A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality
<i>Staphylococcus aureus</i> bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimatel...
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MDPI AG
2023-06-01
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| Online Access: | https://www.mdpi.com/2075-4418/13/11/1975 |
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| author | Petros Ioannou Maria Zacharioudaki Despoina Spentzouri Antonia Koutoulakou Konstantinos Kitsos-Kalyvianakis Christoforos Chontos Stamatis Karakonstantis Sofia Maraki George Samonis Diamantis P. Kofteridis |
| author_facet | Petros Ioannou Maria Zacharioudaki Despoina Spentzouri Antonia Koutoulakou Konstantinos Kitsos-Kalyvianakis Christoforos Chontos Stamatis Karakonstantis Sofia Maraki George Samonis Diamantis P. Kofteridis |
| author_sort | Petros Ioannou |
| collection | DOAJ |
| description | <i>Staphylococcus aureus</i> bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant <i>S. aureus</i> (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (<i>p</i> = 0.05, odds ratio = 12.294) and septic shock (<i>p</i> = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management. |
| first_indexed | 2024-03-11T03:09:12Z |
| format | Article |
| id | doaj.art-095a3e3ab3ef4a199f92577a96db1075 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T03:09:12Z |
| publishDate | 2023-06-01 |
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| series | Diagnostics |
| spelling | doaj.art-095a3e3ab3ef4a199f92577a96db10752023-11-18T07:43:38ZengMDPI AGDiagnostics2075-44182023-06-011311197510.3390/diagnostics13111975A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with MortalityPetros Ioannou0Maria Zacharioudaki1Despoina Spentzouri2Antonia Koutoulakou3Konstantinos Kitsos-Kalyvianakis4Christoforos Chontos5Stamatis Karakonstantis6Sofia Maraki7George Samonis8Diamantis P. Kofteridis9School of Medicine, University of Crete, 71003 Heraklion, GreecePediatrics Department, University Hospital of Heraklion, 71110 Heraklion, GreeceInternal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, GreeceSchool of Medicine, University of Crete, 71003 Heraklion, GreeceSchool of Medicine, University of Crete, 71003 Heraklion, GreeceInternal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, GreeceInternal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, GreeceDepartment of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, GreeceSchool of Medicine, University of Crete, 71003 Heraklion, GreeceSchool of Medicine, University of Crete, 71003 Heraklion, Greece<i>Staphylococcus aureus</i> bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant <i>S. aureus</i> (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (<i>p</i> = 0.05, odds ratio = 12.294) and septic shock (<i>p</i> = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management.https://www.mdpi.com/2075-4418/13/11/1975<i>Staphylococcus aureus</i>bacteremiabloodstream infectionantimicrobial resistancemortality |
| spellingShingle | Petros Ioannou Maria Zacharioudaki Despoina Spentzouri Antonia Koutoulakou Konstantinos Kitsos-Kalyvianakis Christoforos Chontos Stamatis Karakonstantis Sofia Maraki George Samonis Diamantis P. Kofteridis A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality Diagnostics <i>Staphylococcus aureus</i> bacteremia bloodstream infection antimicrobial resistance mortality |
| title | A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality |
| title_full | A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality |
| title_fullStr | A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality |
| title_full_unstemmed | A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality |
| title_short | A Retrospective Study of <i>Staphylococcus aureus</i> Bacteremia in a Tertiary Hospital and Factors Associated with Mortality |
| title_sort | retrospective study of i staphylococcus aureus i bacteremia in a tertiary hospital and factors associated with mortality |
| topic | <i>Staphylococcus aureus</i> bacteremia bloodstream infection antimicrobial resistance mortality |
| url | https://www.mdpi.com/2075-4418/13/11/1975 |
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