Risk factors for mortality and complications in peripheral venous catheter-associated Staphylococcus aureus bacteraemia: a large multicentre cohort study

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES Journal of Hospital Infection Pub Date : 2024-07-18 DOI:10.1016/j.jhin.2024.06.017

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Abstract

Background

Peripheral venous catheter-associated Staphylococcus aureus bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection.

Aim

This cohort study aims to identify the risk factors associated with its mortality and complications.

Methods

Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed.

Findings

A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55–11.03; P = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant S. aureus bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without.

Conclusion

PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.

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外周静脉导管相关金黄色葡萄球菌菌血症死亡率和并发症的风险因素：一项大型多中心队列研究。

背景：外周静脉导管相关金黄色葡萄球菌菌血症（PVC-SAB外周静脉导管相关金黄色葡萄球菌菌血症（PVC-SAB）是一种可能危及生命的院内感染：方法：对西班牙两家三级医院开展的一项前瞻性队列研究进行回顾性分析。研究纳入了 2011 年 1 月至 2019 年 7 月期间入院并在住院期间出现 PVC-SAB 的成人患者。主要结果为全因 30 天和 90 天死亡率。次要结果是菌血症发生时的败血症或脓毒性休克、转移性感染和住院时间。进行了单变量和多变量分析：2011年至2019年期间，243名患者共确诊了256例PVC-SAB。30天和90天全因死亡率分别为18.3%和24.2%。血培养采集后第二天未使用易感抗生素（OR 4.14，[95% CI 1.55-11.03]；P=0.005）、败血症和复杂菌血症被确定为30天和90天死亡率的独立风险因素；耐甲氧西林金黄色葡萄球菌（MRSA）菌血症仅被确定为30天死亡率的独立风险因素，功能依赖仅被确定为90天死亡率的独立风险因素。持续菌血症和败血症与脓毒性转移和心内膜炎有关，脓毒性转移会显著延长住院时间。与未发生脓毒性休克的患者相比，发生脓毒性休克的患者中有更大比例的人随后被送进了医疗机构：结论：PVC-SAB仍然与高死亡率有关。及时使用适当的抗生素对降低死亡率至关重要。综合诊断方法至关重要，尤其是对持续菌血症和植入心血管装置的患者，以排除转移性并发症和心内膜炎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.