Association between empiric multidrug-resistant coverage and in-hospital mortality in adults with sepsis who received empiric anti-MRSA therapy

Abstract

Purpose

The aim of this study was to investigate the association between empiric MDR coverage and in-hospital mortality among adults with sepsis who received empiric anti-MRSA therapy.

Materials and methods

This was a nested case‒control study using Japanese nationwide data from a medical reimbursement system between 2010 and 2017. Patients with sepsis and using empiric antimicrobials with MRSA coverage were extracted. Among them, we enrolled patients with MDR coverage and those without MDR coverage via propensity score matching on the basis of their baseline characteristics.

Results

Both the MDR coverage cohort and the non-MDR coverage cohort each comprised 6,068 patients. The MDR coverage group had more acute organ dysfunction than the non-MDR coverage group did (moderate: 34.0 % vs. 24.3 %; severe: 5.0 % vs. 2.7 %, p < 0.001). The MDR coverage group had significantly higher crude in-hospital mortality than the non-MDR coverage group did (22.9 % vs. 16.7 %, p < 0.001). The conditional logistic regression model revealed that MDR coverage and acute organ dysfunction were significantly associated with in-hospital mortality. The interaction between MDR coverage and severe acute organ dysfunction was statistically significant (p for interaction = 0.02). Stratified by severity, in-hospital mortality rates were reversed between moderate and severe (in-hospital mortality rates: mild 16.4 % vs. 12.3 %; moderate 31.6 % vs. 26.7 %; and severe 42.3 % vs. 44.8 %).

Conclusions

Our study revealed that empiric concomitant MDR coverage might be considered for adults with sepsis who received empiric anti-MRSA therapy if they have multiple acute organ dysfunctions, although their population is small.