Cefazolin therapy for methicillin-susceptible Staphylococcus aureus bacteremia in Japan.
This is a retrospective cohort study of patients who were treated with cefazolin for methicillin-susceptible Staphylococcus aureus bacteremia, at Tokyo Women's Medical University Hospital between January 2006 and December 2010. During the study period, 84/140 (60%) patients received cefazolin (mean age, 54 years; range, 0-94 years, male patients 64%). Of these, 60/84 (71%) cases were hospital acquired infections, 55/84 (65%) had heart disease, and 19/84 (23%) had moderate to severe heart failure (New York Heart Association class III/IV). The treatment failure rate at 12 weeks was 35% (n = 29). All-cause mortality were 15% (n = 13) after 12 weeks and 21% (n = 18) after a year. Secondary endocarditis and neurological events were observed in 10% (n = 8) and 2% (n = 2). Moderate to severe heart failure and retained intravascular devices were associated with treatment failure at 12 weeks by multivariate analysis (P < 0.01, P = 0.018). Our results suggest that hospital-acquired methicillin-susceptible S. aureus bacteremia can cause severe complications in patients with moderate to severe heart failure who retain their intravascular devices. Both effective antimicrobial therapy and removal of infected foci are essential for S. aureus bacteremia treatments.
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: takayo_shouji@tmhp.jp.
Takayo
T
Shoji
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
Yuji
Y
Hirai
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan.
Makiko
M
Osawa
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan; Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.
Kyoichi
K
Totsuka
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D014041:Tokyo / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002437:Cefazolin
Bacteremia; Cefazolin; Methicillin susceptible Staphylococcus aureus; Mortality; Treatment failure