Benedetta Varisco , Pedro María Martínez Pérez-Crespo , Pilar Retamar-Gentil , Inmaculada López Hernandez , Maria Carmen Fariñas-Álvarez , Isabel Fernández-Natal , María Teresa Pérez-Rodríguez , Ane Josune Goikoetxea Aguirre , Juan Manuel Sánchez-Calvo , Luis Buzón Martín , Eva León-Jiménez , David Vinuesa García , José María Reguera-Iglesias , Alberto Bahamonde-Carrasco , Jonathan Fernández Suárez , Jesús Rodríguez-Baño , Luis Eduardo López-Cortés , PROBAC REIPI/GEIH-SEIMC/SAEI Group
{"title":"复杂凝固酶阴性葡萄球菌血症的死亡率预测因素及定义建议。一项多中心前瞻性队列研究。","authors":"Benedetta Varisco , Pedro María Martínez Pérez-Crespo , Pilar Retamar-Gentil , Inmaculada López Hernandez , Maria Carmen Fariñas-Álvarez , Isabel Fernández-Natal , María Teresa Pérez-Rodríguez , Ane Josune Goikoetxea Aguirre , Juan Manuel Sánchez-Calvo , Luis Buzón Martín , Eva León-Jiménez , David Vinuesa García , José María Reguera-Iglesias , Alberto Bahamonde-Carrasco , Jonathan Fernández Suárez , Jesús Rodríguez-Baño , Luis Eduardo López-Cortés , PROBAC REIPI/GEIH-SEIMC/SAEI Group","doi":"10.1016/j.cmi.2024.12.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.</div></div><div><h3>Results</h3><div>Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01–1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45–4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22–3.84), SOFA score (HR: 1.09, 95% CI: 1.03–1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29–3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30–0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52–4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26–0.83).</div></div><div><h3>Discussion</h3><div>A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 4","pages":"Pages 607-615"},"PeriodicalIF":8.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a multicentre prospective cohort study\",\"authors\":\"Benedetta Varisco , Pedro María Martínez Pérez-Crespo , Pilar Retamar-Gentil , Inmaculada López Hernandez , Maria Carmen Fariñas-Álvarez , Isabel Fernández-Natal , María Teresa Pérez-Rodríguez , Ane Josune Goikoetxea Aguirre , Juan Manuel Sánchez-Calvo , Luis Buzón Martín , Eva León-Jiménez , David Vinuesa García , José María Reguera-Iglesias , Alberto Bahamonde-Carrasco , Jonathan Fernández Suárez , Jesús Rodríguez-Baño , Luis Eduardo López-Cortés , PROBAC REIPI/GEIH-SEIMC/SAEI Group\",\"doi\":\"10.1016/j.cmi.2024.12.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.</div></div><div><h3>Methods</h3><div>A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.</div></div><div><h3>Results</h3><div>Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01–1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45–4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22–3.84), SOFA score (HR: 1.09, 95% CI: 1.03–1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29–3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30–0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52–4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26–0.83).</div></div><div><h3>Discussion</h3><div>A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.</div></div>\",\"PeriodicalId\":10444,\"journal\":{\"name\":\"Clinical Microbiology and Infection\",\"volume\":\"31 4\",\"pages\":\"Pages 607-615\"},\"PeriodicalIF\":8.7000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Microbiology and Infection\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1198743X24006037\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/12/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Microbiology and Infection","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1198743X24006037","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a multicentre prospective cohort study
Objectives
The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.
Methods
A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.
Results
Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01–1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45–4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22–3.84), SOFA score (HR: 1.09, 95% CI: 1.03–1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29–3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30–0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52–4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26–0.83).
Discussion
A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.
期刊介绍：
Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.
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