title: Predictive factors for early mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia.
abstract: OBJECTIVE
  A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia.
  
  
  METHODS
  All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models.
  
  
  RESULTS
  A total of 579 episodes were recorded. Mortality was observed in 179 patients (31%): it was early in 49 (8.5%) patients and late in 130 (22.5%). Independent risk factors for EM were [OR (95% CI)] initial Pitt score >3 [3.99 (1.72-3.24)], previous rapid fatal disease [3.67 (1.32-10.24)], source of infection lower respiratory tract or unknown [3.76 (1.31-10.83) and 2.83 (1.11-7.21)], non-nosocomial acquisition [2.59 (1.16-5.77)] and inappropriate initial antibiotic therapy [3.59 (1.63-7.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM.
  
  
  CONCLUSIONS
  In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.
authors: Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain. ogasch@bellvitgehospital.cat
authors: O
authors: O
authors: Gasch
authors: M
authors: M
authors: Camoez
authors: M A
authors: MA
authors: Domínguez
authors: B
authors: B
authors: Padilla
authors: V
authors: V
authors: Pintado
authors: B
authors: B
authors: Almirante
authors: J A
authors: JA
authors: Lepe
authors: M
authors: M
authors: Lagarde
authors: E
authors: E
authors: Ruiz de Gopegui
authors: J A
authors: JA
authors: Martínez
authors: M
authors: M
authors: Montejo
authors: J
authors: J
authors: Torre-Cisneros
authors: A
authors: A
authors: Arnáiz
authors: M A
authors: MA
authors: Goenaga
authors: N
authors: N
authors: Benito
authors: J
authors: J
authors: Rodríguez-Baño
authors: M
authors: M
authors: Pujol
mesh_terms: D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality*; D016896:Treatment Outcome
keywords: MRSA; bloodstream infections; empirical antibiotic therapy