Survival Benefit of Empirical Therapy for Staphylococcus aureus Bloodstream Infections in Infants.

Published

Journal Article

The impact of early adequate empirical antibiotic therapy on outcomes of infants in the neonatal intensive care unit (NICU) who develop Staphylococcus aureus bloodstream infections (BSI) is unknown.Infants with S. aureus BSI discharged in 1997-2012 from 348 NICUs managed by the Pediatrix Medical Group were identified. Early adequate empirical antibiotic therapy was defined as exposure to ≥1 antibiotic with anti-staphylococcal activity on the day the first positive blood culture was obtained. All other cases were defined as inadequate empirical antibiotic therapy. We evaluated the association between inadequate empirical antibiotic therapy on outcomes controlling for gestational age, small for gestational age status, gender, discharge year, mechanical ventilation, inotropic support and use of supplemental oxygen. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, death before hospital discharge and length of bacteremia.Of the 3339 infants with S. aureus BSI, 2492 (75%) had methicillin-susceptible S. aureus (MSSA) BSI and 847 (25%) had methicillin-resistant S. aureus (MRSA) BSI. Inadequate empirical antibiotic therapy was administered in 725 (22%) cases. Inadequate empirical antibiotic therapy was associated with increased 30-day mortality (odds ratio: 2.03; 95% confidence interval: 1.08-3.82) among infants with MRSA BSI. Inadequate empirical antibiotic therapy was not associated with increases in mortality among infants with MSSA BSI.After controlling for confounders, inadequate empirical antibiotic therapy was associated with a modestly increased mortality at 30 days for infants with MRSA BSI.

Full Text

Duke Authors

Cited Authors

  • Thaden, JT; Ericson, JE; Cross, H; Bergin, SP; Messina, JA; Fowler, VG; Benjamin, DK; Clark, RH; Hornik, CP; Smith, PB; Antibacterial Resistance Leadership Group,

Published Date

  • November 2015

Published In

Volume / Issue

  • 34 / 11

Start / End Page

  • 1175 - 1179

PubMed ID

  • 26222060

Pubmed Central ID

  • 26222060

Electronic International Standard Serial Number (EISSN)

  • 1532-0987

International Standard Serial Number (ISSN)

  • 0891-3668

Digital Object Identifier (DOI)

  • 10.1097/INF.0000000000000850

Language

  • eng