Clinical significance of Staphylococcus aureus bacteremia in patients with liver cirrhosis

• Published in: European journal of clinical microbiology & infectious diseases Vol. 31; no. 12; pp. 3309 - 3316
• Main Authors: Park, H. J., Lee, Y.-M., Bang, K. M., Park, S.-Y., Moon, S. M., Park, K.-H., Chong, Y. P., Kim, S.-H., Lee, S.-O., Choi, S.-H., Jeong, J.-Y., Woo, J. H., Kim, Y. S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Bacteremia - mortality; Bacteremia - pathology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Body temperature; Catheters; Cirrhosis; Clinical significance; Cohort Studies; Disease; Drug resistance; Female; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Hypotension; Immunity; Infection; Infectious diseases; Internal Medicine; Leukocytes; Liver; Liver cirrhosis; Liver Cirrhosis - complications; Liver diseases; Liver Function Tests; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Nosocomial infections; Other diseases. Semiology; Prognosis; Prospective Studies; Sepsis; Septic shock; Severity of Illness Index; Staphylococcal Infections - mortality; Staphylococcal Infections - pathology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - isolation & purification; Staphylococcus infections; Survival Analysis; Young Adult; South Korea; Septic Shock; Liver Cirrhosis; Solid Organ Transplant Recipient; Peripheral White Blood Cell; Infective Endocarditis; Human; Microbiology; Liver; Hepatic disease; Bacteremia; Infection; Cirrhosis; Bacteriosis; Bacteria; Micrococcales; Digestive diseases; Micrococcaceae; Staphylococcal infection; Staphylococcus aureus
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1697-4

Patients with liver cirrhosis (LC) have impaired immunity and thus are predisposed to infections. Few studies have attempted to evaluate Staphylococcus aureus bacteremia (SAB) in LC patients. Therefore, this study prospectively evaluated the clinical characteristics and outcomes of 642 episodes of SAB from August 1, 2008 to September 31, 2010. Of 642 patients with SAB, 109 (17.0 %) were classified as LC patients whereas the remaining 533 (83.0 %) were classified as non-LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (32 % vs. 22 %, respectively; P  = 0.047). The 30-day mortality rates of patients with MSSA bacteremia and MRSA bacteremia were not significantly different among LC patients (35.1 % with MSSA vs. 26.9 % with MRSA; P  = 0.41). A univariate analysis of the 30-day mortality rate of LC patients with SAB for survivors and non-survivors showed that rapidly fatal or ultimately fatal according to the criteria of McCabe and Jackson (OR 5.0; 95 % CI 1.60–15.65), septic shock at initial presentation (OR 3.5; 95 % CI 1.18–10.39) and Child-Pugh class C (OR 2.8; 95 % CI 1.20–6.59) were associated with increased mortality. In contrast, the removal of the eradicable focus was associated with decreased mortality (OR 0.14; 95 % CI 0.04–0.52). Disease severity and liver dysfunction may be useful for predicting the prognosis of SAB in LC patients.