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Clin Microbiol Infect. 2019 Jun;25(6):723-732. doi: 10.1016/j.cmi.2018.09.018. Epub 2018 Oct 2.

Impact of antimicrobial treatment duration on outcome of Staphylococcus aureus bacteraemia: a cohort study.

Author information

1
Department of Internal Medicine, Division of Infectious Diseases, Ewha Womans University School of Medicine, Seoul, South Korea.
2
Department of Internal Medicine, Seoul National University Bundang Hospital, Seognnam, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
3
Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, South Korea. Electronic address: iammedkid@naver.com.
4
Department of Internal Medicine, Seoul National University Bundang Hospital, Seognnam, South Korea.
5
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
6
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
7
Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
8
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
9
Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejon, South Korea.
10
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
11
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea.
12
Inje University Haeundae Paik Hospital, Busan, South Korea.
13
Department of Internal Medicine, Seoul National University Bundang Hospital, Seognnam, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: eskim@snubh.org.
14
Seoul National University Bundang Hospital, South Korea.
15
Chonnam National University Hospital, South Korea.
16
Seoul National University Hospital, South Korea.
17
Pusan National University Hospital, South Korea.
18
Yonsei University Wonju College of Medicine, South Korea.
19
Chungnam National University Hospital, South Korea.
20
Inje University Ilsan Paik Hospital, South Korea.
21
Daegu Fatima Hospital, South Korea.
22
Inje University Haeundae Paik Hospital, South Korea.

Abstract

OBJECTIVES:

To assess the outcome of Staphylococcus aureus bacteraemia (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 to 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 bacteraemia, metastatic infection, prosthesis and endocarditis. If any of the factors were present, then 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 a composite of 90-day mortality or 30-day recurrence. Duration of antibiotic administration was classified as <14 or ≥14 days in the SS group and <28 or ≥28 days in the LW group.

RESULTS:

Among 2098 cases, the outcome was analysed in 1866 cases, of which 591 showed poor outcome. The SS group accounted for 964 cases and the LW group for 852. On multivariate analysis, age over 65 years, pneumonia, higher Sequential Organ Failure Assessment (SOFA) score and 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.

KEYWORDS:

Antibacterial agents; Staphylococcus aureus; bacteraemia; complications

PMID:
30287412
DOI:
10.1016/j.cmi.2018.09.018

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