Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia : analysis of a multicentre prospective study
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature..
PURPOSE: Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients.
METHODS: We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes.
RESULTS: Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as 'without metastatic infection (6.3%)', 'with metastatic infection (17.4%)', and 'uncertain for metastatic infection (76.3%)'. 30-day mortality increased as the severity of diagnosis shifted from 'without metastatic infection' to 'uncertain for metastatic infection' and 'with metastatic infection' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia.
CONCLUSIONS: The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as 'high-risk' and 'uncertain for metastatic infection' remains an area for improvement.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology - (2024) vom: 27. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Kim, Taeeun [VerfasserIn] |
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| Links: |
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| Themen: |
Complicated bacteraemia |
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| Anmerkungen: |
Date Revised 27.02.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1007/s10096-024-04790-2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM369017366 |
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| 100 | 1 | |a Kim, Taeeun |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia |b analysis of a multicentre prospective study |
| 264 | 1 | |c 2024 | |
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| 520 | |a © 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. | ||
| 520 | |a PURPOSE: Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients | ||
| 520 | |a METHODS: We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes | ||
| 520 | |a RESULTS: Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as 'without metastatic infection (6.3%)', 'with metastatic infection (17.4%)', and 'uncertain for metastatic infection (76.3%)'. 30-day mortality increased as the severity of diagnosis shifted from 'without metastatic infection' to 'uncertain for metastatic infection' and 'with metastatic infection' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia | ||
| 520 | |a CONCLUSIONS: The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as 'high-risk' and 'uncertain for metastatic infection' remains an area for improvement | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Staphylococcus aureus bacteraemia | |
| 650 | 4 | |a Complicated bacteraemia | |
| 650 | 4 | |a Metastatic infection | |
| 650 | 4 | |a Methicillin-resistance | |
| 650 | 4 | |a Risk stratification | |
| 700 | 1 | |a Lee, Sang-Rok |e verfasserin |4 aut | |
| 700 | 1 | |a Park, Seong Yeon |e verfasserin |4 aut | |
| 700 | 1 | |a Moon, Song Mi |e verfasserin |4 aut | |
| 700 | 1 | |a Jung, Jiwon |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Min Jae |e verfasserin |4 aut | |
| 700 | 1 | |a Sung, Heungsup |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Mi-Na |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Sung-Han |e verfasserin |4 aut | |
| 700 | 1 | |a Choi, Sang-Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Sang-Oh |e verfasserin |4 aut | |
| 700 | 1 | |a Kim, Yang Soo |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Eun Hee |e verfasserin |4 aut | |
| 700 | 1 | |a Chong, Yong Pil |e verfasserin |4 aut | |
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