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Risk Factors for Mortality in Staphylococcus aureus Bacteremia

Published online by Cambridge University Press:  02 January 2015

Lucieni Oliveira Conterno ,
Sergio Barsanti Wey  and
Adauto Castelo
Lucieni Oliveira Conterno
Affiliation:
Infectious Diseases Division of Marilia Medical School, São Paulo, Brazil
Sergio Barsanti Wey*
Affiliation:
Division of Infectious Diseases of São Paulo Federal Medical School–UNIFESP, São Paulo, Brazil
Adauto Castelo
Affiliation:
Division of Infectious Diseases of São Paulo Federal Medical School–UNIFESP, São Paulo, Brazil
*
Rua Botucatu 740, DIPA-UNIFESP, 04023-062 São Paulo, SP, Brazil
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Abstract

Objective:

To analyze risk factors for, and the role of methicillin resistance in, mortality in Staphylococcus aureus bacteremia.

Design:

Nested case-control study.

Setting:

General teaching hospital with a high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains, in São Paulo, Brazil.

Patients:

136 patients over 14 years old with documented S aureus bacteremia. Those who died were compared with those who survived at least 14 days.

Results:

Mortality within 14 days of bacteremia was 39% (53/136). Mean age was 47 years. Hospital-acquired bacteremia represented 86% (117/136) of episodes. In 26% (35/136), infection was related to an intravascular catheter and in 13% (17/136) to the respiratory tract. Septic shock occurred in 22% (30/136) of cases. MRSA was isolated in 66% (90/136). Multivariate analysis identified three variables that were significantly and independently associated with mortality: site of entry (lung, odds ratio [OR], 17.0; unknown, OR, 12.3; others, OR, 6.6); occurrence of shock (OR, 8.9), and resistance of S aureus to methicillin (OR, 4.2).

Conclusion:

