Risk Dactors for Death in Patients with Staphylococcus aureus Bacteremia / 감염과화학요법

ABSTRACT

BACKGROUND: Staphylococcus aureus is a common cause of severe infection and frequently results in death or disability. We investigated potential risk factors influencing clinical outcome in S. aureus bacteremia (SAB). MATERIALS AND METHODS: Our study is based on retrospective chart review for episodes of SAB from 168 patients, identified between January 2003 and December 2005. Twenty patients were excluded: 2 patients with infective endocarditis and 18 patients with metastatic lesions. Demographic, underlying diseases, sources of SAB, antimicrobial therapy, laboratory, and microbiologic characteristics were identified. Outcome was classified as death or survival 12 weeks after onset of SAB. RESULTS: A total of 97 patients had survived and 51 patients died 12 weeks after the onset of SAB. Death group was older (66.4+/-13.6 vs. 59.4+/-14.9 years, P=0.007) and had higher Acute Physiology and Chronic Health Evaluation II system score (17.5+/-6.3 vs. 13.5+/-5.1, P<0.001) and the acute physiology score (11.1+/-5.5 vs. 8.0+/-4.3, P<0.001). Patients with nosocomial SAB (36 (70.6%) vs. 49 (50.5%), P=0.03] and ineradicable primary source of SAB [46 (90.2%) vs. 66 (68.0%), P=0.005] were more vulnerable to death. Multivariate analysis shows that hospital acquisition [adjusted odds ratio (OR)=2.93], ineradicable primary source (adjusted OR=5.74) and high APACHE II score (adjusted OR=1.22) lead to higher mortality rate from SAB. CONCLUSION: Our study shows hospital acquisition, ineradicable primary source, and high APACHE II score are the risk factors related to death from SAB. On the other hand, methicillin resistance or initially ineffective antimicrobial therapy is not much correlated with mortality rate from SAB.