Archive for March 6, 2011

Risk factors associated with long-term prognosis of patients with Staphylococcus aureus bacteremia.

Infection. 2010 Dec  V.38 N.6 p.465-70.

Hanses F, Spaeth C, Ehrenstein BP, Linde HJ, Schölmerich J, Salzberger B.

Department of Internal Medicine I, University Hospital, University of Regensburg, 93042 Regensburg, Germany. frank.hanses@klinik.uni-r.de

Abstract

OBJECTIVE

To estimate risk factors associated with long-term outcome (i.e., 1-year survival) in patients with Staphylococcus aureus bacteremia (SAB).

METHODS AND MATERIALS

This was a retrospective study in which the microbiological laboratory data records of patients admitted to the University Hospital of Regensburg between January 2004 and June 2005 were examined to identify those patients with blood cultures positive for S. aureus. Corresponding clinical records for all patients were reviewed using a standardized questionnaire. Of the 119 patients identified with SAB, 80 were available for the >1-year follow-up.

RESULTS

Crude 1-year mortality was 47.5; 30- and 90-day mortality was 28.8 and 37.5%, respectively. In-hospital mortality was 28.8%. There were no significant differences in 1-year survival in terms of age, gender, antibiotic resistance, and mode of acquisition (nosocomial vs. community-acquired). A significantly better survival was observed with an identifiable focus present, if the chosen empiric antibiotic therapy was adequate or if the body mass index of the patient was >24.

CONCLUSION

In summary, in this patient cohort, considerable additional mortality due to SAB beyond 30 or 90 days was present. Our results suggest that long-term survival data should be taken into account in outcome studies involving patients with S. aureus bacteremia.

abstract

http://www.ncbi.nlm.nih.gov/pubmed/20878456?dopt=Abstract

March 6, 2011 at 2:39 pm Leave a comment

Mortality associated with in-hospital bacteraemia caused by Staphylococcus aureus: a multistate analysis with follow-up beyond hospital discharge.

J Antimicrob Chemother 2011 Feb V.66  p.381.

Wolkewitz M, Frank U, Philips G, Schumacher M, Davey P; on behalf of the BURDEN study group.

Collaborators (15)Frank U, Wilson C, Lawrie-Blum D, Kaier K, Schroeren-Boersch B, Davey P, Chalkley M, Heather D, Ansari F, Suetens C, Lambert ML, Grundmann H, de Kraker M, Schumacher M, Wolkewitz M.

Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany.

Abstract

Objectives

The main objective was to study the impact of in-hospital bacteraemia caused by Staphylococcus aureus on mortality within 90 days after admission. We compared methicillin-resistant S. aureus (MRSA) with methicillin-susceptible S. aureus (MSSA).

Patients and methods

The study population consisted of adult residents of Tayside, Scotland, UK, from 1 January 2005 to 30 September 2006 who had a new admission to Ninewells Hospital between 1 July 2005 and 30 June 2006. All patients (n = 3132) in the same wards as the patients infected with S. aureus were included. We addressed key weaknesses in previous studies by using a cohort design and applying a multistate model, which addressed the temporal dynamics. Critically, the model recognized that death and discharge from the hospital are competing events and that delay in discharge independently increases the risk of death.

Results

The cohort included 3132 patients, of whom 494 died within 90 days after admission, 34 developed MRSA bacteraemia and 26 MSSA bacteraemia in the hospital. In comparison with patients without S. aureus bacteraemia, the death hazard was 5.6 times greater with MRSA [95% confidence interval (CI) 3.36-9.41] and 2.7 times greater with MSSA bacteraemia (95% CI 1.33-5.39). After adjustment for co-morbidity, hospitalization, age and sex, the death hazard was 2.9 times greater with MRSA (95% CI 1.70-4.88) and 1.7 times greater with MSSA bacteraemia (95% CI 0.84-3.47).

Conclusions

Time-dependent models such as the proposed multistate model are necessary to address the temporal dynamics of admission, infection, discharge and death. The impact of S. aureus bacteraemia on mortality should be considered on two levels: the burden of disease, i.e. nosocomial infection with S. aureus bacteraemia, and the burden of resistance to methicillin.

abstract

http://www.ncbi.nlm.nih.gov/pubmed/21098543?dopt=Abstract

March 6, 2011 at 2:38 pm Leave a comment


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