Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, and Sackler School of Medicine, Tel-Aviv University, Petah-Tiqva, Israel.
Int J Infect Dis. 2012 Jun;16(6):e457-63. doi: 10.1016/j.ijid.2012.02.009. Epub 2012 Apr 11.
To analyze clinical features and outcomes of patients with hospital-acquired (HA) and healthcare-associated (HCA) Staphylococcus aureus bacteremia.
A retrospective cohort study was conducted from 1988 to 2007. We compared patients with clinically significant HA with those with HCA S. aureus bacteremia. Risk factors for 30-day all-cause mortality were assessed using multivariable logistic regression analysis. Cox regression analysis was used to estimate the hazard ratio (HR) for 5-year mortality with 95% confidence intervals (CI).
Of 1261 episodes, 735 (58.3%) were HA and 526 (41.7%) were HCA. The percentage of MRSA was 48.2% (354/735) in HA vs. 42.2% (222/526) in HCA bacteremia; p=0.04. The percentages of HCA S. aureus bacteremia and MRSA bacteremia did not vary throughout the study period. Mortality at 30 days was 40.2% (507/1261) and at 1 year was 63.4% (800/1261); this was comparable for HA and HCA bacteremia. Five-year survival curves in both settings followed very similar patterns (HR 1.01, 95% CI 0.89-1.15). Risk factors for 30-day mortality were similar, except for primary bacteremia and pre-existing heart valve disease in the HA group.
HCA S. aureus bacteremia shares many similarities with HA bacteremia with respect to the prevalence of MRSA strains, mortality rates, and risk factors for death, and should be managed similarly.
分析医院获得性（HA）和医疗保健相关性（HCA）金黄色葡萄球菌菌血症患者的临床特征和结局。
本研究为 1988 年至 2007 年进行的回顾性队列研究。我们比较了有临床意义的 HA 与 HCA 金黄色葡萄球菌菌血症患者。使用多变量逻辑回归分析评估 30 天全因死亡率的危险因素。使用 Cox 回归分析估计 5 年死亡率的风险比（HR）及其 95%置信区间（CI）。
在 1261 例感染中，735 例（58.3%）为 HA，526 例（41.7%）为 HCA。HA 中耐甲氧西林金黄色葡萄球菌（MRSA）的比例为 48.2%（354/735），HCA 中为 42.2%（222/526）；p=0.04。整个研究期间，HCA 金黄色葡萄球菌菌血症和 MRSA 菌血症的比例没有变化。30 天死亡率为 40.2%（507/1261），1 年死亡率为 63.4%（800/1261）；HA 和 HCA 菌血症的死亡率相当。两种情况下的 5 年生存曲线模式非常相似（HR 1.01，95%CI 0.89-1.15）。30 天死亡率的危险因素相似，但 HA 组有原发性菌血症和先前存在的心脏瓣膜病。
HCA 金黄色葡萄球菌菌血症与 HA 菌血症在 MRSA 菌株的流行、死亡率和死亡危险因素方面具有许多相似之处，应采用类似的方式进行治疗。
