International Journal of Clinical Pharmacy

, Volume 36, Issue 6, pp 1282–1289 | Cite as

Outcomes of ceftriaxone use compared to standard of therapy in methicillin susceptible staphylococcal aureus (MSSA) bloodstream infections

  • Ursula C. PatelEmail author
  • Erin L. McKissic
  • Douglas Kasper
  • Joseph R. Lentino
  • Constance T. Pachucki
  • Todd Lee
  • Bert K. Lopansri
Research Article


Background Standard of care therapy (SOCT) for the treatment of methicillin susceptible staphylococcal aureus (MSSA) infections requires multiple daily infusions. Despite questionable efficacy due to high protein binding, ceftriaxone (CTX) is frequently used for treatment of MSSA at Hines VA Hospital. Objective The objective of this study was to determine clinical and microbiological outcomes in patients with MSSA bacteremia treated with CTX compared to SOCT. Setting This retrospective study was conducted at the Edward Hines, Jr. VA Hospital which is a comprehensive health care center serving the veteran population of the greater metropolitan Chicago and northwest Indiana regions and is institutionally affiliated with the Loyola University Medical Center. The Hines VA provides medical care to over 56,000 veterans and operates approximately 500 hospital beds, including acute care and nursing home beds. Method We conducted a retrospective cohort study of patients with MSSA bacteremia treated at Hines VA Hospital between January 2000 and September 2009. Patients who received either SOCT or CTX for >50 % of the treatment course and for the appropriate duration were included. Patients who were on multiple antibiotics concurrently or who received <14 days of therapy were excluded. Main outcome measure The primary outcome of this study is to compare clinical outcomes of patients with MSSA bacteremia who were treated with CTX compared to those who received standard of care agents. Results Ninety-three patients with MSSA bacteremia were included in the analysis. Fifty-one were treated with SOCT and 42 with CTX. There were no differences in microbiological cure between SOCT (94.1 %) and CTX (95.2 %) (p = 0.812). Clinical cure was similar between groups (74.5 % for SOCT, 83.3 % for CTX) (p = 0.303). CTX was used more often to treat Staphylococcus aureus bacteremia associated with osteomyelitis whereas endocarditis and central line associated infections were treated more frequently with SOCT (p = 0.01). More patients treated with CTX were managed in the ambulatory setting (64 vs. 24 %; p = <0.001). There was a trend toward a longer hospital stay with SOCT. Conclusion Clinical outcomes for MSSA bacteremia did not differ significantly between patients treated with CTX and SOCT. Findings suggest that CTX may be an alternative for outpatient management of MSSA bacteremia.


Bacteremia Ceftriaxone MSSA S. aureus United States Veterans 




Conflicts of interest

No conflicts of interest to report.


  1. 1.
    Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob. 2006;5:2.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Naber C. Staphylococcus aureus bacteremia: epidemiology, pathophysiology, and management strategies. Clin Infect Dis. 2009;48(4):S231–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005;293:3012–21.PubMedCrossRefGoogle Scholar
  4. 4.
    Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, et al. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med. 2003;163:2066–72.PubMedCrossRefGoogle Scholar
  5. 5.
    de Kraker ME, Davey PG, Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Med. 2011;8:e1001104.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Rubin RJ, Harrington CA, Poon A, Dietrich K, Greene JA, Moiduddin A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis. 1999;5(1):9–17.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Fowler VG, Sexton DJ. Treatment of Staphylococcus aureus bacteremia in adults. In: Post TW, editor. UpToDate. Waltham: UpToDate; 2010 (Accessed Oct 2010).Google Scholar
  8. 8.
    Fowler VG Jr, Sanders LL, Sexton DJ, Kong L, Marr KA, Gopal AK, et al. Outcomes of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis. 1998;27:478–86.PubMedCrossRefGoogle Scholar
  9. 9.
    Chang FY, Peacock JE Jr, Musher DM, Triplett P, MacDonald BB, Mylotte JM, et al. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Medicine (Baltimore). 2003;82(5):333–9.CrossRefGoogle Scholar
  10. 10.
    Stryjewski ME, Szczech LA, Benjamin DK Jr, Inrig JK, Kanafani ZA, Engemann JJ, et al. Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. Clin Infect Dis. 2007;44:190–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Williams DN, Rehm SJ, Tice AD, Bradley JS, Kind AC, Craig WA. Practice guidelines for community-based parenteral anti-infective therapy: IDSA practice guidelines committee. Clin Infect Dis. 1997;25:787–801.PubMedCrossRefGoogle Scholar
  12. 12.
    Paladino JA, Poretz D. Outpatient parenteral antimicrobial therapy today. Clin Infect Dis. 2010;51(2):S198–208.PubMedCrossRefGoogle Scholar
  13. 13.
    Tice A, Siebold G, Martinelli L. Adverse effects from intravenous antibiotics with OPAT. Presented at the 40th annual meeting of the infectious diseases society of America, Chicago, IL. 2002.Google Scholar
  14. 14.
    Hamilton RA, Kowalsky SF, McCormick EM, Echols RM. Protein binding of CTX, cefoperazone, and ceftizoxime. Clin Pharm. 1987;6:567–9.PubMedGoogle Scholar
  15. 15.
    Schmidt S, Rock K, Sahre M, Burkhardt O, Brunner M, Lobmeyer M, et al. Effect of protein binding on the pharmacological activity of highly bound antibiotics. Antimicrob Agents Chemother. 2008;3994–4000.Google Scholar
  16. 16.
    Van der Auwera P, Klastersky J. Study of the influence of protein binding on serum bactericidal titers and killing rates in volunteers receiving ceftazidime, cefotaxime and CTX. J Hosp Infect. 1990;15:23–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Guglielmo BJ, Luber AD, Paletta D Jr, Jacobs RA. Ceftriaxone therapy for staphylococcal osteomyelitis: a review. Clin Infect Dis. 2000;30:205–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Wynn M, Dalovisio JR, Tice AD, Jiang X. Evaluation of the efficacy and safety of outpatient parenteral antimicrobial therapy for infections with methicillin-sensitive Staphylococcus aureus. South Med J. 2005;98(6):590–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Paul M, Zemer-Weisezug N, Talker O, Lishtzinsky Y, Lev B, Samra Z, et al. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia? Clin Microbiol Infect. 2011;17(10):1581–6.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Ursula C. Patel
    • 1
    Email author
  • Erin L. McKissic
    • 2
  • Douglas Kasper
    • 3
  • Joseph R. Lentino
    • 3
  • Constance T. Pachucki
    • 3
  • Todd Lee
    • 4
  • Bert K. Lopansri
    • 3
  1. 1.Department of Pharmacy (119)Edward Hines, Jr. VA HospitalHinesUSA
  2. 2.Department of PharmacyEdward Hines, Jr. VA Medical CenterHinesUSA
  3. 3.Section of Infectious Diseases/Medicine ServiceEdward Hines, Jr. VA Medical CenterHinesUSA
  4. 4.Department of ResearchEdward Hines, Jr. VA Medical CenterHinesUSA

Personalised recommendations