Mortality in Staphylococcus aureus bacteraemia remains high despite adherence to quality indicators: secondary analysis of a prospective cohort study

Willekens, Rein; Puig-Asensio, Mireia; Suanzes, Paula; Fernández-Hidalgo, Núria; Larrosa, Nieves; González-López, Juan José; Rodríguez-Pardo, Dolors; Pigrau, Carles; Almirante, Benito

doi:10.1016/j.jinf.2021.10.001

Cited by 15 publications

(13 citation statements)

References 38 publications

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“…The reported 28-day mortality rate was 14.5% which is lower than that reported in the literature (21–42%) [ 5 – 10 ]. One hypothesis of the increased mortality among aforementioned studies could be due to the higher rate of MRSA as compared to the present study (7.9%) [ 6 – 10 ]; the rate of MRSA in the present study is comparable to that reported from S. aureus surgical site infections from a multicenter Swiss study [ 26 ].…”

Section: Discussionmentioning

confidence: 60%

“…Due to its complexity, a holistic approach incorporating diagnostic workup (follow-up blood cultures, echocardiography, metastatic foci identification) and management (antimicrobial treatment and source control) is needed to improve outcome [ 2 – 4 ]. Despite such an approach, mortality remains high, ranging from 21 to 42% [ 5 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Several factors have been associated with worst outcome among patients with S. aureus bacteremia, such as age, comorbidities [ 5 , 6 , 9 – 11 ], presence of sepsis or septic shock [ 6 , 9 , 12 , 13 ], immunosuppression [ 14 , 15 ], and specific foci of infection, such as pneumonia, endocarditis or bacteremia of unknown origin [ 5 , 8 , 9 , 11 ]. Although, aforementioned factors are unmodifiable, management of bacteremia can also impact outcome; appropriate antimicrobial treatment was repeatedly shown to improve outcome [ 6 , 7 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study

Papadimitriou-Olivgeris

Caruana

Senn

et al. 2023

Eur J Clin Microbiol Infect Dis

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S. aureus bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with S. aureus bacteremia and evaluate the role of early source control. This retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of S. aureus bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of S. aureus bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (P < 0.001), nosocomial bacteremia (P 0.019), time to blood culture positivity ≤ 13 h (P 0.004), persistent bacteremia for ≥ 48 h (P 0.004), sepsis (P < 0.001), bacteremia of unknown origin (P 0.036) and lower respiratory tract infection (P < 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (P < 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (P < 0.001) was associated with better survival. Mortality among patients with S. aureus bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study

Papadimitriou-Olivgeris

Caruana

Senn

et al. 2023

Eur J Clin Microbiol Infect Dis

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“…Staphylococcus aureus is one of the leading causes of bacteremia in both community and nosocomial-acquired infections. S. aureus bacteremia (SAB) is associated with increased mortality which is influenced by the presence of metastatic foci, such as infective endocarditis (IE) (1)(2)(3)(4)(5)(6). IE is estimated to complicate 10-20% of SAB (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia

Papadimitriou‐Olivgeris¹,

Monney²,

Mueller³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionInfective endocarditis (IE) is a common complication of Staphylococcus aureus bacteremia (SAB). The study aimed to develop and validate a prediction score to determine IE risk among SAB.MethodsThis retrospective study included adults with SAB (2015–2021) and divided them into derivation and validation cohorts. Using the modified 2015 European Society of Cardiology modified Duke Criteria for definite IE, the LAUSTAPHEN score was compared to previous scores.ResultsAmong 821 SAB episodes, 419 and 402 were divided into derivation and validation cohorts, respectively. Transthoracic and transoesophageal echocardiography (TOE) were performed in 77.5 and 42.1% of episodes, respectively. Definite IE was diagnosed in 118 episodes (14.4%). Derivation cohort established that cardiac predisposing factors, such as cardiac implantable electronic devices, prolonged bacteremia ≥48 h, and vascular phenomena were independently associated with IE. In addition to those parameters, native bone and joint infections were used to constitute the LAUSTAPHEN score. LAUSTAPHEN and VIRSTA scores misclassified <4% of IE cases as low risk. Misclassification using POSITIVE and PREDICT scores was >10%. The number of TOEs required to safely exclude IE were 66.9 and 51.6% with VIRSTA and LAUSTAPHEN, respectively.DiscussionLAUSTAPHEN and VIRSTA scores exhibited the lowest misclassification rate of IE cases to the low-risk group. However, the number of patients requiring TOE was higher for VIRSTA than for LAUSTAPHEN.

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“…RMD Open RMD Open RMD Open causing secondary infections, such as endocarditis, osteomyelitis and joint infections. [3][4][5] Risk factors include high age, male sex, comorbidities, implanted devices, surgical procedures and intravenous catheters. 6 7 We have previously demonstrated an approximately doubled risk of S. aureus bacteraemia in Danish patients with RA compared with the general population and an up to fivefold increased risk for patients with RA with orthopaedic implants.…”

Section: What This Study Addsmentioning

confidence: 99%

Antirheumatic treatment, disease activity and risk ofStaphylococcus aureusbacteraemia in rheumatoid arthritis: a nationwide nested case–control study

et al. 2022

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ObjectivesTo assess how biological disease-modifying antirheumatic drugs (bDMARDs), glucocorticoids and disease activity affect risk ofStaphylococcus aureusbacteraemia (SAB) in patients with rheumatoid arthritis (RA).MethodsIn a nationwide cohort of patients with RA from the DANBIO registry, we conducted a nested case–control study including first-time microbiologically verified SAB cases from 2010 to 2018 and incidence density matched controls (1:4 by sex, age). We interlinked Danish registries and identified antirheumatic treatments, RA-specific clinical characteristics, comorbidities and socioeconomic status. The relative risk of SAB was assessed by adjusted ORs with 95% CIs and number needed to harm (NNH) reflected the absolute risk.ResultsAmong 30 479 patients, we identified 180 SAB cases (incidence rate: 106.7/100 000 person-years) and matched 720 controls (57% women, median age 73 years, IQR: 65–80). Risk of SAB was increased in current (OR 1.8 (95% CI 1.1 to 3.2)) and former bDMARD users (OR 2.5 (95% CI 0.9 to 7.0)), and in current users of oral glucocorticoids ≤7.5 prednisolone-equivalent mg/day (OR 2.2 (95% CI 1.3 to 4.0) and >7.5 mg/day (OR 9.5 (95% CI 3.9 to 22.7)) (non-use as reference). ORs for moderate/high disease activity compared with remission were 1.6 (95% CI 0.8 to 3.3)/1.5 (95% CI 0.6 to 4.3). Risk was increased in patients with longstanding RA (>10 years vs ≤3 years, OR=2.4 (95% CI 1.1 to 5.3)). The NNH was 1172(95% CI 426 to 9374) for current use of bDMARDs and 110(95% CI 43 to 323) for glucocorticoids >7.5 mg/day.ConclusionWe identified a dose-dependent increased risk of SAB in patients with RA currently using oral glucocorticoids. Daily use of >7.5 mg appeared to be a clinically relevant risk factor, whereas the absolute risk was low for bDMARDs. No clear impact of disease activity was found.

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Mortality in Staphylococcus aureus bacteraemia remains high despite adherence to quality indicators: secondary analysis of a prospective cohort study

Cited by 15 publications

References 38 publications

Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study

Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study

The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia

Antirheumatic treatment, disease activity and risk ofStaphylococcus aureusbacteraemia in rheumatoid arthritis: a nationwide nested case–control study

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