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Antimicrobial Agents and Chemotherapy, May 2009, p. 2014-2019, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.01232-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Continuous versus Intermittent Infusion of Oxacillin for Treatment of Infective Endocarditis Caused by Methicillin-Susceptible Staphylococcus aureus{triangledown}

Darrel W. Hughes,1,2,3 Christopher R. Frei,2,3 Pamela R. Maxwell,1,2,3 Kay Green,1 Jan E. Patterson,4,5 George E. Crawford,4,5 and James S. Lewis II1,2,3,4*

Department of Pharmacy Services, University Health System, San Antonio, Texas,1 The University of Texas at Austin College of Pharmacy, Austin, Texas,2 Pharmacotherapy Education and Research Center, The University of Texas Health Science Center at San Antonio, San Antonio, Texas,3 Department of Medicine, Division of Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, Texas,4 South Texas Veterans Health Care System, San Antonio, Texas5

Received 16 September 2008/ Returned for modification 30 October 2008/ Accepted 18 February 2009

Infective endocarditis (IE) is the fourth leading cause of life-threatening infection in the United States and imposes significant morbidity and mortality. The American Heart Association guidelines for the diagnosis and treatment of IE do not address continuous-infusion (CI) oxacillin. This retrospective study compares outcomes between CI oxacillin and intermittent-infusion (II) oxacillin in the treatment of IE caused by methicillin-susceptible Staphylococcus aureus (MSSA). A total of 709 medical records were reviewed for inpatients with definitive IE treated between 1 January 2000 and 31 December 2007. Continuous data were analyzed by Student's t test or the Wilcoxon rank sum test. The chi-square test or Fisher's exact test was used to compare nominal data. A multivariate logistic model was constructed. One hundred seven patients met eligibility criteria for inclusion into the study. Seventy-eight patients received CI oxacillin, whereas 28 received II oxacillin. CI and II groups were similar with respect to 30-day mortality (8% versus 10%, P = 0.7) and length of stay (20 versus 25 days, P = 0.4) but differed in 30-day microbiological cure (94% versus 79%, P = 0.03). Sixty-three patients received synergistic gentamicin, whereas 44 did not. The gentamicin and no-gentamicin groups were similar with respect to 30-day mortality (11% versus 4%, P = 0.2) and 30-day microbiological cure (90% versus 89%, P = 0.8); however, times to defervescence (4 versus 2 days, P = 0.02) were significantly different. CI oxacillin is an effective alternative to II oxacillin for the treatment of IE caused by MSSA and may improve microbiological cure. This convenient and pharmacodynamically optimized dosing regimen for oxacillin deserves consideration for patients with IE caused by MSSA.

* Corresponding author. Mailing address: Department of Pharmacy Services, University Health System, and University of Texas Health Science Center at San Antonio, 4502 Medical Dr., San Antonio, TX 78229. Phone: (210) 358-0421. Fax: (210) 358-4168. E-mail: james.lewis{at}uhs-sa.com

{triangledown} Published ahead of print on 2 March 2009.

Antimicrobial Agents and Chemotherapy, May 2009, p. 2014-2019, Vol. 53, No. 5
0066-4804/09/$08.00+0     doi:10.1128/AAC.01232-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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