 |
|
Clinical Identifiers of Complicated Staphylococcus aureus Bacteremia
Vance G. Fowler, Jr, MD, MHS;
Maren K. Olsen, PhD;
G. Ralph Corey, MD;
Christopher W. Woods, MD, MPH;
Christopher H. Cabell, MD;
L. Barth Reller, MD;
Allen C. Cheng, MB, BS;
Tara Dudley, MS;
Eugene Z. Oddone, MD, MHS
Arch Intern Med. 2003;163:2066-2072.
Background Complications of Staphylococcus aureus bacteremia (SAB) are often difficult to identify. The ability to accurately predict the likelihood of these complications would impact patient management. This investigation sought to define readily available clinical characteristics that could help identify patients at risk for complicated SAB.
Methods A prospective, observational cohort study was conducted from September 1994 through December 1999. Patients were followed up for 12 weeks after the initial positive blood culture result. The primary end point was complicated SAB (attributable mortality, complicated infection, embolic stroke, or recurrent S aureus infection during the 12-week follow-up period). The predictive model was validated using bootstrap resampling.
Results Complicated SAB was present in 43% of 724 consecutive adult hospitalized patients identified during the study period. The full predictive model had a high discriminative ability (bootstrap-corrected c index, 0.78). The strongest predictor of complicated SAB was a positive follow-up blood culture result at 48 to 96 hours. A scoring system based on the presence or absence of 4 risk factors (community acquisition, skin examination findings suggesting acute systemic infection, persistent fever at 72 hours, and positive follow-up blood culture results at 48-96 hours) accurately identified complicated SAB (bootstrap-corrected c index, 0.76).
Conclusion Readily available clinical variables can help identify patients at risk for complicated SAB.
From the Divisions of Infectious Diseases (Drs Fowler, Corey, and Reller, and Mr Cheng) and Cardiology (Dr Cabell), Department of Medicine, and Department of Biostatistics and Bioinformatics (Dr Olsen), Clinical Microbiology Laboratory (Drs Woods and Reller), and Division of General Internal Medicine (Dr Oddone), Duke University Medical Center, Durham, NC; and Center for Health Services Research in Primary Care, Veterans Administration Medical Center, Durham (Drs Olsen, Woods, and Oddone and Ms Dudley). The authors have no relevant financial interest in this article.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Phase II, Randomized, Multicenter, Double-Blind, Placebo-Controlled Trial of a Polyclonal Anti-Staphylococcus aureus Capsular Polysaccharide Immune Globulin in Treatment of Staphylococcus aureus Bacteremia
Rupp et al.
Antimicrob. Agents Chemother. 2007;51:4249-4254.
ABSTRACT
| FULL TEXT
A Stitch in Time -- A 64-year-old man with a history of coronary artery disease and peripheral vascular disease was admitted to the hospital with a several-month history of fevers, chills, and fatigue
Graber et al.
NEJM 2007;357:1029-1034.
FULL TEXT
Age- and Sex-Associated Trends in Bloodstream Infection: A Population-Based Study in Olmsted County, Minnesota
Uslan et al.
Arch Intern Med 2007;167:834-839.
ABSTRACT
| FULL TEXT
A Predictive Model of Recurrent Lower Extremity Cellulitis in a Population-Based Cohort
McNamara et al.
Arch Intern Med 2007;167:709-715.
ABSTRACT
| FULL TEXT
Daptomycin versus Standard Therapy for Bacteremia and Endocarditis Caused by Staphylococcus aureus.
Fowler et al.
NEJM 2006;355:653-665.
ABSTRACT
| FULL TEXT
Phase II, Randomized, Double-Blind, Multicenter Study Comparing the Safety and Pharmacokinetics of Tefibazumab to Placebo for Treatment of Staphylococcus aureus Bacteremia.
Weems et al.
Antimicrob. Agents Chemother. 2006;50:2751-2755.
ABSTRACT
| FULL TEXT
18F-FDG PET in Detecting Metastatic Infectious Disease
Bleeker-Rovers et al.
JNM 2005;46:2014-2019.
ABSTRACT
| FULL TEXT
Infective Endocarditis: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: Endorsed by the Infectious Diseases Society of America
Baddour et al.
Circulation 2005;111:e394-e434.
ABSTRACT
| FULL TEXT
Frequency of Infective Endocarditis Among Infants and Children With Staphylococcus aureus Bacteremia
Valente et al.
Pediatrics 2005;115:e15-e19.
ABSTRACT
| FULL TEXT
Outcome of inappropriate initial antimicrobial treatment in patients with methicillin-resistant Staphylococcus aureus bacteraemia
Kim et al.
J Antimicrob Chemother 2004;54:489-497.
ABSTRACT
| FULL TEXT
Mannose-binding Lectin-deficient Mice Are Susceptible to Infection with Staphylococcus aureus
Shi et al.
J. Exp. Med. 2004;199:1379-1390.
ABSTRACT
| FULL TEXT
Staphylococcus aureus Bacteremia: Treatment Effectiveness and Failure
JWatch Infect. Diseases 2003;2003:3-3.
FULL TEXT
|
