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    Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia

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    Author
    Holmes, NE; Robinson, JO; van Hal, SJ; Munckhof, WJ; Athan, E; Korman, TM; Cheng, AC; Turnidge, JD; Johnson, PDR; Howden, BP
    Date
    2018-03-05
    Source Title
    BMC Infectious Diseases
    Publisher
    BMC
    University of Melbourne Author/s
    Athan, Eugene; Holmes, Natasha; Howden, Benjamin; Cheng, Allen; Johnson, Paul
    Affiliation
    Microbiology and Immunology
    Medicine and Radiology
    Medical Education
    Metadata
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    Document Type
    Journal Article
    Citations
    Holmes, N. E., Robinson, J. O., van Hal, S. J., Munckhof, W. J., Athan, E., Korman, T. M., Cheng, A. C., Turnidge, J. D., Johnson, P. D. R. & Howden, B. P. (2018). Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. BMC INFECTIOUS DISEASES, 18 (1), https://doi.org/10.1186/s12879-018-3011-2.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256118
    DOI
    10.1186/s12879-018-3011-2
    Abstract
    BACKGROUND: Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. METHODS: Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. RESULTS: Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. CONCLUSIONS: This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

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