Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia

A propensity-matched analysis

Young Kyung Yoon, Dae Won Park, Jang Wook Sohn, Hyo Youl Kim, Yeon Sook Kim, Chang Seop Lee, Mi Suk Lee, Seong Yeol Ryu, Hee Chang Jang, Young Ju Choi, Cheol In Kang, Hee Jung Choi, Seung Soon Lee, Shin Woo Kim, Sang Il Kim, Eu Suk Kim, Jeong Yeon Kim, Kyung Sook Yang, Kyong Ran Peck, Ja Kim Min

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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.

Original languageEnglish
Article number331
JournalBMC Infectious Diseases
Volume16
Issue number1
DOIs
Publication statusPublished - 2016 Jul 15

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Methicillin-Resistant Staphylococcus aureus
Bacteremia
Anti-Bacterial Agents
Delivery of Health Care
Mortality
Odds Ratio
Confidence Intervals
Glycopeptides
Septic Shock
Hospital Mortality
Therapeutics
Sepsis
Propensity Score
Republic of Korea
Microbial Sensitivity Tests
Vancomycin
Teaching Hospitals
Multicenter Studies
Observational Studies
Comorbidity

Keywords

  • Anti-bacterial agents
  • Bacteremia
  • Methicillin-resistant Staphylococcus aureus
  • Risk factors
  • Treatment outcome

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia : A propensity-matched analysis. / Yoon, Young Kyung; Park, Dae Won; Sohn, Jang Wook; Kim, Hyo Youl; Kim, Yeon Sook; Lee, Chang Seop; Lee, Mi Suk; Ryu, Seong Yeol; Jang, Hee Chang; Choi, Young Ju; Kang, Cheol In; Choi, Hee Jung; Lee, Seung Soon; Kim, Shin Woo; Kim, Sang Il; Kim, Eu Suk; Kim, Jeong Yeon; Yang, Kyung Sook; Peck, Kyong Ran; Min, Ja Kim.

In: BMC Infectious Diseases, Vol. 16, No. 1, 331, 15.07.2016.

Research output: Contribution to journalArticle

Yoon, Young Kyung ; Park, Dae Won ; Sohn, Jang Wook ; Kim, Hyo Youl ; Kim, Yeon Sook ; Lee, Chang Seop ; Lee, Mi Suk ; Ryu, Seong Yeol ; Jang, Hee Chang ; Choi, Young Ju ; Kang, Cheol In ; Choi, Hee Jung ; Lee, Seung Soon ; Kim, Shin Woo ; Kim, Sang Il ; Kim, Eu Suk ; Kim, Jeong Yeon ; Yang, Kyung Sook ; Peck, Kyong Ran ; Min, Ja Kim. / Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia : A propensity-matched analysis. In: BMC Infectious Diseases. 2016 ; Vol. 16, No. 1.
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T1 - Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia

T2 - A propensity-matched analysis

AU - Yoon, Young Kyung

AU - Park, Dae Won

AU - Sohn, Jang Wook

AU - Kim, Hyo Youl

AU - Kim, Yeon Sook

AU - Lee, Chang Seop

AU - Lee, Mi Suk

AU - Ryu, Seong Yeol

AU - Jang, Hee Chang

AU - Choi, Young Ju

AU - Kang, Cheol In

AU - Choi, Hee Jung

AU - Lee, Seung Soon

AU - Kim, Shin Woo

AU - Kim, Sang Il

AU - Kim, Eu Suk

AU - Kim, Jeong Yeon

AU - Yang, Kyung Sook

AU - Peck, Kyong Ran

AU - Min, Ja Kim

PY - 2016/7/15

Y1 - 2016/7/15

N2 - 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.

AB - 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.

KW - Anti-bacterial agents

KW - Bacteremia

KW - Methicillin-resistant Staphylococcus aureus

KW - Risk factors

KW - Treatment outcome

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