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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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Affiliated Author(s)
류성열
Alternative Author(s)
Ryu, Seong Yeol
Journal Title
BMC Infectious Diseases
ISSN
1471-2334
Issued Date
2016
Keyword
Methicillin-resistant Staphylococcus aureusBacteremiaRisk factorsTreatment outcomeAnti-bacterial agents
Abstract
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.
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine
Citation
Young Kyung Yoon et al. (2016). Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis. BMC Infectious Diseases, 16, 331–331. doi: 10.1186/s12879-016-1650-8
Type
Article
ISSN
1471-2334
DOI
10.1186/s12879-016-1650-8
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/32370
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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