Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases.
BACKGROUND
Staphylococcus aureus bacteremia is still a serious problem, and the optimal treatment is under debate. Only a few studies concerning treatment are available.


METHODS
The study population was all patients with a positive blood culture result for S aureus in Copenhagen County, Denmark, from May 1994 through April 1996. Of 278 patients with S aureus bacteremia, 186 were evaluated according to outcome in a prospective, observational follow-up study. The time above the minimum inhibitory concentration was estimated for dicloxacillin sodium for each treatment regimen and evaluated by logistic regression along with other potential risk factors.


RESULTS
The following variables were statistically associated with death: the presence of an uneradicated focus (odds ratio [OR], 6.7; 95% confidence interval [CI], 2.1-21.0); the presence of septic shock (OR, 3.7; 95% CI, 1.5-9.1); the total daily dose of penicillinase-stable penicillin less than 4 g (OR, 3.7; 95% CI, 1.3-11.1); and age 60 years or older (OR, 2.4; 95% CI, 1.1-5.3). The following variables were significantly associated with recurrence: the total daily dose of penicillinase-stable penicillin less than 3 g (OR, 3.9; 95% CI, 1.6-10.0) and the presence of a secondary focus (OR, 3.2; 95% CI, 1.3-7.7). Among 155 patients with observation time longer than duration of treatment, this factor (duration of treatment, <14 days) was significantly related to mortality (OR, 0.84; 95% CI, 0.76-0.94).


CONCLUSIONS
Focus eradication and the dosing of penicillinase-stable penicillin are important to the outcome of S aureus bacteremia. We recommend treatment with at least 1 g of penicillinase-stable penicillins 4 times daily for longer than 14 days.
Jensen
Allan G
AG
Bldg 45, Sector for Microbiology, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. allan.garlik@dadlnet.dk
Wachmann
Carsten H
CH
Espersen
Frank
F
Scheibel
Jens
J
Skinhøj
Peter
P
Frimodt-Møller
Niels
N
D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D004009:Dicloxacillin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010405:Penicillinase / Q000627:therapeutic use*; D010406:Penicillins / Q000627:therapeutic use*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D015996:Survival Rate; D016896:Treatment Outcome; D065093:beta-Lactamase Inhibitors
D010406:Penicillins; D065093:beta-Lactamase Inhibitors; D004009:Dicloxacillin; D010405:Penicillinase