title: Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.
abstract: BACKGROUND
  Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals.
  
  
  METHODS
  Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis.
  
  
  RESULTS
  A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality.
  
  
  CONCLUSIONS
  The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
authors: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey. myilmaz@medipol.edu.tr.
authors: Mesut
authors: M
authors: Yilmaz
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. nelaldi61@yahoo.com.
authors: Nazif
authors: N
authors: Elaldi
authors: Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. ilkerinancbalkan@hotmail.com.
authors: İlker İnanç
authors: İİ
authors: Balkan
authors: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey. farslan@medipol.edu.tr.
authors: Ferhat
authors: F
authors: Arslan
authors: Department of Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey. aysebatirel@yahoo.com.
authors: Ayşe Alga
authors: AA
authors: Batırel
authors: Department of Medical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. zbakici@cumhuriyet.edu.tr.
authors: Mustafa Zahir
authors: MZ
authors: Bakıcı
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey. mggozel@cumhuriyet.edu.tr.
authors: Mustafa Gokhan
authors: MG
authors: Gozel
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey. s-ewil@hotmail.com.
authors: Sevil
authors: S
authors: Alkan
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey. adogancelik@yahoo.com.tr.
authors: Aygül Doğan
authors: AD
authors: Çelik
authors: Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. arzumyetkin@yahoo.com.
authors: Meltem Arzu
authors: MA
authors: Yetkin
authors: Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey. hurrembodur@gmail.com.
authors: Hürrem
authors: H
authors: Bodur
authors: Department of Medical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey. melda@uludag.edu.tr.
authors: Melda
authors: M
authors: Sınırtaş
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey. halisakalin@gmail.com.
authors: Halis
authors: H
authors: Akalın
authors: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. aybalaaltay@hotmail.com.
authors: Fatma Aybala
authors: FA
authors: Altay
authors: Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. isencanibu@yahoo.com.
authors: İrfan
authors: İ
authors: Şencan
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. emelazak@mynet.com.
authors: Emel
authors: E
authors: Azak
authors: Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. sgundes@yahoo.com.
authors: Sibel
authors: S
authors: Gündeş
authors: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey. bceylan@medipol.edu.tr.
authors: Bahadır
authors: B
authors: Ceylan
authors: Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey. drrozturk@gmail.com.
authors: Recep
authors: R
authors: Öztürk
authors: Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Samsun, Turkey. hakanomu@omu.edu.tr.
authors: Hakan
authors: H
authors: Leblebicioglu
authors: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Istanbul, Turkey. vahabo@hotmail.com.
authors: Haluk
authors: H
authors: Vahaboglu
authors: Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey. alimert@medipol.edu.tr.
authors: Ali
authors: A
authors: Mert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality*; D013211:Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D014421:Turkey
chemical_list: D000900:Anti-Bacterial Agents