Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia.
Limited data on the clinical outcome of vancomycin treatment compared with that of beta-lactam treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia (MSSA-B) are available. We used different and complementary approaches: (i) a retrospective cohort study using a propensity score to adjust for confounding by treatment assignment and (ii) a matched case-control study. Of all patients with S. aureus bacteremia (SAB) in two university-affiliated hospitals over a 7-year period, 294 patients with MSSA-B were enrolled in the cohort study. The cases for the case-control study were defined as patients who received vancomycin treatment for MSSA-B; the controls, who were patients that received beta-lactam treatment for MSSA-B, were selected at a 1:2 (case:control) ratio according to the objective matching scoring system and the propensity score system. In the cohort study, SAB-related mortality in patients with vancomycin treatment (37%, 10/27) was significantly higher than that in those with beta-lactam treatment (18%, 47/267) (P = 0.02). In addition, multivariate analysis revealed that vancomycin treatment was associated with SAB-related mortality when independent predictors for SAB-related mortality and propensity score were considered (adjusted odds ratio of 3.3, 95% confidence interval of 1.2 to 9.5). In the case-control study using the objective matching scoring system and the propensity score system, SAB-related mortality in case patients was 37% (10/27) and in control patients 11% (6/54) (P < 0.01). Our data suggest that vancomycin is inferior to beta-lactam in the treatment of MSSA-B.
Kim
Sung-Han
SH
Department of Internal Medicine, Seoul National University College of Medicine, 28 Youngundong, Chongrogu, Seoul 110-744, Republic of Korea.
Kim
Kye-Hyung
KH
Kim
Hong-Bin
HB
Kim
Nam-Joong
NJ
Kim
Eui-Chong
EC
Oh
Myoung-don
MD
Choe
Kang-Won
KW
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007723:Korea; D008297:Male; D008712:Methicillin / Q000494:pharmacology* / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D013211:Staphylococcus aureus / Q000187:drug effects*; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*; D047090:beta-Lactams / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D014640:Vancomycin; D008712:Methicillin