17984229

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1

Limited data on the clinical outcome of vancomycin treatment compared with that of beta-lactam treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia (MSSA-B) are available. We used different and complementary approaches: (i) a retrospective cohort study using a propensity score to adjust for confounding by treatment assignment and (ii) a matched case-control study. Of all patients with S. aureus bacteremia (SAB) in two university-affiliated hospitals over a 7-year period, 294 patients with MSSA-B were enrolled in the cohort study. The cases for the case-control study were defined as patients who received vancomycin treatment for MSSA-B; the controls, who were patients that received beta-lactam treatment for MSSA-B, were selected at a 1:2 (case:control) ratio according to the objective matching scoring system and the propensity score system. In the cohort study, SAB-related mortality in patients with vancomycin treatment (37%, 10/27) was significantly higher than that in those with beta-lactam treatment (18%, 47/267) (P = 0.02). In addition, multivariate analysis revealed that vancomycin treatment was associated with SAB-related mortality when independent predictors for SAB-related mortality and propensity score were considered (adjusted odds ratio of 3.3, 95% confidence interval of 1.2 to 9.5). In the case-control study using the objective matching scoring system and the propensity score system, SAB-related mortality in case patients was 37% (10/27) and in control patients 11% (6/54) (P < 0.01). Our data suggest that vancomycin is inferior to beta-lactam in the treatment of MSSA-B.

eng

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MEDLINE

0066-4804

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192-7

pubmed-meshheading:17984229-Adult, pubmed-meshheading:17984229-Aged, pubmed-meshheading:17984229-Anti-Bacterial Agents, pubmed-meshheading:17984229-Bacteremia, pubmed-meshheading:17984229-Case-Control Studies, pubmed-meshheading:17984229-Cohort Studies, pubmed-meshheading:17984229-Female, pubmed-meshheading:17984229-Hospitals, University, pubmed-meshheading:17984229-Humans, pubmed-meshheading:17984229-Korea, pubmed-meshheading:17984229-Male, pubmed-meshheading:17984229-Methicillin, pubmed-meshheading:17984229-Microbial Sensitivity Tests, pubmed-meshheading:17984229-Middle Aged, pubmed-meshheading:17984229-Staphylococcal Infections, pubmed-meshheading:17984229-Staphylococcus aureus, pubmed-meshheading:17984229-Treatment Outcome, pubmed-meshheading:17984229-Vancomycin, pubmed-meshheading:17984229-beta-Lactams

Outcome of vancomycin treatment in patients with methicillin-susceptible Staphylococcus aureus bacteremia.

Journal Article, Clinical Trial