Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review.

IF 3.7 Q2 INFECTIOUS DISEASES
JAC-Antimicrobial Resistance Pub Date : 2024-05-06 eCollection Date: 2024-06-01 DOI:10.1093/jacamr/dlae069
Calvin Ka-Fung Lo, Ashwin Sritharan, Jiesi Zhang, Nicole Li, Cindy Zhang, Frank Wang, Mark Loeb, Anthony D Bai
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Abstract

Background: The cefazolin inoculum effect (CzIE) is a phenomenon whereby some MSSA isolates demonstrate resistance to cefazolin when a high bacterial inoculum is used for susceptibility testing. The clinical significance of this phenotypic phenomenon remains unclear. We conducted a systematic review to answer the following question: In patients with serious MSSA infection treated with cefazolin, does infection due to CzIE-positive MSSA isolates result in worse clinical outcomes than infection due to CzIE-negative MSSA isolates?

Methods: Ovid MEDLINE, Embase, Cochrane CENTRAL, medRxiv and bioRxiv were searched from inception until 12 April 2023. Studies were included if they tested for CzIE in clinical isolates from MSSA infections in humans. Two independent reviewers extracted data and conducted risk-of-bias assessment. Main outcomes were treatment failure and mortality. Pooling of study estimates was not performed given the heterogeneity of patient populations and outcome definitions.

Results: Twenty-three observational studies were included. CzIE presence amidst MSSA isolates ranged from 0% to 55%. There was no statistically significant mortality difference in two studies that compared MSSA infections with and without CzIE, with ORs ranging from 0.72 to 19.78. Of four studies comparing treatment failure, ORs ranged from 0.26 to 13.00. One study showed a significantly higher treatment failure for the CzIE group, but it did not adjust for potential confounders.

Conclusions: The evidence on CzIE is limited by small observational studies. In these studies, CzIE did not predict higher mortality in MSSA infections treated with cefazolin. Our findings do not support CzIE testing in clinical practice currently.

严重 MSSA 感染中头孢唑啉接种体效应的临床意义:系统综述。
背景:头孢唑啉接种量效应(CzIE)是指在使用高细菌接种量进行药敏试验时,一些 MSSA 分离物对头孢唑啉产生耐药性的现象。这种表型现象的临床意义尚不清楚。我们进行了一项系统综述,以回答以下问题:在接受头孢唑啉治疗的严重 MSSA 感染患者中,CzIE 阳性 MSSA 分离物导致的感染是否会比 CzIE 阴性 MSSA 分离物导致的感染导致更差的临床结果?对 Ovid MEDLINE、Embase、Cochrane CENTRAL、medRxiv 和 bioRxiv 进行了检索,检索时间从开始至 2023 年 4 月 12 日。如果研究对来自人类 MSSA 感染的临床分离物进行了 CzIE 检测,则纳入该研究。两位独立审稿人提取了数据并进行了偏倚风险评估。主要结果为治疗失败和死亡率。鉴于患者群体和结果定义的异质性,未对研究结果进行汇总:结果:共纳入 23 项观察性研究。MSSA 分离物中的 CzIE 存在率从 0% 到 55% 不等。有两项研究比较了有 CzIE 和无 CzIE 的 MSSA 感染,结果显示死亡率差异不明显,OR 从 0.72 到 19.78 不等。在四项比较治疗失败的研究中,ORs 从 0.26 到 13.00 不等。一项研究显示,CzIE组的治疗失败率明显较高,但该研究并未调整潜在的混杂因素:结论:关于CzIE的证据受到小型观察性研究的限制。在这些研究中,CzIE并不能预测使用头孢唑啉治疗的MSSA感染的死亡率。我们的研究结果不支持目前在临床实践中进行 CzIE 检测。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.30
自引率
0.00%
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审稿时长
16 weeks
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