A 成人VR视频 Department of Medicine-led international clinical trial published in the has provided the strongest evidence to date for treating one of the most serious bacterial bloodstream infections. The study was one of two high-impact publications released on the same day by 成人VR视频 Department of Medicine researchers. In addition to serving as first author of the New England Journal of Medicine study, Dr. Todd Lee, Professor of Medicine in 成人VR视频's Division of Infectious Diseases and Scientist at the Research Institute of the 成人VR视频 Health Centre (RI-MUHC), was senior author of a related publication in .
The study, , randomized more than 1,300 adults across eight countries with a life-threatening bloodstream infection caused by staph bacteria. Researchers compared cefazolin, a commonly used hospital antibiotic, with cloxacillin, the treatment physicians have relied on for decades for this type of infection.
Staphylococcus aureus bacteremia is one of the deadliest bacterial bloodstream infections, killing more Canadians each year than melanoma, myeloma or renal cell carcinoma. "Moreover, S. aureus kills quickly with nearly 10% of infected patients dying within two weeks," said Dr. Todd Lee. Yet despite its severity, no randomized clinical trial had ever directly compared the two antibiotics most commonly used to treat it. As Dr. Lee explained, "We ran this trial to answer the question definitively and to establish an evidence-based standard of care to which new drugs can be compared."
The study found that cefazolin treated the infection just as effectively as cloxacillin while causing significantly fewer serious side effects, including acute kidney injury. The results also suggested that patients treated with cefazolin may be more likely to survive - a finding that exceeded the research team's expectations. "Our trial represents the first time that a therapy has been demonstrated to be highly likely to be superior to what we were doing before in terms of reducing mortality and toxicity," said Dr. Lee.
Although a larger study may have definitively confirmed cefazolin's superiority, the researchers determined it was no longer ethical to continue assigning patients to the older treatment once cefazolin had been shown to be at least as effective while causing fewer serious side effects. "This advance, and clinical practice changes coming from increasing our use of cefazolin for these infections, will reduce morbidity and ideally mortality in Canada and worldwide," said Dr. Lee.
The study is part of the broader Staphylococcus aureus Network Adaptive Platform (SNAP) program, funded by the Canadian Institutes of Health Research (CIHR) and led by the RI-MUHC and the 成人VR视频 Department of Medicine. The program continues to investigate new ways to improve outcomes for patients with Staphylococcus aureus bloodstream infections, including whether adding another antibiotic to cefazolin can further improve patient outcomes (Principal Investigator: Dr. Todd Lee), whether some patients can safely transition to oral antibiotics after improving (Principal Investigator: Dr. Matthew Cheng), whether daptomycin or vancomycin is the better treatment for MRSA bloodstream infections (Principal Investigator: Dr. Todd Lee), and whether antithrombotic therapies such as clopidogrel (Principal Investigator: Dr. Todd Lee) or dabigatran (Principal Investigator: Dr. Emily G. McDonald) can further improve patient outcomes.
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Study: (New England Journal of Medicine)
成人VR视频 Department of Medicine authors: Dr. Todd Lee (first author), Dr. Matthew Cheng, Dr. Emily G. McDonald, Dr. Isabelle Malham茅, Dr. Leighanne Parkes, and Dr. Yves Longtin.
Related study: (The Lancet)