Impact of initial antibiotic choice and delayed appropriate treatment on the outcome of Staphylococcus aureus bacteremia

• Published in: European journal of clinical microbiology & infectious diseases Vol. 25; no. 3; pp. 181 - 185
• Main Authors: KHATIB, R, SAEED, S, SHARMA, M, RIEDERER, K, FAKIH, M. G, JOHNSON, L. B
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.03.2006; Springer Nature B.V
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Bacteria; Bacterial diseases; Bacterial sepsis; beta-Lactams - administration & dosage; beta-Lactams - pharmacology; beta-Lactams - therapeutic use; Biological and medical sciences; Drug Administration Schedule; Female; Human bacterial diseases; Humans; Infectious diseases; Male; Medical sciences; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Mortality; Pharmacology. Drug treatments; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus - drug effects; Staphylococcus infections; Time Factors; Treatment Outcome; Vancomycin - administration & dosage; Vancomycin - pharmacology; Vancomycin - therapeutic use; Prognosis; Microbiology; Bacteremia; Infection; Antibiotic; Treatment; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Antibacterial agent; Staphylococcal infection; Staphylococcus aureus
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-006-0096-0

The study presented here investigated the impact of initial antibiotic choice (beta-lactams vs vancomycin) on the outcome of 342 patients with Staphylococcus aureus bacteremia (50.9% with methicillin-resistant isolates) encountered between 1 January 2002 and 30 June 2003. Initial antibiotics were inappropriate (beta-lactams) in 60 (34.5%) methicillin-resistant cases and suboptimal (vancomycin) in 62 (36.9%) methicillin-susceptible cases. Time to effective antibiotic therapy was longer in methicillin-resistant cases (25.5+/-28.6 vs 9.6+/-16.6 h; p<0.0005). All-cause in-hospital mortality was higher with inappropriate therapy (35.0 vs 20.9%; p=0.02). Initial vancomycin treatment was associated with a higher incidence of delayed clearance (>or=3 days) of methicillin-susceptible bacteremia (56.3 vs 37.0%; p=0.03). The results indicate inappropriate initial therapy is associated with higher in-hospital mortality and initial vancomycin may delay clearance.