Table 2.
Clinical managements and mortality of patients with bacteremia
| SLB (n = 22) | SEB (n = 110) | SAB (n = 110) | P value among three groups |
P value SLB—SEB |
P value SLB—SAB |
|
|---|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | ||||
| Clinical managements | ||||||
| Follow-up blood cultures | 17 (77) | 93 (85) | 99 (90) | 0.21 | ||
| Echocardiography | 12 (55) | 40 (36) | 91 (83) | < 0.01 | 0.11 | < 0.01 |
| Early source control | 10/14 (71) | 43/56 (77) | 42/58 (72) | 0.84 | ||
| Days to source control, median (IQR) | 1 (0–2) | 1 (0–2) | 0 (0–3) | 0.35 | ||
| Days to appropriate treatmenta, median (IQR) | 0 (0–2) | 1 (1–2) | 0 (0–1) | < 0.01 | 0.04 | 0.28 |
| Empiric glycopeptide | 2 (9) | 45 (41) | 60 (55) | < 0.01 | < 0.01 | < 0.01 |
| Early optimal therapyb, c (within 24 h) | 18/21 (86) | 94 (85) | 101/106 (95) | 0.046 | 0.6 | 0.1 |
| Definitive therapyc | ||||||
| Cefazolind | 9/21 (43) | 8 (7) | 37/106 (35) | < 0.01 | < 0.01 | 0.49 |
| Third-generation cephalosporinse | 2/21 (10) | 3 (3) | 16/106 (15) | < 0.01 | 0.14 | 0.50 |
| Cefepime | 1/21 (5) | 2 (2) | 5/106 (5) | 0.47 | ||
| Oral cephalosporinsf | 2/21 (10) | 0 | 0 | < 0.01 | 0.02 | 0.03 |
| β-lactam/β-lactamase inhibitorsg | 1/21 (5) | 1 (1) | 11/106 (10) | < 0.01 | 0.19 | 0.42 |
| Meropenem | 1/21 (5) | 1 (1) | 5/106 (5) | 0.22 | ||
| Glycopeptidesh | 5/21 (24) | 90 (82) | 30/106 (28) | < 0.01 | < 0.01 | 0.67 |
| Daptomycin | 0 | 5 (5) | 2/106 (2) | 0.36 | ||
| Combination therapy | 2 (9) | 4 (4) | 10 (9) | 0.24 | ||
| Rifampicin | 1/21 (5) | 3 (3) | 6/106 (6) | 0.59 | ||
| Gentamycin | 1/21 (5) | 1 (1) | 2/106 (2) | 0.47 | ||
| Levofloxacin | 1/21 (5) | 0 | 0 | 0.01 | 0.02 | 0.02 |
| Clindamycin | 0 | 0 | 2/106 (2) | 0.30 | ||
| Duration of treatment (days), median (IQR) | 16 (8–27) | 13 (10–18) | 19 (14–33) | < 0.01 | 0.29 | 0.20 |
| 7-day mortality | 2 (9) | 1 (1) | 8 (7) | 0.04 | 0.02 | 0.77 |
| 30-day mortality | 3/21 (15) | 9 (8) | 19 (17) | 0.13 | ||
| Hospital mortality | 5/21 (24) | 18 (16) | 28 (25) | 0.24 | ||
Data are expressed as numbers (%) unless otherwise indicated
Abbreviations: SLB Staphylococcus lugdunensis bacteremia, SAB Staphylococcus aureus bacteremia, SEB Staphylococcus epidermidis bacteremia, IQR Interquartile range
aDays to appropriate treatment defined as the time from blood culture collection to the start at least 1 active drug in accordance with in vitro susceptibility
bEarly optimal therapy defined as starting β lactam antibiotics for methicillin susceptible isolates and glycopeptide or daptomycin for methicillin resistant isolates within 24 h of obtaining drug susceptibility and adjustment of the glycopeptide trough > 15 µg/ml
cThe denominator was the number of patients who were alive within 24 h of obtaining drug susceptibility
dNafcillin and oxacillin were not available in Japan
eThird-generation cephalosporins included ceftriaxone or cefotaxime
fOral cephalosporins included cefalexin or cefcapene pivoxil. Two patients with mild SSTI in the SLB group were treated as outpatients using oral antibiotics
gβ-lactam/β-lactamase inhibitors included ampicillin/sulbactam or piperacillin/tazobactam
hGlycopeptides included vancomycin or teicoplanin