TITLE

Thrombocytopenia in Staphylococcus aureus Bacteremia: Risk Factors and Prognostic Importance

AUTHOR(S)
Gafter-Gvili, Anat; Mansur, Nariman; Bivas, Assaf; Zemer-Wassercug, Noa; Bishara, Jihad; Leibovici, Leonard; Paul, Mical
PUB. DATE
May 2011
SOURCE
Mayo Clinic Proceedings;May2011, Vol. 86 Issue 5, p389
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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.
ACCESSION #
61207733

 

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