Conterno L O, Wey S B, Castelo A
Infectious Diseases Division of Marilia Medical School, São Paulo, Brazil.
Infect Control Hosp Epidemiol. 1998 Jan;19(1):32-7. doi: 10.1086/647704.
To analyze risk factors for, and the role of methicillin resistance in, mortality in Staphylococcus aureus bacteremia.
Nested case-control study.
General teaching hospital with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains, in São Paulo, Brazil.
136 patients over 14 years old with documented S aureus bacteremia. Those who died were compared with those who survived at least 14 days.
Mortality within 14 days of bacteremia was 39% (53/136). Mean age was 47 years. Hospital-acquired bacteremia represented 86% (117/136) of episodes. In 26% (35/136), infection was related to an intravascular catheter and in 13% (17/136) to the respiratory tract. Septic shock occurred in 22% (30/136) of cases. MRSA was isolated in 66% (90/136). Multivariate analysis identified three variables that were significantly and independently associated with mortality: site of entry (lung, odds ratio [OR], 17.0; unknown, OR, 12.3; others, OR, 6.6); occurrence of shock (OR, 8.9), and resistance of S aureus to methicillin (OR, 4.2).
Our study shows that S aureus bacteremia has a high mortality, especially when the lung is the source of infection and when shock develops; resistance to methicillin may be another risk factor for poor outcome.
分析金黄色葡萄球菌菌血症患者的死亡危险因素以及耐甲氧西林在死亡中的作用。
巢式病例对照研究。
巴西圣保罗一所耐甲氧西林金黄色葡萄球菌（MRSA）菌株高流行的综合教学医院。
136例14岁以上有金黄色葡萄球菌菌血症记录的患者。将死亡患者与存活至少14天的患者进行比较。
菌血症发生后14天内的死亡率为39%（53/136）。平均年龄为47岁。医院获得性菌血症占病例的86%（117/136）。26%（35/136）的感染与血管内导管有关，13%（17/136）与呼吸道有关。22%（30/136）的病例发生感染性休克。66%（90/136）分离出MRSA。多变量分析确定了三个与死亡率显著且独立相关的变量：感染源部位（肺部，比值比[OR]，17.0；不明，OR，12.3；其他部位，OR，6.6）；休克的发生（OR，8.9），以及金黄色葡萄球菌对甲氧西林的耐药性（OR，4.2）。
我们的研究表明，金黄色葡萄球菌菌血症死亡率高，尤其是当感染源为肺部且发生休克时；对甲氧西林耐药可能是预后不良的另一个危险因素。
