Gold-standard antibiotic suboptimal for end-stage renal disease
medwireNews: Only one-fifth of patients with end-stage renal disease and methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia are treated with cefazolin, research suggests.
Cefazolin is 38% more effective than vancomycin in reducing hospitalization and death rates, show the study findings published in Journal of the American Society of Nephrology.
"The data suggest there is an opportunity to improve outcomes for patients through appropriate antibiotic selection," said lead study author Kevin Chan (Fresenius Medical Care North America, Waltham, Massachusetts) in a press release.
The 2006-2010 population surveillance study, which included 293,094 chronic hemodialysis outpatients, showed an overall bloodstream infection rate of 15.4 cases per 100 outpatient-years.
Specifically, the MSSA bloodstream infection rate was estimated to be 2.1 cases per 100 outpatient-years while the methicillin-resistant S. aureus (MRSA) infection rate was 1.9 cases per 100 outpatient-years.
Analysis of antibiotic prescription trends over the 5-year study period showed that 1 week after blood culture collection, 56.1% and 16.7% of outpatients with MSSA bacteremia were treated with vancomycin and cefazolin. Even after 2 weeks, more than twice as many patients with MSSA were prescribed vancomycin.
Over the 5-year study period, vancomycin treatment for MSSA increased significantly, from 49.4% in 2006 to 66.4% in 2010. Conversely, cefazolin use for MSSA bacteremia decreased significantly by 8.0% over the same time period.
These findings are particularly concerning, given that cefazolin was shown to be associated with a 38% lower rate of hospitalization and death, and a 48% lower rate of sepsis compared with vancomycin for treatment of culture-positive MSSA infection.
"It may not be widely appreciated that cefazolin may be more effective at eradicating bloodstream infections over vancomycin," says Chan and team, adding that large practice disparities for antibiotic treatment in this patient population could be contributing to excess infection-related morbidity and mortality.
"There are currently no renal practice guidelines for the treatment of bloodstream infection in dialysis which would likely decrease such clinical variability in infection care," conclude the researchers.
medwireNews (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Ingrid Grasmo, medwireNews Reporter