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Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Purpose

Distinguishing between complicated and uncomplicated Staphylococcus aureus bacteraemia (SAB) is therapeutically essential. However, this distinction has limitations in reflecting the heterogeneity of SAB and encouraging targeted diagnostics. Recently, a new risk stratification system for SAB metastatic infection, involving stepwise approaches to diagnosis and treatment, has been suggested. We assessed its applicability in methicillin-resistant SAB (MRSAB) patients.

Methods

We retrospectively analysed data of a 3-year multicentre, prospective cohort of hospitalised patients with MRSAB. We classified the patients into three risk groups: low, indeterminate, and high, based on the new system and compared between-group management and outcomes.

Results

Of 380 patients with MRSAB, 6.3% were classified as low-, 7.6% as indeterminate-, and 86.1% as high-risk for metastatic infection. No metastatic infection occurred in the low-, 6.9% in the indeterminate-, and 19.6% in the high-risk groups (P < 0.001). After an in-depth diagnostic work-up, patients were finally diagnosed as ‘without metastatic infection (6.3%)’, ‘with metastatic infection (17.4%)’, and ‘uncertain for metastatic infection (76.3%)’. 30-day mortality increased as the severity of diagnosis shifted from ‘without metastatic infection’ to ‘uncertain for metastatic infection’ and ‘with metastatic infection’ (P = 0.09). In multivariable analysis, independent factors associated with metastatic complications were suspicion of endocarditis in transthoracic echocardiography, clinical signs of metastatic infection, Pitt bacteraemia score ≥ 4, and persistent bacteraemia.

Conclusions

The new risk stratification system shows promise in predicting metastatic complications and guiding work-up and management of MRSAB. However, reducing the number of cases labelled as ‘high-risk’ and ‘uncertain for metastatic infection’ remains an area for improvement.

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Funding

This study was supported by the Korean Society of Internal Medicine (Grant 2020–179), by a National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) (Grant Number: NRF-2022R1F1A1074848), and by EMBRI Grants 2022-EMBRISN0002 from the Eulji University.

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Author notes

  1. Song Mi Moon

    Present address: Department of Internal Medicine at Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

  2. Eun Hee Song and Yong Pil Chong contributed equally to this work.

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Nowon Eulji University Hospital, Seoul, Republic of Korea

    Taeeun Kim

  2. Division of Infectious Diseases, Department of Internal Medicine, Cheongju St Mary’s Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea

    Sang-Rok Lee

  3. Division of Infectious Diseases, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Gyeonggi-do, Republic of Korea

    Seong Yeon Park

  4. Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Ho Choi, Sang-Oh Lee, Yang Soo Kim & Yong Pil Chong

  5. Department of Laboratory Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Heungsup Sung & Mi-Na Kim

  6. Departments of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea

    Eun Hee Song

  7. Department of Internal Medicine, Gil Medical Center, Gachon University School of Medicine, Incheon, Republic of Korea

    Song Mi Moon

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  1. Taeeun Kim
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Correspondence to Eun Hee Song or Yong Pil Chong.

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Kim, T., Lee, SR., Park, S.Y. et al. Validation of a new risk stratification system-based management for methicillin-resistant Staphylococcus aureus bacteraemia: analysis of a multicentre prospective study. Eur J Clin Microbiol Infect Dis (2024). https://doi.org/10.1007/s10096-024-04790-2

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