Yahav Dafna, Shaked Hila, Goldberg Elad, Yassin Sharief, Eliakim-Raz Noa, Paul Mical, Bishara Jihad, Leibovici Leonard
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Road, 49100, Petah-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Ramat-Aviv, Israel.
Infection. 2017 Feb;45(1):51-57. doi: 10.1007/s15010-016-0919-6. Epub 2016 Jul 13.
Changes in the epidemiology of Staphylococcus aureus bacteremia (SAB) have been described in recent decades. Decreased mortality has been reported over time, mostly from countries with low methicillin resistance rates. We aimed to describe time trends in SAB in a tertiary center with high methicillin resistance rates.
We retrospectively analyzed 1692 patients with SAB, and compared between three time periods: 1988-1994 (342 patients), 1998-2004 (597 patients) and 2005-2010 (753 patients).
In our cohort, 30 days mortality increased significantly with time, reaching 42.9 % during 2005-2010. The latter period was characterized by higher rates of older patients (35.1 % aged 80 years and older), with lower functional capacity (46.5 % bedridden) and higher rates of comorbidities (33.6 % renal disease, 24.8 % heart failure, 19.0 % dementia). These patients were more likely to be ventilated (18.7 %) and carry a urinary catheter at presentation (46.6 %); present with septic shock (15.9 %) and have pneumonia (20.5 %) or endocarditis (7.2 %) as source. Similar characteristics were found among patients younger than 50 years and with independent functional status. No significant increase in methicillin resistant Staph aureus (MRSA) rates or inappropriate empirical therapy was demonstrated during 2005-2010.
In our cohort, increased mortality in recent years in patients with SAB can be explained by baseline condition of patients. MRSA or inappropriate empiric therapy did not explain the increase in mortality. The patients afflicted with SAB changed over time. Epidemiology and outcomes of SAB vary with time and according to geographical location. External validity of studies should be taken into consideration.
近几十年来，金黄色葡萄球菌菌血症（SAB）的流行病学已发生变化。据报道，随着时间推移死亡率有所下降，主要来自耐甲氧西林率较低的国家。我们旨在描述一家耐甲氧西林率较高的三级中心SAB的时间趋势。
我们回顾性分析了1692例SAB患者，并比较了三个时间段：1988 - 1994年（342例患者）、1998 - 2004年（597例患者）和2005 - 2010年（753例患者）。
在我们的队列中，30天死亡率随时间显著增加，在2005 - 2010年期间达到42.9%。后一时期的特点是老年患者比例较高（80岁及以上患者占35.1%），功能能力较低（46.5%卧床不起），合并症发生率较高（33.6%患有肾病，24.8%患有心力衰竭，19.0%患有痴呆）。这些患者更有可能接受通气治疗（18.7%），就诊时携带导尿管（46.6%）；出现感染性休克（15.9%），并且以肺炎（20.5%）或心内膜炎（7.2%）作为感染源。在年龄小于50岁且功能状态独立的患者中也发现了类似特征。在2005 - 2010年期间，未发现耐甲氧西林金黄色葡萄球菌（MRSA）率或不适当经验性治疗有显著增加。
在我们的队列中，近年来SAB患者死亡率增加可由患者的基线状况来解释。MRSA或不适当的经验性治疗并不能解释死亡率的增加。患SAB的患者随时间发生了变化。SAB的流行病学和结局随时间以及地理位置而有所不同。应考虑研究的外部效度。
