ANALYSIS OF RISK FACTORS FOR MORTALITY IN METHICILLIN SENSITIVE STAPHYLOCOCCUS AUREUS BACTERAEMIA: CEFAZOLIN IS ASSOCIATED WITH BETTER OUTCOME

Öz

Objective: Methicillin-sensitive Staphylococcus aureus (MSSA) is frequent cause of bacteraemias and associated with substantial mortality. We defined risk factors for mortality among patients with either community-acquired (CA) or healthcare-associated (HCA) MSSA bacteraemia with special emphasis on treatment options including cefazolin and other antimicrobials (mainly ampicillin-sulbactam). Material and Method: All adult patients who were hospitalized and whose blood cultures were positive for MSSA between 2009 and 2014 were included. Patients with CA and HCA MSSA bacteraemia were compared. Results: 83% of the 127 patients with MSSA bacteraemia had HCA. The mortality rate of patients was 20.5% and this did not differ between patients with either CA or HCA MSSA bacteraemia. In the multivariate analysis, higher comorbidity index (HR 1.557), presence of metastatic foci (HR 2.883), and requirement for ICU support (HR 16.239) were found as independent risk factors for mortality, and cefazolin use was found to be protective against mortality (HR 0.178). Conclusion: Patients with MSSA bacteraemia should be treated with cefazolin instead of other antimicrobial options, especially in countries where anti-staphylococcal penicillins are not available or in patients who cannot tolerate anti-staphylococcal penicillins, as cefazolin was found to be protective against mortality

Anahtar Kelimeler

• Methicillin-sensitive Staphylococcus aureus,healthcare associated bacteraemia,cefazolin

STAPHYLOCOCCUS AUREUS BAKTERİYEMİLERİNDE MORTALİTE RİSK FAKTÖRLERİNİN ANALİZİ: SEFAZOLİN DAHA İYİ SONUÇLA İLİŞKİLİ

Öz

Amaç: Metisiline duyarlı Staphylococcus aureus (MSSA), önemli bir bakteriyemi etkeni olup, hastalarda ciddi mortaliteye neden olur. Bu çalışmada, toplum kaynaklı (TK) veya sağlık bakımı (SB)’yla ilişkili MSSA bakteriyemilerinde mortaliteye etki eden risk faktörlerinin belirlenmesi amaçlanmıştır. Ayrıca MSSA bakteriyemilerinin tedavi seçeneklerinden sefazolin ve özellikle ampisilin-sulbaktam olmak üzere diğer antimikrobiklerin tedavideki yeterlikleri karşılaştıırlmıştır. Gereç ve Yöntem: 2009-2014 yılları arasında hastanemizde yatarak tedavi edilen ve MSSA bakteriyemisi tanısı konulan erişkin hastalar çalışmaya dahil edildi. TK veya SB ilişkili MSSA bakteriyemisi olan hastalar karşılaştırıldı. Bulgular: Toplam 127 MSSA bakteriyemili hastanın %83’ü SB ile ilişkiliydi. Mortalite oranı %20,5 olup, TK ve SB MSSA bakteriyemili hastalar arasında fark yoktu. Çok değişkenli analizde yüksek komorbidite indeksi (HR 1,557), metastatik infeksiyon odağı varlığı (HR 2,883) ve yoğun bakım desteğine ihtiyacın olması (HR 16,239) mortalite için bağımsız risk faktörleri, tedavide sefazolin kullanımı ise mortaliteyi azaltan bir faktör olarak saptandı (HR 0,178). Sonuç: Diğer antimikrobiyallerle karşılaştırıldığında sefazolinle tedavi edilen MSSA bakteriyemilerinde klinik sonuçlar daha iyi belirlendiği için, özellikle antistafilokoksik penisilinlerin bulunmadığı yerlerde veya bu ajanları tolere edemeyen hastalarda diğer antimikrobiklerin yerine sefazolin tercih edilmelidir.

Anahtar Kelimeler

• Metisiline duyarlı Staphylococcus aureus,sağlık bakımı ile ilişkili bakteriyemi,sefazolin

Kaynakça

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