Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-30T21:32:48.887Z Has data issue: false hasContentIssue false
  • English
  • Français

Empirical Antimicrobial Therapy for Bloodstream Infection Due to Methicillin-Resistant Staphylococcus aureus: No Better than a Coin Toss

Published online by Cambridge University Press:  02 January 2015

Carrie A. Herzke ,
Luke F. Chen ,
Deverick J. Anderson ,
Yong Choi ,
Daniel J. Sexton  and
Keith S. Kaye
Carrie A. Herzke*
Affiliation:
Johns Hopkins University Medical Institute, Baltimore, Maryland
Luke F. Chen
Affiliation:
Duke University Medical Center, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Durham, North Carolina
Yong Choi
Affiliation:
Duke University Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Duke University Medical Center, Durham, North Carolina
Keith S. Kaye
Affiliation:
Wayne State University Medical Center, Detroit, Michigan
*
Johns Hopkins Medical Institute, 600 North Wolfe Street, Park 307, Baltimore, MD 21287 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Despite the high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in the hospital, the proportion of patients with MRSA bacteremia who receive appropriate empirical therapy remains suboptimal.

Objective.

To investigate the proportion of patients with MRSA bloodstream infection (BSI) who received appropriate empirical antibiotic therapy and to identify risk factors associated with receipt of appropriate empirical therapy.

Methods.

We studied a cohort of patients from 10 hospitals. The primary outcome was the proportion of patients who received appropriate empirical antibiotic therapy for MRSA BSI. Appropriate therapy was defined as receipt of daptomycin, linezolid, quinupristin-dalfopristin, or vancomycin within 1 calendar day after the first blood culture result positive for S. aureus (ie, before antimicrobial susceptibilities were known). Multivariable logistic regression was used to determine variables associated with receipt of appropriate empirical therapy.

Results.

The study included 562 patients with MRSA BSI. The mean (± standard deviation) age of the patients was 64 ± 16 years, and 288 (51.2%) were male. Only 291 (51.8%) patients received appropriate empirical therapy. Patients were more likely to receive appropriate therapy if they required hemodialysis (odds ratio [OR], 1.36 [95% confidence interval {CI}, 1.00–1.85]), had undergone knee or hip arthroplasty (OR, 3.04 [95% CI, 1.21–7.6]), had a central venous catheter at admission (OR, 1.72 [95% CI, 1.01–2.93]), or had a McCabe score of 1 at admission (OR, 1.83 [95% CI, 1.16–2.83]). Bowel incontinence (OR, 0.41 [95% CI, 0.19–0.92]) and BSIs categorized as primary (OR, 0.41 [95% CI, 0.27–0.63]) were associated with a decreased likelihood of receiving appropriate empirical therapy.

Conclusions.

Only half of patients with MRSA BSI received appropriate empirical therapy. Factors associated with receiving appropriate empirical antibiotics included the presence of a central venous catheter at admission and a history of joint arthroplasty. Surprisingly, prior MRSA infection was not predictive of receipt of appropriate antimicrobial therapy.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1057 - 1061
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphybcoccus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
2.Wisplinghoff, H, Bischoff, T, Tallent, SM, Seifert, H, Wenzel, RP, Edmond, MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309–317.Google Scholar
3.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
4.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
5.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592–598.Google Scholar
6.Roghmann, MC. Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia. Arch Intern Med 2000;160:1001–1004.CrossRefGoogle Scholar
7.Shurland, S, Zhan, M, Bradham, DD, Roughmann, MC. Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:273–279.CrossRefGoogle ScholarPubMed
8.Leibovici, L, Shraga, I, Drucker, M, Konigsberger, H, Samra, Z, Pitlik, SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998;244:379–386.CrossRefGoogle ScholarPubMed
9.Kaye, KS, Anderson, DJ, Choi, Y, Link, K, Thacker, P, Sexton, DJ. The deadly toll of invasive methicillin-resistant Staphylococcus aureus infection in community hospitals. Clin Infect Dis 2008;46:1568–1577.CrossRefGoogle ScholarPubMed
10.Kaye, KS, Schmidt, K, Peiper, C. The effect of increasing age on the risk of surgical site infection. J Infect Dis 2005;191:1056–1062.CrossRefGoogle ScholarPubMed
11.Kaye, KS, Sloane, R, Sexton, DJ, Schmader, KA. Risk factors for surgical site infections in older people. J Am Geriatr Soc 2006;54:391–396.CrossRefGoogle ScholarPubMed
12.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
13.McCabe, W. Gram-negative bacteremia, I: etiology and ecology. Arch Intern Med 1962;110:847–852.Google Scholar
14.Katz, S, Ford, AB, Moskowitz, RW, Jackson, BA, Jaffe, MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.Google Scholar
15.Friedman, ND, Kaye, KS, Stout, JE, et al.Health care–associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791–797.Google Scholar
16.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
17.Social Security Index (SSDI). Available at: http://ssdi.rootsweb.com. Accessed December 15, 2007.Google Scholar
18.Edwards, C, Counsell, A, Boulton, C, Moran, CG. Early infection after hip fracture surgery: risk factors, costs and outcome. J Bone Joint Surg Br 2008;90:770–777.CrossRefGoogle ScholarPubMed
19.Kourbatova, EV, Halvosa, JS, King, MD, Ray, SM, White, N, Blumberg, HM. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 clone as a cause of health care-associated infections among patients with prosthetic joint infections. Am J Infect Control 2005;33:385–391.CrossRefGoogle ScholarPubMed
20.Ridgeway, S, Wilson, J, Charlet, A, Kefatos, G, Pearson, A, Coello, R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005;87:844–850.Google Scholar
21.Kim, PW, Perl, TM, Keelaghan, EF, et al.Risk of mortality with a bloodstream infection is higher in the less severely ill at admission. Am J Respir Crit Care Med 2005;171:616–620.CrossRefGoogle ScholarPubMed
22.Glenn, KR, Craig, A, Kainer, MA. Thirty-day and 180-day case fatality rates among invasive methicillin-resistant Staphylococcus aureus patients (Tennessee, 2004–2007). In: Program and abstracts of the International Conference on Emerging Infectious Diseases 2008; March 16–19, 2008; Atlanta, GA. Abstract 264.Google Scholar