Sharcon Worcester

SAN FRANCISCO – Cefazolin was better tolerated than nafcillin for the outpatient treatment of methicillin-sensitive Staphylococcus aureus among clinic patients included in a retrospective cohort study.

A number of drug-related adverse events occurred more often in 366 patients who received outpatient parenteral antimicrobial therapy (OPAT) with nafcillin, compared with 119 patients treated with cefazolin, including rash (13.9% vs. 4.2%), renal dysfunction (11.4% vs. 3.3%), and transaminitis (8.1% vs. 1.6%), Dr. Ilan Youngster reported at an annual scientific meeting on infectious diseases.

The patients in this study were adults with a mean age of 57 years in the nafcillin group and 56 years in the cefazolin group.

Furthermore, neutropenia developed in 8.4% of nafcillin patients, compared with 3.3% of cefazolin patients, and Clostridium difficile colitis developed in 2.4% vs. 0.8% of the nafcillin and cefazolin patients, respectively, said Dr. Youngster, a research fellow at Boston Children’s Hospital and Massachusetts General Hospital, Boston.

The discontinuation rate was significantly higher in the nafcillin group than in the cefazolin group, with 34% and 7% of patients in the groups, respectively, failing to complete the prespecified treatment course, he said. Nine patients who discontinued nafcillin switched over to cefazolin and completed treatment without any further drug-related adverse events.

The findings have implications for treatment of methicillin-sensitive Staphylococcus aureus (MSSA), which is a major pathogen in both community and health care–acquired infection, and one of the most common infections requiring prolonged antimicrobial administration.

Both nafcillin and cefazolin are considered first-line options for therapy for most MSSA infections, and recent studies suggest that the two beta-lactam antibiotics have similar efficacy, Dr. Youngster explained.

In addition to cost and efficacy, the differences in tolerability between these two drugs should be considered when deciding on long-term intravenous treatment for MSSA in the OPAT setting, he said. A failure to tolerate treatment will result in exposure to a partially treated infection should treatment be discontinued prematurely, or to the inconvenience of returning for another evaluation and a change of treatment.

Although the current study did not compare the efficacy of the two drugs, a clinical data collection system now in place will allow for such assessments going forward, he said.

IDWeek is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Youngster reported having no disclosures.

SAN FRANCISCO – Cefazolin was better tolerated than nafcillin for the outpatient treatment of methicillin-sensitive Staphylococcus aureus among clinic patients included in a retrospective cohort study.

A number of drug-related adverse events occurred more often in 366 patients who received outpatient parenteral antimicrobial therapy (OPAT) with nafcillin, compared with 119 patients treated with cefazolin, including rash (13.9% vs. 4.2%), renal dysfunction (11.4% vs. 3.3%), and transaminitis (8.1% vs. 1.6%), Dr. Ilan Youngster reported at an annual scientific meeting on infectious diseases.

The patients in this study were adults with a mean age of 57 years in the nafcillin group and 56 years in the cefazolin group.

Furthermore, neutropenia developed in 8.4% of nafcillin patients, compared with 3.3% of cefazolin patients, and Clostridium difficile colitis developed in 2.4% vs. 0.8% of the nafcillin and cefazolin patients, respectively, said Dr. Youngster, a research fellow at Boston Children’s Hospital and Massachusetts General Hospital, Boston.

The discontinuation rate was significantly higher in the nafcillin group than in the cefazolin group, with 34% and 7% of patients in the groups, respectively, failing to complete the prespecified treatment course, he said. Nine patients who discontinued nafcillin switched over to cefazolin and completed treatment without any further drug-related adverse events.

The findings have implications for treatment of methicillin-sensitive Staphylococcus aureus (MSSA), which is a major pathogen in both community and health care–acquired infection, and one of the most common infections requiring prolonged antimicrobial administration.

Both nafcillin and cefazolin are considered first-line options for therapy for most MSSA infections, and recent studies suggest that the two beta-lactam antibiotics have similar efficacy, Dr. Youngster explained.

In addition to cost and efficacy, the differences in tolerability between these two drugs should be considered when deciding on long-term intravenous treatment for MSSA in the OPAT setting, he said. A failure to tolerate treatment will result in exposure to a partially treated infection should treatment be discontinued prematurely, or to the inconvenience of returning for another evaluation and a change of treatment.

Although the current study did not compare the efficacy of the two drugs, a clinical data collection system now in place will allow for such assessments going forward, he said.

IDWeek is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Youngster reported having no disclosures.

SAN FRANCISCO – Cefazolin was better tolerated than nafcillin for the outpatient treatment of methicillin-sensitive Staphylococcus aureus among clinic patients included in a retrospective cohort study.

A number of drug-related adverse events occurred more often in 366 patients who received outpatient parenteral antimicrobial therapy (OPAT) with nafcillin, compared with 119 patients treated with cefazolin, including rash (13.9% vs. 4.2%), renal dysfunction (11.4% vs. 3.3%), and transaminitis (8.1% vs. 1.6%), Dr. Ilan Youngster reported at an annual scientific meeting on infectious diseases.

