作为感染性心内膜炎风险标志的金黄色葡萄球菌血培养阳性时间:回顾性队列研究

IF 8.2 1区 医学 Q1 IMMUNOLOGY
Martin Strömdahl, Karl Hagman, Karolina Hedman, Anna Westman, Magnus Hedenstierna, Johan Ursing
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Time to Staphylococcus aureus Blood Culture Positivity as a risk marker of Infective Endocarditis: A Retrospective Cohort Study
Background Endocarditis occurs in approximately 10-15% of patients with Staphylococcus aureus bacteremia. Short time to positivity (TTP) in blood culture flasks has been linked to endocarditis in smaller studies. This study evaluated the association between TTP and endocarditis in S. aureus bacteremia in a large cohort. Methods Adult patients with ≥1 S. aureus positive blood culture treated at a tertiary level, 500-bed hospital in Stockholm, Sweden between 2011-2021 were retrospectively identified. The primary outcome was the presence of infective endocarditis. Results A total of 1703 episodes of S. aureus bacteremia (23/1703 MRSA) in 1610 patients were included. Median age was 75 years (interquartile range [IQR] 63-84) and median Charlson comorbidity index was 2 (IQR 1-3). Echocardiography was performed in 1102/1703 (65%). Thirty-day mortality was 406/1703 (24%) and endocarditis was found in 154/1703 (9%). Median TTP was shorter in patients with endocarditis (9 [IQR 7-12] hours) compared to patients without endocarditis (13 [IQR 10-18] hours, p<0.001). The risk of endocarditis decreased with 11% per hour (OR 0.89 [95% CI 0.54-0.92] p<0.001) in a univariate analysis using TTP as a continuous variable. In multivariate analysis TTP<13 hours (the median) was independently associated with endocarditis (OR 3.59, [95% CI 2.35-5.3] p<0.001). The negative predictive value of TTP>13 hours for endocarditis was 96% (95% CI 95-97). Conclusions Short TTP was associated with endocarditis. The negative predictive value of >95% suggests that TTP>13 hours can be used to risk stratify patients with S. aureus bacteremia.
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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