Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.
Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
BMC Infect Dis. 2018 Mar 5;18(1):107. doi: 10.1186/s12879-018-3011-2.
Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure.
Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012.
Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%.
This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.
多项研究已经确定了许多与金黄色葡萄球菌菌血症（SAB）患者临床结局不良相关的因素。一项新的研究旨在更深入地了解院内并发症和治疗失败的危险因素。
前瞻性地招募了住院的金黄色葡萄球菌菌血症（SAB）成年患者入组多中心队列。主要结局是 30 天治疗失败（包括全因死亡率、持续性菌血症或复发性菌血症），次要措施包括 6 个月和 12 个月的院内并发症和死亡率。数据来自 2011 年 2 月至 2012 年 12 月招募的 222 例患者。
30 天治疗失败率为 14.4%（30 天死亡率 9.5%）。多变量分析预测治疗失败的因素包括年龄>70 岁、Pitt 菌血症评分≥2、SAB 发病时 CRP>250mg/L 以及 SAB 发病后持续发热；SAB 发病时血清白蛋白、接受适当的经验性治疗、近期医疗就诊和进行超声心动图检查具有保护作用。6 个月和 12 个月的死亡率分别为 19.1%和 24.2%。45%的患者至少发生了一次院内并发症，包括 19.5%的肾毒性。
本研究表明澳大利亚 SAB 的 30 天结局有显著改善。然而，我们已经确定了改善 SAB 结局的重要领域，特别是减少肾功能障碍和院内治疗相关并发症。