The patients in this study were adults with a mean age of 57 years in the nafcillin group and 56 years in the cefazolin group.

Furthermore, neutropenia developed in 8.4% of nafcillin patients, compared with 3.3% of cefazolin patients, and Clostridium difficile colitis developed in 2.4% vs. 0.8% of the nafcillin and cefazolin patients, respectively, said Dr. Youngster, a research fellow at Boston Children’s Hospital and Massachusetts General Hospital, Boston.

The discontinuation rate was significantly higher in the nafcillin group than in the cefazolin group, with 34% and 7% of patients in the groups, respectively, failing to complete the prespecified treatment course, he said. Nine patients who discontinued nafcillin switched over to cefazolin and completed treatment without any further drug-related adverse events.

The findings have implications for treatment of methicillin-sensitive Staphylococcus aureus (MSSA), which is a major pathogen in both community and health care–acquired infection, and one of the most common infections requiring prolonged antimicrobial administration.

Both nafcillin and cefazolin are considered first-line options for therapy for most MSSA infections, and recent studies suggest that the two beta-lactam antibiotics have similar efficacy, Dr. Youngster explained.

In addition to cost and efficacy, the differences in tolerability between these two drugs should be considered when deciding on long-term intravenous treatment for MSSA in the OPAT setting, he said. A failure to tolerate treatment will result in exposure to a partially treated infection should treatment be discontinued prematurely, or to the inconvenience of returning for another evaluation and a change of treatment.

Although the current study did not compare the efficacy of the two drugs, a clinical data collection system now in place will allow for such assessments going forward, he said.

IDWeek is the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Youngster reported having no disclosures.

SAN FRANCISCO – Influenza vaccination during pregnancy was associated with significantly lower odds of delivering a preterm or small for gestational age infant during a period of widespread influenza activity, but the effects varied based on maternal characteristics, according to findings from a large retrospective cohort study.

A highly significant overall association was seen between maternal vaccination with trivalent inactivated influenza vaccine and reduced odds of preterm birth among all 8,393 women with live births between Jan. 1, 2005, and Dec. 31, 2008, who were included in the study (odds ratio, 0.39). However, vaccination was most protective against preterm birth among white women (OR, 0.34) and women of higher socioeconomic status (OR, 0.30), Dr. Saad Omer of Emory University, Atlanta, reported an annual scientific meeting on infectious diseases.

©AvailableLight/istockphoto.com

Vaccination protected against small for gestational age birth only among those at higher risk for influenza-related morbidity, including those enrolled in the WIC (Women, Infant, and Children) program (OR, 0.20) and black women (OR, 0.15), Dr. Omer said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Data for this study were derived from the Georgia pregnancy risk assessment and monitoring system, as well as from hospital discharges and birth certificates. A number of prior studies have demonstrated beneficial effects of maternal immunization on maternal outcomes, and a 2011 study by Dr. Omer was the first to demonstrate overall beneficial effects on fetal outcomes following maternal influenza vaccine.

In that study, maternal vaccination was associated with reduced odds of preterm birth during local, regional, and widespread periods of influenza activity (OR, 0.44, 0.41, and 0.28, respectively), and with reduced odds of delivering a small for gestational age infant during the widespread activity period (OR, 0.31), he said (PLoS Med. 2011;8:e1000441). These findings have been replicated in subsequent studies.

But this is a complex process, and there is increasing recognition that inflammation and other factors play a role in preterm birth, he explained, noting: "There is substantial epidemiological and biological evidence that maternal characteristics are associated with adverse birth outcomes."

The current study is the first to look at fetal outcomes stratified by some of these maternal characteristics, he noted.

The outcomes were similar in magnitude to those in his 2011 study – but were restricted to the period of widespread influenza activity.

"And essentially, we had restriction of effect by race," he added, noting that there also was heterogeneity among the two outcomes (preterm birth and small for gestational age birth).

"So the bottom line is, yes, we saw – especially during the period of widespread influenza activity – that there was reduction of odds in both preterm birth and small for gestational age, but there’s more to this story. There is heterogeneity, perhaps based on underlying risk factors and mechanisms through which these extraneous factors have an impact on birth outcome," he said.

Currently, three international trials looking at some of these outcomes are underway, he said, adding: One hopes that from these trials "we’ll have a little bit more clarity both in terms of the actual clinical effect of these interventions, but also in terms of biologic pathways that are involved."

Dr. Omer reported having no disclosures.

SAN FRANCISCO – Influenza vaccination during pregnancy was associated with significantly lower odds of delivering a preterm or small for gestational age infant during a period of widespread influenza activity, but the effects varied based on maternal characteristics, according to findings from a large retrospective cohort study.

A highly significant overall association was seen between maternal vaccination with trivalent inactivated influenza vaccine and reduced odds of preterm birth among all 8,393 women with live births between Jan. 1, 2005, and Dec. 31, 2008, who were included in the study (odds ratio, 0.39). However, vaccination was most protective against preterm birth among white women (OR, 0.34) and women of higher socioeconomic status (OR, 0.30), Dr. Saad Omer of Emory University, Atlanta, reported an annual scientific meeting on infectious diseases.

