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Staphylococcus aureus treatment often mismanaged in Europe

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More than a quarter of patients sampled who had Staphylococcus aureus bacteremia did not receive adequate antimicrobial therapy, indicated findings from a retrospective cohort study that included patients from hospitals in nine Western European countries.

“These findings suggest that thousands of patients receive inadequate treatment for S. aureus bacteremia in European countries and that, even with low estimated rates of attributable morality due to inadequate empirical treatment, many patients may die as a result,” Ammerlaan et al wrote.

Researchers from several European sites enrolled 334 adult patients — all with either hospital- or community-associated S. aureus bacteremia — who were randomly selected from 60 hospitals in Denmark, France, Germany, Italy, the Netherlands, Spain, Sweden, Switzerland and the United Kingdom. Adequate antimicrobial therapy was defined as IV administration of at least one antibiotic to which the isolate showed in vitro susceptibility, initiated within two days after disease onset. The following findings were reported:

• 28% of patients (n=94) did not receive adequate antibiotic treatment.
• Inadequate antibiotic treatment was identified in 21% of patients with methicillin-susceptible S. aureus isolates (n=257) and 52% of patients with methicillin-resistant S. aureus (n=77).
• 92% of patients with MSSA received adequate treatment five days after index blood cultures were taken compared with 83% of patients with MRSA (P<.001).
• Patients with longer hospital stays (OR=1.01; 95% CI, 1.00-1.03) and those with methicillin-resistant isolates (OR=3.7; 95% CI, 2.2-6.4) were significantly associated with inadequate treatment.
• Overall 30-day mortality rates were 24% (n=80).
• Increased 30-day mortality was associated with age (OR=1.6; 95% CI, 1.03-1.10), Charlson comorbidity score (OR=2.1; 95% CI, 1.2-3.6), severe sepsis or septic shock (OR=2.7; 95% CI, 1.5-4.8) and ICU stay at disease onset (OR=2.9; 95% CI, 1.5-5.6) but not with inadequate treatment (OR=0.7; 95% CI, 0.4-1.3).

The researchers confirmed that MRSA rates at the participating hospitals were representative in each study country using data from the European Antimicrobial Resistance Surveillance System. “This suggests that the results and outcomes of this study adequately reflect the present situation in Western Europe regarding the adequacy of antibiotic treatment of patients with S. aureus bacteremia,” they wrote.

Ammerlaan H. Clin Infect Dis. 2009;49:997-1005.