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

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Holmes, NE; Robinson, JO; van Hal, SJ; Munckhof, WJ; Athan, E; Korman, TM; Cheng, AC; Turnidge, JD; Johnson, PDR; Howden, BPDate
2018-03-05Source Title
BMC Infectious DiseasesPublisher
BMCUniversity of Melbourne Author/s
Athan, Eugene; Holmes, Natasha; Howden, Benjamin; Cheng, Allen; Johnson, PaulAffiliation
Microbiology and ImmunologyMedicine and Radiology
Medical Education
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Journal ArticleCitations
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 AccessAbstract
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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