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Comparison of clinical outcomes in patients with Staphylococcus aureus bacteraemia and endocarditis presenting with or without systemic inflammatory response syndrome

Abstract number: 1733_348

Kanafani Z., Vigliani G., Boucher H., Chambers H., Rupp M., Nasraway S., Rehm S., Campion M., Abrutyn E., Karchmer A., Levine D., Fatkenheuer G., Brodt H., Wolf T., Corey R.

Objectives:S. aureus is a unique pathogen with an ability to invade normal tissues including normal heart valves. Determining the optimal length of therapy (LOT) at onset of S. aureus bacteraemia (SAB) is therefore difficult. In addition, the effect of the systemic inflammatory response syndrome (SIRS) on the outcome of patients with documented SAB (SIRS + SAB = sepsis) has not been determined. We evaluated the final diagnosis and outcomes in patients with documented SAB enrolled in the recently reported SAB/S. aureus infective endocarditis (SAIE) daptomycin trial who presented with and without SIRS (sepsis) at baseline.

Methods: The SAB/SAIE daptomycin trial was a randomised study conducted between August 2002 and February 2005 in 44 sites in the United States and Europe. Eligible patients had ≥1 positive blood cultures for S. aureus within two days of enrolment. Patients were randomised to daptomycin 6 mg/kg/d or combination of either vancomycin 1 g every 12 hours or antistaphylococcal penicillin 2 g every 4 hours, both with gentamicin 1 mg/kg every 8 hours for 4 days. Investigators determined the duration of treatment based on the working diagnosis. Final diagnosis and outcome at the end of therapy (EOT) and test of cure (TOC) were determined by an adjudication committee blinded to treatment group assignment. SIRS was considered present at baseline if patients met 2 or more of the following criteria: temperature <36°C or >38°C, heart rate >90 bpm, respiratory rate >20 breaths/min, WBC <4,000 mm3 or 12,000/mm3 or bands >10%.

Results: One hundred and seventy-six of the 235 patients enrolled with SAB (75%) met SIRS criteria. The proportion with MRSA was similar in 38.6% patients with and 35.6% without SIRS. Complicated SAB or SAIE was the final diagnosis in 133/176 (75.6%) with SIRS and 41/59 (69.5%) without SIRS. Patients with and without SIRS had similar success rates at EOT (78.4 vs 71.2%) and TOC (71.0 vs 64.4%) and similar mortality by 42 days after treatment (11.4 vs 11.9%).

Conclusion: SAB is associated with a high rate of complicated disease and SAIE irrespective of the presence of SIRS at baseline. The absence of SIRS is not a useful predictor of outcome and should not be used to limit duration of therapy in patients with SAB.

Final diagnosisSIRS (N = 176) n (%)No SIRS (N = 59) n (%)
R-sided IE29 (16.5)6 (10.2)
L-sided IE14 (8.0)4 (6.8)
Complicated SAB90 (51.1)31 (52.5)
Uncomplicated SAB43 (24.4)18 (30.5)

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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