Factors for mortality in patients with persistent Staphylococcus aureus bacteremia: The importance of treatment response rather than bacteremia duration.

J Microbiol Immunol Infect

Division of Infectious Diseases, Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea; Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Republic of Korea. Electronic address:

Published: October 2023

AI Article Synopsis

  • The study examines the unclear criteria for antibiotic failure in persistent Staphylococcus aureus bacteremia (SAB) and its impact on patient mortality.
  • Researchers evaluated data from 221 patients treated across four hospitals, finding a 30-day in-hospital mortality rate of 28.5%, with key mortality factors being age, comorbidity indices, and the Pitt bacteremia score (PBS) at treatment day 4.
  • The findings suggest that the PBS at day 4 is a stronger predictor of mortality than treatment response symptoms like fever reduction and longer bacteremia duration, which may aid in developing better treatment approaches for persistent SAB cases.

Article Abstract

Background: The criteria for antibiotic failure in persistent Staphylococcus aureus bacteremia (SAB) are unclear, but treatment response and bacteremia duration are commonly used indicators of antibiotic failure. We evaluated the effects of treatment response and bacteremia duration on mortality in persistent SAB.

Methods: We retrospectively identified patients with persistent SAB in four university-affiliated hospitals between 2017 and 2021. Bacteremia duration was calculated from the first day of active antibiotic therapy, and persistent SAB was defined as bacteremia lasting for 2 or more days. Defervescence and Pitt bacteremia score (PBS) were used to evaluate treatment response at treatment day 4. The primary outcome was 30-day in-hospital mortality. Time-dependent multivariable Cox regression analysis and subgroup analysis according to methicillin resistance were performed.

Results: A total of 221 patients was included in the study, and the 30-day in-hospital mortality was 28.5%. There was no significant difference in bacteremia duration between survived and deceased patients. Independent factors for mortality included age, Charlson comorbidity index, initial PBS, pneumonia, and removal of the eradicable focus. PBS at treatment day 4 ≥ 3 was the strongest risk factor (adjusted hazard ratio [HR] = 4.260), but defervescence was not. Bacteremia duration was not an independent factor except for 13 days or more of methicillin-resistant SAB (adjusted HR = 1.064).

Conclusions: In patients with persistent SAB, PBS at treatment day 4 was associated with 30-day in-hospital mortality rather than defervescence and bacteremia duration. The results of this study could help determine early intensified treatment strategies in persistent SAB patients.

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Source
http://dx.doi.org/10.1016/j.jmii.2023.07.010DOI Listing

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