Effect of adequate empiric antibiotic therapy on survival of patients with methicillin-resistant Staphylococcus aureus bacteraemia

Abstract number: 1734_76

Hazzan R., Paul M., Shaked H., Wattad M., Konigsberger H., Rubinovitch B., Leibovici L., Bishara J.

Objective: Glycopeptides are the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. We evaluated the effect of empirical treatment with glycopeptides for MRSA bacteraemia on mortality.

Methods: Retrospective chart review of prospectively identified patients with clinically-significant MRSA bacteraemia, in a primary and tertiary care hospital. Empirical treatment was defined as that initiated during the first 48 hours. Mortality was defined as 30-day all cause mortality. Variables evaluated included: age, sex, functional capacity, healthcare acquisition of infection, presence of intravascular catheters, urinary catheter, mechanical ventilation, recent surgery or invasive procedures, steroid or cytotoxic therapy, neutropenia, source of infection; Background conditions: diabetes, renal failure, hemodialysis, prosthetic valve, pacemaker, other prosthetic device, malignancy, lung disease, liver disease, wounds, heart and vascular disease, McCabe and Charlson score; Infection presentation: temperature, shock, leukocytes, platelets, creatinine, albumin, liver function tests. Univariate comparisons were performed using the chi-square test or t-test. Multivariate analysis was performed using forward conditional binary regression.

Results: We included 150 episodes of MRSA bacteraemia among 141 patients. Significant risk factors for mortality are shown in the table. Empirical glycopeptide (vancomycin) treatment was administered to 44.9% of patients that remained alive at 30 days compared to 29.5% of those that died (unadjusted p = 0.06). Patients who were given vancomycin empirically had significantly more frequent repeated episodes of bacteraemia, implanted catheters, diabetes, hemodialysis, prosthetic valves, recent angiography, higher albumin and no malignancy. Significant risk factors for 30-day all cause mortality on multivariate analysis included no empirical treatment with vancomycin (p = 0.03), septic shock (p < 0.001) and total leukocyte count (p = 0.01). The small number of cases evaluated limits our analysis.

N episodes8961 
Fuctional status (full unrestricted activity)36 (41.4%)14 (24.1%)0.03
Decubitus ulcer, burns of chronic wounds10 (11.2%)20 (32.8%)0.001
Septic shock7 (8.4%)27 (50%)<0.001
Temperature, °C, mean (SD)38.5 (0.71)38.1 (1.15)0.03
White blood cells, K/micl, mean (SD)13.2 (0.76)15.9 (0.70)0.04
Empirical glycopeptide treatment40 (44.9%)18 (29.5%)0.06

Conclusion: Among patients with MRSA bacteraemia, empirical treatment including vancomycin reduced 30-day mortality.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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