Skip to main content
SpringerLink
Log in

Penicillin versus anti-staphylococcal beta-lactams for penicillin-susceptible Staphylococcus aureus blood stream infections: a retrospective cohort study

  • Brief Report
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective of the study is to assess the efficacy and tolerability of penicillins compared to anti-staphylococcal beta-lactams for treatment of penicillin-susceptible Staphylococcus aureus bloodstream infections (PSSA BSI). A retrospective cohort study was conducted of 140 sequential PSSA BSI presenting to a local health district (90 cases included). Penicillin susceptibility was confirmed by disc diffusion, Vitek® and Nitrocefin beta-lactamase methods. Clinical information regarding comorbidities and infection complexity was recorded. Antibiotic choice, dosage and duration were reviewed. Outcomes were compared according to the definitive treatment with either penicillin or ASBLs. The primary outcome was 30-day mortality. Secondary outcomes included renal injury, microbiological relapse and treatment tolerability. Ninety patients met inclusion criteria and were included in subsequent analysis. Of PSSA BSI, 69% were community acquired. Eighty-two percent had complex PSSA infections. The average duration of bacteraemia was 2.8 days (SD = 1.8 days). Sixty-six patients received definitive penicillin treatment, with a mean of 3.5 days of empiric antibiotics prior to penicillin. Twenty-four patients received definitive ASBL treatment (11 cefazolin, 13 flucloxacillin). There was no difference in 30-day mortality between groups (p = 1). There was no difference in renal injury (p > 0.5), hospital length of stay (p = 0.59) or microbiological relapse within 1 year (p = 0.17). Penicillin treatment was well tolerated. Our data supports penicillin as a suitable and well-tolerated alternative to ASBL in managing complex PSSA BSI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Availability of data and material

Deidentified data is provided as part of the replication package and has been uploaded into file submissions for the journal.

Code availability

Code for data cleaning and analysis is provided in the Excel spreadsheet uploaded into file submissions for the journal.

References

  1. Resistance AGoA (2021) Sepsis outcome programs - 2019 report. In: Care ACoSaQiH, editor. Level 5, 255 Elizabeth Street, Sydney NSW 2000: Australian Commission on Safety and Quality in Health Care

  2. Butler-Laporte G, Lee TC, Cheng MP (2018) Increasing rates of penicillin sensitivity in Staphylococcus aureus. Antimicrob Agents Chemother 26;62(7):e00680–18. https://doi.org/10.1128/AAC.00680-18

  3. Limited TG. Directed therapy for bloodstream infections, including sepsis and septic shock. 2019. In: eTG complete [digital] [Internet]. Melbourne. Available from: https://tg.org.au.

  4. Henderson A, Harris P, Hartel G, Paterson D, Turnidge J, Davis JS et al (2019) Benzylpenicillin versus flucloxacillin for penicillin-susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study. Int J Antimicrob Agents 54(4):491–495

    Article  CAS  Google Scholar 

  5. Nissen JL, Skov R, Knudsen JD, Østergaard C, Schønheyder HC, Frimodt-Møller N et al (2013) Effectiveness of penicillin, dicloxacillin and cefuroxime for penicillin-susceptible Staphylococcus aureus bacteraemia: a retrospective, propensity-score-adjusted case–control and cohort analysis. J Antimicrob Chemother 68(8):1894–1900

    Article  CAS  Google Scholar 

  6. SM. Bell JNP, D. L. Rafferty, J. K. Allerton, P. M. James (2018) Antibiotic susceptibility testing by the CDS method. In: Department of Microbiology NHP, editor. NSW: NSW Health Pathology

  7. Levi TM, de Souza SP, de Magalhães JG, de Carvalho MS, Cunha ALB, Dantas JGAdO et al (2013) Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva 25(4):290–6

  8. Turnidge JD, Kotsanas D, Munckhof W, Roberts S, Bennett CM, Nimmo GR et al (2009) Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand. Med J Aust 191(7):368–373

    Article  Google Scholar 

  9. Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr (2015) Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 28(3):603–661

    Article  CAS  Google Scholar 

  10. Minejima E, Mai N, Bui N, Mert M, Mack WJ, She RC et al (2020) Defining the breakpoint duration of Staphylococcus aureus bacteremia predictive of poor outcomes. Clin Infect Dis 70(4):566–573

    Article  Google Scholar 

  11. Sweeney DA, Kalil AC (2020) Be quick but don’t hurry: septic shock, Staphylococcus aureus bacteremia, and the timing of appropriate antibiotics. Critical Care Med 48(4):608–609. https://doi.org/10.1097/CCM.0000000000004278

  12. Davido B, Lawrence C, Dinh A, Bouchand F (2018) Back to the future with the use of penicillin in penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia. Am J Med. 131(4):e155

    Article  Google Scholar 

  13. Tong SYC, Campbell A, Bowen AC, Davis JS (2019) A survey of infectious diseases and microbiology clinicians in Australia and New Zealand about the management of Staphylococcus aureus bacteremia. Clin Infect Dis 69(10):1835–1836

    Article  Google Scholar 

  14. Papanicolas LE, Bell JM, Bastian I (2014) Performance of phenotypic tests for detection of penicillinase in Staphylococcus aureus isolates from Australia. J Clin Microbiol 52(4):1136–1138

    Article  Google Scholar 

  15. Rao SN, Rhodes NJ, Lee BJ, Scheetz MH, Hanson AP, Segreti J et al (2015) Treatment outcomes with cefazolin versus oxacillin for deep-seated methicillin-susceptible Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 59(9):5232–5238

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Austin Hospital, 145 Studley Road, Heidelberg, VIC, Australia

    Gemma Reynolds

  2. Department of Infectious Diseases and Microbiology, Wollongong Hospital, Wollongong, NSW, Australia

    Simeon Crawford, Niladri Ghosh & Peter Newton

  3. Illawarra Health and Medical Research Institute, Wollongong, NSW, Australia

    Simeon Crawford

  4. Research Central, Illawarra Shoalhaven Local Health District, NSW, Wollongong, Australia

    Jose Cuenca

  5. Microbiology, NSW Health Pathology, Wollongong Hospital, Wollongong, Australia

    Peter Newton

Authors
  1. Gemma Reynolds
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simeon Crawford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jose Cuenca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Niladri Ghosh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Newton
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SC, NG and PN conceived of the project. GR and SC collected the data, performed data analysis and drafted the manuscript. JC performed the data analysis. GR, SC, JC, NG and PN assisted with drafting and critically revising the manuscript.

Corresponding author

Correspondence to Gemma Reynolds.

Ethics declarations

Ethics approval

This study is approved by the Illawarra Shoalhaven Local Health District ethics committee Approval 2017/243.

Consent to participate

N/A.

Consent for publication

N/A.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(PDF 112 KB)

ESM 2

(CSV 82.0 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Reynolds, G., Crawford, S., Cuenca, J. et al. Penicillin versus anti-staphylococcal beta-lactams for penicillin-susceptible Staphylococcus aureus blood stream infections: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 41, 147–151 (2022). https://doi.org/10.1007/s10096-021-04330-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-021-04330-2

Search

Navigation