# Ceftriaxone for Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Descriptive Case Series of Nine Patients During a Cefazolin Shortage

## TL;DR

This study reports on nine patients with MSSA bacteremia who were treated with ceftriaxone during a cefazolin shortage and had favorable outcomes.

## Contribution

The paper provides real-world evidence on ceftriaxone's use for MSSA bacteremia during a cefazolin shortage.

## Key findings

- All nine patients achieved clinical resolution with no deaths or relapses observed.
- The majority of infections were catheter-related and non-endocarditis cases.
- The median duration of intravenous antibiotic therapy was 31 days.

## Abstract

Introduction

Cefazolin is the standard treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. During drug shortages, alternative agents such as ceftriaxone may be considered, though evidence supporting its efficacy is conflicting. We aim to describe the clinical characteristics and outcomes of patients with MSSA bacteremia treated with ceftriaxone during a nationwide cefazolin shortage in Japan.

Methods

We conducted a retrospective case series at a single tertiary care hospital. We reviewed the records of nine adult patients hospitalized between April 2019 and March 2020 who received ceftriaxone for at least half of their intravenous therapy duration for MSSA bacteremia.

Results

The median age of the nine patients was 69 years. The infection was nosocomial in seven (78%) patients. The most common sources of infection were catheter-related. All patients achieved clinical resolution. The median duration of total intravenous antibiotic therapy was 31 days. No deaths occurred within 30 days, and no microbiological relapses were observed during a 90-day follow-up period.

Conclusion

In this small case series, ceftriaxone was associated with favorable outcomes in nine patients with MSSA bacteremia, the majority of whom had non-endocarditis, catheter-related infections. While these observations are encouraging, cefazolin remains the preferred agent. The role of ceftriaxone should be further evaluated in larger studies.