Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Clin Infect Dis. 2024 Apr 10;78(4):846-854. doi: 10.1093/cid/ciad784.
Recommended duration of antibiotic treatment of Staphylococcus aureus bacteremia (SAB) is frequently based on distinguishing uncomplicated and complicated SAB, and several risk factors at the onset of infection have been proposed to define complicated SAB. Predictive values of risk factors for complicated SAB have not been validated, and consequences of their use on antibiotic prescriptions are unknown.
In a prospective cohort, patients with SAB were categorized as complicated or uncomplicated through adjudication (reference definition). Associations and predictive values of 9 risk factors were determined, compared with the reference definition, as was accuracy of Infectious Diseases Society of America (IDSA) criteria that include 4 risk factors, and the projected consequences of applying IDSA criteria on antibiotic use.
Among 490 patients, 296 (60%) had complicated SAB. In multivariable analysis, persistent bacteremia (odds ratio [OR], 6.8; 95% confidence interval [CI], 3.9-12.0), community acquisition of SAB (OR, 2.9; 95% CI, 1.9-4.7) and presence of prosthetic material (OR, 2.3; 95% CI, 1.5-3.6) were associated with complicated SAB. Presence of any of the 4 risk factors in the IDSA definition of complicated SAB had a positive predictive value of 70.9% (95% CI, 65.5-75.9) and a negative predictive value of 57.5% (95% CI, 49.1-64.8). Compared with the reference, IDSA criteria yielded 24 (5%) false-negative and 90 (18%) false-positive classifications of complicated SAB. Median duration of antibiotic treatment of these 90 patients was 16 days (interquartile range, 14-19), all with favorable clinical outcome.
Risk factors have low to moderate predictive value to identify complicated SAB and their use may lead to unnecessary prolonged antibiotic use.
金黄色葡萄球菌菌血症（SAB）的抗生素治疗推荐时间通常基于区分单纯性和复杂性 SAB，并且已经提出了感染开始时的几个危险因素来定义复杂性 SAB。这些危险因素对复杂性 SAB 的预测值尚未得到验证，其在抗生素处方中的使用后果也未知。
在一项前瞻性队列研究中，通过裁决将 SAB 患者分为单纯性或复杂性（参考定义）。通过与参考定义进行比较，确定了 9 个危险因素的关联和预测值，以及包括 4 个危险因素的美国传染病学会（IDSA）标准的准确性，以及应用 IDSA 标准对抗生素使用的预计后果。
在 490 名患者中，有 296 名（60%）患有复杂性 SAB。多变量分析显示，持续性菌血症（优势比 [OR]，6.8；95%置信区间 [CI]，3.9-12.0）、社区获得性 SAB（OR，2.9；95% CI，1.9-4.7）和存在假体材料（OR，2.3；95% CI，1.5-3.6）与复杂性 SAB 相关。IDSA 定义中复杂 SAB 的 4 个危险因素中的任何一个存在，其阳性预测值为 70.9%（95% CI，65.5-75.9），阴性预测值为 57.5%（95% CI，49.1-64.8）。与参考标准相比，IDSA 标准导致 24 例（5%）假阴性和 90 例（18%）假阳性分类为复杂性 SAB。这 90 名患者的抗生素治疗中位时间为 16 天（四分位间距，14-19），所有患者的临床结局均良好。
危险因素对识别复杂性 SAB 的预测值较低且中等，其使用可能导致不必要的抗生素使用延长。
Zotero 插件
