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Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment.
Crit Care Med. 2006 Aug; 34(8):2069-74.CC

Abstract

OBJECTIVE

The first goal of this investigation was to determine the rate of appropriate initial antimicrobial administration to patients with methicillin-resistant Staphylococcus aureus (MRSA) sterile-site infections. Our second goal was to evaluate the influence of appropriate initial treatment of MRSA sterile-site infection on outcome.

DESIGN

A retrospective, single-center, observational cohort study.

SETTING

Barnes-Jewish Hospital, a 1200-bed urban teaching facility.

PATIENTS

Adult patients requiring hospitalization identified to have an MRSA sterile-site infection.

INTERVENTIONS

Retrospective data collection from automated hospital and pharmacy databases.

MEASUREMENTS AND MAIN RESULTS

Five hundred forty-nine patients with S. aureus sterile site infections were identified during a 3-yr period (January 2002 through December 2004). One hundred twenty-seven (23.1%) died during hospitalization. Hospital mortality was statistically greater for patients receiving inappropriate initial antimicrobial treatment (n = 380) within 24 hrs of a positive culture than for those receiving appropriate initial treatment (n = 169) (26.1% vs. 16.6%; p = .015). Multiple logistic regression analysis identified inappropriate initial antimicrobial treatment (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.48-2.50; p = .0134), vasopressor administration (AOR, 5.49; 95% CI, 4.08-7.38; p < .001), and increasing age (1-yr increments) (AOR, 1.03; 95% CI, 1.02-1.04; p < .001) as independent determinants of hospital mortality.

CONCLUSIONS

Inappropriate initial antimicrobial treatment of MRSA sterile-site infections is common and is associated with an increased risk of hospital mortality. Appropriate antimicrobial treatment of MRSA sterile-site infections may be maximized by increased use of initial empirical antimicrobial treatment regimens targeting MRSA in patients at risk for this infection until organism identification and susceptibility become known.

Authors+Show Affiliations

Critical Care Specialty Resident, Barnes-Jewish Hospital, St. Louis, MO, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16763516

Citation

Schramm, Garrett E., et al. "Methicillin-resistant Staphylococcus Aureus Sterile-site Infection: the Importance of Appropriate Initial Antimicrobial Treatment." Critical Care Medicine, vol. 34, no. 8, 2006, pp. 2069-74.
Schramm GE, Johnson JA, Doherty JA, et al. Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment. Crit Care Med. 2006;34(8):2069-74.
Schramm, G. E., Johnson, J. A., Doherty, J. A., Micek, S. T., & Kollef, M. H. (2006). Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment. Critical Care Medicine, 34(8), 2069-74.
Schramm GE, et al. Methicillin-resistant Staphylococcus Aureus Sterile-site Infection: the Importance of Appropriate Initial Antimicrobial Treatment. Crit Care Med. 2006;34(8):2069-74. PubMed PMID: 16763516.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment. AU - Schramm,Garrett E, AU - Johnson,Jennifer A, AU - Doherty,Joshua A, AU - Micek,Scott T, AU - Kollef,Marin H, PY - 2006/6/10/pubmed PY - 2006/9/1/medline PY - 2006/6/10/entrez SP - 2069 EP - 74 JF - Critical care medicine JO - Crit. Care Med. VL - 34 IS - 8 N2 - OBJECTIVE: The first goal of this investigation was to determine the rate of appropriate initial antimicrobial administration to patients with methicillin-resistant Staphylococcus aureus (MRSA) sterile-site infections. Our second goal was to evaluate the influence of appropriate initial treatment of MRSA sterile-site infection on outcome. DESIGN: A retrospective, single-center, observational cohort study. SETTING: Barnes-Jewish Hospital, a 1200-bed urban teaching facility. PATIENTS: Adult patients requiring hospitalization identified to have an MRSA sterile-site infection. INTERVENTIONS: Retrospective data collection from automated hospital and pharmacy databases. MEASUREMENTS AND MAIN RESULTS: Five hundred forty-nine patients with S. aureus sterile site infections were identified during a 3-yr period (January 2002 through December 2004). One hundred twenty-seven (23.1%) died during hospitalization. Hospital mortality was statistically greater for patients receiving inappropriate initial antimicrobial treatment (n = 380) within 24 hrs of a positive culture than for those receiving appropriate initial treatment (n = 169) (26.1% vs. 16.6%; p = .015). Multiple logistic regression analysis identified inappropriate initial antimicrobial treatment (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.48-2.50; p = .0134), vasopressor administration (AOR, 5.49; 95% CI, 4.08-7.38; p < .001), and increasing age (1-yr increments) (AOR, 1.03; 95% CI, 1.02-1.04; p < .001) as independent determinants of hospital mortality. CONCLUSIONS: Inappropriate initial antimicrobial treatment of MRSA sterile-site infections is common and is associated with an increased risk of hospital mortality. Appropriate antimicrobial treatment of MRSA sterile-site infections may be maximized by increased use of initial empirical antimicrobial treatment regimens targeting MRSA in patients at risk for this infection until organism identification and susceptibility become known. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/16763516/Methicillin_resistant_Staphylococcus_aureus_sterile_site_infection:_The_importance_of_appropriate_initial_antimicrobial_treatment_ L2 - https://dx.doi.org/10.1097/01.CCM.0000227655.41566.3E DB - PRIME DP - Unbound Medicine ER -