AI Article Synopsis
- Staphylococcus epidermidis (SE) is typically considered low-risk but can cause significant bloodstream infections (BSIs) in ICU patients, prompting this study to investigate its impact on this population.
- The study reviewed 59 ICU patients with SE-BSIs, finding a high incidence of septic shock, especially among immunocompromised individuals, demonstrated by low blood pressure and elevated lactate levels.
- The findings raise concerns about antibiotic resistance and highlight the importance of monitoring central venous access, with a notable 28-day mortality rate of 46% among those with septic shock due to SE.
Article Abstract
Objectives: Staphylococcus epidermidis (SE) is a supposedly low-virulence agent, which may cause proven bloodstream infections (BSIs), with little-known consequences on intensive care unit (ICU) patients. We aimed at studying ICU patients diagnosed with BSIs caused by SE (SE-BSIs).
Methods: We constituted a retrospective cohort in two medical ICUs. SE-BSIs were defined by two or more independent SE-positive blood cultures of the same strain, within 48 hours, without concurrent infection.
Results: We included 59 patients; 58% were men (n = 34), with median age of 67 (interquartile range 60-74) years and a simplified acute physiology score II of 59 (36-74) points, and 56% were immunocompromised (n = 33). Among the 37 (63%) patients requiring norepinephrine initiation or increase at the onset of SE-BSI versus patients not requiring vasopressors (37%; n = 22), concomitant arterial lactate levels reached 2.8 (1.9-5.8) versus 1.5 (1.3-2.2) mmol/l (P <0.01), whereas the mean blood pressure was 49 (42-54) versus 61 (56-65) mm Hg (P = 0.01) and the mortality was 46% (n = 17) vs 14% (n = 3) at day 28 (P = 0.01), respectively. Regarding antibiotics, the susceptibility rates toward linezolid and vancomycin were 71% (n = 41/58) and 100% (n = 54/54), respectively. At the time of SE-BSI, all but one patient had a central venous access device.
Conclusion: This work highlights SE-BSIs as a cause of septic shock, mostly in immunocompromised ICU patients, with increasing concerns about resistance to antibiotics and central line management.
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| http://dx.doi.org/10.1016/j.ijid.2023.07.014 | DOI Listing |
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