296. Cefazolin (CEZ) therapy for methicillin-susceptible Staphylococcus aureus (MSSA)bacteremia: the only treatment available in Japan
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Background:CEZ is the treatment agent of first choice, and the only agent available in Japan, for the treatment of bacteremia caused by MSSA because no penicillinase-resistant penicillins are available in this country. The efficacy of CEZ therapy for MSSA bacteremia is not yet completely understood, at least not as well as that of oxacillin and nafcillin.

Methods:Retrospective review of clinical charts. patients with MSSA bacteremia, diagnosed from two or more positive blood cultures, treated with CEZ at our institution from January 1, 2006 through 31 December, 2010, were identified. The diagnosis, clinical features and complications until 3 months after the onset were reviewed.

Results:During the 60-month period specified above, 140 patients with MSSA bacteremia were identified. Of these, 84 (60%) had received CEZ therapy. The mean age of these patients was 54 (0-94) years, and 54 (64.3%) were male, 23 (27.4%) had diabetes mellitus, and 13 (15.5%) were under maintenance hemodialysis therapy. The infection was hospital-acquired in 60 of the 84 (71.4%) patients. The primary clinical diagnosis was catheter-related bloodstream infection in 43 (51.1%) patients, surgical site infection in 12 (14.3%) patients, bone, muscle and/or joint infection in 10 (12%) patients, skin and soft tissue infection in 6 (7.1%) patients, and infective endocarditis (IE) in 3 (3.6%) patients. The cure rate after 3 months was 82.1% (n=69). Treatment failure or recurrence of primary infection was seen in 14 cases (16.6%). Sixteen (19%) patients had one or more metastatic abscesses, and eight (9.5%) had secondary IE. There was no case of metastatic abscess in the central nervous system (CNS). MSSA bacteremia-related death was seen in 12% (n=10) of the cases. 

Conclusion:This is the first and largest case study of patients with MSSA bacteremia treated with CEZ. The outcome of CEZ therapy for MSSA bacteremia was not much different from that generally reported for the penicillinase-resistant penicillins, although only limited data could be analyzed in this retrospective study. CEZ therapy for MSSA bacteremia appeared to prevent CNS complications, one of the most important concerns, even though the cerebrospinal fluid penetration of the drug is very poor. 


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Takayo Shoji, MD, Yusuke Ainoda, MD., Takahiro Fujita, MD., Yuji Hirai, MD PhD and Kyoichi Totsuka, M.D.PhD, Infectious Disease, Tokyo Women's Medical University, Tokyo, Japan

Disclosures:

T. Shoji, None

Y. Ainoda, None

T. Fujita, None

Y. Hirai, None

K. Totsuka, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.