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Antimicrobial Agents and Chemotherapy, January 2008, p. 192-197, Vol. 52, No. 1
0066-4804/08/$08.00+0     doi:10.1128/AAC.00700-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Outcome of Vancomycin Treatment in Patients with Methicillin-Susceptible Staphylococcus aureus Bacteremia{triangledown}

Sung-Han Kim,1,3 Kye-Hyung Kim,1 Hong-Bin Kim,1 Nam-Joong Kim,1 Eui-Chong Kim,2,3 Myoung-don Oh,1,3* and Kang-Won Choe1,3

Departments of Internal Medicine,1 Laboratory Medicine, Seoul National University College of Medicine,2 Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea3

Received 30 May 2007/ Returned for modification 10 August 2007/ Accepted 26 October 2007

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.

* Corresponding author. Mailing address: Department of Internal Medicine, Seoul National University College of Medicine, 28 Youngundong, Chongrogu, Seoul 110-744, Republic of Korea. Phone: 82-2-2072-2945. Fax: 82-2-762-9662. E-mail: mdohmd{at}snu.ac.kr

{triangledown} Published ahead of print on 5 November 2007.

Antimicrobial Agents and Chemotherapy, January 2008, p. 192-197, Vol. 52, No. 1
0066-4804/08/$08.00+0     doi:10.1128/AAC.00700-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Rehm, S. J., Boucher, H., Levine, D., Campion, M., Eisenstein, B. I., Vigliani, G. A., Corey, G.R., Abrutyn, E. (2008). Daptomycin versus vancomycin plus gentamicin for treatment of bacteraemia and endocarditis due to Staphylococcus aureus: subset analysis of patients infected with methicillin-resistant isolates. J Antimicrob Chemother 62: 1413-1421 [Abstract] [Full Text]  
  • MacGowan, A. P., on behalf of the BSAC Working Parties on Resistanc, (2008). Clinical implications of antimicrobial resistance for therapy. J Antimicrob Chemother 62: ii105-ii114 [Abstract] [Full Text]  
  • (2008). MSSA Bacteremia: Vancomycin vs. {beta}-Lactams. JWatch Infect. Diseases 2008: 4-4 [Full Text]  


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