title: Survival Benefit of Empirical Therapy for Staphylococcus aureus Bloodstream Infections in Infants.
abstract: BACKGROUND
  The impact of early adequate empirical antibiotic therapy on outcomes of infants in the neonatal intensive care unit (NICU) who develop Staphylococcus aureus bloodstream infections (BSI) is unknown.
  
  
  METHODS
  Infants with S. aureus BSI discharged in 1997-2012 from 348 NICUs managed by the Pediatrix Medical Group were identified. Early adequate empirical antibiotic therapy was defined as exposure to ≥1 antibiotic with anti-staphylococcal activity on the day the first positive blood culture was obtained. All other cases were defined as inadequate empirical antibiotic therapy. We evaluated the association between inadequate empirical antibiotic therapy on outcomes controlling for gestational age, small for gestational age status, gender, discharge year, mechanical ventilation, inotropic support and use of supplemental oxygen. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, death before hospital discharge and length of bacteremia.
  
  
  RESULTS
  Of the 3339 infants with S. aureus BSI, 2492 (75%) had methicillin-susceptible S. aureus (MSSA) BSI and 847 (25%) had methicillin-resistant S. aureus (MRSA) BSI. Inadequate empirical antibiotic therapy was administered in 725 (22%) cases. Inadequate empirical antibiotic therapy was associated with increased 30-day mortality (odds ratio: 2.03; 95% confidence interval: 1.08-3.82) among infants with MRSA BSI. Inadequate empirical antibiotic therapy was not associated with increases in mortality among infants with MSSA BSI.
  
  
  CONCLUSIONS
  After controlling for confounders, inadequate empirical antibiotic therapy was associated with a modestly increased mortality at 30 days for infants with MRSA BSI.
authors.affiliation: From the *Division of Infectious Diseases, †Department of Pediatrics, ‡Duke Clinical Research Institute, §Department of Medicine, Duke University School of Medicine, Durham, North Carolina; and ‖Pediatrix-Obstetrix Center for Research and Education, MEDNAX National Medical Group, Sunrise, Florida.
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Thaden
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Ericson
authors.forename: Heather
authors.initials: H
authors.lastname: Cross
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Bergin
authors.forename: Julia A
authors.initials: JA
authors.lastname: Messina
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Reese H
authors.initials: RH
authors.lastname: Clark
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hornik
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality*; D036262:Empirical Research; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000401:mortality*; D013211:Staphylococcus aureus; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents