Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia

Natasha E. Holmes, J. Owen Robinson, Sebastiaan J. van Hal, Wendy J. Munckhof, Eugene Athan, Tony M. Korman, Allen C. Cheng, John D. Turnidge, Paul D.R. Johnson, Benjamin P. Howden, J. Owen Robinson, VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Methods: Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Results: Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. Conclusions: This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

Original languageEnglish
Article number107
JournalBMC Infectious Diseases
Volume18
Issue number1
DOIs
Publication statusPublished - 5 Mar 2018

Keywords

  • Bacteraemia
  • Complication
  • Mortality
  • Staphylococcus aureus
  • Treatment failure

Cite this

Holmes, N. E., Robinson, J. O., van Hal, S. J., Munckhof, W. J., Athan, E., Korman, T. M., ... VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN) (2018). Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. BMC Infectious Diseases, 18(1), [107]. https://doi.org/10.1186/s12879-018-3011-2
Holmes, Natasha E. ; Robinson, J. Owen ; van Hal, Sebastiaan J. ; Munckhof, Wendy J. ; Athan, Eugene ; Korman, Tony M. ; Cheng, Allen C. ; Turnidge, John D. ; Johnson, Paul D.R. ; Howden, Benjamin P. ; Owen Robinson, J. ; VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN). / Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. In: BMC Infectious Diseases. 2018 ; Vol. 18, No. 1.
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title = "Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia",
abstract = "Background: Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Methods: Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Results: Treatment failure at 30-days was recorded in 14.4{\%} of patients (30-day mortality 9.5{\%}). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1{\%} and 24.2{\%} respectively. 45{\%} experienced at least one in-hospital complication, including nephrotoxicity in 19.5{\%}. Conclusions: This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.",
keywords = "Bacteraemia, Complication, Mortality, Staphylococcus aureus, Treatment failure",
author = "Holmes, {Natasha E.} and Robinson, {J. Owen} and {van Hal}, {Sebastiaan J.} and Munckhof, {Wendy J.} and Eugene Athan and Korman, {Tony M.} and Cheng, {Allen C.} and Turnidge, {John D.} and Johnson, {Paul D.R.} and Howden, {Benjamin P.} and {Owen Robinson}, J. and {VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)}",
year = "2018",
month = "3",
day = "5",
doi = "10.1186/s12879-018-3011-2",
language = "English",
volume = "18",
journal = "BMC Infectious Diseases",
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Holmes, NE, Robinson, JO, van Hal, SJ, Munckhof, WJ, Athan, E, Korman, TM, Cheng, AC, Turnidge, JD, Johnson, PDR, Howden, BP, Owen Robinson, J & VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN) 2018, 'Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia' BMC Infectious Diseases, vol. 18, no. 1, 107. https://doi.org/10.1186/s12879-018-3011-2

Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. / Holmes, Natasha E.; Robinson, J. Owen; van Hal, Sebastiaan J.; Munckhof, Wendy J.; Athan, Eugene; Korman, Tony M.; Cheng, Allen C.; Turnidge, John D.; Johnson, Paul D.R.; Howden, Benjamin P.; Owen Robinson, J.; VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN).

In: BMC Infectious Diseases, Vol. 18, No. 1, 107, 05.03.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia

AU - Holmes, Natasha E.

AU - Robinson, J. Owen

AU - van Hal, Sebastiaan J.

AU - Munckhof, Wendy J.

AU - Athan, Eugene

AU - Korman, Tony M.

AU - Cheng, Allen C.

AU - Turnidge, John D.

AU - Johnson, Paul D.R.

AU - Howden, Benjamin P.

AU - Owen Robinson, J.

AU - VANESSA study group, on behalf of the Australasian Society for Infectious Diseases (ASID) Clinical Research Network (CRN)

PY - 2018/3/5

Y1 - 2018/3/5

N2 - Background: Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Methods: Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Results: Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. Conclusions: This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

AB - Background: Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. Methods: Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. Results: Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. Conclusions: This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.

KW - Bacteraemia

KW - Complication

KW - Mortality

KW - Staphylococcus aureus

KW - Treatment failure

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U2 - 10.1186/s12879-018-3011-2

DO - 10.1186/s12879-018-3011-2

M3 - Article

VL - 18

JO - BMC Infectious Diseases

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SN - 1471-2334

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ER -