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Outcome of inappropriate empirical antibiotic therapy in patients with Staphylococcus aureus bacteraemia: analytical strategy using propensity scores

Cited 48 time in Web of Science Cited 51 time in Scopus
Authors
Kim, S.-H.; Park, W.-B.; Lee, C-S.; Kang, C.-I.; Bang, J.-W.; Kim, H.-B.; Kim, N.-J.; Kim, E.-C.; Oh, M. D.; Choe, K.-W.
Issue Date
2006
Publisher
Wiley-Blackwell
Citation
Clin Microbiol Infect 2006; 12: 13-21
Keywords
Anti-Bacterial Agents/pharmacology/*therapeutic useBacteremia/*drug therapy/microbiology/*mortalityBias (Epidemiology)Case-Control StudiesCohort StudiesLogistic Models*Medication ErrorsMultivariate AnalysisStaphylococcal Infections/drug therapy/microbiology/mortalityStaphylococcus aureus/*drug effectsTreatment Outcome
Abstract
Patients with Staphylococcus aureus bacteraemia (SAB) who received either inappropriate or appropriate empirical therapy were compared by using two risk stratification models: (1) a cohort study using a propensity score to adjust for confounding by empirical treatment assignment; and (2) a propensity-matched case-control study. Inappropriate empirical therapy was modelled on the basis of patient characteristics, and included in the multivariate model to adjust for confounding. For case-matching analysis, patients with inappropriate empirical therapy (cases) were matched to those with appropriate empirical therapy (controls) on the basis of the propensity score (within 0.03 on a scale of 0-1). In total, 238 patients with SAB were enrolled in the cohort study. Characteristics associated with inappropriate empirical therapy were methicillin resistance, underlying haematological malignancy, no history of colonisation with methicillin-resistant S. aureus, and a long hospital stay before SAB. These variables were included in the propensity score, which had an area under the receiver operating characteristics curve of 85%. In the cohort study, SAB-related mortality was 39% (45/117) for inappropriate empirical therapy vs. 28% (34/121) for appropriate empirical therapy (odds ratio (OR) 1.60; 95% CI 0.93-2.76). After adjustment for independent predictors for mortality and the propensity score, inappropriate empirical therapy was not associated with mortality (adjusted OR 1.39; 95% CI 0.62-3.15). In the matched case-control study (50 pairs), SAB-related mortality was 32% (16/50) for inappropriate empirical therapy and 28% (14/50) for appropriate empirical therapy (McNemar's test; p 0.85; OR 1.15; 95% CI 0.51-2.64). In conclusion, inappropriate empirical therapy resulted in only a slight tendency towards increased mortality in patients with SAB.
ISSN
1198-743X (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16460541

http://hdl.handle.net/10371/11873
DOI
https://doi.org/10.1111/j.1469-0691.2005.01294.x
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College of Medicine/School of Medicine (의과대학/대학원)Laboratory Medicine (검사의학전공)Journal Papers (저널논문_검사의학전공)
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