Early empirical glycopeptide therapy for patients with methicillin-resistant Staphylococcus aureus bacteraemia:: impact on the outcome

Objectives: To evaluate whether appropriate early empirical glycopeptide therapy improves outcomes of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Methods: We retrospectively collected the data for all adult patients with confirmed MRSA bacteraemia diagnosed and treated at National Taiwan University Hospital during the period 1 April 1997-31 March 2001, and followed their survival up to three years. The main outcome measures were MRSA-related death and all-cause mortality. Results: There were 77 MRSA-related deaths among 162 patients. There was no statistically significant difference in MRSA-related deaths between patients receiving glycopeptides before or within 48 h after blood culture (n = 43) (55%, 18/33, non-septic shock group; 90%, 9/10, septic shock group) or those whose glycopeptide therapy was begun more than 48 h after blood culture (n = 119) (37%, 40/107, non-septic shock group; 83%, 10/12, septic shock group) (P = 0.11 and 1.00, respectively). The outcome measure of all-cause mortality from 30 days to 3 years yields similar results. Multivariate logistic regression analysis and Cox analysis showed that the length of delay (daily increment) between blood culture sampling and start of glycopeptide therapy did not have a statistically significant impact on MRSA-related death or all-cause 30-day mortality after adjusting for the effect of other variables [adjusted odds ratio 0.99, 95% confidence interval (95% CI) 0.88-1.12; adjusted hazard ratio 0.87, 95% CI 0.74-1.02, respectively). Conclusions: The hypothesis that earlier empirical use of glycopeptide therapy reduces mortality in patients with hospital-acquired MRSA bacteraemia was not supported.