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Critical Care Medicine:
doi: 10.1097/01.CCM.0000227655.41566.3E
Continuing Medical Education Article

Methicillin-resistant Staphylococcus aureus sterile-site infection: The importance of appropriate initial antimicrobial treatment*

Schramm, Garrett E. PharmD; Johnson, Jennifer A. MD; Doherty, Joshua A. BS; Micek, Scott T. PharmD; Kollef, Marin H. MD

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Abstract

Objective: The first goal of this investigation was to determine the rate of appropriate initial antimicrobial administration to patients with methicillin-resistant Staphylococcus aureus (MRSA) sterile-site infections. Our second goal was to evaluate the influence of appropriate initial treatment of MRSA sterile-site infection on outcome.

Design: A retrospective, single-center, observational cohort study.

Setting: Barnes-Jewish Hospital, a 1200-bed urban teaching facility.

Patients: Adult patients requiring hospitalization identified to have an MRSA sterile-site infection.

Interventions: Retrospective data collection from automated hospital and pharmacy databases.

Measurements and Main Results: Five hundred forty-nine patients with S. aureus sterile site infections were identified during a 3-yr period (January 2002 through December 2004). One hundred twenty-seven (23.1%) died during hospitalization. Hospital mortality was statistically greater for patients receiving inappropriate initial antimicrobial treatment (n = 380) within 24 hrs of a positive culture than for those receiving appropriate initial treatment (n = 169) (26.1% vs. 16.6%; p = .015). Multiple logistic regression analysis identified inappropriate initial antimicrobial treatment (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.48–2.50; p = .0134), vasopressor administration (AOR, 5.49; 95% CI, 4.08–7.38; p < .001), and increasing age (1-yr increments) (AOR, 1.03; 95% CI, 1.02–1.04; p < .001) as independent determinants of hospital mortality.

Conclusions: Inappropriate initial antimicrobial treatment of MRSA sterile-site infections is common and is associated with an increased risk of hospital mortality. Appropriate antimicrobial treatment of MRSA sterile-site infections may be maximized by increased use of initial empirical antimicrobial treatment regimens targeting MRSA in patients at risk for this infection until organism identification and susceptibility become known.

LEARNING OBJECTIVES: On completion of this article, the reader should be able to:

1. Explain the impact of appropriate initial antimicrobial treatment for methicillin-resistant Staphylococcus aureus (MRSA) sterile site infections.

2. List examples of “sterile sites” used.

3. Use this information in a clinical setting.

Dr. Kollef has disclosed that he is/was the recipient of grant/research funds from Merck, Elan, Pfizer, and Bard. All remaining authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.

Visit the Critical Care Medicine Web site (www.ccmjournal.org) for information on obtaining continuing medical education credit.

© 2006 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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