Kuehl, Richard, Morata, Laura, Boeing, Christian, Subirana, Isaac, Seifert, Harald, Rieg, Siegbert, Kern, Winfried V., Kim, Hong Bin, Kim, Eu Suk, Liao, Chun-Hsing, Tilley, Robert, Lopez-Cortes, Luis Eduardo, Llewelyn, Martin J., Fowler, Vance G., Thwaites, Guy ORCID: 0000-0002-2858-2087, Cisneros, Jose Miguel, Scarborough, Matt, Nsutebu, Emmanuel, Ferrer, Mercedes Gurgui, Perez, Jose L., Barlow, Gavin, Hopkins, Susan, Ternavasio-de la Vega, Hugo Guillermo, Toeroek, M. Estee, Wilson, Peter, Kaasch, Achim J. and Soriano, Alex (2020). Defining persistent Staphylococcus aureus bacteraemia: secondary analysis of a prospective cohort study. Lancet Infect. Dis., 20 (12). S. 1409 - 1418. OXFORD: ELSEVIER SCI LTD. ISSN 1474-4457

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Abstract

Background Staphylococcus aureus persistent bacteraemia is only vaguely defined and the effect of different durations of bacteraemia on mortality is not well established. Our primary aim was to analyse mortality according to duration of bacteraemia and to derive a clinically relevant definition for persistent bacteraemia. Methods We did a secondary analysis of a prospective observational cohort study at 17 European centres (nine in the UK, six in Spain, and two in Germany), with recruitment between Jan 1, 2013, and April 30, 2015. Adult patients who were consecutively hospitalised with monomicrobial S aureus bacteraemia were included. Patients were excluded if no follow-up blood culture was taken, if the first follow-up blood-culture was after 7 days, or if active antibiotic therapy was started more than 3 days after first blood culture. The primary outcome was 90-day mortality. Univariable and time-dependent multivariable Cox regression analysis were used to assess predictors of mortality. Duration of bacteraemia was defined as bacteraemic days under active antibiotic therapy counting the first day as day 1. Findings Of 1588 individuals assessed for eligibility, 987 were included (median age 65 years [IQR 51-75]; 625 [63%] male). Death within 90 days occurred in 273 (28%) patients. Patients with more than 1 day of bacteraemia (315 [32%]) had higher Charism comorbidity index and sequential organ failure assessment scores and a longer interval from first symptom to first blood culture. Crude 90-day mortality increased from 22% (148 of 672) with 1 day of bacteraemia, to 39% (85 of 218) with 2-4 days, 43% (30 of 69) with 5-7 days, and 36% (10 of 28) with snore than 7 days of bacteraemia. Metastatic infections developed in 39 (6%) of 672 patients with 1 day of bacteraemia versus 40 (13%) of 315 patients if bacteraemia lasted for at least 2 days. The second day of bacteraemia had the highest HR and earliest cutoff significantly associated with mortality (adjusted hazard ratio 1.93, 95% CI 1.51-2.46; p<0.0001). Interpretation We suggest redefining the cutoff duration for persistent bacteraemia as 2 days or more despite active antibiotic therapy. Our results favour follow-up blood cultures after 24 h for early identification of all patients with increased risk of death and metastatic infection. Copyright (C) 2020 Elsevier Ltd. All rights reserved.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kuehl, RichardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Morata, LauraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boeing, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Subirana, IsaacUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seifert, HaraldUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rieg, SiegbertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kern, Winfried V.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kim, Hong BinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kim, Eu SukUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liao, Chun-HsingUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tilley, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lopez-Cortes, Luis EduardoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Llewelyn, Martin J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fowler, Vance G.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thwaites, GuyUNSPECIFIEDorcid.org/0000-0002-2858-2087UNSPECIFIED
Cisneros, Jose MiguelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Scarborough, MattUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nsutebu, EmmanuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ferrer, Mercedes GurguiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perez, Jose L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Barlow, GavinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hopkins, SusanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ternavasio-de la Vega, Hugo GuillermoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Toeroek, M. EsteeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wilson, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaasch, Achim J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Soriano, AlexUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-309844
DOI: 10.1016/S1473-3099(20)30447-3
Journal or Publication Title: Lancet Infect. Dis.
Volume: 20
Number: 12
Page Range: S. 1409 - 1418
Date: 2020
Publisher: ELSEVIER SCI LTD
Place of Publication: OXFORD
ISSN: 1474-4457
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RISK-FACTORS; MORTALITY; INFECTIONS; PREDICTORS; VANCOMYCIN; THERAPY; TIMEMultiple languages
Infectious DiseasesMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/30984

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