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The Scientific World Journal
Volume 2013, Article ID 457435, 7 pages
http://dx.doi.org/10.1155/2013/457435
Clinical Study

Timing of Initiating Glycopeptide Therapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: The Impact on Clinical Outcome

1Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
2Department of Clinical Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan

Received 23 November 2012; Accepted 23 December 2012

Academic Editors: G. Dimopoulos and J. Lipman

Copyright © 2013 Chen-Hsiang Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

When a Staphylococcus-like organism (SLO) is microscopically found in Gram staining of blood culture (BC) specimen, it seems reasonable to administrate a glycopeptide (GP) for empirical therapy. The paper investigates the risk factors for 14-day mortality in patients with methicillin-resistance Staphylococcus aureus bacteremia (MRSAB) and clarifies the impact of the timing for initiating GP therapy. A retrospective study identifies patients with MRSAB (endocarditis was excluded) between 2006 and 2009. Patients were categorized as receiving GP at the interval before a preliminary BC report indicating the growth of SLO and the onward 24 hours or receiving GP 24 h after a preliminary BC report indicating the growth of SLO. Total 339 patients were enrolled. There was no difference on the 14-day overall or infection-related mortality rates at the time to administer GP. Multivariate analysis disclosed pneumonia (OR = 4.47; of 95% CI; of 2.09–9.58; ) and high APACHE II score (OR, 2.81, with 95% CI, 1.19–6.65; ) were independent risk factors for infection-related mortality. The mortality rate did not decrease following administrating GP immediately after a preliminary BC indicating SLO growth. An additional research for the optimal timing for initiating GP treatment is warranted.