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agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia

Title
agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia
Authors
Kang C.K.Kim Y.K.Jung S.-I.Park W.B.Song K.-H.Park K.-H.Choe P.G.Jang H.-C.Lee S.Kim Y.-S.Kwak Y.G.Kwon K.T.Kiem S.Kim C.-J.Kim E.S.Kim H.B.The Korea Infectious Diseases (Kind) Study Group
Ewha Authors
김충종
SCOPUS Author ID
김충종scopus
Issue Date
2017
Journal Title
European Journal of Clinical Microbiology and Infectious Diseases
ISSN
0934-9723JCR Link
Citation
pp. 1 - 5
Publisher
Springer Verlag
Indexed
SCI; SCIE; SCOPUS scopus
Abstract
Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) often persists despite appropriate antibiotic therapy. It is unclear what microbiological factors contribute to poor clinical outcomes in persistent MRSAB (pMRSAB). We aimed to identify clinical and microbiological risk factors for in-hospital mortality in pMRSAB. We analysed MRSAB cases prospectively collected between 2009 and 2016 at 11 hospitals in Korea, defining cases of pMRSAB as MRSAB lasting ≥5 days despite administration of effective antibiotics. The first blood isolates from the pMRSAB cases were tested for staphylococcal cassette chromosome mec type, staphylococcal protein A type, accessary gene regulator (agr) type, genes for Panton-Valentine leukocidin and phenol-soluble modulin-mec, vancomycin minimum inhibitory concentration, vancomycin heteroresistance, and agr functionality. We also collected clinical information for each case. Of 960 MRSAB cases, 152 pMRSAB were finally eligible. Univariable analysis revealed that in-hospital mortality was significantly associated with Charlson’s comorbidity-weighted index (CCWI) score, Pitt bacteremia score, sequential organ failure assessment score, presentation with septic shock, pneumonia, agr dysfunction, and vancomycin heteroresistance. Bone and joint infections were negatively associated with in-hospital mortality. Multivariable analysis revealed the following independent risk factors for in-hospital mortality: CCWI score [adjusted odds ratio (aOR), per one point, 1.25; 95% confidence interval (CI), 1.08–1.44; P = 0.003), Pitt bacteremia score (aOR, per one point, 1.33; 95% CI, 1.09–1.62; P = 0.005), non-eradicated foci of infection (aOR, 3.12; 95% CI, 1.18–8.27; P = 0.022), and agr dysfunction (aOR, 2.48; 95% CI, 1.12–5.47; P = 0.025). agr dysfunction is an independent risk factor for in-hospital mortality in pMRSAB. © 2017 Springer-Verlag GmbH Germany
DOI
10.1007/s10096-017-3044-2
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의료원 > 의료원 > Journal papers
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