| Objective:This study was purposed to evaluate the prediction of failure in Staphylococcus aureus bacteremia, through the analysis of the related factor about the clinical prognosis.Methods:A retrospective study was carried out to analyze the medical records of 191 patients which were confirmed diagnosis with staphylococcus aureus bacteremia in the First Affiliated Hospital of Zhejiang University School of Medicine. These patients were divided into two groups based on clinical prognosis whether failure or not, at the day 30. The following clinical characteristics were compared, the clinical data, APACHII score, source of infection risk stratification, the incidence of septic shock, early treatment response, whether methicillin-resistant and blood culture positive before,vancomycin susceptibility.usege of antibiotics and immune inhibitors before,invasive operation. Use univariate and multivariate logistic regression analysis to get prognostic factors of Staphylococcus aureus bacteremia in the patients. Totally 52 cases of patients with confirmed SA-BSI were divided into two groups based on therapeutic regimen (treated with glycopeptides and alternated to linezolid later or only with linezolid).The following clinical characteristics were compared, the clinical data, the fever abating time, bacterial clearance rate, clinical efficiency, fatality rate and adverse events.Results:1. A total of 191 patients with Staphylococcus aureus bacteremia were with mean age of 55.68±1.42 years, renal insufficiency (46.1%) and diabetes (44.5%),were the most common basic diseases.2. The failure and success groups had statistically significant difference in scores of APACHII, risk level of the source of BSI, incidence of septic shock, early response to treatment, methicillin-resistant staphylococcus aureus.The patients with staphylococcus aureus pneumonia,had higher chance of failure, and the source of catheter infection t had low failure rate than other parts of the source of infection in the treatment of patients.3.The univariate analysis of the prognostic factors associated with Staphylococcus aureus bacteremia indicated that older age, diabetes, ICU admission, recent hospitalization,multiple lesions of migration and the use of antibiotics,blood culture positive before,septic shock,MRSA,usage of immunosuppressant, APACHEII> 14, lack of early treatment response.4. In a multivariate logistic regression model, lack of response at day 3 was the strongest predictor for the treatment failure at day 30, the other factors include septic shock, blood culture positive, multiple source of infection.5. Success rate of the patients with early effective treatment was 78.4% in 30 days, the treatment success rate of the patients with poor response to early treatment was 33.3%, the differences were statistically significant between the two groups (P= 0.000). Some patients who had eraly response to the treatment had final treatment failure in 30 day, the reasons included:high risk source, insufficient treatment, did not remove the catheter.6.The total clinical efficiency in both groups is 76.9%,here was no statistically significant difference in antifebrile time, bacterial clearance rate within 14 days, clinical efficiency, the cumulative fatality rate (28 days) between these two groups.Conclusion:1.The most common basic diseases were renal insufficiency and diabetes. Staphylococcus aureus bloodstream infections mostly occurred in the male patients. The patients of failure group had higher APACHII scores, higher risk level of the source of BSI, higher incidence of septic shock, higher prevalence of diabetes,greater likelihood infected by MRSA,higher percentage in hospital before.The patients with staphylococcus aureus pneumonia had higher chance of failure, and the source of catheter infection than other parts of the source of infection in the treatment of patients with low failure rate.2.In a multivariate logistic regression model, lack of response at day 3.was the strongest predictor for the treatment failure at day 30, the other factors include septic shock, blood culture positive, multiple source of infection.3. Some patients who had eraly response to the treatment had final treatment failure in 30 day, the reasons included:high risk source, insufficient treatment, did not remove the catheter.4. There were both high clinical efficiencys in linezolid group and the alternative group. There was no statistically significant difference in bacterial clearance rate within 14 days, the cumulative fatality rate (28 days) between these two groups.The antifebrile time was a bit shoter in linezolid group than the alternative group,but there was no statistically significant difference too.Initial treatment with glycopeptides switched to linezolid,the final results had effective treatment, didn’t increase mortality. |
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