β -内酰胺治疗甲氧西林敏感金黄色葡萄球菌菌血症:头孢唑林与抗葡萄球菌青霉素的比较综述

Julius Li, K. Echevarria, K. Traugott
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引用次数: 39

摘要

甲氧西林敏感金黄色葡萄球菌(MSSA)菌血症与高发病率和死亡率相关。传统上,抗葡萄球菌青霉素(asp)被认为是治疗MSSA菌血症的首选药物。在几项研究中,万古霉素已被证明具有较差的结果,仅推荐用于严重青霉素过敏的患者。尽管对于非严重青霉素过敏的患者,头孢唑林被认为是asp的替代方案,但与asp相比,头孢唑林在药理学上具有一些优势,例如更方便的给药方案,并且作为节省成本举措的一部分,抗菌药物管理计划越来越多地将头孢唑林作为MSSA感染的首选药物。对A型β -内酰胺酶水解易感性的担忧,特别是在心内膜炎等深部感染的高接种时;不必要的革兰氏阴性覆盖带来的选择压力;由于缺乏比较临床数据,因此不能推荐头孢唑林作为MSSA菌血症的一线治疗药物。然而,最近的临床研究表明,与asp相比,头孢唑林的临床疗效相似,但耐受性更好,由于药物不良反应而停药的比率更低。其他变量,如充分的源头控制(例如,血管内导管拔除、清创或引流)和通过积极给药头孢唑林增强药效学,可能会减轻头孢唑林接种效应和决定改善临床结果的因素的作用。在这篇综述中,我们强调头孢唑林与asp在治疗MSSA菌血症中的应用,重点是临床疗效和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
β‐Lactam Therapy for Methicillin‐Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins
Methicillin‐susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost‐saving initiatives. Concerns about susceptibility to hydrolysis by type A β‐lactamases, particularly at high inocula seen in deep‐seated infections such as endocarditis; selective pressures from unnecessary gram‐negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first‐line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety.
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