Sequential Time to Positivity of Blood Cultures can Be a Predictor of Prognosis of Patients with Persistent Staphylococcus aureus Bacteremia.

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Sequential Time to Positivity of Blood Cultures can Be a Predictor of Prognosis of Patients with Persistent Staphylococcus aureus Bacteremia.

Clin Microbiol Infect. 2014 Feb 25;

Authors: Hsu MS, Huang YT, Hsu HS, Liao CH

Abstract
A short time-to-positivity (TTP) correlates with poor clinical outcome in patients with S. aureus bacteremia, but the association between sequential TTPs and the outcome of these patients is unclear. Sequential TTPs from patients with S. aureus bacteremia persisting > 48 hours were analyzed with respect to clinical parameters and patient outcome at a tertiary hospital. During the 5-year study period, 87 patients (9.2%; mean age, 64 years) had persistent S. aureus bacteremia, with an average Pittsburgh bacteremia score of 2.7. Forty-eight patients (55%) had methicillin-resistant Staphylococcus aureus and 28 (32%) had nosocomial infection. The most common underlying diseases were end-stage renal disease (43%). The most common infection site was catheter-related infection (31%), followed by infective endocarditis (18%). The in-hospital mortality rate was 40%. Higher Pittsburgh scores (p=0.005; OR, 1.37; 95% confident interval [CI], 1.1-1.7) and a ratio of the 2(nd) TTP/1(st) TTP < 1.5 (p=0.004; OR, 0.2; 95% CI, 0.07-0.6) were independent risk factors for mortality. Among patients receiving adequate empirical therapy, a second positive blood culture growing within 12 hours is more frequent in patients that finally died. Factors associated with 2(nd) TTP/1(st) TTP < 1.5 included older age (p=0.02; OR, 0.96; 95% CI, 0.92-0.99) and inadequate empirical antimicrobial agents (p=0.01; OR, 3.53; 95% CI, 1.42-8.78). Among patients with persistent S. aureus bacteremia, a ratio of 2(nd) TTP/1(st) TTP < 1.5 is a predictor of poor outcome. Physicians should search for interventions that guarantee all patients with S. aureus bacteremia receive adequate empirical therapy. This article is protected by copyright. All rights reserved.

PMID: 24612429 [PubMed - as supplied by publisher]

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