Prospective study of 424 cases of Staphylococcus aureus bacteraemia:: determination of factors affecting incidence and mortality

被引:155
作者
Hill, PC
Birch, M
Chambers, S
Drinkovic, D
Ellis-Pegler, RB
Everts, R
Murdoch, D
Pottumarthy, S
Roberts, SA
Swager, C
Taylor, SL
Thomas, MG
Wong, CG
Morris, AJ
机构
[1] Green Lane Hosp, Dept Clin Microbiol, Clin Microbiol Lab, Auckland 3, New Zealand
[2] Auckland Hosp, Dept Infect Dis, Auckland, New Zealand
[3] Auckland Hosp, Dept Clin Microbiol, Auckland, New Zealand
[4] Middlemore Hosp, Dept Clin Microbiol, Auckland 6, New Zealand
[5] N Shore Hosp, Microbiol Lab, Auckland, New Zealand
[6] Christchurch Hosp, Dept Infect Dis, Christchurch, New Zealand
[7] Christchurch Hosp, Dept Clin Microbiol, Christchurch, New Zealand
关键词
Staphylococcus aureus; bacteraemia; infection; nosocomial infection;
D O I
10.1111/j.1444-0903.2001.00029.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Staphylococcus aureus bacteraemia (SAB) is a common complication of S. aureus infection and is associated with a high mortality. Aims: To document prospectively the pattern of ill- ness associated with SAB in New Zealand and, by recording patient demographic factors and clinical features, to identify risk factors associated with a poor outcome. Methods: From 1 July 1996 to 31 December 1997, adults with SAB were prospectively studied in six tertiary care hospitals. All information obtained from patients' records was recorded on worksheets and transferred to a computerized spreadsheet for analysis. Results: There were 424 patients with SAB. Maori (relative risk (RR) = 1.8, 95% confidence interval (CI) = 1.3-2.6) and Pacific Island people (RR = 4.0, 95% CI = 3.1-5.3) were significantly more likely than people of European descent to acquire SAB, but not to die from the infection. Fifty per cent of cases were community acquired. A source was identified for 85%: intravenous catheter (31%), primarily hospital acquired, and skin/soft tissue (22%), primarily community acquired, were the most common foci. The 30-day mortality was 19%, 83% of whom died within 2 weeks. Risk factors for a poor outcome were: increasing age above 60, female sex (RR = 1.4, 95% CI = 1.0-2.1), diabetes mellitus (RR = 1.5, 95% CI = 1.0-2.4), immunosuppression (RR = 1.5, 95% CI = 1.0-2.4), pre-existing renal impairment (RR = 1.8, 95% CI = 1.2-2.7), malignancy (RR = 2.2, 95% CI = 1.4-3.5), lung as a source (RR = 2.8, 95% CI = 1.9-4.2) and unknown source (RR = 2.3, 95% CI = 1.5-3.3). Mortality was also accurately predicted by two multifactor scoring systems. There was a low rate of methicillin resistance (5%). Conclusions: Staphylococcus aureus bacteraemia is more likely to occur in certain ethnic groups, while mortality is associated with other identifiable risk factors and continues to be high. Intravenous catheters remain the most common and most preventable cause of SAB.
引用
收藏
页码:97 / 103
页数:7
相关论文
共 28 条
  • [1] Abbott W, 1999, NEW ZEAL MED J, V112, P243
  • [2] ENTEROBACTER BACTEREMIA - CLINICAL-FEATURES AND EMERGENCE OF ANTIBIOTIC-RESISTANCE DURING THERAPY
    CHOW, JW
    FINE, MJ
    SHLAES, DM
    QUINN, JP
    HOOPER, DC
    JOHNSON, MP
    RAMPHAL, R
    WAGENER, MM
    MIYASHIRO, DK
    YU, VL
    [J]. ANNALS OF INTERNAL MEDICINE, 1991, 115 (08) : 585 - 590
  • [3] Conterno LO, 1998, INFECT CONT HOSP EP, V19, P32
  • [4] Community and hospital acquired Staphylococcus aureus septicaemia: 115 cases from a Dublin teaching hospital
    Cunney, RJ
    McNamara, EB
    AlAnsari, N
    Smyth, EG
    [J]. JOURNAL OF INFECTION, 1996, 33 (01) : 11 - 13
  • [5] Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists:: Experience with 244 patients
    Fowler, VG
    Sanders, LL
    Sexton, DJ
    Kong, LK
    Marr, KA
    Gopal, AK
    Gottlieb, G
    McClelland, RS
    Corey, GR
    [J]. CLINICAL INFECTIOUS DISEASES, 1998, 27 (03) : 478 - 486
  • [6] CDC DEFINITIONS FOR NOSOCOMIAL INFECTIONS, 1988
    GARNER, JS
    JARVIS, WR
    EMORI, TG
    HORAN, TC
    HUGHES, JM
    [J]. AMERICAN JOURNAL OF INFECTION CONTROL, 1988, 16 (03) : 128 - 140
  • [7] Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus
    Harbarth, S
    Rutschmann, O
    Sudre, P
    Pittet, D
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1998, 158 (02) : 182 - 189
  • [8] ANTIBIOTIC-THERAPY FOR PSEUDOMONAS-AERUGINOSA BACTEREMIA - OUTCOME CORRELATIONS IN A PROSPECTIVE-STUDY OF 200 PATIENTS
    HILF, M
    YU, VL
    SHARP, J
    ZURAVLEFF, JJ
    KORVICK, JA
    MUDER, RR
    [J]. AMERICAN JOURNAL OF MEDICINE, 1989, 87 (05) : 540 - 546
  • [9] Bone and joint infections at a tertiary-care hospital: Review of one hundred seventy-eight cases
    Hill, PC
    Wong, CGS
    Lang, SDR
    [J]. INFECTIOUS DISEASES IN CLINICAL PRACTICE, 1999, 8 (08) : 368 - 373
  • [10] Kloos W.E., 1999, Manual of Clinical Microbiology, P264