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Risk Factors for Hospital-Acquired Staphylococcus aureus Bacteremia
Allan G. Jensen, MD;
Carsten H. Wachmann, MSc, PhD;
Kjeld B. Poulsen, MD, PhD;
Frank Espersen, MD, PhD;
Jens Scheibel, MD;
Peter Skinhøj, MD, PhD;
Niels Frimodt-Møller, MD, PhD
Arch Intern Med. 1999;159:1437-1444.
Background Staphylococcus aureus bacteremia (SAB) acquired in hospitals continues to be a frequent and serious complication to hospitalization, and no previous case-control studies dealing with risk factors of this severe disease are available.
Methods Based on a 1-year prospective analysis, the data from all patients with hospital-acquired SAB admitted to 4 hospitals in Copenhagen County, Denmark, from May 1, 1994, through April 30, 1995, were evaluated. Eighty-five patients with hospital-acquired SAB were matched to 85 control patients with a similar primary diagnosis at admission (matched controls). Of these, 62 patients with hospital-acquired SAB were compared with 118 other patients with a similar time of admission, who were randomly selected with no clinical evidence of SAB (unmatched controls).
Results The incidence of hospital-acquired SAB was 0.71 per 1000 hospital admissions. The presence of a central venous catheter (odds ratio, 6.9; 95% confidence interval [CI], 2.8-17.0), anemia (odds ratio, 3.3; 95% CI, 1.4-7.6), and hyponatremia (odds ratio, 3.3; 95% CI, 1.5-7.0) was significantly associated with hospital-acquired SAB in a conditional and a usual logistic regression analysis. Nasal carriage was not an independent risk factor, but nasal carriers among patients in surgery (odds ratio, 4.0; 95% CI, 1.3-13.0) had a significantly higher risk for hospital-acquired SAB compared with matched and unmatched controls. The presence of hospital-acquired SAB increased the mortality rate 2.4-fold (95% CI, 1.1-5.2).
Conclusions The presence of a central venous catheter is an important risk factor, and hyponatremia and anemia are associated with the development of hospital-acquired SAB. Furthermore, hospital-acquired SAB in itself increases mortality.
From the Sector for Microbiology (Drs Jensen, Poulsen, Espersen, and Frimodt-Møller) and the Biostatistical Unit (Dr Wachmann), Statens Serum Institut; the Department of Clinical Microbiology, Herlev University Hospital (Dr Scheibel); and the Department of Infectious Diseases, Rigshospitalet (Dr Skinhøj), Copenhagen, Denmark.
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