Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis

Abstract

BackgroundThe 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).MethodsA 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.ResultsIn 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.ConclusionInappropriate 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.

Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study

“…Inappropriate EAT was not associated with short-term (2–30 days) mortality, an outcome measure that has been studied intensively. Similar to our findings, several studies have reported that inappropriate EAT was not associated with short-term mortality with the cautions that most of these studies included relatively few patients and investigated either individual microorganisms or groups of microorganisms or only reported in-hospital mortality [ 6 , 11 , 12 , 20 , 49 – 52 ]. Nonetheless, the majority of studies focusing on short-term mortality have shown that inappropriate EAT is associated with all-cause mortality as summarised by two major reviews [ 21 , 22 ].…”

“…Antibiotics are therefore given on an empirical basis and early initiation of appropriate empirical antibiotic treatment (EAT) has been associated with markedly improved survival in patients with septic shock [ 5 ]. Nevertheless, existing studies have provided conflicting evidence of the association between appropriate EAT and short-term mortality for bacteraemic patients [ 6 – 20 ]. It is likely that much of the controversy stems from heterogeneity and inadequacy in study designs, which make the comparisons of EAT and bacteraemia outcomes difficult [ 21 , 22 ].…”

Punicalagin protects bovine endometrial epithelial cells against lipopolysaccharide-induced inflammatory injury

“…However, the use of these drugs is associated with severe side effects (Kumar et al, 2016;Yoon et al, 2016), indicating the need for natural methods of inflammation control. Punicalagin, a large natural polyphenolic compound found in pomegranates, is a traditional medicine reported to…”

Genomic and Long-Term Transcriptomic Imprints Related to the Daptomycin Mechanism of Action Occurring in Daptomycin- and Methicillin-Resistant Staphylococcus aureus Under Daptomycin Exposure

“…Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the major multidrug-resistant pathogens responsible for severe infections with high mortality rates ( Stefani et al, 2015 ; Yoon et al, 2016 ; Britt et al, 2017 ). The subset of daptomycin-resistant (DAP R ) S. aureus is of particular concern for the cumulative non-reversible metabolic changes demonstrated in resistant strains and for the difficulty in the treatment of severe infections ( Bayer et al, 2013 ; Reed et al, 2019 ).…”