Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Int J Infect Dis. 2018 Aug;73:78-84. doi: 10.1016/j.ijid.2018.06.004. Epub 2018 Jun 13.
Data on the management and outcomes of Staphylococcus aureus bacteraemia (SAB) in resource-limited settings are limited. The aim of this study was to describe a cohort of South African patients with SAB, and explore the factors associated with complicated infection and death.
This was a prospective observational study of patients over the age of 13 years admitted to a South African referral hospital with SAB.
One hundred SAB infection episodes occurring in 98 patients were included. SAB was healthcare-associated in 68.4%; 24.0% of all cases were caused by methicillin-resistant S. aureus (MRSA). Ninety-day mortality was 47.0%, with 83.3% of deaths attributable to SAB. There was a trend towards increased 90-day mortality with MRSA infection (odds ratio (OR) 1.28, 95% confidence interval (CI) 1.0-15.1) and the presence of comorbidities (OR 4.1, 95% CI 1.0-21.6). The risk of complicated infection was higher with non-optimal definitive antibiotic therapy (OR 8.5, 95% CI 1.8-52.4), female sex (OR 3.8, 95% CI 1.1-16.3), and community-acquired infection (OR 7.4, 95% CI 2.0-33.1). Definitive antibiotic therapy was non-optimal in 22.6% of all cases.
SAB-related mortality was high. A large proportion of cases may be preventable, and there is a need for improved antibiotic management.
有关资源有限环境中金黄色葡萄球菌菌血症（SAB）管理和结局的数据有限。本研究旨在描述南非 SAB 患者队列，并探讨与复杂感染和死亡相关的因素。
这是一项对南非转诊医院中年龄在 13 岁以上的 SAB 住院患者进行的前瞻性观察性研究。
共纳入了 98 例患者的 100 例 SAB 感染发作。68.4%的 SAB 为医源性感染；所有病例中有 24.0%是耐甲氧西林金黄色葡萄球菌（MRSA）引起的。90 天死亡率为 47.0%，其中 83.3%的死亡归因于 SAB。MRSA 感染（比值比 [OR] 1.28，95%置信区间 [CI] 1.0-15.1）和合并症存在（OR 4.1，95% CI 1.0-21.6）与 90 天死亡率增加呈趋势。非最佳确定性抗生素治疗（OR 8.5，95% CI 1.8-52.4）、女性（OR 3.8，95% CI 1.1-16.3）和社区获得性感染（OR 7.4，95% CI 2.0-33.1）的情况下，发生复杂感染的风险更高。所有病例中有 22.6%的确定性抗生素治疗并不理想。
SAB 相关死亡率很高。很大一部分病例可能是可以预防的，需要改善抗生素管理。
