Kim Sung-Han, Kim Kye-Hyung, Kim Hong-Bin, Kim Nam-Joong, Kim Eui-Chong, Oh Myoung-don, Choe Kang-Won
Department of Internal Medicine, Seoul National University College of Medicine, 28 Youngundong, Chongrogu, Seoul 110-744, Republic of Korea.
Antimicrob Agents Chemother. 2008 Jan;52(1):192-7. doi: 10.1128/AAC.00700-07. Epub 2007 Nov 5.
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.
与β-内酰胺类药物治疗相比，关于耐甲氧西林金黄色葡萄球菌菌血症（MSSA-B）患者使用万古霉素治疗的临床结局的可用数据有限。我们采用了不同且互补的方法：（i）一项回顾性队列研究，使用倾向评分来调整治疗分配造成的混杂因素；（ii）一项匹配病例对照研究。在7年期间，两所大学附属医院的所有金黄色葡萄球菌菌血症（SAB）患者中，294例MSSA-B患者被纳入队列研究。病例对照研究的病例定义为接受万古霉素治疗的MSSA-B患者；对照组为接受β-内酰胺类药物治疗的MSSA-B患者，根据客观匹配评分系统和倾向评分系统按1:2（病例:对照）的比例选择。在队列研究中，接受万古霉素治疗的患者中SAB相关死亡率（37%，10/27）显著高于接受β-内酰胺类药物治疗的患者（18%，47/267）（P = 0.02）。此外，多变量分析显示，在考虑SAB相关死亡率和倾向评分的独立预测因素时，万古霉素治疗与SAB相关死亡率相关（调整后的优势比为3.3，95%置信区间为1.2至9.5）。在使用客观匹配评分系统和倾向评分系统的病例对照研究中，病例组患者的SAB相关死亡率为37%（10/27），对照组患者为11%（6/54）（P < 0.01）。我们的数据表明，在治疗MSSA-B方面，万古霉素不如β-内酰胺类药物。
