Thrombocytopenia in Staphylococcus aureus Bacteremia: Risk Factors and Prognostic Importance

Gafter-Gvili, Anat; Mansur, Nariman; Bivas, Assaf; Zemer-Wassercug, Noa; Bishara, Jihad; Leibovici, Leonard; Paul, Mical
May 2011
Mayo Clinic Proceedings;May2011, Vol. 86 Issue 5, p389
Academic Journal
OBJECTIVE: To identify risk factors and outcomes associated with thrombocytopenia at sepsis onset In Staphylococcus aureus bacteremia. PATIENTS AND METHODS: This single-center, retrospective, cohort study consists of all adult patients with a first episode of clinical S aureus bacteremia between April 1, 1988, and September 30, 1994, and between January 1, 1999, and December 31, 2007. Thrombocytopenia was defined as a platelet count less than 150 x 109/L. The primary outcome was 30-day all-cause mortality. Risk factors for 30-day all-cause mortality were identified using univariate and multivariable analyses. Multivariable analysis was conducted using forward step logistic regression analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for risk of death. RESULTS: A total of 1052 patients had clinical S aureus bacteremia. Thrombocytopenia at sepsis onset was present in 235 patients (22.3%). Thrombocytopenla was associated with community-acquired bacteremia, infections caused by methiclllin-sensitive S aureus, high-magnitude bacteremia (defined as >4 positive blood cultures [≥3 separate positive blood culture sets]), and endocarditis. Patients with thrombocytopenia presented more commonly with severe sepsis reflected by septic shock and acute renal failure. Thirty-day mortality was significantly higher among patients with thrombocytopenla (132/235 [56.2%]) vs those without thrombocytopenia (281/817 [34.4%]; P<.001). Higher mortality was associated with the degree of thrombocytopenia. In multivariable analysis, thrombocytopenia at baseline remained an independent risk factor for 30-day mortality (OR, 282; 95% CI, 1.87-4.24). The adjusted association between thrombocytopenla and death remained similar among the 917 patients with mono-microblai bacteremia (OR, 2.88; 95% Cl, 1.83-4.53) and the 945 patients who did not die within the first 48 hours (OR, 2.88; 95% Ci, 1.87-4.45.). CONCLUSION: We observed a strong association between throm- bocytopenla at sepsis onset and all-cause mortality in S aureus bacteremia, possibly related to mechanisms other than sepsis alone.


Related Articles

  • CPB-assisted aortic valve replacement in a pregnant 27-year-old with endocarditis. Marcoux, J.; Rosin, M.; Mycyk, T. // Perfusion;Sep2009, Vol. 24 Issue 5, p361 

    A 27-year-old, G3P2A0 female with acute Staph aureus (SA) endocarditis successfully underwent CPB-assisted aortic valve replacement with a bioprosthetic aortic valve at 22 weeks' gestation. This patient's presentation of acute endocarditis complicated by septic shock, congestive heart failure,...

  • Acute onset of shortness of breath and mental changes. Undavia, Manish; Suma, Valentin; Cosme-Thormann, Braulio; Cohen, Ronnie // Cortlandt Forum;11/25/2005, Vol. 18 Issue 11, p82 

    The article discusses the diagnostic challenge presented by a case of acute onset of shortness of breath and mental changes in a 70-year-old man who was admitted to the emergency room. Evaluation of the patient, laboratory data, and initial diagnosis are detailed. The patient had clinical as...

  • Renal thrombotic microangiopathy in a patient with septic disseminated intravascular coagulation. Yusuke Sakamaki; Konosuke Konishi; Koichi Hayashi; Akinori Hashiguchi; Matsuhiko Hayashi; Eiji Kubota; Takao Saruta; Hiroshi Itoh // BMC Nephrology;2013, Vol. 14 Issue 1, p1 

    Background The mechanism for the development of thrombotic microangiopathy (TMA) during sepsis has only been partially elucidated. TMA is recognized as a disease caused by various factors, and may be involved in the emergence of organ damage in severe sepsis. Here we report a case of TMA that...

  • Skin Commensal Staphylococci May Act as Reservoir for Fusidic Acid Resistance Genes. Hung, Wei-Chun; Chen, Hsiao-Jan; Lin, Yu-Tzu; Tsai, Jui-Chang; Chen, Chiao-Wei; Lu, Hsiao-Hung; Tseng, Sung-Pin; Jheng, Yao-Yu; Leong, Kin Hong; Teng, Lee-Jene // PLoS ONE;11/18/2015, Vol. 10 Issue 11, p1 

    We analyzed the occurrence and mechanisms of fusidic acid resistance present in staphylococci isolated from 59 healthy volunteers. The fingers of the volunteers were screened for the presence of staphylococci, and the collected isolates were tested for resistance to fusidic acid. A total of 34...

  • Mannose-Binding Lectin Is a Critical Factor in Systemic Complement Activation during Meningococcal Septic Shock. Sprong, Tom; Mollnes, Tom Eirik; Neeleman, Chris; Swinkels, Dorine; Netea, Mihai G.; van der Meer, Jos W. M.; van Deuren, Marcel // Clinical Infectious Diseases;11/1/2009, Vol. 49 Issue 9, p1380 

    Background. Systemic activation of complement during meningococcal disease is associated with severe disease and poor outcome. The exact mechanism of activation of complement is unknown but is important for future therapies aimed at modulating the complement system in this disease. Methods. We...

  • Traumatic Shock Alias Posttrauma Critical Illness. Hardaway, Robert M. // American Surgeon;Mar2000, Vol. 66 Issue 3, p284 

    Trauma is the most common cause of death under the age of 45. Many trauma patients die of multiple organ failure, especially acute respiratory distress syndrome. The basic cause of traumatic shock has only partially been elucidated. Data resources include research papers on the subject of trauma...

  • Ebola Hemorrhagic Fever and Septic Shock. Bray, Mike; Mahanty, Siddhartha // Journal of Infectious Diseases;12/1/2003, Vol. 188 Issue 11, p1613 

    Editorial. Discusses findings of studies that shed light on early events that both permit rapid viral dissemination and cause some of the major features of Ebola hemorrhagic fever. Basis of disseminated intravascular coagulation that is seen in septic shock; Ebola virus pathogenesis; Clinical...

  • Interferon-β/ribavirin.  // Reactions Weekly;9/14/2013, Issue 1469, p27 

    The article presents a case study of a 60-year-old woman who developed a septic shock caused by disseminated intravascular coagulation (DIC) after being treated with interferon-β and ribavirin.

  • Primary mural endocarditis with enormous vegetation in the left ventricle. Takemoto, Kazushi; Hirata, Kumiko; Kubo, Takashi; Imanishi, Toshio; Akasaka, Takashi // European Heart Journal - Cardiovascular Imaging;Jun2013, Vol. 14 Issue 6, p514 

    Clinical images of the head, chest, and abdominal computed tomography of a 68-year-old man with left-sided facial palsy are presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics