SNAP Trial Journal Club
Cefazolin vs antistaphylococcal penicillins for MSSA bacteremia: a review of the SNAP trial, mortality outcomes, safety, and clinical implications.
The New England Journal of Medicine published the SNAP trial in June 2026. This post is a journal club breaking down the SNAP trial and what change it may bring to our clinical practice.
Background/Overview
Title: Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia
Citation: Staphylococcus aureus Network Adaptive Platform (SNAP) Trial Group; Lee TC, Barina LA, Walls G, et al. Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia. N Engl J Med. 2026 Jun 18;394(23):2329-2339.
Objective: To evaluate the efficacy and safety of cefazolin for the treatment of methicillin-susceptible S. aureus bacteremia
Background: Staphylococcus aureus bactermia is the leading cause of bacteria-related death worldwide, but preferred treatment, specifically in methicillin-suscetpbile S. aureus bactermia, is still unclear. Antistaphylococcal penicillins have traditionally been favored because of concerns regarding the cefazolin inoculum effect, but some observational data suggest cefazolin is superior to antistaphylococcal penicillins in regards to similar clinical outcomes and fewer adverse effects. Due to the nature of these data being observational, they are subject to biases. The Staphylococcus aureus Network Adaptive Platform (SNAP) trial sought to answer several questions around treatment of S. aureus bactermia.
Primary Efficacy Measure: death from any cause within 90 days after platform entry