Clinicians have opted for antistaphylococcal penicillins over cefazolin for patients with methicillin-susceptible S. aureus bacteremia due to habit, guidelines, and a theoretical concern about the cefazolin inoculum effect.In this randomized trial, however, cefazolin met noninferiority for 90-day mortality (15% vs 17%) against two antistaphylococcal penicillins, cloxacillin and flucloxacillin.Patients assigned to cefazolin also had a lower incidence of acute kidney injury within 14 days versus those taking the antistaphylococcal penicillins (13.9% vs 19.6%).
Cefazolin was effective for the treatment of bacteremia caused by methicillin-susceptible Staphylococcus aureus (MSSA), findings of an international open-label platform trial showed.
Among patients hospitalized with penicillin-resistant MSSA bacteremia, the 90-day mortality rate was 15% among those randomized to cefazolin versus 17% for those receiving either cloxacillin or flucloxacillin (adjusted OR 0.81, 95% credible interval [CrI] 0.59-1.12).
By Bayesian analysis, cefazolin's probability of noninferiority to the antistaphylococcal penicillins was 99.2% and its probability of superiority 89.8% in the study of nearly 1,300 individuals, as reported by Stephen Tong, MBBS, PhD, and fellow collaborators of the Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group.
