title: Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment.
abstract: OBJECTIVE
  The first goal of this investigation was to determine the rate of appropriate initial antimicrobial administration to patients with methicillin-resistant Staphylococcus aureus (MRSA) sterile-site infections. Our second goal was to evaluate the influence of appropriate initial treatment of MRSA sterile-site infection on outcome.
  
  
  METHODS
  A retrospective, single-center, observational cohort study.
  
  
  METHODS
  Barnes-Jewish Hospital, a 1200-bed urban teaching facility.
  
  
  METHODS
  Adult patients requiring hospitalization identified to have an MRSA sterile-site infection.
  
  
  METHODS
  Retrospective data collection from automated hospital and pharmacy databases.
  
  
  RESULTS
  Five hundred forty-nine patients with S. aureus sterile site infections were identified during a 3-yr period (January 2002 through December 2004). One hundred twenty-seven (23.1%) died during hospitalization. Hospital mortality was statistically greater for patients receiving inappropriate initial antimicrobial treatment (n = 380) within 24 hrs of a positive culture than for those receiving appropriate initial treatment (n = 169) (26.1% vs. 16.6%; p = .015). Multiple logistic regression analysis identified inappropriate initial antimicrobial treatment (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.48-2.50; p = .0134), vasopressor administration (AOR, 5.49; 95% CI, 4.08-7.38; p < .001), and increasing age (1-yr increments) (AOR, 1.03; 95% CI, 1.02-1.04; p < .001) as independent determinants of hospital mortality.
  
  
  CONCLUSIONS
  Inappropriate initial antimicrobial treatment of MRSA sterile-site infections is common and is associated with an increased risk of hospital mortality. Appropriate antimicrobial treatment of MRSA sterile-site infections may be maximized by increased use of initial empirical antimicrobial treatment regimens targeting MRSA in patients at risk for this infection until organism identification and susceptibility become known.
authors.affiliation: Critical Care Specialty Resident, Barnes-Jewish Hospital, St. Louis, MO, USA.
authors.forename: Garrett E
authors.initials: GE
authors.lastname: Schramm
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Doherty
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy; D001431:Bacteriological Techniques; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000188:drug therapy; D013203:Staphylococcal Infections / Q000188:drug therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014662:Vasoconstrictor Agents