Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study

Abstract

BackgroundStaphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals.MethodsAdult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010–2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis.ResultsA total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality.ConclusionsThe results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.

Incidence and outcomes of systemic infections in patients with leadless pacemakers: Data from the Micra IDE study

“…The second death was also in a patient with aortic valve endocarditis with indication for surgery that refused surgical treatment and died of complications due to endocarditis. This is not an unexpected finding since mortality from bacteremia and endocarditis is fairly high, ranging from 20%‐30% in prior reports …”

“…This is not an unexpected finding since mortality from bacteremia and endocarditis is fairly high, ranging from 20%-30% in prior reports. 19,20 In this small series, we show that patients implanted with a Micra pacemaker who developed bacteremia (mainly with S. aureus and other virulent bacteria such as VRE) did not show any clear signs of device seeding and the majority of patients responded to antibiotics without any evidence of persistent or recurrent infection with the same organism. Patients with recurrent bacteremia developed the second event a mean of 223 days after the initial episode.…”

Recommendations for approaches to meticillin‐resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.

“…Outcomes of MRSA infection in comparison with MSSA infection are frequently studied in human hospitals due to concern about increased mortality from drug resistance and also to assess the impact on healthcare cost. Although some of the more recent reports appear to document an increased risk of mortality in certain patient groups with MRSA, conflicting results remain, likely due to the heterogeneity of MRSA infections (blood stream infections versus skin and soft tissue infections) and healthcare provision and bias from patient characteristics (age, co‐morbidities). In a case series of 11 dogs with MRSA surgical site or skin infection, systemic antibacterial therapy based on susceptibility testing improved or resolved the infection in nine of 11 dogs; one dog had been euthanized with radiographic evidence of osteomyelitis, the other lost to follow‐up .…”

Evaluation of treatment outcomes of patients with MRSA bacteremia following antimicrobial stewardship programs with pharmacist intervention

“…Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality . Compliance with evidence‐based quality‐of‐care indicators (QCIs) in the treatment improves a patient's prognosis .…”

“…However, infectious diseases caused by methicillin‐resistant S. aureus (MRSA) are different from those caused by methicillin‐sensitive S. aureus , and, specifically, differences in the vulnerability of the affected populations and delays in commencing appropriate antimicrobial therapy lead to worse outcomes in cases of MRSA infection. Furthermore, in cases of SAB, methicillin resistance is reported to be an independent factor exacerbating prognosis . There are no reports evaluating the QCIs for MRSA bacteremia (MRSA‐B).…”