Epidemiologie, Verlauf und Prognose der Staphylococcus-aureus-Bakteriämie - Erste Ergebnisse der INSTINCT-Kohorte

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund und Fragestellung: Staphylococcus aureus gehört zu den häufigsten Erregern einer Sepsis, und die S.-aureus-Bakteriämie (SAB) stellt eine der schwersten sowohl ambulant erworbenen als auch nosokomialen Infektionen dar. Die Epidemiologie und Prognose dieser Infektion ist für Deutschland nicht zuverlässig beschreibbar, da prospektiv erhobene Daten fehlen.

Patienten und Methodik: In einer prospektiven Kohortenstudie (Invasive Staphylococcus aureus Infection Cohor t; INSTINCT) werden über eine Internet-basierte Dokumentation multizentrisch und standardisiert Daten zu SAB erfasst und ausgewertet. Die Daten werden von speziell geschultem Personal erhoben. Sie umfassen Angaben zu Vorerkrankungen, Risikofaktoren, Verlauf, Therapie, Komplikationen und Behandlungsergebnis. Den ersten Ergebnissen liegen Daten aus zwei Zentren zugrunde.

Ergebnisse: Vom 1.1.2006 bis zum 31.10.2007 wurden 263 Patienten mit SAB dokumentiert. In 52 % der Fälle handelte es sich um nosokomial erworbene Infektionen, 28 % waren nicht-nosokomiale, jedoch Gesundheitssystem-assoziierte („healthcare-associated”) Infektionen, und 20 % waren ambulant erworbene Infektionen. Das Durchschnittsalter betrug 61 Jahre, 38 % der Patienten waren weiblich. In 62 % lag eine primäre SAB vor, in 38 % der Fälle konnte eine sekundäre Bakteriämie bei gleichzeitiger S. aureus Organinfektion diagnostiziert werden. Die mittlere Bakteriämiedauer betrug 3,3 Tage. Die mittlere Krankenhausverweildauer betrug 27 Tage. Die 7-Tages-Letalität betrug 8 %, die Gesamtletalität während des Krankenhausaufenthaltes lag bei 22 %.

Folgerung: Die SAB ist auch in Deutschland eine häufige Erkrankung mit ernster Prognose.

Summary

Objective: Staphylococcus aureus is a leading cause of bloodstream infection and S. aureus bacteremia (SAB) is one of the most severe infections acquired in hospital or in the community. The epidemiology and prognosis of this infection in Germany is not fully understood because of the lack of prospective data.

Methods: A prospective, multicenter cohort study (INSTINCT, Invasive Staphylococcus aureus Infection Cohort) was initiated to record and analyse data on patients with SAB through an internet-based documentation. Data are being obtained by specially trained personnel. Clinical variables recorded are comorbidities, risk factors, clinical course, therapy, complications and outcome. Prospectively acquired data from 1 January 2006 to 31 October 2007 are now available from two of the study centers.

Results: During this period 263 patients with SAB were identified. 52 % of patients had hospital-acquired infections, 28 % had non-nosocomial but healthcare-associated infections, and 20 % had community-acquired infections. The mean patient age was 61 years, 38 % of patients were female. 62 % of the patients had primary bloodstream infections, while 38 % had a secondary bacteremia, diagnosed on the basis of an underlying organ infection with S. aureus. The mean duration of bacteremia was 3.3 days. Average duration of hospitalization was 27 days. The seven-day mortality was 8 % and in-hospital mortality 22 %.

Conclusions: SAB is a common infection in Germany with a serious prognosis.

