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Observational Study
. 2014 Mar;68(3):242-51.
doi: 10.1016/j.jinf.2013.10.015. Epub 2013 Nov 16.

Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies

Achim J Kaasch  1 , Gavin Barlow  2 , Jonathan D Edgeworth  3 , Vance G Fowler Jr  4 , Martin Hellmich  5 , Susan Hopkins  6 , Winfried V Kern  7 , Martin J Llewelyn  8 , Siegbert Rieg  7 , Jesús Rodriguez-Baño  9 , Matthew Scarborough  10 , Harald Seifert  11 , Alex Soriano  12 , Robert Tilley  13 , M Estée Tőrők  14 , Verena Weiß  5 , A Peter R Wilson  15 , Guy E Thwaites  16 ; ISAC, INSTINCT, SABG, UKCIRG, and Colleagues
Collaborators, Affiliations
Observational Study

Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies

Achim J Kaasch et al. J Infect. 2014 Mar.

Erratum in

  • J Infect. 2014 Sep;69(3):306-7

Abstract

Objectives: Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome.

Methods: We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States.

Results: The median age of participants was 64 years (interquartile range 50-75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001).

Conclusion: The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.

Keywords: Bacteraemia; Mortality; Pooled analysis; Staphylococcus aureus bloodstream infection.

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Conflict of interest statement

Conflict of interest

J.E. and H.S. serve on an advisory committee for Basilea Pharmaceutica International, V.G.F. for Merck, A.P.R.W. for Quintiles and Momentum, H.S. for Astellas, Astra Zeneca, Cubist, 3M Medica, Novartis, and Theravance. V.G.F. was a paid consultant for Pfizer, Novartis, Galderma, Novadigm, Durata, Achaogen, Affinium, Medicines Co., Cerexa, and MedImmune, H.S. for Astellas, Basilea, Gilead, MSD Sharp & Dohme, Pfizer, and SIRS-Lab, J.R.B. for Roche, Merck, Janssen-Cilag, Pfizer, and Novartis. V.G.F. has received research grants or support from Merck, Theravance, Cerexa, Pfizer, Medimmune, Novartis, NIH, and Advanced Liquid Logics, J.R.B. from Novartis, H.S. from Basilea, and Novartis. J.R.B. has received payments for lectures from Merck, Astellas, Pfizer, AstraZeneca, and Novartis; H.S. from Astellas, Astra Zeneca, Gilead, MSD Sharp&Dohme, Novartis, Pfizer, and Oxoid, A.J.K. from BD Biosciences, Biomérieux, MSD Sharp & Dohme, and ViiV Healthcare, A.S. from Novartis and Pfizer. V.G.F. holds a patent on NCGR. V.G.F. has received royalties from UpToDate, M.E.T. from Oxford University Press. V.G.F. has been paid for developing and delivering educational presentations for Cubist, Cerexa, and Theravance. S.R. has received travel support from Astellas and MSD Sharp & Dohme, A.J.K. from Janssen-Cila, and. M.E.T from Illumina Inc. All other authors: no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Flow diagram of patients enrolled in the different studies.
Figure 2
Figure 2
Kaplan–Meier survival plot up to 90 days by dominant infective focus (p<0.0001, logrank test). Censored cases (patients lost to follow-up) are denoted by +.
Figure 3
Figure 3
Forest plot for 30-day mortality by study.
See this image and copyright information in PMC

References

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