Abstract：
S. aureus bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with S. aureus bacteremia and evaluate the role of early source control. This retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of S. aureus bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of S. aureus bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (P < 0.001), nosocomial bacteremia (P 0.019), time to blood culture positivity ≤ 13 h (P 0.004), persistent bacteremia for ≥ 48 h (P 0.004), sepsis (P < 0.001), bacteremia of unknown origin (P 0.036) and lower respiratory tract infection (P < 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (P < 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (P < 0.001) was associated with better survival. Mortality among patients with S. aureus bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality.
摘要：
金黄色葡萄球菌菌血症与高死亡率相关。目的是确定金黄色葡萄球菌菌血症患者死亡率的预测因子，并评估早期来源控制的作用。这项回顾性研究是在洛桑大学医院进行的，瑞士。包括2015年至2021年成年患者中金黄色葡萄球菌菌血症的所有发作。在学习期间,包括839例金黄色葡萄球菌菌血症，其中7.9%是由于耐甲氧西林的分离株。菌血症与骨或关节感染有关（268;31.9%），其次是不明原因的菌血症（158;18.8％），经证实的心内膜炎（118;14.1％）和下呼吸道感染（79;9.4％）。28天总死亡率为14.5%。Cox多元回归模型显示,Charlson合并症指数>5(P<0.001),院内菌血症（P0.019），血培养阳性时间≤13h（P0.004），持续菌血症≥48小时（P0.004），脓毒症（P<0.001），不明原因菌血症（P0.036）和下呼吸道感染（P<0.001）与28天死亡率相关，而感染发病48h内的传染病咨询（P<0.001）与更好的生存率相关。在感染发作后48小时内，575次发作和345次发作（60.0％）进行源控制。第二个多变量分析的结果证实，早期来源控制（P<0.001）与更好的生存率相关。金黄色葡萄球菌菌血症患者的死亡率很高，早期来源控制是预后的关键决定因素。在48h内进行传染病咨询对降低死亡率具有重要作用。
