Cefazolin Versus Anti-Staphylococcal Penicillins for the Treatment of Patients with Methicillin-Susceptible Staphylococcus aureus Infection: A Meta-Analysis with Trial Sequential Analysis

Autor: John M. Allen, Ariel Pomputius, Lolade S Bakare, Lindsey M. Childs-Kean, Kenneth P. Klinker, Anthony M. Casapao
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: Infectious Diseases and Therapy, Vol 8, Iss 4, Pp 671-686 (2019)
Infectious Diseases and Therapy
ISSN: 2193-6382
2193-8229
DOI: 10.1007/s40121-019-00259-4
Popis: Introduction Methicillin-susceptible Staphylococcus aureus (MSSA) is a common cause of infection in humans. Beta-lactam antibiotics are the preferred agents, with anti-staphylococcal penicillins (ASPs) or the first-generation cephalosporin, cefazolin, favored by clinicians. Recent studies comparing the two strategies suggest similar outcomes between the agents. The purpose of this meta-analysis was to explore differences between cefazolin and ASPs for the treatment of MSSA infections. Methods We performed a meta-analysis with trial sequential analysis (TSA) of observational or cohort studies using a random-effects model. Two blinded reviewers independently assessed studies for inclusion, risk of bias, and data extraction. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, and antibiotic discontinuation due to adverse events. Subgroup analyses were conducted for the primary outcome by type of ASP, studies with a high percentage of deep-seated infections, and studies of low to moderate risk of bias. Results After performing a comprehensive search of the literature, and screening for study inclusion, 19 studies (13,390 patients) were included in the final meta-analysis. Fifteen of the 19 studies (79%) were judged as having a low or moderate risk of bias. Use of cefazolin was associated with lower all-cause mortality [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.56–0.91, p = 0.006, I2 = 28%], clinical failure (OR 0.55, 95% CI 0.41–0.74, p
Databáze: OpenAIRE
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