Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study
- Authors
- Kim, Taeeun; Lee, Sang-Rok; Park, Seong Yeon; Moon, Song Mi; Jung, Jiwon; Kim, Min Jae; Sung, Heungsup; Kim, Mi-Na; Kim, Sung-Han; Choi, Sang-Ho; Lee, Sang-Oh; Kim, Yang Soo; Song, Eun Hee; Chong, Yong Pil
- Issue Date
- May-2024
- Publisher
- SPRINGER
- Keywords
- Staphylococcus aureus bacteraemia; Methicillin-resistance; Complicated bacteraemia; Metastatic infection; Risk stratification
- Citation
- EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, v.43, no.5, pp 841 - 851
- Pages
- 11
- Journal Title
- EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
- Volume
- 43
- Number
- 5
- Start Page
- 841
- End Page
- 851
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/91452
- DOI
- 10.1007/s10096-024-04790-2
- ISSN
- 0934-9723
1435-4373
- 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.
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