title: Coagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcome.
abstract: It is uncertain whether an initial inappropriate empirical antibiotic treatment of coagulase-negative staphylococci (CoNS) bacteremia adversely affects the outcome. A retrospective cohort study of CoNS bacteremia was performed at the Dongguk University Ilsan Hospital during a 3-year period. During the study period, 109 patients with CoNS bacteremia were enrolled. The median age of the patients was 72 years and most (96%, 105/109) had one or more comorbid diseases. Among the participants, 29% (32/109) received an appropriate empirical antimicrobial therapy. The 30-day mortality was 24% (26/109) and CoNS bacteremia-related mortality was 14% (15/109). There was no difference in the CoNS bacteremia-related mortality between the group with an inappropriate empirical treatment (13%, 10/77) and that with an appropriate treatment (16%, 5/32) (p = 0.46). In the multivariate analysis using the Cox regression analysis method, Pitt bacteremia scores [hazard ratio (HR) 1.48; 95% confidence interval (CI) 1.09-2.01; p = 0.01] and retention of eradicable focus (HR 5.0; 95% CI 1.39-17.9; p = 0.01) were found to be associated with CoNS bacteremia-related mortality. The results suggest that inappropriate empirical therapy might not necessarily be associated with the 30-day mortality or CoNS bacteremia-related mortality. Conversely, Pitt bacteremia scores and retention of eradicable focus were associated with poor outcomes.
authors.affiliation: Divisions of Infectious Diseases, Department of Internal Medicine, Dongguk University, Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 410-773, Republic of Korea, psy99ch@hanmail.net.
authors.forename: S Y
authors.initials: SY
authors.lastname: Park
authors.forename: K H
authors.initials: KH
authors.lastname: Kwon
authors.forename: J-W
authors.initials: JW
authors.lastname: Chung
authors.forename: H J
authors.initials: HJ
authors.lastname: Huh
authors.forename: S L
authors.initials: SL
authors.lastname: Chae
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003030:Coagulase / Q000172:deficiency*; D015897:Comorbidity; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009026:Mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013210:Staphylococcus / Q000145:classification* / Q000302:isolation & purification; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D003030:Coagulase
references.citation: J Antimicrob Chemother. 2004 Aug;54(2):489-97
references.pmid: 15254028
references.citation: Ann Intern Med. 1991 Feb 15;114(4):332-3
references.pmid: 1987879
references.citation: Arch Intern Med. 1962 Nov;110:63-75
references.pmid: 13957202
references.citation: Am Heart J. 2001 Oct;142(4):571-6
references.pmid: 11579344
references.citation: Ann Intern Med. 1989 Jan 1;110(1):9-16
references.pmid: 2908834
references.citation: J Clin Microbiol. 2006 May;44(5):1834-5
references.pmid: 16672415
references.citation: Ann Intern Med. 2004 Jan 6;140(1):26-32
references.pmid: 14706969
references.citation: Ann Intern Med. 2004 Jan 6;140(1):18-25
references.pmid: 14706968
references.citation: Clin Infect Dis. 2009 Oct 15;49(8):1187-94
references.pmid: 19780661
references.citation: Infect Control Hosp Epidemiol. 2005 Jun;26(6):559-66
references.pmid: 16018432
references.citation: Lancet Infect Dis. 2002 Nov;2(11):677-85
references.pmid: 12409048
references.citation: Intern Med J. 2001 Mar;31(2):97-103
references.pmid: 11480485
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Arch Intern Med. 2002 Jan 14;162(1):25-32
references.pmid: 11784216
references.citation: J Infect. 2013 Feb;66(2):155-62
references.pmid: 23103291
references.citation: Rev Esp Quimioter. 2012 Sep;25(3):199-205
references.pmid: 22987266
references.citation: Clin Infect Dis. 2009 Jul 1;49(1):1-45
references.pmid: 19489710
references.citation: Clin Microbiol Infect. 2006 Jan;12(1):13-21
references.pmid: 16460541
references.citation: Clin Infect Dis. 2003 Sep 15;37(6):794-9
references.pmid: 12955640
references.citation: Antimicrob Agents Chemother. 2005 Feb;49(2):760-6
references.pmid: 15673761
references.citation: Am J Med. 1991 Sep 16;91(3B):152S-157S
references.pmid: 1656747
references.citation: Haematologica. 1997 Jul-Aug;82(4):415-9
references.pmid: 9299853
references.citation: Clin Infect Dis. 2004 Aug 1;39(3):309-17
references.pmid: 15306996