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An Antimicrobial Stewardship Program’s Evaluation of the Safety and Efficacy of Continuous Infusion of Nafcillin in the Treatment of Methicillin-Sensitive Staphylococcus aureus Bacteremia

Bauer, Karri A. PharmD, BCPS*; Gentene, Anthony J. PharmD*; West, Jessica E. MSPH; Shidham, Ganesh MD; Goff, Debra A. PharmD, FCCP*

Infectious Diseases in Clinical Practice: March 2013 - Volume 21 - Issue 2 - p 111–113
doi: 10.1097/IPC.0b013e318278f539
Original Articles

Objectives Methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections constitute a tremendous burden. Nafcillin is considered an antibiotic of choice. Reports have demonstrated a correlation with nafcillin and the development of acute interstitial nephritis (AIN). Studies have demonstrated the advantages of continuous infusion β-lactam therapy over intermittent infusion. The Antimicrobial Stewardship Program at The Ohio State University Medical Center implemented nafcillin continuous infusion in the treatment of MSSA bacteremia. This study was conducted to determine if a difference exists in the incidence of AIN or acute renal failure (ARF) between nafcillin intermittent versus continuous infusion. Second, we evaluated clinical efficacy.

Methods This retrospective study compared 132 inpatients with MSSA bacteremia admitted from June 1, 2007, through June 30, 2008 (intermittent infusion, 2 g every 4 hours for 30 minutes) and July 1, 2008, through August 31, 2009 (continuous infusion, 6 g every 12 hours for 12 hours).

Results There was no difference in the incidence of AIN or ARF. A trend toward decreased mortality (16.3% vs. 8.4%, P = 0.25) and duration of bacteremia (4.9 vs. 4.2 days, P = 0.08) was observed.

Conclusions The results of this study support the use of nafcillin continuous infusion without increased incidence of AIN or ARF.

This study was conducted to determine if a difference exists in the incidence of acute interstitial nephritis (AIN), acute renal failure (ARF), or clinical efficacy between nafcillin intermittent vs. continuous infusion in MSSA bacteremia. There was no difference in the incidence of AIN or ARF. A trend towards decreased mortality and duration of bacteremia was observed. The results of this study support the use of continuous infusion nafcillinwithout increased incidence of AIN or ARF.

From the *Department of Pharmacy, The Ohio State University Medical Center; †Division of Infectious Diseases and ‡Division of Nephrology, College of Medicine, The Ohio State University.

Correspondence to: Debra A. Goff, PharmD FCCP, Infectious Diseases, Department of Pharmacy, The Ohio State University Medical Center, 410 W 10th Ave, Room 368, Doan Hall, Columbus, OH 43210. E-mail: Debbie.goff@osumc.edu.

The authors have no funding or conflicts of interest to disclose.

Requests for reprints should be sent to the corresponding author’s address.

Original abstract was presented in part at the 25th meeting of the Great Lakes Pharmacy Resident Conference in West Lafayette, Indiana, on April 29, 2010.

© 2013 by Lippincott Williams & Wilkins.