Our study shows that S aureus bacteremia has a high mortality, especially when the lung is the source of infection and when shock develops; resistance to methicillin may be another risk factor for poor outcome.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 1 , January 1998 , pp. 32 - 37
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1. French, GL, ChengG, AFB, Duthie, R, Cockram, CS. Septicaemia in Hong Kong. J Antimicrob Chemother 1990;25(suppl C):115–125.CrossRefGoogle ScholarPubMed
2. Ispahani, P, Pearson, NJ, Greenwood, D. An analysis of community- and hospital-acquired bacteraemia in a large teaching hospital in the United Kingdom. Q J Med 1987;63:427–440.Google Scholar
3. Morrison, AJ Jr, Freer, CV, Searcy, MA, Landry, SM, Wenzel, RP. Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia. Infect Control 1986;7:550–553.Google Scholar
4. Banerjee, N, Emori, TG, Culver, DH, Gaynes, RP, Jarvis, WR, Horan, T, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989: National Nosocomial Infections Surveillance System. Am J Med 1991;91(suppl 3B):86S–96S.CrossRefGoogle ScholarPubMed
5. Wenzel, RP. Methicillin-resistant S aureus and S epidermidis strains: modern hospital pathogens. Infect Control 1986;7(suppl 2.):118, 119.Google Scholar
6. Gransden, WR, Eykin, SJ, Phillips, I. Staphylococcus aureus bacteraemia: 400 episodes in St Thomas's Hospital. BMJ 1984;288:300–303.CrossRefGoogle ScholarPubMed
7. Mylotte, JM, McDermott, C, Spooner, JA. Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. Reviews of Infectious Diseases 1987;9:891–907.Google Scholar
8. Cohen, SH, Morita, MM, Bradford, M. A seven-year experience with methicillin-resistant Staphylococcus aureus . Am J Med 1991;91(suppl B):233S–237S.Google Scholar
9. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
10. Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
11. Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis 1983;148:763.CrossRefGoogle ScholarPubMed
12. Turnidge, J, Lawson, P, Munro, R, Benn, R. A National survey of antimicrobial resistance in Staphylococcus aureus in Australian teaching hospitals. Med J Aust 1989;150:65–72.CrossRefGoogle ScholarPubMed
13. French, GL, Cheng, AFB, Ling, JML, MO, P, Donnan, S. HongKong strains of methicillin-resistant and methicillin-sensitive Staphylococcus aureus have similar virulence. J Hosp Infect 1990;15:117–125.Google Scholar
14. Levy, CE, Montelli, AC, Furtado, JS, Pereira, AA, Mamizuka, EM, Silva, MLR, et al. Resistência a drogas em cepas bacterianas de pacientes de serviços hospitalares: laboratório de referência do sistema COBA. Revista de Microbiologia de São Paulo 1991;22:21–27.Google Scholar
15. Correa, FJB, Hultzle, RRU, Rodrigues, E, Higaki, Y, Silva, GA, Malik, AM. Distribuição percentual de germes isolados de infecções hospitalares em 24 hospitais do Estado de São Paulo. In: Conferencia Nacional em Controle de Infecções, São Paulo, setembro de 1991. Programa. São Paulo: Associação Paulista de Estudos e Controle de Infecção Hospitalar; 1991:30, 31 (Resumo).Google Scholar
16. Lewis, E, Saravolatz, LD. Comparison of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. Am J Infect Control 1985;13:109–114.CrossRefGoogle ScholarPubMed
17. McManus, AT, Mason, AD, McManus, WF, Fruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg 1989;124:1456–1459.Google Scholar
18. Bone, RC, Balk, RA, Cerra, FB, Dellinger, RP, Fein, AL, Knaus, WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–1655.Google Scholar
19. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1989. Am J Infect Control 1988;16:128–140.CrossRefGoogle Scholar
20. Geerdes, HF, Ziegler, D, Lode, H, Hund, M, Loerr, A, Fangmann, W, et al. Septicemia in 980 patients at a university hospital in Berlin: prospective studies during 4 selected years between 1979 and 1989. Clin Infect Dis 1992;15:991–1002.CrossRefGoogle Scholar
21. McCabe, WR, Jackson, GG. Gram-negative bacteremia: II, clinical, laboratory, and therapeutic observations. Arch Intern Med 1962;110:856–864.CrossRefGoogle Scholar
22. Hinshaw, L, Peduzzi, P, Young, E, Sprung, C, Shatney, C, Sheagren, J, et al. Effect of high-dose glucorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 1987;317:659–665.Google Scholar
23. Watanakunakorn, C. Bacteremic Staphylococcus aureus pneumonia. Scand J Infect Dis 1987;19:623–627.Google Scholar
24. Quarles, LD, Rutsky, EA, Rostand, SG. Staphylococcus aureus bacteremia in patients on chronic hemodialysis. Am J Kidney Dis 1985;6:412–419.CrossRefGoogle ScholarPubMed
25. Horan, TC, White, JW, Jarvis, WR, et al. Nosocomial infection surveillance, 1984. MMWR 1986;35:17–29.Google Scholar
26. Aube, H, Milan, C, Blettery, B. Risk factors for septic shock in the early management of bacteremia. Am J Med 1992;93:283–288.CrossRefGoogle ScholarPubMed
27. Bihari, DJ. Septicaemia: the clinical diagnosis. J Antimicrob Chemother 1990;25(suppl C):1–7.Google Scholar
28. Hershow, RC, Khair, WF, Smith, NL. A comparison of clinical virulence of nosocomial acquired methicillin infection in a university hospital. Infect Control Hosp Epidemiol 1992;13:587–593.Google Scholar
29. Romero-Vivas, Rubio M, Fernandez, C, Picazo, J. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995;21:1417–1423.Google Scholar
30. Sader, HS, Pignatari, ACC, Hollis, RJ, Jones, RN. Evaluation of interhospital spread of methicillin-resistant Staphylococcus aureus in São Paulo Brazil, using pulsed-field electrophoresis of chromosomal DNA. Infect Control Hosp Epidemiol 1994;15:320–323.CrossRefGoogle Scholar