©AvailableLight/istockphoto.com

Vaccination protected against small for gestational age birth only among those at higher risk for influenza-related morbidity, including those enrolled in the WIC (Women, Infant, and Children) program (OR, 0.20) and black women (OR, 0.15), Dr. Omer said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Data for this study were derived from the Georgia pregnancy risk assessment and monitoring system, as well as from hospital discharges and birth certificates. A number of prior studies have demonstrated beneficial effects of maternal immunization on maternal outcomes, and a 2011 study by Dr. Omer was the first to demonstrate overall beneficial effects on fetal outcomes following maternal influenza vaccine.

In that study, maternal vaccination was associated with reduced odds of preterm birth during local, regional, and widespread periods of influenza activity (OR, 0.44, 0.41, and 0.28, respectively), and with reduced odds of delivering a small for gestational age infant during the widespread activity period (OR, 0.31), he said (PLoS Med. 2011;8:e1000441). These findings have been replicated in subsequent studies.

But this is a complex process, and there is increasing recognition that inflammation and other factors play a role in preterm birth, he explained, noting: "There is substantial epidemiological and biological evidence that maternal characteristics are associated with adverse birth outcomes."

The current study is the first to look at fetal outcomes stratified by some of these maternal characteristics, he noted.

The outcomes were similar in magnitude to those in his 2011 study – but were restricted to the period of widespread influenza activity.

"And essentially, we had restriction of effect by race," he added, noting that there also was heterogeneity among the two outcomes (preterm birth and small for gestational age birth).

"So the bottom line is, yes, we saw – especially during the period of widespread influenza activity – that there was reduction of odds in both preterm birth and small for gestational age, but there’s more to this story. There is heterogeneity, perhaps based on underlying risk factors and mechanisms through which these extraneous factors have an impact on birth outcome," he said.

Currently, three international trials looking at some of these outcomes are underway, he said, adding: One hopes that from these trials "we’ll have a little bit more clarity both in terms of the actual clinical effect of these interventions, but also in terms of biologic pathways that are involved."

Dr. Omer reported having no disclosures.

SAN FRANCISCO – Influenza vaccination during pregnancy was associated with significantly lower odds of delivering a preterm or small for gestational age infant during a period of widespread influenza activity, but the effects varied based on maternal characteristics, according to findings from a large retrospective cohort study.

A highly significant overall association was seen between maternal vaccination with trivalent inactivated influenza vaccine and reduced odds of preterm birth among all 8,393 women with live births between Jan. 1, 2005, and Dec. 31, 2008, who were included in the study (odds ratio, 0.39). However, vaccination was most protective against preterm birth among white women (OR, 0.34) and women of higher socioeconomic status (OR, 0.30), Dr. Saad Omer of Emory University, Atlanta, reported an annual scientific meeting on infectious diseases.

©AvailableLight/istockphoto.com

Vaccination protected against small for gestational age birth only among those at higher risk for influenza-related morbidity, including those enrolled in the WIC (Women, Infant, and Children) program (OR, 0.20) and black women (OR, 0.15), Dr. Omer said at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Data for this study were derived from the Georgia pregnancy risk assessment and monitoring system, as well as from hospital discharges and birth certificates. A number of prior studies have demonstrated beneficial effects of maternal immunization on maternal outcomes, and a 2011 study by Dr. Omer was the first to demonstrate overall beneficial effects on fetal outcomes following maternal influenza vaccine.

In that study, maternal vaccination was associated with reduced odds of preterm birth during local, regional, and widespread periods of influenza activity (OR, 0.44, 0.41, and 0.28, respectively), and with reduced odds of delivering a small for gestational age infant during the widespread activity period (OR, 0.31), he said (PLoS Med. 2011;8:e1000441). These findings have been replicated in subsequent studies.

But this is a complex process, and there is increasing recognition that inflammation and other factors play a role in preterm birth, he explained, noting: "There is substantial epidemiological and biological evidence that maternal characteristics are associated with adverse birth outcomes."

The current study is the first to look at fetal outcomes stratified by some of these maternal characteristics, he noted.

The outcomes were similar in magnitude to those in his 2011 study – but were restricted to the period of widespread influenza activity.

"And essentially, we had restriction of effect by race," he added, noting that there also was heterogeneity among the two outcomes (preterm birth and small for gestational age birth).

"So the bottom line is, yes, we saw – especially during the period of widespread influenza activity – that there was reduction of odds in both preterm birth and small for gestational age, but there’s more to this story. There is heterogeneity, perhaps based on underlying risk factors and mechanisms through which these extraneous factors have an impact on birth outcome," he said.

Currently, three international trials looking at some of these outcomes are underway, he said, adding: One hopes that from these trials "we’ll have a little bit more clarity both in terms of the actual clinical effect of these interventions, but also in terms of biologic pathways that are involved."

Dr. Omer reported having no disclosures.