Korean J Infect Dis.  2002 Oct;34(5):293-304.

The Effects of Initial Empirical Antibiotics Regimens on the Outcomes of Staphylococcus aureus Bacteremia

• Kim SH
• Park WB
• Lee KD
• Kang CI
• Choe YJ
• Kim HB
• Park SW
• Kim US
• Oh MD
• Kim EC
• Choe KW

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.

Keyword

Staphylococcus aureus; Bacteremia; Empirical antibiotics regimen; Methicillin-resistance

MeSH Terms

Anti-Bacterial Agents*
Bacteremia*
Cohort Studies
Humans
Kidney Failure, Chronic
Logistic Models
Mortality
Retrospective Studies
Staphylococcus aureus*
Staphylococcus*
Tertiary Healthcare
Vancomycin
Anti-Bacterial Agents
Vancomycin