Michihiko Goto, MD, MSCI1,2; Daniel Livorsi, MD6; Makoto Jones, MD, MS7,8;. Justin Albertson, MS1; Rajeshwari Nair, MBBS, MPH1,3; Amy O'shea, PhD1,2;.
840. Comparative Effectiveness of Third-Generation Cephalosporins Versus Penicillinase-Stable Penicillins for Treatment of MethicillinSusceptible Staphylococcus aureus Infections Complicated by Bacteremia: A Nationwide Cohort Study Jennifer Mcdanel, PhD1,2,3; Mary-Claire Roghmann, MD, MS, FIDSA, FSHEA4,5; Eli Perencevich, MD, MS, FIDSA, FSHEA1,2,3; Michael Ohl, MD, MSPH1,2; Michihiko Goto, MD, MSCI1,2; Daniel Livorsi, MD6; Makoto Jones, MD, MS7,8; Justin Albertson, MS1; Rajeshwari Nair, MBBS, MPH1,3; Amy O’shea, PhD1,2; Marin Schweizer, PhD1,2,3; 1Iowa City Veterans Affairs Health Care System, Iowa City, Iowa; 2University of Iowa Carver College of Medicine, Iowa City, Iowa; 3University of Iowa College of Public Health, Iowa City, Iowa; 4Veterans Affairs Maryland Healthcare System, Baltimore, Maryland; 5University of Maryland School of Medicine, Baltimore, Maryland; 6Indiana University School of Medicine, Indianapolis, Indiana; 7University of Utah School of Medicine, Salt Lake City, Utah; 8Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Session: 132. Bacteremia and Endocarditis Friday, October 9, 2015: 12:30 PM Background. Third-generation cephalosporins (e.g. ceftriaxone) could be a convenient therapy for MSSA infections complicated by bacteremia, due to its once daily dosing. This study compared deﬁnitive therapy with the third generation cephalosporins ceftriaxone and cefotaxime (3GC) with penicillinase-stable penicillins (PSP) (e.g. nafcillin or oxacillin) among patients with MSSA infections complicated by bacteremia. Methods. This retrospective cohort study included patients admitted to 121 Veterans
Health Administration hospitals from 2003 to 2010. Patients were included if they had a blood culture positive for MSSA and received deﬁnitive therapy with ceftriaxone, cefotaxime, nafcillin, or oxacillin. Deﬁnitive therapy was deﬁned as the receipt of an antimicrobial between 4 to 14 days after the ﬁrst positive blood culture was collected. Cox proportional hazard regression and ordinal logistic regression (categories: no recurrence, recurrence, death) were used to examine the association between treatment and recurrence or death. Recurrent MSSA infections were deﬁned as a MSSA positive blood culture between 45 to 365 days after the ﬁrst MSSA positive blood culture. Results. Of 2642 patients, 609 (23%) patients received therapy with a 3GC. Both 30day mortality (hazards ratio (HR): 1.06; 95% conﬁdence interval (CI): 0.83-1.37) and 90day mortality (HR: 1.16; 95% CI: 0.95-1.40) were similar between patients who received 3GC compared with patients who received PSP after controlling for severity of illness, comorbidity score, age, skin and soft tissue infections, endocarditis, osteomyelitis, hepatitis C, and diabetes. Additionally, the odds of having a recurrent infection were similar for patients who received 3GC compared with patients who received PSP after controlling for those factors (odds ratio: 1.01; 95% CI: 0.80-1.29). Conclusion. In this large, multi-center study, a signiﬁcant difference was not observed among patients receiving therapy with 3GC compared with patients receiving PSP for MSSA infections complicated by bacteremia. If validated in an individually randomized trial, 3GC might be an appropriate deﬁnitive therapy for treating patients with MSSA infections complicated by bacteremia. Disclosures. E. Perencevich, Cubist Pharmaceuticals, inc: Grant Investigator, Research grant
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