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Treatment and Outcome of Staphylococcus aureus Bacteremia
A Prospective Study of 278 Cases
Allan G. Jensen, MD;
Carsten H. Wachmann, MSc, PhD;
Frank Espersen, MD, PhD;
Jens Scheibel, MD;
Peter Skinhøj, MD, PhD;
Niels Frimodt-Møller, MD, PhD
Arch Intern Med. 2002;162:25-32.
Background Staphylococcus aureus bacteremia is still a
serious problem, and the optimal treatment is under debate. Only a few studies
concerning treatment are available.
Methods The study population was all patients with a positive blood culture
result for S aureus in Copenhagen County, Denmark,
from May 1994 through April 1996. Of 278 patients with S aureus bacteremia, 186 were evaluated according to outcome in a prospective,
observational follow-up study. The time above the minimum inhibitory concentration
was estimated for dicloxacillin sodium for each treatment regimen and evaluated
by logistic regression along with other potential risk factors.
Results The following variables were statistically associated with death: the
presence of an uneradicated focus (odds ratio [OR], 6.7; 95% confidence interval
[CI], 2.1-21.0); the presence of septic shock (OR, 3.7; 95% CI, 1.5-9.1);
the total daily dose of penicillinase-stable penicillin less than 4 g (OR,
3.7; 95% CI, 1.3-11.1); and age 60 years or older (OR, 2.4; 95% CI, 1.1-5.3).
The following variables were significantly associated with recurrence: the
total daily dose of penicillinase-stable penicillin less than 3 g (OR, 3.9;
95% CI, 1.6-10.0) and the presence of a secondary focus (OR, 3.2; 95% CI,
1.3-7.7). Among 155 patients with observation time longer than duration of
treatment, this factor (duration of treatment, <14 days) was significantly
related to mortality (OR, 0.84; 95% CI, 0.76-0.94).
Conclusions Focus eradication and the dosing of penicillinase-stable penicillin
are important to the outcome of S aureus bacteremia.
We recommend treatment with at least 1 g of penicillinase-stable penicillins
4 times daily for longer than 14 days.
From the Sector for Microbiology (Drs Jensen, Espersen, and Frimodt-Møller)
and Biostatistical Unit (Dr Wachmann), Statens Serum Institut; the Department
of Clinical Microbiology, Herlev University Hospital (Dr Scheibel); and the
Department of Infectious Diseases, Rigshospitalet (Dr Skinhøj), Copenhagen,
Denmark.
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