Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

Autor: Ploenchan Chetchotisakd, Pitchayanant Ariyaprasert, Narisara Chantratita, Sharon J. Peacock, Shawna Okamoto, T. Eoin West, Sarunporn Tandhavanant, Pornpan Suntornsut, Chanthiwa Wikraiphat, Jirasak Anukunananchai, Sunchai Phiphitaporn, Weera Mahavanakul, P. Srisamang
Rok vydání: 2017
Předmět:
Male
Staphylococcus aureus
medicine.medical_specialty
030204 cardiovascular system & hematology
Staphylococcal infections
law.invention
Tertiary Care Centers
Sepsis
03 medical and health sciences
0302 clinical medicine
law
Virology
Internal medicine
Diabetes Mellitus
medicine
Coagulopathy
Humans
Prospective Studies
030212 general & internal medicine
Intensive care medicine
Prospective cohort study
Survival analysis
Aged
business.industry
Interleukin-8
Disease Management
Articles
Disseminated Intravascular Coagulation
Middle Aged
Staphylococcal Infections
Prognosis
Thailand
medicine.disease
Survival Analysis
Intensive care unit
Anti-Bacterial Agents
3. Good health
Community-Acquired Infections
Intensive Care Units
Infectious Diseases
Respiratory failure
Fluid Therapy
Female
Parasitology
Respiratory Insufficiency
business
Biomarkers
Cohort study
Zdroj: The American Journal of Tropical Medicine and Hygiene
ISSN: 1476-1645
0002-9637
Popis: Staphylococcus aureus infection is a persistent threat in resource-restricted settings in southeast Asia but informative data about this disease remain limited. We analyzed characteristics, management, and predictors of outcome in severely septic patients with community-onset S. aureus infection in northeast Thailand. We performed a prospective, multicenter observational cohort study of community-onset S. aureus sepsis in four referral hospitals recruiting patients at least 14 years of age admitted between March 2010 and December 2013. One hundred and nineteen patients with severe staphylococcal sepsis were enrolled. Diabetes was the most common underlying condition. Methicillin-resistant infection was rare. Twenty-eight-day mortality was 20%. Ninety-two percent of patients received appropriate antibiotic therapy and 82% were administered intravenous fluids on the first hospital day, although only 14% were managed in an intensive care unit (ICU). On univariable analysis, clinical variables at enrollment significantly associated with death at 28 days were coagulopathy or respiratory failure. Plasma interleukin (IL)-8 concentration alone accurately predicted mortality (area under the receiver operating curve = 0.82, 95% confidence interval = 0.73-0.90). In multivariable analysis, addition of IL-8 concentration to a mortality prediction model containing clinical variables further improved the predictive ability of the model. We conclude that severe staphylococcal sepsis in northeast Thailand causes significant mortality. Diabetes is a common preexisting condition and most patients are managed outside the ICU even if they receive vasoactive/inotropic agents or mechanical ventilation. While clinical factors apparent on presentation including coagulopathy and respiratory failure predict death, plasma IL-8 improves this prediction.
Databáze: OpenAIRE
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