title: Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study.
abstract: Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5-78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44-1.69), septic shock (OR 5.11; 95% CI 3.84-6.80), metastatic cancer (OR 4.28; 95% CI 2.88-6.38), and unknown primary focus (OR 2.62; 95% CI 2.02-3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17-0.95) and vancomycin (OR 0.37; 95% CI 0.17-0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia.
authors: Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France. Electronic address: pit.braquet@gmail.com.
authors: P
authors: P
authors: Braquet
authors: Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy, France; INSERM, CIC-EC, CIE6, Nancy, France; CHU Nancy, Nancy, France.
authors: F
authors: F
authors: Alla
authors: INSERM, CIC1407, Lyon, France; CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon, UMR 5558, Lyon, France.
authors: C
authors: C
authors: Cornu
authors: Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nancy, France.
authors: F
authors: F
authors: Goehringer
authors: CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France.
authors: L
authors: L
authors: Piroth
authors: UMR CNRS 6249 Chrono-environnement, Université de Bourgogne Franche-Comté, CHU de Besançon, Besançon, France.
authors: C
authors: C
authors: Chirouze
authors: Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, France.
authors: M
authors: M
authors: Revest
authors: Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.
authors: C
authors: C
authors: Lechiche
authors: Université Paris Diderot Sorbonne, Paris, France; IAME, INSERM, UMR 1137, CIC 1425, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Paris, France.
authors: X
authors: X
authors: Duval
authors: Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France. Electronic address: v-le_moing@chu-montpellier.fr.
authors: V
authors: V
authors: Le Moing
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D003428:Cross Infection / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage* / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D013211:Staphylococcus aureus; D016019:Survival Analysis; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D010406:Penicillins; D014640:Vancomycin
keywords: Antistaphylococcal penicillin; Bacteraemia; Prognostic factors; Staphylococcus aureus; Vancomycin