Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Service of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Service of General Internal Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Clin Microbiol Infect. 2020 May;26(5):626-631. doi: 10.1016/j.cmi.2019.07.019. Epub 2019 Jul 26.
The aim was to evaluate the effect of duration of therapy (DOT) on mortality and relapse for patients with Staphylococcus aureus bacteraemia (SAB).
We performed a retrospective single-centre cohort study including adult patients with SAB. We determined the association between DOT (≤14 days versus >14 days) and mortality by adjusted hazard ratios (aHR) and 95% confidence intervals through Cox regression adjusted for immortal-time bias and confounding by indication, stratified by presence of complicated SAB (any of: endocarditis, implant, duration of SAB >2 days, fever >3 days). The primary outcome was 90-day all-cause mortality, and the secondary outcome was 90-day relapse.
Between January 2010 and December 2015, we included 530 patients, of whom 94 out of 530 (17.7%) had methicillin-resistant SAB and 305 out of 530 (57.6%) had complicated SAB. Ninety-day mortality was 27.0% (143/530), with no significant trend across the study period; median time to death was 17 days (interquartile range (IQR) 8-30) after onset of SAB. Median DOT was 20 days (IQR 13-39). Patients with complicated SAB had significantly reduced mortality with DOT >14 days (aHR 0.32, 95% CI 0.16-0.64). DOT was not associated with mortality in patients with uncomplicated SAB (aHR 0.85; 0.41-1.78). Eighteen (18/530) patients (3.4%) relapsed; on univariate analysis, DOT was not associated with relapse (HR 1.01; 0.97-1.06).
DOT >14 days is associated with higher survival in patients with complicated SAB, but not for patients with uncomplicated SAB. No association was found for relapse, but 90-day relapse was very low in this cohort. Importantly, 90-day mortality remained high across the study period.
评估治疗持续时间（DOT）对金黄色葡萄球菌菌血症（SAB）患者死亡率和复发率的影响。
我们进行了一项回顾性单中心队列研究，纳入了成人 SAB 患者。我们通过 Cox 回归调整了 Immortal-time 偏倚和指示性混杂因素，确定了 DOT（≤14 天与>14 天）与死亡率之间的关联，并通过调整后的危险比（aHR）和 95%置信区间进行了评估，按是否存在复杂 SAB（任何一种：心内膜炎、植入物、SAB 持续时间>2 天、发热>3 天）进行分层。主要结局是 90 天全因死亡率，次要结局是 90 天复发率。
2010 年 1 月至 2015 年 12 月，我们纳入了 530 例患者，其中 94 例（17.7%）为耐甲氧西林金黄色葡萄球菌 SAB，305 例（57.6%）为复杂 SAB。90 天死亡率为 27.0%（143/530），整个研究期间无明显趋势；SAB 发病后中位死亡时间为 17 天（四分位距（IQR）8-30）。中位 DOT 为 20 天（IQR 13-39）。DOT>14 天的复杂 SAB 患者死亡率显著降低（aHR 0.32，95%CI 0.16-0.64）。在无并发症的 SAB 患者中，DOT 与死亡率无关（aHR 0.85；0.41-1.78）。有 18 例（18/530）患者（3.4%）复发；单因素分析显示，DOT 与复发无关（HR 1.01；0.97-1.06）。
DOT>14 天与复杂 SAB 患者的生存率升高相关，但与无并发症的 SAB 患者无关。复发与 DOT 无关，但本队列中 90 天复发率非常低。重要的是，整个研究期间 90 天死亡率仍然很高。
