Implementation of a cefazolin-based stewardship pathway for methicillin-susceptible Staphylococcus aureus bloodstream infections paired with infectious diseases consultation

Benjamin J. Lee, Sonia N. Rao, Sheila K. Wang, Jane Y. Lee, Irfana Y. Lakada, Elise M. Gilbert, Viktorija O. Barr, Michael J. Postelnick, Sarah H Sutton, Teresa R Zembower, Maureen K Bolon, Marc H. Scheetz, Nathaniel J. Rhodes*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Scopus citations


Methicillin-susceptible Staphylococcus aureus (MSSA) infections have been successfully treated both with cefazolin and antistaphylococcal penicillins; cefazolin appears effective in MSSA bloodstream infections (BSIs). Thus, our antimicrobial stewardship programme (ASP) implemented a clinical pathway supporting cefazolin use in MSSA-BSIs and restricting oxacillin use to infectious diseases (ID) consultation due to cefazolin's lower cost and more convenient dosing. This before and after quasi-experimental study was conducted to describe the impact on outcomes and process of care measures associated with implementing this pathway among patients with MSSA-BSI. Definitive treatment with cefazolin increased over the study period from 17.3% to 69.8% post-implementation. Clinical failure (5.8% vs. 2.3%; P = 0.62) and in-hospital mortality (3.8% vs. 0%; P = 0.50) were rare pre- and post-implementation. Median hospital length of stay among survivors was similar between pre- and post-implementation periods (P = 0.31). Duration of bacteraemia [median (IQR) 3 (2–4) days vs. 2 (2–3) days; P = 0.002] and rates of re-infection after culture clearance (9.6% vs. 0%; P = 0.06) were reduced post-implementation. Frequency of source control (P = 0.71) and time to source control (P = 0.52) were similar between study periods. Significant increases in ID consultations (33.3% [3/9] vs. 73.3% [22/30]; P = 0.047) and median (IQR) 24-h daily doses [2 (1–3) g vs. 6 (3–6) g; P < 0.01] were seen for patients treated with cefazolin post-implementation. ASPs may find implementation of a similar pathway to be an effective means of improving the care of patients infected with MSSA.

Original languageEnglish (US)
Pages (from-to)650-654
Number of pages5
JournalInternational Journal of Antimicrobial Agents
Issue number5
StatePublished - May 1 2017



  • Antimicrobial stewardship
  • Bloodstream infection
  • Cefazolin
  • Infectious diseases consultation
  • Methicillin-susceptible Staphylococcus aureus
  • Oxacillin

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Pharmacology (medical)

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