Survival following Staphylococcus aureus bloodstream infection: A prospective multinational cohort study assessing the impact of place of care

Nambiar, Kate; Seifert, Harald; Rieg, Siegbert; Kern, Winfried V.; Scarborough, Matt; Gordon, N Claire; Kim, Hong Bin; Song, Kyoung Ho; Tilley, Robert; Gott, Hannah; Liao, Chun-Hsing; Edgeworth, Jonathan D; Nsutebu, Emmanuel; López-Cortés, Luis Eduardo; Morata, Laura; Walker, A. Sarah; Thwaites, Guy; Llewelyn, Martin; Kaasch, Achim J.; Sepsis,

doi:10.1016/j.jinf.2018.08.015

Cited by 54 publications

(40 citation statements)

References 19 publications

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“…In this study, all-cause mortality rates were in the range expected for low-risk foci [23] and did not differ between the groups. This was somewhat surprising, because patients with foreign bodies were on average 10 years older and had more comorbid conditions.…”

Section: Discussionmentioning

confidence: 59%

Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study

Kaasch

Kern

Joost

et al. 2019

Open Forum Infectious Diseases

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Background The standard treatment duration in low-risk Staphylococcus aureus bloodstream (SAB) is 14 days. However, it is unclear whether an extended course of antimicrobial therapy is necessary in patients with clinically uninfected prosthetic joints/osteosyntheses or pacemakers/automated implanted cardioverter-defibrillators (AICDs). Thus, we compared the duration of antimicrobial therapy and outcomes in patients with and those without clinically uninfected foreign bodies. Methods We conducted a post hoc analysis of data from the prospective Invasive Staphylococcus aureus Infection Cohort (INSTINCT) study. Adult low-risk patients who survived ≥4 days were assessed for duration of treatment, SAB-related events (attributable death, relapse, or new deep-seated infection), and survival. Results Of the 1288 patients enrolled, 292 satisfied criteria for low-risk SAB. Forty-three patients (15%) had a clinically uninfected pacemaker/AICD or orthopedic implant. Patients with foreign bodies were significantly older (mean age, 72 vs 62 years for those without; P < .001; P = .9) and had a higher Charlson score (median, 3 vs 2; P = .06). The total duration of antimicrobial therapy (median, 18 vs 17 days, respectively; P = .7), all-cause mortality rate (16% vs 14%; P = .7), and prevalence of SAB-related events within 90 days were similar (2% vs 2%) in the 2 groups. At 1-year follow-up, SAB-related events were more frequent in patients with foreign bodies (7% vs 4% in those without; P = .4) (hazard ratio, 1.41; 95% confidence interval, .35–5.69; in a multivariable Cox model), but this difference was not statistically significant. Conclusions Low-risk patients with clinically uninfected foreign bodies received a similar duration of antimicrobial therapy without a significant impact on mortality rate. The observed higher hazard ratio of SAB-related events within 1 year necessitates additional studies before recommendations concerning treatment duration in this patient subgroup can be adapted or modified.

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Section: Discussionmentioning

confidence: 59%

Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study

Kaasch

Kern

Joost

et al. 2019

Open Forum Infectious Diseases

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“…Next, patients with TPN support were found to be younger, more frequently female and with less comorbidity in comparison to non-TPN patients with S. aureus bacteremia. These are all factors that are associated with a lower mortality risk in the general population [ 12 , 15 , 20 , 35 ]. Nevertheless, receiving TPN was still independently associated with an increased survival probability in the multivariate Cox model.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, S. aureus CLABSIs frequently lead to long hospitalizations, prolonged antibiotic courses and, if recurrent, eventually to loss of vascular access [ 17 , 18 , 19 ]. Nevertheless, mortality from SAB in patients with a CVC as the main focus seems lower than in patients with other dominant foci [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ], with a 7–21% attributable mortality rate at 30 days [ 21 , 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition

et al. 2020

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Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients.

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“…Staphylococcus aureus (S. aureus) is one of the leading pathogens causing community-acquired and hospital-acquired bloodstream infections ranking second after Escherichia coli. Incidences were estimated between 10 to 30 cases per 100,000 person-years (1) and hospital mortality is high, ranging between 15 and 40% (2,3).…”

Section: Introductionmentioning

confidence: 99%

Management of Staphylococcus aureus Bloodstream Infections

et al. 2021

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Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.

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Survival following Staphylococcus aureus bloodstream infection: A prospective multinational cohort study assessing the impact of place of care

Abstract: We observed significant differences in adjusted mortality between hospitals, suggesting differences in quality of care. However, mortality is strongly influenced by patient mix and thus, crude mortality is not a suitable quality indicator.

Cited by 54 publications

References 19 publications

Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study

Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study

Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition

Management of Staphylococcus aureus Bloodstream Infections

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