.59-1.12; probability of non-inferiority 99.2%). AKI occurred in 13.9% versus 19.6% of patients, respectively (aOR 0.67; 95%CrI 0.50-0.89; probability of superiority 99.7%).

Cefazolin is non-inferior to flucloxacillin in the treatment of MSSA bacteremia and is associated with less AKI.