Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes
Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes
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DOI：
10.1093/cid/ciz257
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发表时间：
2020-02-15
影响因子：
11.8
通讯作者：
Wong-Beringer, Annie
中科院分区：
文献类型：
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作者：
Minejima, Emi;Mai, Nikki;Wong-Beringer, Annie
背景：持续性金黄色葡萄球菌菌血症（SAB）是根据文献中不同的持续时间定义的。主要目的是确定与菌血症持续时间相关的不良结局的风险：对SAB成人住院患者进行多中心、前瞻性、观察性研究。审查病历中的相关数据。患者按菌血症持续时间分组：短（1-2天），中间（3-6天），延长（>= 7天），并比较危险因素和outcome.Results：884例患者中，63%有短期，28%中间，9%延长菌血症。总体平均年龄为57岁，70%为男性。延长组的耐甲氧西林SAB比例最高（P < .0001）。抗生素治疗的选择对菌血症持续时间没有显著影响;然而，与短期组相比，长期组和中期组的源控制程序时间延迟（3.5 vs 3 vs 1天，P <0.0001）。随着菌血症持续时间的增加，转移性并发症、住院时间和30天死亡率逐渐加重（P <0.0001）。每持续一天的菌血症与1.16的相对死亡风险相关（95%可信区间，1.10-1.22; P < .0001），通过受试者操作特征分析确定，从第3天开始风险显著增加。SAB的最佳管理应尽快实现细菌清除，以最大限度地降低每一天阳性血培养的死亡风险。源控制延迟而非抗葡萄球菌治疗类型与菌血症延长和预后不良显著相关。
Background: Persistent Staphylococcus aureus bacteremia (SAB) is defined based on varying duration in literature. The primary objective was to determine the risk of poor outcomes in relation to bacteremia duration.Methods: Multicenter, prospective, observational study of adult hospitalized patients with SAB. Medical records were reviewed for pertinent data. Patients were grouped by bacteremia duration: short (1-2 days), intermediate (3-6 days), and prolonged (>= 7 days) and compared for risk factors and outcomes.Results: Of 884 patients, 63% had short, 28% intermediate, and 9% prolonged bacteremia. Overall mean age was 57 years, and 70% were male. The prolonged group had the highest proportion of methicillin-resistant SAB (P < .0001). Choice of antibiotic therapy did not significantly affect bacteremia duration; however, time to source-control procedure was delayed in the prolonged and intermediate groups compared with the short group (3.5 vs 3 vs 1 day, P < .0001). Metastatic complications, length of stay, and 30-day mortality were progressively worse as bacteremia duration increased (P < .0001). Every continued day of bacteremia was associated with a relative risk of death of 1.16 (95% confidence interval, 1.10-1.22; P < .0001), with a significant increase in risk starting at 3 days as determined by receiver operating characteristic analysis.Conclusions: Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of antistaphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes.