title: Timing of initiating glycopeptide therapy for methicillin-Resistant Staphylococcus aureus bacteremia: the impact on clinical outcome.
abstract: When a Staphylococcus-like organism (SLO) is microscopically found in Gram staining of blood culture (BC) specimen, it seems reasonable to administrate a glycopeptide (GP) for empirical therapy. The paper investigates the risk factors for 14-day mortality in patients with methicillin-resistance Staphylococcus aureus bacteremia (MRSAB) and clarifies the impact of the timing for initiating GP therapy. A retrospective study identifies patients with MRSAB (endocarditis was excluded) between 2006 and 2009. Patients were categorized as receiving GP at the interval before a preliminary BC report indicating the growth of SLO and the onward 24 hours or receiving GP 24 h after a preliminary BC report indicating the growth of SLO. Total 339 patients were enrolled. There was no difference on the 14-day overall or infection-related mortality rates at the time to administer GP. Multivariate analysis disclosed pneumonia (OR = 4.47; of 95% CI; of 2.09-9.58; P < 0.01) and high APACHE II score (OR, 2.81, with 95% CI, 1.19-6.65; P = 0.02) were independent risk factors for infection-related mortality. The mortality rate did not decrease following administrating GP immediately after a preliminary BC indicating SLO growth. An additional research for the optimal timing for initiating GP treatment is warranted.
authors: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan. lee900@adm.cgmh.org.tw
authors: Chen-Hsiang
authors: CH
authors: Lee
authors: Chun-Chih
authors: CC
authors: Chien
authors: Jien-Wei
authors: JW
authors: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015996:Survival Rate; D017334:Teicoplanin / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin
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