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

Abstract
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.
AuthorsR Khatib, S Saeed, M Sharma, K Riederer, M G Fakih, L B Johnson
JournalEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology (Eur J Clin Microbiol Infect Dis) Vol. 25 Issue 3 Pg. 181-5 (Mar 2006) ISSN: 0934-9723 [Print] Germany
PMID16505987 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-Bacterial Agents
  • beta-Lactams
  • Vancomycin
Topics
  • Adult
  • Anti-Bacterial Agents (administration & dosage, pharmacology, therapeutic use)
  • Bacteremia (drug therapy, microbiology, mortality)
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Methicillin Resistance
  • Microbial Sensitivity Tests
  • Middle Aged
  • Staphylococcal Infections (drug therapy, microbiology, mortality)
  • Staphylococcus aureus (drug effects)
  • Time Factors
  • Treatment Outcome
  • Vancomycin (administration & dosage, pharmacology, therapeutic use)
  • beta-Lactams (administration & dosage, pharmacology, therapeutic use)

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