Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study

Marin L Schweizer; Jon P Furuno; Anthony D Harris; J Kristie Johnson; Michelle D Shardell; Jessina C McGregor; Kerri A Thom; George Sakoulas; Eli N Perencevich

doi:10.1371/journal.pone.0011432

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Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study

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Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study

Marin L Schweizer, Jon P Furuno, Anthony D Harris, J Kristie Johnson, Michelle D Shardell, Jessina C McGregor, Kerri A Thom, George Sakoulas and Eli N Perencevich

PloS one, Vol.5(7), e11432

07/02/2010

DOI: 10.1371/journal.pone.0011432

PMCID: PMC2896397

PMID: 20625395

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Abstract

Appropriate empiric therapy, antibiotic therapy with in vitro activity to the infecting organism given prior to confirmed culture results, may improve Staphylococcus aureus outcomes. We aimed to measure the clinical impact of appropriate empiric antibiotic therapy on mortality, while statistically adjusting for comorbidities, severity of illness and presence of virulence factors in the infecting strain. We conducted a retrospective cohort study of adult patients admitted to a tertiary-care facility from January 1, 2003 to June 30, 2007, who had S. aureus bacteremia. Time to appropriate therapy was measured from blood culture collection to the receipt of antibiotics with in vitro activity to the infecting organism. Cox proportional hazard models were used to measure the association between receipt of appropriate empiric therapy and in-hospital mortality, statistically adjusting for patient and pathogen characteristics. Among 814 admissions, 537 (66%) received appropriate empiric therapy. Those who received appropriate empiric therapy had a higher hazard of 30-day in-hospital mortality (Hazard Ratio (HR): 1.52; 95% confidence interval (CI): 0.99, 2.34). A longer time to appropriate therapy was protective against mortality (HR: 0.79; 95% CI: 0.60, 1.03) except among the healthiest quartile of patients (HR: 1.44; 95% CI: 0.66, 3.15). Appropriate empiric therapy was not associated with decreased mortality in patients with S. aureus bacteremia except in the least ill patients. Initial broad antibiotic selection may not be widely beneficial.

Staphylococcal Infections - drug therapy

Staphylococcus aureus - physiology

Humans

Middle Aged

Bacteremia - drug therapy

Bacteremia - mortality

Male

Bacteremia - microbiology

Anti-Bacterial Agents - therapeutic use

Staphylococcal Infections - mortality

Adult

Female

Anti-Bacterial Agents - pharmacology

Retrospective Studies

Staphylococcus aureus - drug effects

Cohort Studies

Details

Title: Subtitle: Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study
Creators: Marin L Schweizer - Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America. marin-schweizer@uiowa.edu
Jon P Furuno
Anthony D Harris
J Kristie Johnson
Michelle D Shardell
Jessina C McGregor
Kerri A Thom
George Sakoulas
Eli N Perencevich
Resource Type: Journal article
Publication Details: PloS one, Vol.5(7), e11432
DOI: 10.1371/journal.pone.0011432
PMID: 20625395
PMCID: PMC2896397
NLM abbreviation: PLoS One
ISSN: 1932-6203
eISSN: 1932-6203
Publisher: United States
Grant note: 1K24AI079040-01A1 / NIAID NIH HHS KL2 RR024141 / NCRR NIH HHS 1K01AI071015-02 / NIAID NIH HHS K12HD043489 / NICHD NIH HHS K12 HD043489 / NICHD NIH HHS KL2RR024141 / NCRR NIH HHS 1K12RR02350-03 / NCRR NIH HHS 1R01A160859-01A1 / PHS HHS K24 AI079040 / NIAID NIH HHS K01 AI071015 / NIAID NIH HHS
Language: English
Date published: 07/02/2010
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779491902771

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