Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteraemia: a...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Epidemiology

Background:

• Coagulase-negative staphylococci (CoNS) are a significant cause of bloodstream infections (BSIs), particularly in healthcare settings.
• Defining complicated CoNS BSIs is crucial for risk stratification and guiding treatment strategies.
• Predictors of mortality in CoNS BSI patients require further elucidation to improve patient management.

Purpose of the Study:

• To establish a definition for complicated CoNS BSIs.
• To identify independent predictors of 30-day mortality in patients with CoNS BSIs.
• To assess the impact of specific criteria on mortality risk in CoNS BSI.

Main Methods:

• Prospective cohort study across 26 Spanish hospitals (October 2016 - March 2017).
• Inclusion of 445 CoNS BSI cases, with detailed data collection on infection characteristics and patient outcomes.
• Cox regression analysis to identify independent predictors of 30-day mortality.

Main Results:

• Complicated CoNS BSI was present in 53.9% of cases, associated with significantly higher 30-day mortality (22.1% vs. 11.7%).
• Independent predictors of mortality included advanced age, cerebrovascular disease, immunosuppressive therapy, higher SOFA score, and complicated bacteraemia.
• Early catheter removal was found to be protective (HR: 0.47), while fever lasting ≥72 hours increased mortality risk (HR: 2.52).

Conclusions:

• A significant proportion of CoNS BSIs meet criteria for complicated infections, correlating with increased mortality risk.
• The proposed criteria for complicated CoNS BSIs require further validation in larger studies.
• Identifying key mortality predictors like age, comorbidities, and specific infection characteristics can guide clinical decision-making.