Risk factors for mortality in Staphylococcus aureus bacteremia.
Risk factors for mortality in Staphylococcus aureus bacteremia.
复制标题
金黄色葡萄球菌菌血症死亡的危险因素。
DOI：
10.1086/647704
复制
发表时间：
1998
影响因子：
4.5
通讯作者：
Adauto Castelo
中科院分区：
文献类型：
--
作者：
L. Conterno;S. Wey;Adauto Castelo
目的
分析金黄色葡萄球菌菌血症死亡率的危险因素和甲氧西林耐药的作用。
设计
巢式病例对照研究。
设置
巴西圣保罗一家耐甲氧西林金黄色葡萄球菌（MRSA）菌株流行率较高的综合教学医院。
患者
136例14岁以上的患者，记录了金黄色葡萄球菌菌血症。将死亡的人与存活至少14天的人进行比较。
结果
菌血症14天内死亡率为39%（53/136）。平均年龄为47岁。医院获得性菌血症占86%（117/136）。26%（35/136）的感染与血管内导管有关，13%（17/136）的感染与呼吸道有关。感染性休克发生率为22%（30/136）。MRSA检出率为66%（90/136）。多变量分析确定了与死亡率显著独立相关的三个变量：进入部位（肺部，比值比[OR]，17.0;未知，OR，12.3;其他，OR，6.6）;休克发生率（OR，8.9）和金黄色葡萄球菌对甲氧西林耐药（OR，4.2）。
结论
我们的研究表明，金黄色葡萄球菌菌血症有很高的死亡率，特别是当肺部是感染源和休克发展时;对甲氧西林的耐药性可能是预后不良的另一个危险因素。
OBJECTIVE
To analyze risk factors for, and the role of methicillin resistance in, mortality in Staphylococcus aureus bacteremia.
DESIGN
Nested case-control study.
SETTING
General teaching hospital with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains, in São Paulo, Brazil.
PATIENTS
136 patients over 14 years old with documented S aureus bacteremia. Those who died were compared with those who survived at least 14 days.
RESULTS
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).
CONCLUSION
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.