Sie befinden Sich nicht im Netzwerk der Universität Paderborn. Der Zugriff auf elektronische Ressourcen ist gegebenenfalls nur via VPN oder Shibboleth (DFN-AAI) möglich. mehr Informationen...
agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia
Ist Teil von
European journal of clinical microbiology & infectious diseases, 2017-11, Vol.36 (11), p.2187-2191
Ort / Verlag
Berlin/Heidelberg: Springer Berlin Heidelberg
Erscheinungsjahr
2017
Quelle
MEDLINE
Beschreibungen/Notizen
Methicillin-resistant
Staphylococcus aureus
bacteremia (MRSAB) often persists despite appropriate antibiotic therapy. It is unclear what microbiological factors contribute to poor clinical outcomes in persistent MRSAB (pMRSAB). We aimed to identify clinical and microbiological risk factors for in-hospital mortality in pMRSAB. We analysed MRSAB cases prospectively collected between 2009 and 2016 at 11 hospitals in Korea, defining cases of pMRSAB as MRSAB lasting ≥5 days despite administration of effective antibiotics. The first blood isolates from the pMRSAB cases were tested for staphylococcal cassette chromosome
mec
type, staphylococcal protein A type,
accessary gene regulator
(
agr
) type, genes for Panton-Valentine leukocidin and phenol-soluble modulin-
mec
, vancomycin minimum inhibitory concentration, vancomycin heteroresistance, and
agr
functionality. We also collected clinical information for each case. Of 960 MRSAB cases, 152 pMRSAB were finally eligible. Univariable analysis revealed that in-hospital mortality was significantly associated with Charlson’s comorbidity-weighted index (CCWI) score, Pitt bacteremia score, sequential organ failure assessment score, presentation with septic shock, pneumonia,
agr
dysfunction, and vancomycin heteroresistance. Bone and joint infections were negatively associated with in-hospital mortality. Multivariable analysis revealed the following independent risk factors for in-hospital mortality: CCWI score [adjusted odds ratio (aOR), per one point, 1.25; 95% confidence interval (CI), 1.08–1.44;
P
= 0.003), Pitt bacteremia score (aOR, per one point, 1.33; 95% CI, 1.09–1.62;
P =
0.005), non-eradicated foci of infection (aOR, 3.12; 95% CI, 1.18–8.27;
P
= 0.022), and
agr
dysfunction (aOR, 2.48; 95% CI, 1.12–5.47;
P =
0.025).
agr
dysfunction is an independent risk factor for in-hospital mortality in pMRSAB.