IMPACT OF TIME TO APPROPRIATE THERAPY ON MORTALITY IN PATIENTS WITH VANCOMYCIN INTERMEDIATE STAPHYLOCOCCUS AUREUS INFECTION.
Antimicrob Agents Chemother. 2016 Jul 11;
Authors: Burnham JP, Burnham CA, Warren DK, Kollef MH
BACKGROUND: Despite the increasing incidence of vancomycin-intermediate Staphylococcus aureus (VISA) infections, few studies have examined the impact of delay in receipt of appropriate antimicrobial therapy on outcomes in VISA patients. We examined the effects of timing of appropriate antimicrobial therapy in a cohort of patients with sterile site methicillin-resistant S. aureus (MRSA) and VISA infections.
METHODS: In this single center, retrospective cohort study, we identified all patients with MRSA or VISA sterile site infections from June 2009 - February 2015. Clinical outcomes were compared according to MRSA/VISA classification, demographics, comorbidities, and antimicrobial treatment. Thirty day all-cause mortality was modeled with Kaplan-Meier curves. Multivariate logistic regression analysis (MVLRA) was used to determine odds ratios for mortality.
RESULTS: We identified 354 patients with MRSA (n=267) or VISA (n=87) sterile site infection. Fifty-five patients (15.5%) were non-survivors. Factors associated with mortality in MVLRA included pneumonia, unknown source of infection, APACHE II score, solid-organ malignancy, and admission from skilled care facilities. Time to appropriate antimicrobial therapy was not significantly associated with outcome. Presence of a VISA infection as compared to non-VISA S. aureus did not result in excess mortality. Linezolid use was a risk for mortality in patients with APACHE II ≥14.
CONCLUSIONS: Our results suggest that empiric vancomycin use in patients with VISA infections does not result in excess mortality. Future studies should 1) include larger numbers of patients with VISA infections to confirm these findings and 2) determine the optimal antibiotic therapy for critically ill patients with MRSA and VISA infections.
PMID: 27401565 [PubMed - as supplied by publisher]