Predicting methicillin resistance and the effect of inadequate empiric therapy on survival in patients with Staphylococcus aureus bacteremia.

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Abstract
THE RESTRICTION of vancomycin hydrochloride use is recommended as a measure to decrease the emergence of vancomycin resistance in gram-positive organisms,1 including enterococcus and Staphylococcus aureus; however, vancomycin also is the treatment of choice for methicillin-resistant S aureus (MRSA) infections.2 If vancomycin use is restricted to patients with documented infections due to methicillin-resistant organisms, then patients with MRSA infections may not receive vancomycin for the first 48 hours of therapy until the cultures are reported as positive for S aureus. This study was performed to determine factors that predict MRSA bacteremia in patients with S aureus bacteremia and if ineffective empiric antibiotic therapy increased the risk of death in patients with S aureus bacteremia.