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

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.