Infect Chemother. 2008 May-Jun;40(3):148-153. Korean.
Published online Jun 20, 2008.
Copyright © 2008 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy
Original Article

Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

Soo-youn Moon, M.D.,1 Mi Suk Lee, M.D.,1 Jun Seong Son, M.D.,1 Hee Joo Lee, M.D.,2 and Sang-Oh Lee, M.D.1
    • 1Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
    • 2Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
Received March 21, 2008; Accepted April 28, 2008.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB).

Materials and Methods

Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB.

Results

A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4±13.6 vs. 59.4±14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5±6.3 vs. 13.5±5.1, P<0.001) and the acute physiology score (11.1±5.5 vs. 8.0±4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB.

Conclusion

Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.

Keywords
Staphylococcus aureus; Bacteremia; Death; Risk factor

Figures

Fig. 1
Selection of patients.

Tables

Table 1
Baseline Characteristics of the Patients

Table 2
Univariate Analysis of Risk Factors for Death in Patients with Staphylococcus aureus Bacteremia

Table 3
Multivariate Analysis of Risk Factors for Death in Staphylococcus aureus Bacteremia

Notes

This study was supported by Kyung Hee University Research Fund (KHU-20051038).

References

    1. Kaech C, Elzi L, Sendi P, Frei R, Laifer G, Bassetti S, Fluckiger U. Course and outcome of Staphylococcus aureus bacteremia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre. Clin Microbiol Infect 2006;12:345–352.
    1. Mylotte JM, Tayara A. Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort. Clin Infect Dis 2000;31:1170–1174.
    1. Topeli A, Unal S, Akalin HE. Risk factors influencing clinical outcome in Staphylococcus aureus bacteraemia in a Turkish University Hospital. Int J Antimicrob Agents 2000;14:57–63.
    1. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644–1655.
    1. Petti CA, Fowler VG Jr. Staphylococcus aureus bacteremia and endocarditis. Infect Dis Clin North Am 2002;16:413–435.
    1. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2005;111:e394–e434.
    1. Soriano A, Martinez JA, Mensa J, Marco F, Almela M, Moreno-MartÍnez A, Sánchez F, Muoz I, Jiménez de Anta MT, Soriano E. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.
    1. Gopal AK, Fowler VG Jr, Shah M, Gesty-Palmer D, Marr KA, McClelland RS, Kong LK, Gottlieb GS, Lanclos K, Li J, Sexton DJ, Corey GR. Prospective analysis of Staphylococcus aureus bacteremia in nonneutropenic adults with malignancy. J Clin Oncol 2000;18:1110–1115.
    1. McCabe WR, Jackson GG. Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 1962;110:847–855.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.
    1. Kim SH, Park WB, Lee CS, Kang CI, Bang JW, Kim HB, Kim NJ, Kim EC, Oh MD, Choe KW. Outcome of inappropriate empirical antibiotic therapy in patients with Staphylococcus aureus bacteraemia: analytical strategy using propensity scores. Clin Microbiol Infect 2006;12:13–21.
    1. Wang FD, Chen YY, Chen TL, Liu CY. Risk factors and mortality in patients with nosocomial Staphylococcus aureus bacteremia. Am J Infect Control 2008;36:118–122.
    1. Hawkins C, Huang J, Jin N, Noskin GA, Zembower TR, Bolon M. Persistent Staphylococcus aureus bacteremia: an analysis of risk factors and outcomes. Arch Intern Med 2007;167:1861–1867.
    1. Hill PC, Birch M, Chambers S, Drinkovic D, Ellis-Pegler RB, Everts R, Murdoch D, Pottumarthy S, Roberts SA, Swager C, Taylor SL, Thomas MG, Wong CG, Morris AJ. Prospective study of 424 cases of Staphylococcus aureus bacteraemia: determination of factors affecting incidence and mortality. Intern Med J 2001;31:97–103.
    1. Jensen AG, Wachmann CH, Poulsen KB, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Risk factors for hospital-acquired Staphylococcus aureus bacteremia. Arch Intern Med 1999;159:1437–1444.
    1. Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, Cheng AC, Dudley T, Oddone EZ. Clinical identifiers of complicated Staphylococcus aureus bacteremia. Arch Intern Med 2003;163:2066–2072.
    1. Feld R. Vancomycin as part of initial empirical antibiotic therapy for febrile neutropenia in patients with cancer: pros and cons. Clin Infect Dis 1999;29:503–507.
    1. Fang CT, Shau WY, Hsueh PR, Chen YC, Wang JT, Hung CC, Huang LY, Chang SC. Early empirical glycopeptide therapy for patients with methicillinresistant Staphylococcus aureus bacteraemia: impact on the outcome. J Antimicrob Chemother 2006;57:511–519.
    1. Romero-Vivas J, Rubio M, Fernandez C, Picazo JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995;21:1417–1423.

Metrics
Share
Figures

1 / 1

Tables

1 / 3

PERMALINK