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Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study.
- Source :
- European Journal of Clinical Microbiology & Infectious Diseases; May2024, Vol. 43 Issue 5, p841-851, 11p
- Publication Year :
- 2024
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- METHICILLIN-resistant staphylococcus aureus
BACTEREMIA
LONGITUDINAL method
SYMPTOMS
Subjects
Details
- Language :
- English
- ISSN :
- 09349723
- Volume :
- 43
- Issue :
- 5
- Database :
- Complementary Index
- Journal :
- European Journal of Clinical Microbiology & Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 177370719
- Full Text :
- https://doi.org/10.1007/s10096-024-04790-2