The importance of a judicious and early empiric choice of antimicrobial for methicillin-resistant Staphylococcus aureus bacteraemia.
The purpose of this investigation was to examine the impact of antimicrobial regimens administered for hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia on the all-cause, 14-day mortality. We retrospectively examined the characteristics of the most effective empiric antimicrobial therapy in 87 consecutive patients, hospitalised at a single institution between April 2003 and March 2008, who presented with clinically and microbiologically confirmed MRSA bacteraemia. The all-cause mortality was measured 14 days after the diagnosis was made. The administration of an effective antimicrobial against MRSA <48 h after the collection of blood cultures was the single, significant predictor of survival (odds ratio 3.85; 95% confidence interval 1.37-10.80; p = 0.01). The survival of patients treated with vancomycin versus other antimicrobial agents was similar. Among subgroups treated with vancomycin, the lowest mortality (6%) was observed among patients treated (a) within 48 h after the collection of blood cultures and (b) with doses sufficient to keep the blood concentrations in the area under the 0-24 h curve >400 μg h/ml (≥2.0 g/day). The empiric administration of antimicrobials effective against MRSA bacteraemia within 48 h after the collection of blood cultures increased the 14-day survival. If vancomycin is chosen, ≥2.0 g/day should be administered, starting within 48 h.
Shime
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Division of Intensive Care Medicine, Department of Anaesthesiology and Intensive Care, Kyoto Prefectural University, School of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan. shime@koto.kpu-m.ac.jp
Kosaka
T
T
Fujita
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N
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D019540:Area Under Curve; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D001769:Blood / Q000382:microbiology; D003470:Culture Media; D004334:Drug Administration Schedule; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D003470:Culture Media; D014640:Vancomycin