Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia.
Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia.
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DOI：
10.1186/s12879-018-3011-2
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发表时间：
2018-03-05
影响因子：
3.7
通讯作者：
VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)
中科院分区：
文献类型：
--
作者：
Holmes NE;Robinson JO;van Hal SJ;Munckhof WJ;Athan E;Korman TM;Cheng AC;Turnidge JD;Johnson PDR;Howden BP;VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)
各种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住院并发症和治疗失败的风险因素。前瞻性招募因金黄色葡萄球菌菌血症（SAB）住院的成人患者进入多中心队列。主要结局是30天时的治疗失败（全因死亡、持续性菌血症或复发性菌血症的复合终点），次要指标包括6个月和12个月时的住院并发症和死亡率。2011年2月至2012年12月招募的222例患者的数据可用。14.4%的患者记录了30天治疗失败（30天死亡率9.5%）。多变量分析治疗失败的预测因素包括年龄> 70岁、Pitt菌血症评分≥ 2、SAB发作时CRP> 250 mg/L和SAB发作后持续发热; SAB发作时血清白蛋白、接受适当的经验性治疗、近期就医和进行超声心动图检查具有保护作用。6-术后1个月和12个月病死率分别为19.1%和24.2%。45%的患者至少发生了一次住院并发症，包括19.5%的肾毒性。这项研究表明，在澳大利亚的SAB的30天的结果显着改善。然而，我们已经确定了改善SAB结局的重要领域，特别是减少肾功能不全和住院治疗相关并发症。本文的在线版本（10.1186/s12879-018-3011-2）包含补充材料，可供授权用户使用。
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. The online version of this article (10.1186/s12879-018-3011-2) contains supplementary material, which is available to authorized users.
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