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Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries.
Clin Infect Dis 2009; 49(7):997-1005CI

Abstract

BACKGROUND

Little is known about the incidence of inadequate treatment of severe Staphylococcus aureus infection in Europe. We aimed to evaluate the adequacy of antibiotic therapy for S. aureus bacteremia (SAB), to identify determinants of inadequate treatment, and to determine the effect of inadequate treatment on patient outcome in a representative selection of hospitals in 9 Western European countries.

METHODS

In this retrospective cohort study, all adult patients with SAB (due to methicillin-susceptible S. aureus [MSSA] or methicillin-resistant S. aureus [MRSA]) who were admitted to 60 randomly selected hospitals from 1 November 2007 through 31 December 2007 were included. Adequate antimicrobial therapy was defined as intravenous administration of at least 1 antibiotic to which the isolate showed in vitro susceptibility that was initiated within 2 days after onset of SAB.

RESULTS

A total of 334 SAB episodes (257 due to MSSA and 77 due to MRSA) were included. Ninety-four patients (28%) received inadequate empirical therapy (21% in the MSSA group and 52% in the MRSA group). Both length of stay before SAB onset and methicillin-resistant infection were associated with inadequate therapy, with adjusted odds ratios (ORs) of 1.01 (95% confidence interval [CI], 1.00-1.03) and 3.7 (95% CI, 2.2-6.4), respectively. Age (OR, 1.06; 95% CI, 1.03-1.10), Charlson comorbidity score (OR, 2.1; 95% CI, 1.2-3.6), severe sepsis or septic shock (OR, 2.7; 95% CI, 1.5-4.8), and intensive care unit stay at onset of SAB (OR, 2.9; 95% CI, 1.5-5.6) but not inadequate treatment (OR, 0.7; 95% CI, 0.4-1.3) were associated with increased 30-day mortality.

CONCLUSION

Inadequate empirical antimicrobial therapy for SAB is common in Western Europe and is strongly associated with infection caused by MRSA. In this study, inadequate treatment was not associated with increased 30-day mortality rates.

Authors+Show Affiliations

Department of Medical Microbiology, University Medical Center Utrecht, the Netherlands. H.Ammerlaan@umcutrecht.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19719417

Citation

Ammerlaan, Heidi, et al. "Adequacy of Antimicrobial Treatment and Outcome of Staphylococcus Aureus Bacteremia in 9 Western European Countries." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 49, no. 7, 2009, pp. 997-1005.
Ammerlaan H, Seifert H, Harbarth S, et al. Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries. Clin Infect Dis. 2009;49(7):997-1005.
Ammerlaan, H., Seifert, H., Harbarth, S., Brun-Buisson, C., Torres, A., Antonelli, M., ... Bonten, M. (2009). Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 49(7), pp. 997-1005. doi:10.1086/605555.
Ammerlaan H, et al. Adequacy of Antimicrobial Treatment and Outcome of Staphylococcus Aureus Bacteremia in 9 Western European Countries. Clin Infect Dis. 2009 Oct 1;49(7):997-1005. PubMed PMID: 19719417.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries. AU - Ammerlaan,Heidi, AU - Seifert,Harald, AU - Harbarth,Stephan, AU - Brun-Buisson,Christian, AU - Torres,Antoni, AU - Antonelli,Massimo, AU - Kluytmans,Jan, AU - Bonten,Marc, AU - ,, PY - 2009/9/2/entrez PY - 2009/9/2/pubmed PY - 2009/11/3/medline SP - 997 EP - 1005 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 49 IS - 7 N2 - BACKGROUND: Little is known about the incidence of inadequate treatment of severe Staphylococcus aureus infection in Europe. We aimed to evaluate the adequacy of antibiotic therapy for S. aureus bacteremia (SAB), to identify determinants of inadequate treatment, and to determine the effect of inadequate treatment on patient outcome in a representative selection of hospitals in 9 Western European countries. METHODS: In this retrospective cohort study, all adult patients with SAB (due to methicillin-susceptible S. aureus [MSSA] or methicillin-resistant S. aureus [MRSA]) who were admitted to 60 randomly selected hospitals from 1 November 2007 through 31 December 2007 were included. Adequate antimicrobial therapy was defined as intravenous administration of at least 1 antibiotic to which the isolate showed in vitro susceptibility that was initiated within 2 days after onset of SAB. RESULTS: A total of 334 SAB episodes (257 due to MSSA and 77 due to MRSA) were included. Ninety-four patients (28%) received inadequate empirical therapy (21% in the MSSA group and 52% in the MRSA group). Both length of stay before SAB onset and methicillin-resistant infection were associated with inadequate therapy, with adjusted odds ratios (ORs) of 1.01 (95% confidence interval [CI], 1.00-1.03) and 3.7 (95% CI, 2.2-6.4), respectively. Age (OR, 1.06; 95% CI, 1.03-1.10), Charlson comorbidity score (OR, 2.1; 95% CI, 1.2-3.6), severe sepsis or septic shock (OR, 2.7; 95% CI, 1.5-4.8), and intensive care unit stay at onset of SAB (OR, 2.9; 95% CI, 1.5-5.6) but not inadequate treatment (OR, 0.7; 95% CI, 0.4-1.3) were associated with increased 30-day mortality. CONCLUSION: Inadequate empirical antimicrobial therapy for SAB is common in Western Europe and is strongly associated with infection caused by MRSA. In this study, inadequate treatment was not associated with increased 30-day mortality rates. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/19719417/Adequacy_of_antimicrobial_treatment_and_outcome_of_Staphylococcus_aureus_bacteremia_in_9_Western_European_countries_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/605555 DB - PRIME DP - Unbound Medicine ER -