Infection and Drug Resistance (Aug 2018)

Clinical outcomes after initial treatment of methicillin-resistant Staphylococcus aureus infections

  • Shime N,
  • Saito N,
  • Bokui M,
  • Sakane N,
  • Kamimura M,
  • Shinohara T,
  • Kosaka T,
  • Ishikura H,
  • Kobayashi A

Journal volume & issue
Vol. Volume 11
pp. 1073 – 1081

Abstract

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Nobuaki Shime,1,2 Nobuyuki Saito,3 Miya Bokui,4 Naoki Sakane,5 Mitsuhiro Kamimura,6 Tsutomu Shinohara,7 Tadashi Kosaka,8 Hisashi Ishikura,9 Atsuko Kobayashi,10 1Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan; 2Department of Emergency and Critical Care Medicine, Kyoto Medical Centre, Kyoto, Japan; 3Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan; 4Department of Pharmacy, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan; 5Clinical Research Institute, National Hospital Organization Kyoto Medical Centre, Kyoto, Japan; 6Department of Pulmonology, National Hospital Organization Disaster Medical Centre, Tokyo, Japan; 7Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi, Japan; 8Department of Pharmacy, Kyoto Prefectural University, School of Medicine, Kyoto, Japan; 9Department of Surgery, Tokushima Red Cross Hospital, Komatsushima, Japan; 10Department of Central Laboratory, Takarazuka City Hospital, Hyogo, Japan Objective: To evaluate the clinical outcomes associated with anti-methicillin-resistant Staphylococcus aureus (MRSA) antimicrobials. Methods: We reviewed a prospective database of 247 consecutive patients with clinically and microbiologically confirmed MRSA infections, hospitalized in 7 Japanese hospitals between April 2014 and March 2015, and treated with anti-MRSA pharmaceuticals. Survival was measured at 30 days. We examined the relationships between initial antimicrobial administered and survival and organ toxicity. HR and 95% CIs were calculated. Results: Overall 30-day mortality was 12%. The lungs were infected in 105 (41%), skin and soft tissue in 73 (30%), and bones and joints in 21 (9%) patients. Bacteremia complicated the illness in 69 patients (28%). Among 5 pharmaceuticals, vancomycin was prescribed to 174 (71%), linezolid to 38 (16%), teicoplanin to 22 (9%), and daptomycin to 11 (5%) patients. Vancomycin tended to be associated with the lowest survival (HR=2.47; 95% CI=0.93–6.51; P=0.067), particularly in the lung-infected subgroup (HR=4.85; 95% CI=1.12–20.94; P=0.034) after adjustments for baseline illness severity. The incidence of renal dysfunction tended to be higher in patients with trough serum concentrations of vancomycin >15 mg/dL. Conclusion: In this observational study reflecting real-world conditions, vancomycin was associated with higher 30-day mortality and incidence of kidney dysfunction than other anti-MRSA agents. The significance of the differences observed among antimicrobials other than vancomycin is uncertain. Keywords: methicillin-resistant Staphylococcus aureus, vancomycin, linezolid, infectious mortality, renal dysfunction

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