title: Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillin-susceptible Staphylococcus aureus bacteraemia: a retrospective, propensity-score-adjusted case-control and cohort analysis.
abstract: OBJECTIVE
  Penicillin-susceptible Staphylococcus aureus isolates account for a fifth of cases of S. aureus bacteraemia (SAB) in Denmark, but little is known about treatment outcomes with penicillins or other antimicrobials. Here we compare penicillin, dicloxacillin and cefuroxime as definitive treatments in relation to 30 day mortality.
  
  
  METHODS
  A retrospective chart review of 588 penicillin-susceptible S. aureus cases at five centres from January 1995 to December 2010. Data on demographics, antimicrobial treatment, clinical signs and symptoms, and mortality at day 30 were collected. Hazard ratios (HRs) with 95% CIs associated with mortality were modelled using propensity-score-adjusted Cox proportional hazards regression analysis. Propensity-score-matched case-control studies were carried out.
  
  
  RESULTS
  Definitive therapy with cefuroxime was associated with an increased risk of 30 day mortality compared with penicillin (adjusted HR 2.54, 95% CI 1.49-4.32). Other variables that were statistically significantly associated with 30 day mortality included increasing age, disease severity and a primary respiratory focus. Osteomyelitis/arthritis was associated with a lower risk of death than were other secondary manifestations. Propensity-score-matched case-control studies confirmed an increased risk of 30 day mortality: cefuroxime treatment (39%) versus penicillin treatment (20%), P = 0.037; and cefuroxime treatment (38%) versus dicloxacillin treatment (10%), P = 0.004.
  
  
  CONCLUSIONS
  Definitive therapy for penicillin-susceptible SAB with cefuroxime was associated with a significantly higher mortality than was seen with therapy with penicillin or dicloxacillin.
authors.affiliation: Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jette Lindbjerg
authors.initials: JL
authors.lastname: Nissen
authors.forename: Robert
authors.initials: R
authors.lastname: Skov
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
authors.forename: Christian
authors.initials: C
authors.lastname: Ostergaard
authors.forename: Henrik Carl
authors.initials: HC
authors.lastname: Schønheyder
authors.forename: Niels
authors.initials: N
authors.lastname: Frimodt-Møller
authors.forename: Thomas
authors.initials: T
authors.lastname: Benfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D016022:Case-Control Studies; D002444:Cefuroxime / Q000627:therapeutic use*; D015331:Cohort Studies; D003718:Denmark; D004009:Dicloxacillin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D057216:Propensity Score; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D004009:Dicloxacillin; D002444:Cefuroxime
keywords: epidemiology; sepsis; survival analysis