Higher Risk for All-cause Mortality of Staphylococcus aureus Bacteremia in Patients with Non-Dialysis Dependent Chronic Kidney Disease
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD. Materials and Methods: We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018. Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression. Results: As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 nonCKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 – 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 – 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 – 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 – 0.897; P = 0.030) patients. Conclusion: ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.
Abstract
Background: Staphylococcus aureus bacteremia (SAB) is a common and serious infection with a high mortality. Patients with chronic kidney disease (CKD) are vulnerable to SAB, but there have been few studies performed on the clinical characteristics and outcomes of SAB in CKD patients stratified by dialysis. We aimed to estimate the all-cause mortality and identify its predictors in patients with CKD. Materials and Methods: We conducted a retrospective study on the patients with SAB hospitalized in a tertiary care center in Korea between March 2014 and December 2018. Kaplan-Meier analysis was performed to compare all-cause mortality following SAB among patients with non-dialysis dependent CKD (ND-CKD), those receiving dialysis, and those without CKD (non-CKD). The predictors of mortality among CKD patients were analyzed by Cox proportional hazards regression. Results: As a total, 278 SAB of 43 ND-CKD (31 males), 58 dialysis (39 males), and 177 nonCKD (112 males) patients were included. The 30-day mortality was 39.5% in ND-CKD, 27.6% in dialysis, and 7.9% in non-CKD patients. The hazard ratio of all-cause mortality following SAB in ND-CKD was 2.335 (95% confidence interval, 1.203 – 4.531; P = 0.003), compared to non-CKD patients. For methicillin-resistant S. aureus bacteremia (MRSAB), the hazard ratio of all-cause mortality in ND-CKD was 2.628 (95% CI, 1.074 – 6.435; P = 0.011), compared to dialysis patients. Appropriate antibiotics <48 h was independently related to improved survival following SAB among ND-CKD (adjusted HR, 0.304; 95% CI, 0,108 – 0.857; P = 0.024) and dialysis (adjusted HR, 0.323; 95% CI, 0,116 – 0.897; P = 0.030) patients. Conclusion: ND-CKD patients demonstrated poor outcome following SAB and administration of appropriate antibiotics within 48 h could reduce the risk for mortality.
참고문헌 (29)
- Keynan Y, "Staphylococcus aureus bacteremia, risk factors, complications, and management", Crit Care Clin, 29, pp.547~562 (2013)
- Jensen AG, "Treatment and outcome of Staphylococcus aureus bacteremia : a prospective study of 278 cases", Arch Intern Med, 162, pp.25~32 (2002)
- Benfield T, "Increasing incidence but decreasing in-hospital mortality of adult Staphylococcus aureus bacteraemia between 1981 and 2000", Clin Microbiol Infect, 13, pp.257~263 (2007)
- Sarnak MJ, "Pulmonary infectious mortality among patients with end-stage renal disease", Chest, 120, pp.1883~1887 (2001)
- Prezant DJ, "Effect of uremia and its treatment on pulmonary function", Lung, 168, pp.1~14 (1990)
- Nielsen LH, "Risk and prognosis of Staphylococcus aureus bacteremia among individuals with and without end-stage renal disease : a Danish, population-based cohort study", BMC Infect Dis, 15, pp.6~ (2015)
- Chaudry MS, "Increased risk of Staphylococcus aureus bacteremia in hemodialysis-A nationwide study", Hemodial Int, 23, pp.230~238 (2019)
- Inrig JK, "Relationship between clinical outcomes and vascular access type among hemodialysis patients with Staphylococcus aureus bacteremia", Clin J Am Soc Nephrol, 1, pp.518~524 (2006)
- Dellinger RP, "Surviving sepsis campaign : international guidelines for management of severe sepsis and septic shock : 2008", Intensive Care Med, 34, pp.17~60 (2008)
- Kim ES, "Clinical and epidemiological factors associated with methicillin resistance in community-onset invasive Staphylococcus aureus infections : prospective multicenter cross-sectional study in Korea", PLoS One, 9, pp.e114127~ (2014)
- Buck JM, "Community-associated methicillin-resistant Staphylococcus aureus, Minnesota, 2000-2003", Emerg Infect Dis, 11, pp.1532~1538 (2005)
- Miller LG, "Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection : a prospective investigation", Clin Infect Dis, 44, pp.471~482 (2007)
- Naimi TS, "Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996-1998", Clin Infect Dis, 33, pp.990~996 (2001)
- "Chapter 1: Definition and classification of CKD", Kidney Int Suppl, 3, pp.19~62 (2013)
- Harbarth S, "Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus", Arch Intern Med, 158, pp.182~189 (1998)
- Culver DH, "Surgical wound infection rates by wound class, operative procedure, and patient risk index: National Nosocomial Infections Surveillance System", Am J Med, 91(Suppl 3B), pp.152S~157S (1991)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies : development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Paterson DL, "International prospective study of Klebsiella pneumoniae bacteremia : implications of extended-spectrum beta-lactamase production in nosocomial Infections", Ann Intern Med, 140, pp.26~32 (2004)
- Vincent JL, "Use of the SOFA score to assess the incidence of organ dysfunction", failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine, 1998, pp.26, 1793~1800
- Kang CK, "Gender affects prognosis of methicillin-resistant Staphylococcus aureus bacteremia differently depending on the severity of underlying disease", Eur J Clin Microbiol Infect Dis, 37, pp.1119~1123 (2018)
- Blot SI, "Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus", Arch Intern Med, 162, pp.2229~2235 (2002)
- Yaw LK, "A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia : an observational cohort study", Lancet Infect Dis, 14, pp.967~975 (2014)
- Wang JL, "Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus", Clin Infect Dis, 46, pp.799~806 (2008)
- Cosgrove SE, "Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia : a meta-analysis", Clin Infect Dis, 36, pp.53~59 (2003)
- Paul M, "Importance of appropriate empirical antibiotic therapy for methicillin-resistant Staphylococcus aureus bacteraemia", J Antimicrob Chemother, 65, pp.2658~2665 (2010)
- Ammerlaan H, "Adequacy of antimicrobial treatment and outcome of Staphylococcus aureus bacteremia in 9 Western European countries", Clin Infect Dis, 49, pp.997~1005 (2009)
- Minejima E, "Defining the breakpoint duration of Staphylococcus aureus bacteremia predictive of poor outcomes", Clin Infect Dis, 70, pp.566~573 (2020)
- Kim SH, "Outcome of Staphylococcus aureus bacteremia in patients with eradicable foci versus noneradicable foci", Clin Infect Dis, 37, pp.794~799 (2003)
- Kruzel MC, "Determination of vancomycin and daptomycin MICs by different testing methods for methicillin-resistant Staphylococcus aureus", J Clin Microb, 49, pp.2272~2273 (2011)