Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies - 15/02/14

Doi : 10.1016/j.jinf.2013.10.015

Achim J. Kaasch ^a,^⁎ , Gavin Barlow ^b, Jonathan D. Edgeworth ^c, Vance G. Fowler ^d, Martin Hellmich ^e, Susan Hopkins ^f, Winfried V. Kern ^g, Martin J. Llewelyn ^h, Siegbert Rieg ^g, Jesús Rodriguez-Baño ^i,^j, Matthew Scarborough ^k, Harald Seifert ^a, Alex Soriano ^l, Robert Tilley ^m, M. Estée Tőrők ⁿ, Verena Weiß ^e, A.Peter R. Wilson ^o, Guy E. Thwaites ^c,^p
on behalf of
ISAC, INSTINCT, SABG, UKCIRG, and Colleagues^{^p}
With linked authorship to all colleagues in the Acknowledgements section.
^a Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
^b Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
^c Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
^d Department of Medicine, Duke University, Durham, NC, USA
^e Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
^f Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, United Kingdom
^g Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
^h Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
ⁱ Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena
^j Department of Medicine, University of Seville, Seville, Spain
^k Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
^l Service of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
^m Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
ⁿ Department of Medicine, University of Cambridge, Cambridge, United Kingdom
^o Department of Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
^p Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom

^∗Corresponding author. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Cologne, Germany. Tel.: +49 221 47832022; fax: +49 221 47832016.

Summary

Objectives

Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome.

Methods

We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States.

Results

The median age of participants was 64 years (interquartile range 50–75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001).

Conclusion

The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.

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Keywords : Staphylococcus aureus bloodstream infection, Bacteraemia, Mortality, Pooled analysis

Plan

Introduction

Methods

Ethical considerations

Data acquisition and definitions

Statistical analysis

Results

Baseline demographic and clinical variables

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Vol 68 - N° 3

P. 242-251 - mars 2014 Retour au numéro

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Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies - 15/02/14

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Methods

Results

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