title: 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.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, St John Hospital & Medical Center, Detroit, MI 48236, USA. riad.khatib@stjohn.org
authors.forename: R
authors.initials: R
authors.lastname: Khatib
authors.forename: S
authors.initials: S
authors.lastname: Saeed
authors.forename: M
authors.initials: M
authors.lastname: Sharma
authors.forename: K
authors.initials: K
authors.lastname: Riederer
authors.forename: M G
authors.initials: MG
authors.lastname: Fakih
authors.forename: L B
authors.initials: LB
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects*; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D047090:beta-Lactams / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin