Journal Article

Relative efficacy of cefuroxime versus dicloxacillin as definitive antimicrobial therapy in methicillin-susceptible <i>Staphylococcus aureus</i> bacteraemia: a propensity-score adjusted retrospective cohort study

Jon Bjarke Rasmussen, Jenny Dahl Knudsen, Magnus Arpi, Henrik Carl Schønheyder, Thomas Benfield and Christian Østergaard

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 69, issue 2, pages 506-514
Published in print February 2014 | ISSN: 0305-7453
Published online September 2013 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dkt375
Relative efficacy of cefuroxime versus dicloxacillin as definitive antimicrobial therapy in methicillin-susceptible Staphylococcus aureus bacteraemia: a propensity-score adjusted retrospective cohort study

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Objectives

The objective of the present study was to compare the efficacy of cefuroxime with that of dicloxacillin as definitive antimicrobial therapy in methicillin-susceptible Staphylococcus aureus bacteraemia (MS-SAB) using a Danish bacteraemia database, information on the indication for antimicrobial therapy, multivariate adjustment and propensity score (PS) matching.

Methods

This was a retrospective cohort study. MS-SAB cases from 1 January 2006 to 31 December 2008 were included from a total of seven hospitals in the greater Copenhagen area and seven hospitals in the North Denmark Region. Information including demographics, antimicrobial therapy and clinical condition was obtained. The physician's note detailing the indication for starting empirical antimicrobial therapy was given special attention. Hazard ratios (HRs) and 95% CIs for 30 day and 90 day mortality were calculated using PS-adjusted Cox proportional hazards regression analyses. In addition, PS matching was performed.

Results

A total of 691 patients with MS-SAB received either dicloxacillin (n = 368) or cefuroxime (n = 323) as definitive antimicrobial therapy. Twenty-eight different indications for empirical antimicrobial therapy were identified and grouped into eight categories. There was no statistically significant difference in 30 day mortality between the two groups (HR 1.02, 95% CI 0.68–1.52). Definitive antimicrobial therapy with cefuroxime was associated with increased 90 day mortality in a PS-adjusted multivariate analysis (HR 1.43, 95% CI 1.03–1.98) and in the PS matching (OR 1.65, 95% CI 1.06–2.56). Antimicrobial therapy for an indication of ‘severe infection’ was independently associated with 90 day mortality (HR 1.97, 95% CI 1.19–3.28).

Conclusions

Definitive antimicrobial therapy with cefuroxime was associated with significantly higher 90 day mortality than was dicloxacillin therapy in patients with MS-SAB.

Keywords: sepsis; septicaemia epidemiology; S. aureus; β-lactams

Journal Article.  5028 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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