athan-morbidityfrom-2018.pdf (519.92 kB)
Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia
journal contribution
posted on 2018-03-05, 00:00 authored by Natasha E Holmes, J Owen Robinson, Sebastiaan J van Hal, Wendy J Munckhof, Eugene AthanEugene Athan, Tony M Korman, Allen C Cheng, John D Turnidge, Paul D R Johnson, Benjamin P Howden, VANESSA study group, on behalf of the AustralasianBACKGROUND: 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. METHODS: 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. RESULTS: 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%. CONCLUSIONS: 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.
History
Journal
BMC infectious diseasesVolume
18Article number
107Pagination
1 - 9Publisher
BioMed CentralLocation
London, Eng.Publisher DOI
Link to full text
eISSN
1471-2334Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2018, The AuthorsUsage metrics
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Keywords
Staphylococcus aureusBacteraemiaTreatment failureComplicationMortalityAdultAge FactorsAgedAged, 80 and overAnti-Bacterial AgentsAustraliaC-Reactive ProteinCohort StudiesEchocardiographyFemaleHospital MortalityHospitalizationHumansLogistic ModelsMaleMicrobial Sensitivity TestsMiddle AgedMorbidityRisk FactorsStaphylococcal InfectionsVancomycinScience & TechnologyLife Sciences & BiomedicineInfectious DiseasesBLOOD-STREAM INFECTIONMINIMUM INHIBITORY CONCENTRATIONLONG-TERM MORTALITYRISK-FACTORSANTIBIOTIC-TREATMENTNAFCILLINCEFAZOLINNEPHROTOXICITYIMPACTVANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)Microbiology
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