Comparative Analysis of Nafcillin and Oxacillin: Implications for MSSA Treatment - Ep 186

Host Dr. Michael Rybak interviews Drs. Alejandro Perez and Autumn Brenner (UNC Medical Center) about their retrospective study, “Incidence of Acute Kidney Injury with the Use of Nafcillin versus Oxacillin,” comparing 171 nafcillin patients with 467 oxacillin patients. The study found a higher AKI rate with nafcillin (33.3%) versus oxacillin (19.5%), along with higher hypokalemia, suggesting these agents may not be clinically interchangeable from a safety standpoint. They discuss confounding concerns around observed mortality and length-of-stay differences, offer mechanistic explanations, and recommend close monitoring of creatinine and potassium—especially in high-risk patients.