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Role of Comorbidity in Mortality Related to Staphylococcus aureus Bacteremia: A Prospective Study Using the Charlson Weighted Index of Comorbidity

Published online by Cambridge University Press:  02 January 2015

Olivier Lesens ,
Cédric Methlin ,
Yves Hansmann ,
Véronique Remy ,
Martin Martinot ,
Colm Bergin ,
Pierre Meyer  and
Daniel Christmann
Olivier Lesens*
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France Genitourinary Medicine & Infectious Diseases Department, St. James Hospital, Dublin, Ireland Laboratoire de biostatistique, Faculté de Médecine, Strasbourg, France
Cédric Methlin
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France
Yves Hansmann
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France
Véronique Remy
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France
Martin Martinot
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France
Colm Bergin
Affiliation:
Genitourinary Medicine & Infectious Diseases Department, St. James Hospital, Dublin, Ireland
Pierre Meyer
Affiliation:
Laboratoire de biostatistique, Faculté de Médecine, Strasbourg, France
Daniel Christmann
Affiliation:
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Hôpitaux Universitaires, Clinique Médicale A, Hôpitaux Universitaires, Strasbourg, France
*
Service des Maladies Infectieuses et Tropicales, Clinique Médicale A, Fédération des Services de Médecine Interne, Hôpital Civil, 1 place de l'Hôpital - B.P. 426-67091 Strasbourg Cedex, France
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Abstract

Objective:

To demonstrate the effectiveness of the Charlson weighted index of comorbidity (WIC) for controlling comorbidity in prospective studies focusing on mortality in patients with Staphylococcus aureus bacteremia (SAB).

Design:

Cohort study.

Setting:

Two tertiary-care, university-affiliated hospitals in France.

Patients:

One hundred sixty-six inpatients 18 years or older consecutively diagnosed with SAB from May 15, 2001, to May 15, 2002.

Methods:

Patients were prospectively assessed and cases were followed by the infectious diseases consult service at least 3 months after effective antibiotic therapy completion. The Charlson WIC was computed and dichotomized into scores of fewer than 3 points and 3 or more points. Bacteremia source, acute complication due to SAB acquisition in the ICU, and inappropriate empiric antibiotic therapy were recorded. The endpoint was death due to SAB and overall mortality.

Results:

In univariate analysis, the Charlson WIC was able to predict overall mortality and S. aureus-related death. The following variables were found to be independently predictive of mortality due to SAB using the Cox model: an acute complication due to S. aureus (OR, 8.9; CI95, 4 to 19.7; P < .001), a Charlson WIC score of 3 or more (OR, 3; CI95, 1.3 to 5.5; P = .006), and age (OR, 1.04; CI95, 1.009 to 1.07; P < .01).

Conclusions:

Comorbidity contributes to death in patients with SAB. The Charlson WIC is a good predictor of mortality in this population and may be a useful instrument to control comorbidity in studies aiming to investigate risk factors for death due to bacteremia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 12 , December 2003 , pp. 890 - 896
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003 

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References

1. Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584–602.10.1093/clind/24.4.584Google Scholar
2. Mylotte, JM, McDermott, C, Spooner, JA. Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. Reviews of Infectious Diseases 1987;9:891–907.10.1093/clinids/9.5.891Google Scholar
3. McClelland, RS, Fowler, VG Jr, Sanders, IX, et al. Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality. Arch Intern Med 1999;159:1244–1247.10.1001/archinte.159.11.1244Google Scholar
4. Jensen, AG, Wachmann, CH, Espersen, F, Scheibel, J, Skinhoj, P, Frimodt-Moller, N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med 2002;162:25–32.10.1001/archinte.162.1.25Google Scholar
5. Soriano, A, Martinez, JA, Mensa, J, et al. Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2000;30:368–373.10.1086/313650Google Scholar
6. Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995;21:1417–1423.10.1093/clinids/21.6.1417Google Scholar
7. Fowler, VG Jr, Sanders, LL, Sexton, DJ, et al. Outcome of Staphylococcus aureus bacteremia according to compliance with recommendations of infectious diseases specialists: experience with 244 patients. Clin Infect Dis 1998;27:478–486.10.1086/514686Google Scholar
8. Jensen, AG, Wachmann, CH, Poulsen, KB, et al. Risk factors for hospital-acquired Staphylococcus bacteremia. Arch Intern Med 1999;159:1437–1444.10.1001/archinte.159.13.1437Google Scholar
9. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987;40:373–383.10.1016/0021-9681(87)90171-8Google Scholar
10. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3Google Scholar
11. Lautenschlager, S, Herzog, C, Zimmerli, W. Course and outcome of bacteremia due to Staphylococcus aureus: evaluation of different clinical case definitions. Clin Infect Dis 1993;16:567–573.10.1093/clind/16.4.567Google Scholar
12. Mylotte, JM, McDermott, C. Staphylococcus aureus bacteremia caused by infected intravenous catheters. Am J Infect Control 1987;15:1–6.10.1016/0196-6553(87)90069-1Google Scholar
13. Sekeres, MA, Abrutyn, E, Berlin, JA, et al. An assessment of the usefulness of the Duke criteria for diagnosing active infective endocarditis. Clin Infect Dis 1997;24:1185–1190.10.1086/513657Google Scholar
14. Lesens, O, Hansmann, Y, Remy, V, et al. Positive surveillance blood culture is a predictive factor for outcomes in patients with Staphylococcus aureus bacteremia. Presented at the 42nd Annual Meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy; September 27-30, 2002; San Diego, CA.Google Scholar
15. Ibrahim, EH, Shermann, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of blood stream infections on patient outcomes in the ICU setting. Chest 2000;118:146–155.10.1378/chest.118.1.146Google Scholar
16. Soufir, L, Timsit, JF, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396–401.10.1086/501639Google Scholar
17. Knaus, WA, Wagner, DP, Draper, EA, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991;100:1619–1636.10.1378/chest.100.6.1619Google Scholar
18. McCabe, WR, Jackson, GG. Gram negative bacteremia: 1. Etiology and ecology. Arch Intern Med 1962;110:847–855.10.1001/archinte.1962.03620240029006Google Scholar
19. Brun-Buisson, C, Doyon, F, Carlet, J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. JAMA 1995;274:968–974.10.1001/jama.1995.03530120060042Google Scholar
20. Barrett, SP. MRSA pathogenicity and bacteraemia. J Hosp Infect 1997;35:159–161.Google Scholar
21. Pujol, M, Pena, C, Pallares, R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methi-cillin-susceptible strains. Am J Med 1996;100:509–516.10.1016/S0002-9343(96)00014-9Google Scholar
22. Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.10.1086/345476Google Scholar