Predictive factors for early mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia
Por:
Gasch, O, Camoez, M, Dominguez, MA, Padilla, B, Pintado, V, Almirante, B, Lepe, JA, Lagarde, M, de Gopegui, ER, Martinez, JA, Montejo, M, Torre-Cisneros, J, Arnaiz, A, Goenaga, MA, Benito, N, Rodriguez-Bano, J, Pujol, M
Publicada:
1 jun 2013
Resumen:
A high proportion of patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia die within a few days of the onset of infection. However, predictive factors for early mortality (EM) have barely been examined. The aim of this study was to determine the predictive factors for EM in patients with MRSA bacteraemia.
All episodes of MRSA bacteraemia were prospectively followed in 21 Spanish hospitals from June 2008 to December 2009. Epidemiology, clinical data, therapy and outcome were recorded. All MRSA strains were analysed in a central laboratory. Mortality was defined as death from any cause occurring in the 30 days after the onset of MRSA bacteraemia. EM was defined as patients who died within the first 2 days, and late mortality (LM) for patients who died after this period. Multivariate analyses were performed by using logistic regression models.
A total of 579 episodes were recorded. Mortality was observed in 179 patients (31): it was early in 49 (8.5) patients and late in 130 (22.5). Independent risk factors for EM were [OR (95 CI)] initial Pitt score 3 [3.99 (1.723.24)], previous rapid fatal disease [3.67 (1.3210.24)], source of infection lower respiratory tract or unknown [3.76 (1.3110.83) and 2.83 (1.117.21)], non-nosocomial acquisition [2.59 (1.165.77)] and inappropriate initial antibiotic therapy [3.59 (1.637.89)]. When predictive factors for EM and LM were compared, inappropriate initial antibiotic therapy was the only distinctive predictor of EM, while endocarditis and lower respiratory tract sources both predicted LM.
In our large cohort of patients several factors were related to EM, but the only distinctive predictor of EM was inappropriate initial antibiotic therapy.
Filiaciones:
Gasch, O:
IDIBELL, Hosp Univ Bellvitge, Barcelona, Spain
Camoez, M:
IDIBELL, Hosp Univ Bellvitge, Barcelona, Spain
Dominguez, MA:
IDIBELL, Hosp Univ Bellvitge, Barcelona, Spain
Padilla, B:
Hosp Gen Gregorio Maranon, Madrid, Spain
Pintado, V:
Hosp Univ Ramon y Cajal, Madrid, Spain
Almirante, B:
Hosp Univ Vall dHebron, Barcelona, Spain
Lepe, JA:
Hosp Univ Virgen del Rocio, Seville, Spain
Lagarde, M:
Hosp Univ 12 Octubre, Madrid, Spain
de Gopegui, ER:
Hosp Univ Son Dureta, Palma De Mallorca, Spain
Martinez, JA:
Hosp Clin Barcelona, Barcelona, Spain
Montejo, M:
Hosp Cruces, Baracaldo, Spain
Torre-Cisneros, J:
Hosp Univ Reina Sofia, Cordoba, Spain
Arnaiz, A:
Hosp Univ Marques de Valdecilla, Santander, Spain
Goenaga, MA:
Hosp Donostia, Donostia San Sebastian, Spain
Benito, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Rodriguez-Bano, J:
Hosp Univ Virgen de Macarena, Seville, Spain
Pujol, M:
IDIBELL, Hosp Univ Bellvitge, Barcelona, Spain
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