Abstract：
OBJECTIVE: Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients.
METHODS: We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes.
RESULTS: Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as \'without metastatic infection (6.3%)\', \'with metastatic infection (17.4%)\', and \'uncertain for metastatic infection (76.3%)\'. 30-day mortality increased as the severity of diagnosis shifted from \'without metastatic infection\' to \'uncertain for metastatic infection\' and \'with metastatic infection\' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia.
CONCLUSIONS: The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as \'high-risk\' and \'uncertain for metastatic infection\' remains an area for improvement.
METHODS: We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes.
RESULTS: Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as \'without metastatic infection (6.3%)\', \'with metastatic infection (17.4%)\', and \'uncertain for metastatic infection (76.3%)\'. 30-day mortality increased as the severity of diagnosis shifted from \'without metastatic infection\' to \'uncertain for metastatic infection\' and \'with metastatic infection\' (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia.
CONCLUSIONS: The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as \'high-risk\' and \'uncertain for metastatic infection\' remains an area for improvement.
摘要：
目的：区分复杂和不复杂的金黄色葡萄球菌菌血症（SAB）在治疗上至关重要。然而,这种区别在反映SAB的异质性和鼓励针对性诊断方面存在局限性.最近,SAB转移性感染的新风险分层系统，涉及逐步的诊断和治疗方法，有人建议。我们评估了其在耐甲氧西林SAB（MRSAB）患者中的适用性。
方法：我们回顾性分析了3年多中心的数据，MRSAB住院患者的前瞻性队列。我们将患者分为三个风险组：低，不确定，高,基于新系统，并比较了组间管理和结果。
结果：在380例MRSAB患者中，6.3%被归类为低，7.6%不确定-，86.1%为转移性感染的高危人群。在低，6.9%在不确定的范围内-，高危人群为19.6%(P<0.001)。经过深入的诊断工作，患者最终被诊断为“无转移性感染(6.3%)”，“转移性感染（17.4%）”，和“不确定转移性感染（76.3%）”。随着诊断的严重程度从“无转移性感染”转变为“不确定转移性感染”和“有转移性感染”，30天死亡率增加（P=0.09）。在多变量分析中，与转移性并发症相关的独立因素是经胸超声心动图怀疑心内膜炎，转移性感染的临床症状，Pitt菌血症评分≥4分，持续性菌血症。
结论：新的风险分层系统在预测转移性并发症和指导MRSAB的检查和管理方面显示出希望。然而,减少被标记为“高风险”和“不确定转移性感染”的病例数量仍然是一个需要改善的领域。
方法：我们回顾性分析了3年多中心的数据，MRSAB住院患者的前瞻性队列。我们将患者分为三个风险组：低，不确定，高,基于新系统，并比较了组间管理和结果。
结果：在380例MRSAB患者中，6.3%被归类为低，7.6%不确定-，86.1%为转移性感染的高危人群。在低，6.9%在不确定的范围内-，高危人群为19.6%(P<0.001)。经过深入的诊断工作，患者最终被诊断为“无转移性感染(6.3%)”，“转移性感染（17.4%）”，和“不确定转移性感染（76.3%）”。随着诊断的严重程度从“无转移性感染”转变为“不确定转移性感染”和“有转移性感染”，30天死亡率增加（P=0.09）。在多变量分析中，与转移性并发症相关的独立因素是经胸超声心动图怀疑心内膜炎，转移性感染的临床症状，Pitt菌血症评分≥4分，持续性菌血症。
结论：新的风险分层系统在预测转移性并发症和指导MRSAB的检查和管理方面显示出希望。然而,减少被标记为“高风险”和“不确定转移性感染”的病例数量仍然是一个需要改善的领域。
