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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
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BMC Infectious Diseases

ISSN: 1471-2334

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