Hawkins Claudia, Huang Jenny, Jin Nancy, Noskin Gary A, Zembower Teresa R, Bolon Maureen
Department of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N St Clair, Ste 200, Chicago, IL 60611, USA.
Arch Intern Med. 2007 Sep 24;167(17):1861-7. doi: 10.1001/archinte.167.17.1861.
Persistent Staphylococcus aureus bacteremia (pSAB) is an emerging problem among hospitalized patients. We studied key clinical characteristics and outcomes associated with pSAB to better define the epidemiological features of this increasingly recognized clinical entity.
A retrospective case-control study of patients hospitalized with SAB between January 1, 2001, and September 30, 2004, was conducted to compare the clinical characteristics, management, and outcomes of patients with pSAB (> 7 days of bacteremia) with those of a cohort of patients with nonpersistent SAB (< 3 days of bacteremia). Patients with 4 to 6 days of bacteremia were excluded from the analysis. To detect a potential association between reduced susceptibility to vancomycin and persistent methicillin-resistant SAB, vancomycin susceptibilities were confirmed using standard dilution methods.
Eighty-four patients with pSAB and 152 patients with nonpersistent SAB were included in the analysis. Methicillin resistance (odds ratio [OR], 5.22; 95% confidence interval [CI], 2.63-10.38), intravascular catheter or other foreign body use (OR, 2.37; 95% CI, 1.11-3.96), chronic renal failure (OR, 2.08; 95% CI, 1.09-3.96), more than 2 sites of infection (OR, 3.31; 95% CI, 1.17-9.38), and infective endocarditis (OR, 10.30; 95% CI, 2.98-35.64) were independently associated with pSAB. The mean time to device removal was significantly longer in patients with pSAB than in patients with nonpersistent SAB (4.94 vs 1.64 days; P < .01). There was no evidence of reduced vancomycin susceptibility among persistent methicillin-resistant S aureus isolates. Clinical outcomes were significantly worse among patients with pSAB.
Many hospitalized patients may be at risk for pSAB. Aggressive attempts to minimize the risk of complications and poor outcomes associated with pSAB, such as early device removal, should be encouraged.
持续性金黄色葡萄球菌菌血症（pSAB）在住院患者中是一个新出现的问题。我们研究了与pSAB相关的关键临床特征和结局，以更好地界定这种日益受到认可的临床实体的流行病学特征。
对2001年1月1日至2004年9月30日期间因金黄色葡萄球菌菌血症住院的患者进行了一项回顾性病例对照研究，比较pSAB（菌血症持续时间>7天）患者与非持续性金黄色葡萄球菌菌血症（菌血症持续时间<3天）患者队列的临床特征、治疗及结局。菌血症持续时间为4至6天的患者被排除在分析之外。为检测万古霉素敏感性降低与持续性耐甲氧西林金黄色葡萄球菌菌血症之间的潜在关联，采用标准稀释法确认万古霉素敏感性。
84例pSAB患者和152例非持续性金黄色葡萄球菌菌血症患者纳入分析。耐甲氧西林（比值比[OR]，5.22；95%置信区间[CI]，2.63 - 10.38）、使用血管内导管或其他异物（OR，2.37；95% CI，1.11 - 3.96）、慢性肾衰竭（OR，2.08；95% CI，1.09 - 3.96）、感染部位超过2处（OR，3.31；95% CI，1.17 - 9.38）以及感染性心内膜炎（OR，10.30；95% CI，2.98 - 35.64）与pSAB独立相关。pSAB患者的装置移除平均时间显著长于非持续性金黄色葡萄球菌菌血症患者（4.94天对1.64天；P <.01）。在持续性耐甲氧西林金黄色葡萄球菌分离株中没有万古霉素敏感性降低的证据。pSAB患者的临床结局显著更差。
许多住院患者可能有发生pSAB的风险。应鼓励积极采取措施尽量降低与pSAB相关的并发症和不良结局的风险，如早期移除装置。
