Staphylococcus aureus Bloodstream Infection and Endocarditis - A Prospective Cohort Study
Staphylococcus aureus Bloodstream Infection and Endocarditis - A Prospective Cohort Study
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DOI：
10.1371/journal.pone.0127385
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发表时间：
2015-05-28
期刊：
影响因子：
3.7
通讯作者：
Duval, Xavier
中科院分区：
文献类型：
--
作者：
Le Moing, Vincent;Alla, Francois;Duval, Xavier
目的更新高收入国家金黄色葡萄球菌血流感染（SAB）的流行病学及其与感染性心内膜炎（IE）的联系。（n = 2008）在2009年至2011年期间在法国8所大学医院前瞻性招募。非院内获得性占18%，社区获得性占26%。甲氧西林耐药存在于19%的分离株。SAB院内SAB的发生率为0.159/1000患者-住院日（95%置信区间[CI] 0.111-0.219）。37%的患者发现深部感染病灶，最常见的两种是IE（11%）和肺炎（8%）。注射吸毒者IE发生率（38%）、人工瓣膜患者IE（33%）和自体瓣膜病患者IE（20%）较高，但无心脏病、无注射吸毒者IE发生率为40%。IE在社区获得性SAB（IE：21%，校正比值比（aOR）= 2.9，CI = 2.04.3）或非医院医疗保健相关SAB（IE：12%，aOR = 2.3，CI = 1.4-3.5）中更常见。金黄色葡萄球菌脑膜炎（IE：59%）、48小时持续菌血症（IE：25%）和C-反应蛋白> 190 mg/L（IE：15%）也与IE独立相关。严重脓毒症或脓毒性休克的标准符合30%的SAB没有IE（总体住院死亡率24%）和51%的IE（总体住院死亡率35%）。IE是最常见的并发症，经常发生在没有已知易感条件的患者中。
ObjectivesTo update the epidemiology of Staphylococcus aureusbloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).MethodsAll consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.ResultsSAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and communityacquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.04.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). Staphylococcus aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).ConclusionSAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.