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Thrombocytopaenia during methicillin-sensitive Staphylococcus aureus bacteraemia.

E Forsblom1,2, I Tielinen3, E Ruotsalainen3

  • 1Division of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. erik.forsblom@helsinki.fi.

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|December 25, 2016
PubMed
Summary

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Thrombocytopaenia, or low platelet count, in Staphylococcus aureus bacteraemia (SAB) patients is a significant indicator of poor outcomes, especially when persistent at day 7. This study highlights its prognostic value, excluding pre-existing conditions.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Clinical Medicine

Background:

  • Prognostic impact of thrombocytopaenia in Staphylococcus aureus bacteraemia (SAB) is often assessed only at onset.
  • Pre-bacteremic factors predisposing to thrombocytopaenia have not been adequately considered.
  • This study focuses on the prognostic value of low thrombocyte count in SAB, excluding pre-bacteremic influences.

Purpose of the Study:

  • To evaluate the prognostic impact of low thrombocyte count in patients with methicillin-sensitive SAB (MS-SAB).
  • To assess thrombocytopaenia at different time points (blood culture, day 3, day 7) and its association with outcomes.
  • To identify thrombocytopaenia as an independent prognostic marker in SAB, excluding confounding pre-bacteremic factors.

Main Methods:

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  • Multicenter retrospective analysis of 495 MS-SAB patients.
  • Thrombocyte counts were measured at blood culture, day 3, and day 7.
  • Exclusion of patients with chronic alcoholism, liver diseases, and hematologic malignancies to isolate SAB-specific effects.

    • Main Results:

    • Thrombocytopaenia at blood culture and day 3 correlated with endocarditis and defervescence.
    • Ninety-day mortality was significantly higher in patients with thrombocytopaenia at all measured time points (blood culture, day 3, day 7).
    • Thrombocytopaenia at day 7 emerged as a significant independent negative prognostic marker (HR, 3.64; p<0.001), while at day 3 it showed a trend (HR, 1.83; p=0.05).

    Conclusions:

    • Thrombocytopaenia is a significant negative prognostic marker in MS-SAB, particularly when persistent.
    • Thrombocytopaenia at day 7 is a strong independent predictor of poor outcomes in SAB.
    • The timing of thrombocytopaenia assessment is crucial for its prognostic value in SAB.