Safety and Efficacy of Ceftriaxone in the Treatment of Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections: A Noninferiority Retrospective Cohort Study

• Published in: The Annals of pharmacotherapy Vol. 57; no. 4; p. 425
• Main Authors: Ganguly, Anisha, de la Flor, Carolina, Alvarez, Kristin, Brown, L Steven, Mang, Norman S, Smartt, Jillian, King, Helen, Perl, Trish M, Filizola, Hector, Bhavan, Kavita P
• Format: Journal Article
• Language: English
• Published: United States 01.04.2023
• Subjects: Anti-Bacterial Agents - adverse effects; Bacteremia; Cefazolin; Ceftriaxone - adverse effects; Humans; Methicillin - adverse effects; Retrospective Studies; Sepsis; Staphylococcal Infections - drug therapy; Staphylococcus aureus; MSSA; bloodstream infections; ceftriaxone; noninferiority study; cefazolin
• ISSN: 1542-6270
• DOI: 10.1177/10600280221115460

Antistaphylococcal penicillins and cefazolin are the treatments of choice for methicillin-susceptible (MSSA) infections, requiring multiple doses daily. At Parkland, eligible uninsured patients with MSSA bloodstream infections (BSI) receive self-administered outpatient parenteral antimicrobial therapy (S-OPAT). Ceftriaxone was used in a cohort of S-OPAT patients for ease of once-daily dosing. A retrospective study was conducted to evaluate clinical outcomes for patients discharged with ceftriaxone versus cefazolin to treat MSSA BSI. A retrospective cohort noninferiority study design was used to assess treatment efficacy of ceftriaxone versus cefazolin among Parkland S-OPAT patients treated from April 2012 to March 2020. Demographic, clinical, and treatment-related adverse events data were collected. Clinical outcomes included treatment failure as defined by repeat positive blood culture or retreatment within 6 months, all-cause 30-day readmission rates, and central line-associated bloodstream infection (CLABSI) rates. Of 368 S-OPAT patients with MSSA BSI, 286 (77.7%) received cefazolin, and 82 (22.3%) received ceftriaxone. Demographics and comorbidities were similar for both groups. There were no treatment failures in the ceftriaxone group compared with 4 (1%) in the cefazolin group ( = 0.58). No difference in 30-day readmission rate between groups was found. The CLABSI rates were lower in ceftriaxone group (2%) compared with cefazolin (11%; = 0.02). Limitations include retrospective cohort design. Ceftriaxone was found to be noninferior to cefazolin in this study. Our findings suggest that ceftriaxone is a safe and effective treatment of MSSA BSI secondary to osteoarticular or skin and soft tissue infections when used in the S-OPAT setting. OFID on 2018 Nov; 5(Suppl 1): S316: doi: