To the Editor.
—In the article by Dr Leibovici and colleagues1 concerning survival after an episode of bacteremia, one major characteristic of the study group was not addressed—the incidence of infection with resistant organisms.In the study, the appropriateness of empirical antibiotic therapy was based on whether the microorganism was later found to be susceptible to the antibiotic chosen. As such, resistant organisms would be found to be inappropriately treated, and the increased mortality found in patients inappropriately treated may actually reflect a higher mortality associated with resistant organisms. Without mention of the prevalence of resistant organisms, it is difficult to judge the actual appropriateness of empirical antibiotic therapy.Another finding of the study also could be made more meaningful with mention of the organisms' resistance patterns. That finding is the higher mortality associated with certain microorganisms such as Staphylococcus aureus or Enterococcus species. It would be interesting to
Shumate MJ. Survival Following Bacteremia With Resistant Organisms. JAMA. 1996;275(5):360. doi:10.1001/jama.1996.03530290030025
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