Characteristics of Staphylococcus aureus Bacteraemia and Predictors of Early and Late Mortality.
We aimed to describe the characteristics of patients with Staphylococcus aureus bacteremia and to evaluate the risk factors associated with early (7-day) and late (30-day) mortality. We performed an observational study including all consecutive episodes of Staphylococcus aureus bacteremia diagnosed at two Italian university hospitals during 2010-2014. A total of 337 patients were included. Mean age was 69 years (range, 57-78) and 65% were males. Methicillin-resistant S. aureus (MRSA) was identified in 132/337 (39%)cases. Overall 7- and 30-day mortality were 13% and 26%, respectively. Early mortality was associated with increased Charlson scores (OR 1.3, 95% CI 1.1-1.5), MRSA bacteremia (OR 3.2, 95% CI 1.4-8.1), presentation with septic shock (OR 13.5, 95% CI 5.4-36.4), and occurrence of endocarditis (OR 4.5, 95%CI 1.4-14.6). Similar risk factors were identified for late mortality, including increased Charlson scores (OR 1.2, 95% CI 1.1-1.4), MRSA bacteremia (OR 2.1, 95% CI 1.2-3.9), presentation with septic shock (OR 4, 95%CI 1.7-9.7), occurrence of endocarditis (OR 3.8, 95% CI 1.4-10.2) as well as Child C cirrhosis (OR 3.9, 95% CI 1.1-14.4) and primary bacteremia (OR 2.5, 95%CI 1.3-5). Infectious disease consultation resulted in better outcomes both at 7 (OR 0.1, 95% CI 0.05-0.4) and at 30 days (OR 0.4, 95% CI 0.2-0.7). In conclusion, our study highlighted high rates of MRSA infection in nosocomial Staphylococcus aureus bacteremia. Multiple comorbidities, disease severity and methicillin-resistance are key factors for early and late mortality in this group. In patients with Staphylococcus aureus bacteremia, infectious disease consultation remains a valuable tool to improve clinical outcome.
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
Matteo
M
Bassetti
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
Maddalena
M
Peghin
Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
Enrico Maria
EM
Trecarichi
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
Alessia
A
Carnelutti
Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
Elda
E
Righi
Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
Paola
P
Del Giacomo
IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy.
Filippo
F
Ansaldi
IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy.
Cecilia
C
Trucchi
IRCCS AOU San Martino IST, Department of Health Sciences, University of Genoa; Genoa, Italy.
Cristiano
C
Alicino
Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
Roberto
R
Cauda
Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
Assunta
A
Sartor
Institute of Microbiology, Catholic University of the Sacred Heart, Rome, Italy.
Teresa
T
Spanu
Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy.
Claudio
C
Scarparo
Institute of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy.
Mario
M
Tumbarello
D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D013997:Time Factors