Literatur

• 1 Abraham J, Mansour C, Veledar E, Khan B, Lerakis S. Staphylococcus aureus bacteremia and endocarditis: the Grady Memorial Hospital experience with methicillin-sensitive S. aureus and methicillin-resistant S. aureus bacteremia.  Am Heart J. 2004;  147 536-539
  Google Scholar
• 2 Bayer A S, Lam K, Ginzton L, Norman D C, Chiu C Y, Ward J I. Staphylococcus aureus bacteremia. Clinical, serologic, and echocardiographic findings in patients with and without endocarditis.  Arch Intern Med. 1987;  147 457-462
  Google Scholar
• 3 Chamis A L, Peterson G E, Cabell C H. et al . Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators.  Circulation. 2001;  104 1029-1033
  Google Scholar
• 4 Chang F Y, MacDonald B B, Peacock  jr J E. et al . A prospective multicenter study of Staphylococcus aureus bacteremia: incidence of endocarditis, risk factors for mortality, and clinical impact of methicillin resistance.  Medicine (Baltimore). 2003;  82 322-332
  Google Scholar
• 5 Chang F Y, Peacock Jr J E, Musher D M. et al . Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study.  Medicine (Baltimore). 2003;  82 333-339
  Google Scholar
• 6 Collignon P J, Wilkinson I J, Gilbert G L, Grayson M L, Whitby R M. Health care-associated Staphylococcus aureus bloodstream infections: a clinical quality indicator for all hospitals.  Med J Aust. 2006;  184 404-406
  Google Scholar
• 7 Diekema D J, Beekmann S E, Chapin K C, Morel K A, Munson E, Doern G V. Epidemiology and outcome of nosocomial and community-onset bloodstream infection.  J Clin Microbiol. 2003;  41 3655-3660
  Google Scholar
• 8 Fätkenheuer G, Preuss M, Salzberger B. et al . Long-term outcome and quality of care of patients with Staphylococcus aureus bacteremia.  Eur J Clin Microbiol Infect Dis. 2004;  23 157-162
  Google Scholar
• 9 Fowler Jr V G, Sanders L L, Sexton D J. 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
  Google Scholar
• 10 Fowler Jr V G, Sanders L L, Kong L K. et al . Infective endocarditis due to Staphylococcus aureus: 59 prospectively identified cases with follow-up.  Clin Infect Dis. 1999;  28 106-114
  Google Scholar
• 11 Fowler Jr V G, Kaye K S, Simel D L. et al . Staphylococcus aureus bacteremia after median sternotomy: clinical utility of blood culture results in the identification of postoperative mediastinitis.  Circulation. 2003;  108 73-78
  Google Scholar
• 12 Fowler Jr V G, Olsen M K, Corey G R, Woods C W, Cabell C H, Reller L B, Cheng A C, Dudley T, Oddone E Z. Clinical identifiers of complicated Staphylococcus aureus bacteremia.  Arch Intern Med. 2003;  163 2066-72
  Google Scholar
• 13 Frederiksen M S, Espersen F, Frimodt-Møller N. et al . Changing epidemiology of pediatric Staphylococcus aureus bacteremia in Denmark from 1971 through 2000.  Pediatr Infect Dis J. 2007;  26 398-405
  Google Scholar
• 14 González C, Rubio M, Romero-Vivas J, González M, Picazo J J. Bacteremic pneumonia due to Staphylococcus aureus: A comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms.  Clin Infect Dis. 1999;  29 1171-1177
  Google Scholar
• 15 Gopal A K, Fowler Jr V G, Shah M. et al . Prospective analysis of Staphylococcus aureus bacteremia in nonneutropenic adults with malignancy.  J Clin Oncol. 2000;  18 1110-1115
  Google Scholar
• 16 Gottlieb G S, Fowler Jr V G, Kong L K. et al . Staphylococcus aureus bacteremia in the surgical patient: a prospective analysis of 73 postoperative patients who developed Staphylococcus aureus bacteremia at a tertiary care facility.  J Am Coll Surg. 2000;  190 50-57
  Google Scholar
• 17 Hill P C, Birch M, Chambers S. et al . Prospective study of 424 cases of Staphylococcus aureus bacteraemia: determination of factors affecting incidence and mortality.  Intern Med J. 2001;  31 97-103
  Google Scholar
• 18 Jensen A G, Wachmann C H, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases.  Arch Intern Med. 2002;  162 25-32
  Google Scholar
• 19 Jensen A G. Importance of focus identification in the treatment of Staphylococcus aureus bacteraemia.  J Hosp Infect. 2002;  52 29-36
  Google Scholar
• 20 Jernigan J A, Farr B M. Short-course therapy of catheter-related Staphylococcus aureus bacteremia: a meta-analysis.  Ann Intern Med. 1993;  119 304-11
  Google Scholar
• 21 Khatib R, Riederer K, Saeed S. et al . Time to positivity in Staphylococcus aureus bacteremia: possible correlation with the source and outcome of infection.  Clin Infect Dis. 2005;  41 594-598
  Google Scholar
• 22 Klevens R M, Morrison M A, Nadle J. et al . Invasive methicillin-resistant Staphylococcus aureus infections in the United States.  JAMA. 2007;  298 1763-1771
  Google Scholar
• 23 Lodise T P, McKinnon P S, Swiderski L, Rybak M J. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia.  Clin Infect Dis. 2003;  36 1418-1423
  Google Scholar
• 24 McCabe W R, Jackson G G. Gram-negative bacteremia. I. Etiology and ecology.  Arch Intern Med. 1962;  110 847-855
  Google Scholar
• 25 McClelland R S, Fowler Jr V G, Sanders L L. et al . Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality.  Arch Intern Med. 1999;  159 1244-1247
  Google Scholar
• 26 Mylotte J M, Tayara A. Staphylococcus aureus bacteremia: predictors of 30-day mortality in a large cohort.  Clin Infect Dis. 2000;  31 1170-1174
  Google Scholar
• 27 Pedersen M, Benfield T L, Skinhoej P, Jensen A G. Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases.  BMC Infect Dis. 2006;  6 49
  Google Scholar
• 28 Romero-Vivas J, Rubio M, Fernandez C, Picazo J J. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus.  Clin Infect Dis. 1995;  21 1417-1423
  Google Scholar
• 29 Raad I I, Sabbagh M F. Optimal duration of therapy for catheter-related Staphylococcus aureus bacteremia: a study of 55 cases and review.  Clin Infect Dis. 1992;  14 75-82
  Google Scholar
• 30 Shah M A, Sanders L, Lanclos K. et al . Staphylococcus aureus bacteremia in patients with neutropenia.  South Med J. 2002;  95 782-784
  Google Scholar
• 31 Soriano A, Martínez J A, Mensa J. et al . Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia.  Clin Infect Dis. 2000;  30 368-373
  Google Scholar
• 32 Wisplinghoff H, Bischoff T, Tallent S M, Seifert H, Wenzel R P, Edmond M B. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study.  Clin Infect Dis. 2004;  39 309-317
  Google Scholar
• 33 Thomas M G, Morris A J. Cannula-associated Staphylococcus aureus bacteraemia.  Intern Med J. 2005;  35 319-330
  Google Scholar

Prof. Dr. med. Harald Seifert

Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universität zu Köln

Goldenfelsstr. 19 - 21

50935 Köln

Phone: 0221/478-32009

Fax: 0221/478-32035

Email: harald.seifert@uni-koeln.de