Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

Soo-youn Moon; Mi Suk Lee; Jun Seong Son; Hee Joo Lee; Sang-Oh Lee

doi:10.3947/ic.2008.40.3.148

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Moon, Lee, Son, Lee, and Lee: Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

Original Article

Infection and Chemotherapy

Infection and Chemotherapy 2008; 40(3): 148-153.

Published online: 20 June 2008

DOI: https://doi.org/10.3947/ic.2008.40.3.148

Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia

Soo-youn Moon, M.D.¹, Mi Suk Lee, M.D.¹, Jun Seong Son, M.D.¹, Hee Joo Lee, M.D.², Sang-Oh Lee, M.D.¹

¹Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

²Department of Laboratory Medicine, Kyung Hee University School of Medicine, Seoul, Korea.

Correspondence : Sang-Oh Lee, M.D. Division of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3301, Fax: +82-2-3010-6970, soleemd@amc.seoul.kr

Received 21 March 2008 Accepted 28 April 2008

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB).

Materials and Methods

Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB.

Results

A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4±13.6 vs. 59.4±14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5±6.3 vs. 13.5±5.1, P<0.001) and the acute physiology score (11.1±5.5 vs. 8.0±4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB.

Conclusion

Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.

Keywords: Staphylococcus aureus, Bacteremia, Death, Risk factor

Figures and Tables

Fig. 1

Selection of patients.

Table 1

Baseline Characteristics of the Patients

Values are numbers of patients (% of patients) or mean ± standard deviation.

Table 2

Univariate Analysis of Risk Factors for Death in Patients with Staphylococcus aureus Bacteremia

Values are number of patients (% of patients) or mean±standard deviation.

APS, acute physiology score; MRSA, methicillin resistant S. aureus

Table 3

Multivariate Analysis of Risk Factors for Death in Staphylococcus aureus Bacteremia

APS, acute physiology score

Notes

This study was supported by Kyung Hee University Research Fund (KHU-20051038).

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