Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial
<br><strong>Objectives: </strong>Adjunctive rifampicin did not reduce failure/recurrence/death as a composite endpoint in the ARREST trial of Staphylococcus aureus bacteraemia, but did reduce recurrences. We investigated clinically-defined 14-day treatment failure, and recurrence a...
| Main Authors: | , , , , , , , |
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| Format: | Journal article |
| Jezik: | English |
| Izdano: |
Elsevier
2019
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| _version_ | 1826284069797756928 |
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| author | Szubert, AJ Bailey, SL Cooke, GS Peto, T Llewelyn, MJ Edgeworth, JD Walker, AS Thwaites, GE |
| author_facet | Szubert, AJ Bailey, SL Cooke, GS Peto, T Llewelyn, MJ Edgeworth, JD Walker, AS Thwaites, GE |
| author_sort | Szubert, AJ |
| collection | OXFORD |
| description | <br><strong>Objectives: </strong>Adjunctive rifampicin did not reduce failure/recurrence/death as a composite endpoint in the ARREST trial of Staphylococcus aureus bacteraemia, but did reduce recurrences. We investigated clinically-defined 14-day treatment failure, and recurrence and S. aureus-attributed/unattributed mortality by 12-weeks to further define their predictors.</br>
<br><strong>Methods: </strong>A post-hoc exploratory analysis using competing risks models was conducted to identify sub-groups which might benefit from rifampicin. A points-based recurrence risk score was developed and used to compare rifampicin's benefits.</br>
<br><strong>Results: </strong>Recurrence was strongly associated with liver and renal failure, diabetes and immune-suppressive drugs (p < 0.005); in contrast, failure and S. aureus-attributed mortality were associated with older age and higher neutrophil counts. Higher SOFA scores predicted mortality; higher Charlson scores and deep-seated initial infection focus predicted failure. Unexpectedly, recurrence risk increased with increasing BMI in placebo (p = 0.04) but not rifampicin (p = 0.60) participants (pheterogeneity = 0.06). A persistent focus was judged the primary reason for recurrence in 23(74%). A 5-factor risk score based on BMI, Immunosuppression, Renal disease, Diabetes, Liver disease (BIRDL) strongly predicted recurrence (p < 0.001).</br>
<br><strong>Conclusions: </strong>Rifampicin reduces recurrences overall; those with greatest absolute risk reductions were identified using a simple risk score. Source control and adequate duration of antibiotic therapy remain essential to prevent recurrence and improve outcomes.</br> |
| first_indexed | 2024-03-07T01:08:21Z |
| format | Journal article |
| id | oxford-uuid:8c1ddc39-1a33-4e00-808c-7fa33e57f81f |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:08:21Z |
| publishDate | 2019 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:8c1ddc39-1a33-4e00-808c-7fa33e57f81f2022-03-26T22:42:38ZPredictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:8c1ddc39-1a33-4e00-808c-7fa33e57f81fEnglishSymplectic Elements at OxfordElsevier2019Szubert, AJBailey, SLCooke, GSPeto, TLlewelyn, MJEdgeworth, JDWalker, ASThwaites, GE<br><strong>Objectives: </strong>Adjunctive rifampicin did not reduce failure/recurrence/death as a composite endpoint in the ARREST trial of Staphylococcus aureus bacteraemia, but did reduce recurrences. We investigated clinically-defined 14-day treatment failure, and recurrence and S. aureus-attributed/unattributed mortality by 12-weeks to further define their predictors.</br> <br><strong>Methods: </strong>A post-hoc exploratory analysis using competing risks models was conducted to identify sub-groups which might benefit from rifampicin. A points-based recurrence risk score was developed and used to compare rifampicin's benefits.</br> <br><strong>Results: </strong>Recurrence was strongly associated with liver and renal failure, diabetes and immune-suppressive drugs (p < 0.005); in contrast, failure and S. aureus-attributed mortality were associated with older age and higher neutrophil counts. Higher SOFA scores predicted mortality; higher Charlson scores and deep-seated initial infection focus predicted failure. Unexpectedly, recurrence risk increased with increasing BMI in placebo (p = 0.04) but not rifampicin (p = 0.60) participants (pheterogeneity = 0.06). A persistent focus was judged the primary reason for recurrence in 23(74%). A 5-factor risk score based on BMI, Immunosuppression, Renal disease, Diabetes, Liver disease (BIRDL) strongly predicted recurrence (p < 0.001).</br> <br><strong>Conclusions: </strong>Rifampicin reduces recurrences overall; those with greatest absolute risk reductions were identified using a simple risk score. Source control and adequate duration of antibiotic therapy remain essential to prevent recurrence and improve outcomes.</br> |
| spellingShingle | Szubert, AJ Bailey, SL Cooke, GS Peto, T Llewelyn, MJ Edgeworth, JD Walker, AS Thwaites, GE Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title_full | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title_fullStr | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title_full_unstemmed | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title_short | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| title_sort | predictors of recurrence early treatment failure and death from staphylococcus aureus bacteraemia observational analyses within the arrest trial |
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