さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteremia: a systematic review and meta-analysis

CMIに報告されたメタアナ、SABに対すCEZ vs anti-staph penicillin

 

The primary endpoint was 90-day all-cause mortality.

(RR 0.71 [0.50, 1.02], low quality of evidence).

 

Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 [0.54, 0.91], low quality of evidence) and less nephrotoxicity (RR 0.36 [0.21, 0.59], (low quality of evidence)).

www.sciencedirect.com

f:id:akinohanayuki:20190403131051j:plain

 

 感想

 

SABに対しては、CEZですな。

その前に、安定供給が極めて重要ですが。。

 

Summary

Background

For patients with bacteremia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASP) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect.

Objectives

To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with SAB.

Methods

We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26th June 2018. All studies investigating the effects of Cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RR) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I2. The primary endpoint was 90-day all-cause mortality. NOS and GRADE were used for study and data quality assessment.

Results

Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 [0.50, 1.02], low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 [0.54, 0.91], low quality of evidence) and less nephrotoxicity (RR 0.36 [0.21, 0.59], (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 [0.59, 1.18]). For patients with endocarditis (RR 0.71 [0.12, 4.05]) or abscesses (RR 1.17 [0.30, 4.63]), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence).

Conclusion

Cefazolin seemed to be at least equally effective as ASPs while being associated with less nephrotoxicity.

 

 

感染症プラチナマニュアル 2019

感染症プラチナマニュアル 2019