Treatment and Outcome of Staphylococcus aureus Bacteremia

Methods: The study population was all patients with a positive blood culture result for S aureus in Copenha- gen County, Denmark, from May 1994 through April 1996. Of 278 patients with S aureus bacteremia, 186 were evaluated according to outcome in a prospective, obser- vational follow-up study. The time above the minimum inhibitory concentration was estimated for dicloxacillin sodium for each treatment regimen and evaluated by lo- gistic regression along with other potential risk factors. Results: The following variables were statistically asso- ciated with death: the presence of an uneradicated focus (odds ratio (OR), 6.7; 95% confidence interval (CI), 2.1- 21.0); the presence of septic shock (OR, 3.7; 95% CI, 1.5- 9.1); the total daily dose of penicillinase-stable penicil- lin less than 4 g (OR, 3.7; 95% CI, 1.3-11.1); and age 60 years or older (OR, 2.4; 95% CI, 1.1-5.3). The following variables were significantly associated with recurrence: the total daily dose of penicillinase-stable penicillin less than 3 g (OR, 3.9; 95% CI, 1.6-10.0) and the presence of a secondary focus (OR, 3.2; 95% CI, 1.3-7.7). Among 155 patients with observation time longer than duration of treatment, this factor (duration of treatment, 14 days) was significantly related to mortality (OR, 0.84; 95% CI, 0.76-0.94). Conclusions: Focus eradication and the dosing of peni- cillinase-stable penicillin are important to the outcome of S aureus bacteremia. We recommend treatment with at least 1 g of penicillinase-stable penicillins 4 times daily for longer than 14 days. Arch Intern Med. 2002;162:25-32