Impact of Antimicrobial Treatment Duration on Outcome of Staphylococcus aureus Bacteremia: A Cohort Study.
Clin Microbiol Infect. 2018 Oct 01;:
Authors: Kim CJ, Song KH, Park KH, Kim M, Choe PG, Oh MD, Lee SH, Jang HC, Kang SJ, Kim HY, Cheon S, Kwak YG, Choi HJ, Kwon KT, Jeon JH, Kim ES, Kim HB, Korea INfectious Diseases (KIND) Study Group
OBJECTIVES: We aimed to assess the outcome of Staphylococcus aureus bacteremia (SAB) according to factors associated with necessity for longer treatment in conjunction with the duration of treatment.
METHODS: We prospectively collected the data of patients with SAB consecutively during 12-39 months from 11 hospitals. If multiple episodes of SAB occurred in one patient, only the first episode was enrolled. Factors associated with necessity for longer treatment were defined as follows: persistent bacteremia, metastatic infection, prosthesis, and endocarditis. If any of the factors were present, the case was defined as longer antibiotic treatment warranted (LW) group, those without any factors were defined as shorter antibiotic treatment sufficient (SS) group. Poor outcome was defined as composite of 90-day mortality or 30-day recurrence. Duration of antibiotic administration was classified as <14 or ≥14 days in SS-group, and <28 or ≥28 days in LW-group.
RESULTS: Among 2098 cases, the outcome was analyzed in 1866 cases, of which 591 showed poor outcome. SS-group accounted for 964 cases and LW-group for 852 cases. On multivariate analysis, age over 65 years, pneumonia, higher SOFA score, chronic liver diseases were risk factors for poor outcome. Administration of antibiotics less than the recommendation was associated with poor outcome, but this significance was observed only in the LW-group (adjusted odds ratio 1.68, 95% confidence interval 1.00-2.83, p=0.05).
CONCLUSIONS: Inappropriately short antibiotic treatment was associated with poor outcome in the LW-group. Vigilant evaluation for risk factors to determine the duration of treatment may improve the outcome among patients with SAB.
PMID: 30287412 [PubMed - as supplied by publisher]