Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study.
AbstractStaphylococcus aureusinfection is a persistent threat in resource-restricted settings in southeast Asia but informative data about this disease remain limited. We analyzed characteristics, management, and predictors of outcome in severely septic patients with community-onsetS. aureusinfection in northeast Thailand. We performed a prospective, multicenter observational cohort study of community-onsetS. aureussepsis in four referral hospitals recruiting patients at least 14 years of age admitted between March 2010 and December 2013. One hundred and nineteen patients with severe staphylococcal sepsis were enrolled. Diabetes was the most common underlying condition. Methicillin-resistant infection was rare. Twenty-eight-day mortality was 20%. Ninety-two percent of patients received appropriate antibiotic therapy and 82% were administered intravenous fluids on the first hospital day, although only 14% were managed in an intensive care unit (ICU). On univariable analysis, clinical variables at enrollment significantly associated with death at 28 days were coagulopathy or respiratory failure. Plasma interleukin (IL)-8 concentration alone accurately predicted mortality (area under the receiver operating curve = 0.82, 95% confidence interval = 0.73-0.90). In multivariable analysis, addition of IL-8 concentration to a mortality prediction model containing clinical variables further improved the predictive ability of the model. We conclude that severe staphylococcal sepsis in northeast Thailand causes significant mortality. Diabetes is a common preexisting condition and most patients are managed outside the ICU even if they receive vasoactive/inotropic agents or mechanical ventilation. While clinical factors apparent on presentation including coagulopathy and respiratory failure predict death, plasma IL-8 improves this prediction.
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|International Respiratory and Severe Illness Center, University of Washington, Seattle, Washington.|Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington.
T Eoin
TE
West
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Chanthiwa
C
Wikraiphat
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Sarunporn
S
Tandhavanant
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Pitchayanant
P
Ariyaprasert
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Pornpan
P
Suntornsut
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington.
Shawna
S
Okamoto
Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Weera
W
Mahavanakul
Department of Pediatrics, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Pramot
P
Srisamang
Department of Medicine, Udon Thani Regional Hospital, Udon Thani, Thailand.
Sunchai
S
Phiphitaporn
Department of Medicine, Khon Kaen Regional Hospital, Khon Kaen, Thailand.
Jirasak
J
Anukunananchai
Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Ploenchan
P
Chetchotisakd
London School of Hygiene and Tropical Medicine, London, United Kingdom.|Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Sharon J
SJ
Peacock
Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.|Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
Narisara
N
Chantratita
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000503:physiopathology; D019468:Disease Management; D004211:Disseminated Intravascular Coagulation / Q000401:mortality; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000401:mortality; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D016019:Survival Analysis; D062606:Tertiary Care Centers; D013785:Thailand
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016209:Interleukin-8