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Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e318278f539
Original Articles

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*

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Abstract

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.

© 2013 by Lippincott Williams & Wilkins.

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