Turnidge John D, Kotsanas Despina, Munckhof Wendy, Roberts Sally, Bennett Catherine M, Nimmo Graeme R, Coombs Geoffrey W, Murray Ronan J, Howden Benjamin, Johnson Paul D R, Dowling Kate
Women's and Children's Hospital, Adelaide, SA, Australia.
Med J Aust. 2009 Oct 5;191(7):368-73. doi: 10.5694/j.1326-5377.2009.tb02841.x.
To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality.
Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008.
30-day all-cause mortality.
1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%-63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%-25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%-22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-beta-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection.
S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.
记录澳大利亚和新西兰金黄色葡萄球菌菌血症的类型及死亡率，并确定与死亡率相关的因素。
在澳大利亚的24个和新西兰的3个独立或医院病理实验室开展前瞻性观察研究，利用基于网络的数据库前瞻性记录2007年6月至2008年5月所有血培养金黄色葡萄球菌阳性患者的人口统计学特征、选定的风险因素、主要抗生素治疗及死亡率数据。
30天全因死亡率。
共识别出1994例金黄色葡萄球菌菌血症发作，其中1865例有完整的30天随访数据。多数发作起始于社区（60.8%；95%可信区间，58.7% - 63.0%）。耐甲氧西林金黄色葡萄球菌（MRSA）导致450例发作（24.1%；95%可信区间，22.2% - 25.9%），其中123例（27.3%）的药敏谱与社区获得性MRSA一致。30天全因死亡率为20.6%（95%可信区间，18.8% - 22.5%）。单因素分析显示，死亡率增加与年龄较大、欧洲人种、MRSA感染、非源于医疗器械的感染、脓毒症综合征、肺炎/脓胸以及使用糖肽类或其他非β-内酰胺类抗生素治疗显著相关。多变量分析显示，死亡率的独立预测因素为年龄、脓毒症综合征、肺炎/脓胸、有继发灶的器械相关感染、左侧心内膜炎以及使用万古霉素等糖肽类药物治疗，但不包括MRSA感染。
金黄色葡萄球菌菌血症在澳大利亚和新西兰的社区及医院均为常见感染，且与相当高的死亡率相关。侵袭性MRSA感染可能更具生命威胁，部分原因是标准治疗药物万古霉素疗效欠佳。基于网络的全国性金黄色葡萄球菌菌血症及其转归监测不仅重要且易于实现。
