さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals.

少し古いCID論文を復習。

 目的は、より良いMSSA菌血症治療を目指してプラクティスを見直しのためです。

 

CID 2015 Aug 1;61(3):361-7. doi: 10.1093/cid/civ308. Epub 2015 Apr 21.

Comparative effectiveness of beta-lactams versus vancomycin for treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections among 122 hospitals.

PMID: 25900170

www.ncbi.nlm.nih.gov

 

 

P

  • patients with MSSA bloodstream infections

 

E

  • vancomycin

 

C

  • beta-lactam

 

O

  • empiric therapy with a beta-lactam vs vancomycin : mortality  (HR, 1.03; 95% CI, .89-1.20) after adjusting for other factors.
  • definitive therapy with a beta-lactam vs vancomycin : mortality (HR, 0.65; 95% CI, .52-.80) after controlling for other factors. 
  • The hazard of mortality decreased further for patients who received cefazolin or antistaphylococcal penicillins compared with vancomycin (HR, 0.57; 95% CI, .46-.71).

T

  • This retrospective cohort study
  • Veterans Affairs hospitals from 2003 to 2010

Defined

  • Empiric therapy : starting treatment 2 days before and up to 4 days after the first MSSA blood culture was collected. 
  • Definitive therapy : starting treatment between 4 and 14 days after the first positive blood culture was collected.

 

著者の結論はその通りだと思います。

 

For patients with MSSA bloodstream infections, beta-lactams are superior to vancomycin for definitive therapy but not for empiric treatment. Patients should receive beta-lactams for definitive therapy, specifically antistaphylococcal penicillins or cefazolin.