Yilmaz Mesut, Elaldi Nazif, Balkan İlker İnanç, Arslan Ferhat, Batırel Ayşe Alga, Bakıcı Mustafa Zahir, Gozel Mustafa Gokhan, Alkan Sevil, Çelik Aygül Doğan, Yetkin Meltem Arzu, Bodur Hürrem, Sınırtaş Melda, Akalın Halis, Altay Fatma Aybala, Şencan İrfan, Azak Emel, Gündeş Sibel, Ceylan Bahadır, Öztürk Recep, Leblebicioglu Hakan, Vahaboglu Haluk, Mert Ali
Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
Ann Clin Microbiol Antimicrob. 2016 Feb 9;15:7. doi: 10.1186/s12941-016-0122-8.
Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals.
Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis.
A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality.
The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
金黄色葡萄球菌是社区获得性和医疗保健相关菌血症的病因之一。金黄色葡萄球菌菌血症（SAB）的归因死亡率仍然较高，需要明确这种情况的死亡率和临床结局的预测因素。在这项前瞻性观察研究中，我们旨在研究八家土耳其三级护理医院中SAB患者死亡率的预测因素。
纳入有菌血症体征和症状且血培养金黄色葡萄球菌呈阳性的成年患者。记录了3年（2010 - 2012年）期间SAB发作的所有数据，包括人口统计学、临床和实验室检查结果、抗生素使用情况及结局。采用向前选择的Cox比例风险模型评估危险因素对死亡率的独立影响。Cox回归分析中的因变量为28天死亡率。
共纳入255例SAB发作病例。患者的中位年龄为59岁。55%的发作被视为原发性SAB，42.1%的发作源为血管导管。55.7%被定义为医疗保健相关SAB。血培养检出耐甲氧西林金黄色葡萄球菌（MRSA）作为SAB病因的占39.2%。初始经验性治疗不恰当的占28.2%。尽管总体死亡率为52例（20.4%），但28天死亡率为15.3%。在发热发作后，致命结局组和存活组之间，初始经验性抗生素治疗不当的次数以及开始使用合适抗生素的中位时间相似（分别为12/39对60/216以及6对12小时；p>0.05）。高查尔森合并症指数（CCI）评分（p = 0.002）、MRSA（p = 0.017）、入住重症监护病房（ICU）（p < 0.001）以及既往使用过抗生素（p = 0.002）均与死亡率显著相关。Cox分析确定年龄[风险比（HR）1.03；p = 0.023]、入住ICU（HR 6.9；p = 0.002）和高CCI评分（HR 1.32；p = 0.002）为死亡率的独立预测因素。
这项前瞻性研究的结果表明，患者的年龄、入住ICU情况和高CCI评分是死亡率的独立预测因素，MRSA在SAB中也与死亡率显著相关。
