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Table 2 Comparison of clinical and microbiological characteristics and outcomes among patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia according to the appropriateness of empirical antibiotic therapy or treatment outcome in the propensity-matched analyses

From: Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis

Variables Total Empirical antibiotic therapy Treatment outcome
Inappropriate (n = 127) Appropriate (n = 127) OR (95 % CI) Non-survival (n = 81, 31.9 %) Survival (n = 173, 68.1 %) OR (95 % CI)
Male sex 165 (65.0) 84 (66.1) 81 (63.8) 1.03 (0.62–1.72) 59 (70.2) 106 (62.4) 0.66 (0.38–1.15)
Age (years), median (IQR) 67 (52–75) 68 (53–76) 65 (51–73) 0.99 (0.97–1.00) 72 (60–79) 63 (48–72) 1.03 (1.01–1.05)
Category of infection        
 Healthcare-associateda 32 (12.6) 16 (12.6) 16 (12.6) 1.07 (0.52–2.23) 4 (4.8) 28 (16.5) 2.31 (0.91–5.84)
 Nosocomial 222 (87.4) 111 (87.4) 111 (87.4) 80 (95.2) 142 (83.5)
Comorbidity        
 Malignancy 68 (26.8) 30 (23.6) 38 (29.9) 0.66 (0.37–1.16) 33 (39.3) 35 (20.6) 2.63 (1.46–4.73)
 Trauma 24 (9.4) 14 (11.0) 10 (7.9) 1.33 (0.56–3.17) 7 (8.3) 17 (10.0) 0.93 (0.37–2.35)
 Charlson’s comorbidity indexb, median (IQR) 2 (1–4) 2 (1–4) 2 (1–4) 1.08 (0.97–1.19) 3 (2–6) 2 (0–2) 1.37 (1.21–1.54)
Predisposing factors    
 Foreign body retention 4 (1.6) 2 (1.6) 2 (1.6) 1.00 (0.14–7.21) 1 (1.2) 3 (1.8) 0.71 (0.07–6.92)
 Surgical operation 48 (18.9) 24 (18.9) 24 (18.9) 1.00 (0.53–1.87) 14 (16.7) 34 (20.0) 1.09 (0.56–2.12)
 Prior antibiotic use 151 (59.4) 73 (57.5) 78 (61.4) 1.00 (0.60–1.66) 58 (69.0) 93 (54.7) 2.39 (1.33–4.30)
 Third-generation cephalosporins 78 (30.7) 40 (31.5) 38 (29.9) 1.15 (0.68–1.95) 27 (32.1) 51 (30.0) 1.40 (0.81–2.44)
 Fluoroquinolones 39 (15.4) 17 (113.4) 22 (17.3) 0.89 (0.45–1.75) 16 (19.8) 23 (13.5) 1.96 (0.99–3.91)
 Glycopeptides 36 (14.2) 14 (11.0) 22 (17.3) 0.77 (0.38–1.57) 19 (22.6) 17 (10.0) 2.15 (1.05–4.41)
Primary focus of HA-MRSAB       
 CR-BSI 144 (56.7) 72 (56.7) 72 (56.7) 1.03 (0.63–1.70) 52 (61.9) 92 (54.1) 1.03 (0.61–1.75)
 Pneumonia 22 (8.7) 12 (9.4) 10 (7.9) 0.41 (0.62-3.21) 11 (13.1) 11 (6.5) 3.35 (1.46–7.67)
Clinical severity        
 Development of severe sepsis or septic shock 75 (29.5) 33 (26.0) 42 (33.1) 0.64 (0.37–1.09) 43 (51.2) 32 (18.8) 5.24 (2.93–9.38)
 Pitt’s bacteremia scorec, median (IQR) 1 (0–3) 1 (0–3) 1 (0–3) 1.08 (0.94–1.24) 3 (1–4) 1 (0–2) 0..96 (0.82–1.12)
Vancomycin MIC, mg/L      
 MIC ≥1.0 mg/L 211 (96.3) 106 (98.1) 105 (94.6) 1.15 (0.52–2.54) 69 (95.8) 142 (96.6) 1.76 (0.36–8.71)
 MIC ≥1.5 mg/L 94 (42.9) 39 (36.1) 55 (49.5) 0.60 (0.31–1.16) 34 (47.2) 60 (40.8) 1.60 (0.91–2.83)
 MIC ≥2 mg/L 19 (8.7) 8 (7.4) 11 (9.9) 0.47 (0.08–2.61) 9 (12.5) 10 (6.8) 2.46 (0.95–6.34)
 Appropriate empirical antibiotic therapy, n (%) 127 (50.0)     42 (50.0) 85 (50.0) 1.20 (0.71–2.03)
Definitive therapy        
 Vancomycin 145 (57.1) 68 (53.5) 77 (60.6) 0.75 (0.46–1.23) 48 (57.1) 97 (57.1) 1.00 (0.59–1.70)
 Teicoplanin 75 (29.5) 38 (29.9) 37 (29.1) 1.04 (0.61–1.78) 26 (31.0) 49 (28.8) 1.11 (0.63–1.96)
 Linezolid 28 (11.0) 16 (12.6) 12 (9.4) 1.38 (0.63–3.05) 9 (10.7) 19 (11.2) 0.95 (0.41–2.21)
 Arbekacin 45 (17.7) 25 (19.7) 20 (15.7) 1.31 (0.69–2.51) 10 (11.9) 35 (20.6) 0.52 (0.24–1.11)
 Tigecycline 4 (1.6) 2 (1.6) 2 (1.6) 1.00 (0.14–6.99) 2 (2.4) 2 (1.2) 2.05 (0.28–14.80)
 Rifampind 9 (3.5) 7 (5.5) 2 (1.6) 3.65 (0.74–17.9) 0 9 (5.3) 0.95 (0.91–0.98)
Outcomes        
 In-hospital mortality 84 (33.1) 42 (33.1) 42 (33.1) 1.20 (0.71–2.03)    1.20 (0.71–2.03)
 MRSAB-related mortality 40 (15.7) 21 (16.5) 19 (15.0) 1.34 (0.68–2.62) 40 (47.6) 0 2.03 (1.62–2.53)
  1. CR-BSI catheter-related bloodstream infection, IQR interquartile range, MIC minimum inhibitory concentration, MRSA methicillin-resistant Staphylococcus aureus, MRSAB methicillin-resistant Staphylococcus aureus bacteremia
  2. aMRSAB diagnosed within 48 h of hospital admission was considered healthcare-associated infection, if the patient presented with healthcare-associated factor in the preceding 3 months
  3. bCharlson’s comorbidity index was calculated at the first identification of MRSA bloodstream infection
  4. cPitt’s bacteremia score was assessed at the first identification of MRSA bloodstream infection
  5. dRifampin, which was prescribed in the survivals for the maintenance combination treatment during the finishing step for the small number of study cases