1276. Analysis of Treatment Outcome for Uncomplicated Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia (UMRSAB)
Session: Poster Abstract Session: Bacteremia and Endocarditis
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster 4x6_20131 id week murat.pdf (240.6 kB)
  • Background: The Infectious Diseases Society of America (IDSA) recommendation for uncomplicated methicillin-resistant Staphylococcus aureus(MRSA) bacteremia (UMRSAB) is to treat with at least 2 weeks of intravenous (IV) antibiotics. The majority of research about UMRSA has focused on catheter related blood stream infection (CRBSI). Treatment regimens for UMRSAB in non-catheter settings have not been extensively studied.

    Methods: A retrospective cohort study was conducted in an 802 bed tertiary care center from July 2005 through Dec 2012 to analyze UMRSAB from medical records with the following inclusion criteria: exclusion of endocarditis; no implanted prostheses; follow up blood cultures performed 2 - 4 days after the initial set that do not grow MRSA; defervescence within 72 hours of initiating effective therapy; no tunneled catheters and no evidence of metastatic sites of infection.

    Results: Of 1126 consecutive patients with MRSA bacteremia, 146 were uncomplicated. Mean patient age was 58.2 ± 18 years; mean hospital length of stay was 13.9 ± 14.2 days; and mean APACHE II score was12.6 ± 7. The sources of UMRSAB were skin/wound (n=58, 40%), CRBSI (n=34, 23%), unknown (n=33, 22%), genitourinary (n=7, 5%), and respiratory (n=14, 10%). The treatment regimens of patients with UMRSAB from skin/wound etiology were categorized as either IV antibiotic only, oral (PO) antibiotic only, or a combination of inpatient IV and outpatient PO antibiotics (MIX). Of the 58 patients in the skin/wound etiology group, 39 were treated with IV (67%), 5 with PO (8.6%), and 14 with MIX (24%). The duration of treatments for the skin/wound etiology group were IV 19.3 ± 10 days, PO 15 ± 7.2 days and MIX 18.1 ± 11 days, including 5.9 ± 4.5 days of IV and 12.1 ± 10.3 days of PO antibiotics. The overall 30 day mortality in individual treatment groups was 8% (N=3), 0%, and 0%; and recurrences of MRSA were 3% (n=1), 20% (n=1) and 14.3% (n=2) for IV, PO and MIX respectively.

    Conclusion: The present study suggests that clinicians may consider oral antibiotic treatment in selected patients with UMRSAB from a skin/wound source and a lower APACHE II score. Multicenter prospective studies are needed to evaluate optimal treatment.

    Murat Gonulalan, MD1, Samia Arshad, MPH1, Daniela Moreno, B.S.1, Mary Beth Perri, MT2 and Marcus Zervos, MD1,3, (1)Infectious Diseases, Henry Ford Hospital, Detroit, MI, (2)Henry Ford Health System, Detroit, MI, (3)Wayne State University School of Medicine, Detroit, MI

    Disclosures:

    M. Gonulalan, None

    S. Arshad, None

    D. Moreno, None

    M. B. Perri, None

    M. Zervos, None

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