Coagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcome

It is uncertain whether an initial inappropriate empirical antibiotic treatment of coagulase-negative staphylococci (CoNS) bacteremia adversely affects the outcome. A retrospective cohort study of CoNS bacteremia was performed at the Dongguk University Ilsan Hospital during a 3-year period. During t...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2015-07, Vol.34 (7), p.1395-1401
Main Authors: Park, S. Y., Kwon, K. H., Chung, J.-W., Huh, H. J., Chae, S. L.
Format: Article
Language:English
Subjects:
Aged
Anti-Infective Agents - therapeutic use
Antibiotics
Antimicrobial agents
Bacteremia
Biomedical and Life Sciences
Biomedicine
Catheter-Related Infections - drug therapy
Catheter-Related Infections - epidemiology
Catheter-Related Infections - microbiology
Catheters
Coagulase - deficiency
Cohort analysis
Comorbidity
Female
Hospitals
Hospitals, University
Humans
Internal Medicine
Male
Medical Microbiology
Methicillin Resistance
Middle Aged
Mortality
Nosocomial infections
Patients
Regression analysis
Retrospective Studies
Risk Factors
Staphylococcal Infections - drug therapy
Staphylococcal Infections - epidemiology
Staphylococcal Infections - microbiology
Staphylococcus - classification
Staphylococcus - isolation & purification
Statistical analysis
Treatment Outcome
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Summary:It is uncertain whether an initial inappropriate empirical antibiotic treatment of coagulase-negative staphylococci (CoNS) bacteremia adversely affects the outcome. A retrospective cohort study of CoNS bacteremia was performed at the Dongguk University Ilsan Hospital during a 3-year period. During the study period, 109 patients with CoNS bacteremia were enrolled. The median age of the patients was 72 years and most (96 %, 105/109) had one or more comorbid diseases. Among the participants, 29 % (32/109) received an appropriate empirical antimicrobial therapy. The 30-day mortality was 24 % (26/109) and CoNS bacteremia-related mortality was 14 % (15/109). There was no difference in the CoNS bacteremia-related mortality between the group with an inappropriate empirical treatment (13 %, 10/77) and that with an appropriate treatment (16 %, 5/32) ( p  = 0.46). In the multivariate analysis using the Cox regression analysis method, Pitt bacteremia scores [hazard ratio (HR) 1.48; 95 % confidence interval (CI) 1.09–2.01; p  = 0.01] and retention of eradicable focus (HR 5.0; 95 % CI 1.39–17.9; p  = 0.01) were found to be associated with CoNS bacteremia-related mortality. The results suggest that inappropriate empirical therapy might not necessarily be associated with the 30-day mortality or CoNS bacteremia-related mortality. Conversely, Pitt bacteremia scores and retention of eradicable focus were associated with poor outcomes.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-015-2364-3