Timing of Initiating Glycopeptide Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: The Impact on Clinical Outcome

Abstract EN

When a Staphylococcus-like organism (SLO) is microscopically found in Gram staining of blood culture (BC) specimen, it seems reasonable to administrate a glycopeptide (GP) for empirical therapy.

The paper investigates the risk factors for 14-day mortality in patients with methicillin-resistance Staphylococcus aureus bacteremia (MRSAB) and clarifies the impact of the timing for initiating GP therapy.

A retrospective study identifies patients with MRSAB (endocarditis was excluded) between 2006 and 2009.

Patients were categorized as receiving GP at the interval before a preliminary BC report indicating the growth of SLO and the onward 24 hours or receiving GP 24 h after a preliminary BC report indicating the growth of SLO.

Total 339 patients were enrolled.

There was no difference on the 14-day overall or infection-related mortality rates at the time to administer GP.

Multivariate analysis disclosed pneumonia (OR = 4.47; of 95% CI; of 2.09–9.58; P<0.01) and high APACHE II score (OR, 2.81, with 95% CI, 1.19–6.65; P=0.02) were independent risk factors for infection-related mortality.

The mortality rate did not decrease following administrating GP immediately after a preliminary BC indicating SLO growth.

An additional research for the optimal timing for initiating GP treatment is warranted.