Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis

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Background:
The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB).

Methods:
A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses.

Results:
In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71–2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14–13.87), Charlson’s comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27–1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08–9.67) were independent risk factors for mortality.

Conclusion:
Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence.

Keywords:
Methicillin-resistant Staphylococcus aureus, Bacteremia, Risk factors, Treatment outcome, Anti-bacterial agents

Autoři: Young Kyung Yoon ¹; Dae Won Park ¹; Jang Wook Sohn ¹; Hyo Youl Kim ²; Yeon-Sook Kim ³; Chang-Seop Lee ⁴; Mi Suk Lee ⁵; Seong-Yeol Ryu ⁶; Hee-Chang Jang ⁷; Young Ju Choi ⁸; Cheol-In Kang ⁹; Hee Jung Choi ¹⁰; Seung Soon Lee ¹¹; Shin Woo Kim ¹²; Sang Il Kim ¹³; Eu Suk Kim ¹⁴; Jeong Yeon Kim ¹⁵; Kyung Sook Yang ¹⁶; Kyong Ran Peck ⁹; Min Ja Kim ¹
Působiště autorů: Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. ¹; Department of Internal Medicine, Yonsei University Wonju College of Medicine, Won Ju, Republic of Korea. ²; Department of Internal Medicine, Chungnam National University Hospital, Daejon, Republic of Korea. ³; Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea. ⁴; Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea. ⁵; Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea. ⁶; Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea. ⁷; Department of Internal Medicine, National Cancer Center, Seoul, Republic of Korea. ⁸; Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. ⁹; Department of Internal Medicine, Ewha Women’s University School of Medicine, Seoul, Republic of Korea. ¹⁰; Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea. ¹¹; Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea. ¹²; Department of Internal Medicine, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea. ¹³; Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea. ¹⁴; Department of Internal Medicine, Samyook Medical Center, Seoul, Republic of Korea. ¹⁵; Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea. ¹⁶
Vyšlo v časopise: BMC Infectious diseases 2016, 16:331
Kategorie: Research article
prolekare.web.journal.doi_sk: https://doi.org/10.1186/s12879-016-1650-8

© 2016 The Author(s).
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
The electronic version of this article is the complete one and can be found online at: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-016-1650-8

Souhrn

Keywords:
Methicillin-resistant Staphylococcus aureus, Bacteremia, Risk factors, Treatment outcome, Anti-bacterial agents

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