The Effects of Initial Empirical Antibiotics Regimens on the Outcomes of Staphylococcus aureus Bacteremia.
- Author:
Sung Han KIM
1
;
Wan Bum PARK
;
Ki Deok LEE
;
Cheol In KANG
;
Young Ju CHOE
;
Hong Bin KIM
;
Sang Won PARK
;
Ui Seok KIM
;
Myoung Don OH
;
Eui Chong KIM
;
Kang Won CHOE
Author Information
1. Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Republic of Korea. mdohmd@snu.ac.kr
- Publication Type:In Vitro ; Original Article
- Keywords:
Staphylococcus aureus;
Bacteremia;
Empirical antibiotics regimen;
Methicillin-resistance
- MeSH:
Anti-Bacterial Agents*;
Bacteremia*;
Cohort Studies;
Humans;
Kidney Failure, Chronic;
Logistic Models;
Mortality;
Retrospective Studies;
Staphylococcus aureus*;
Staphylococcus*;
Tertiary Healthcare;
Vancomycin
- From:Korean Journal of Infectious Diseases
2002;34(5):293-304
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Because of the concern for the emergence of resistance, the prudent use of vancomycin is essential. However, it is uncertain whether the initial delay in the effective treatment of Staphylococcus aureus bacteremia adversely affects the outcome. We performed this study to determine the outcome of an initial delay in the use of antistaphylococcal antibiotics for Staphylococcus aureus bacteremia (SAB). METHODS: We conducted a retrospective cohort study of 238 with SAB at a tertiary care hospital. Empirical antibiotics treatment was considered ineffective if the isolated strain was not susceptible, in vitro, to antibiotics given during the first 48 hours. The outcome was measured as SAB-related mortality within 8 weeks from the SAB. RESULTS: The mortality for the patients with ineffective empirical regimen (50/117, 42.7%) showed a trend toward being higher than that with effective empirical regimen (38/121, 31.4%), but it did not reach the statistical significance (OR 1.63 95% CI 0.96~2.77, P=0.07). However, in the subgroups of end-stage renal disease ineffective empirical antibiotics adversely affected the outcomes (OR 5.42, 95% CI 1.25~23.49, P=0.02) On multivariate logistic regression analysis, adjusted OR of ineffective empirical regimen for SAB-related mortality was 2.03 (95% CI 1.08~3.82, P=0.03). CONCLUSION: Our findings suggest that an initial delay in the use of antistaphylococcal antibiotics for the first 2 days might adversely affect the outcome when treating SAB, especially in the patients with end-stage renal disease.
