Breakpoints #116 – SNAP Out of It: Rethinking Antistaphylococcal Penicillins for S. Aureus Bacteremia – The SNAP Trial PSSA/MSSA Results
May 4, 2025
In this engaging discussion, guests Steven Tong and Joshua Davis, both esteemed infectious diseases physicians, dive into the monumental SNAP trial addressing Staphylococcus aureus bacteremia. They highlight the trial's innovative design, which allows for exploring multiple clinical questions simultaneously. Key findings reveal the potential superiority of kefazolin over flucloxacillin in mortality and kidney safety outcomes. The conversation also touches on the challenges of patient enrollment and the significance of Bayesian statistics in refining treatment options. Personal anecdotes from their travels add a relatable touch to the science.
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Penicillin Susceptibility Validated
- Penicillin susceptibility in Staphylococcus aureus is real and rising globally.
- Phenotypic disc testing is key for accurate penicillin susceptibility, despite challenges and subjectivity.
Benzyl Penicillin Outperforms Flucloxacillin
- Benzyl penicillin showed lower 90-day mortality and half the acute kidney injury risk compared to flucloxacillin for PSSA.
- The data supports penicillin's safe and effective use guided by susceptibility testing.
Cefazolin Safer and Effective for MSSA
- For MSSA bacteremia, cefazolin is highly likely non-inferior and possibly superior to flucloxacillin in mortality.
- Cefazolin causes significantly less acute kidney injury, confirming it as a safer option.