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. 2018 Oct 11;18(1):508.
doi: 10.1186/s12879-018-3418-9.

Efficacy and Safety of Cefazolin Versus Antistaphylococcal Penicillins for the Treatment of Methicillin-Susceptible Staphylococcus Aureus Bacteremia: A Systematic Review and Meta-Analysis

Free PMC article

Efficacy and Safety of Cefazolin Versus Antistaphylococcal Penicillins for the Treatment of Methicillin-Susceptible Staphylococcus Aureus Bacteremia: A Systematic Review and Meta-Analysis

Changcheng Shi et al. BMC Infect Dis. .
Free PMC article


Background: Antistaphylococcal penicillins (ASPs) and cefazolin have become the most frequent choices for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, the best therapeutic agent to treat MSSA bacteremia remains to be established.

Methods: We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these two regimens for the treatment of MSSA bacteremia. PubMed, EMBASE and the Cochrane Library from inception to February 2018 were searched. The primary outcome was mortality. The secondary outcomes included treatment failure, recurrence of bacteremia, adverse effects (AEs) and discontinuation due to AEs. Data were extracted and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results: A total of ten observational studies met the inclusion criteria. The results indicate that compared to ASPs, cefazolin was associated with significant reduction in mortality (OR, 0.69; 95% CI, 0.58 to 0.82; I2 = 3.4%) and clinical failure (OR, 0.56; 95% CI, 0.37 to 0.85; I2 = 44.9%) without increasing the recurrence of bacteremia (OR, 1.12; 95% CI, 0.94 to 1.34; I2 = 0%). There were no significant differences for the risk of anaphylaxis (OR, 0.91; 95% CI, 0.36 to 2.99; I2 = 0%) or hematotoxicity (OR, 0.56; 95% CI, 0.17 to 1.88; I2 = 0%). However, nephrotoxicity (OR, 0.36; 95% CI, 0.16 to 0.81; I2 = 0%) and hepatotoxicity (OR, 0.12; 95% CI, 0.04 to 0.41; I2 = 0%) were significantly lower in the cefazolin group. Moreover, cefazolin was associated with lower probability of discontinuation due to AEs compared with the ASPs (OR, 0.24; 95% CI, 0.12 to 0.48; I2 = 18%).

Conclusion: The results of present study favor the application of cefazolin and should be regarded as important evidence to help make clinical decisions in choosing a treatment option for treating MSSA bacteremia.

Keywords: Antistaphylococcal penicillins; Bacteremia; Cefazolin; Meta-analysis; Methicillin-susceptible Staphylococcus aureus.

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Competing interests

The authors declare that they have no competing interests.

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Fig. 1
Fig. 1
Flow diagram of the literature search and selection process
Fig. 2
Fig. 2
Forest plots of odds ratios for mortality
Fig. 3
Fig. 3
Funnel plots of mortality

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