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Thrombocytopaenia during methicillin-sensitive Staphylococcus aureus bacteraemia

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Abstract

The prognostic impact of thrombocytopaenia in Staphylococcus aureus bacteraemia (SAB) has previously been determined at bacteraemia onset only and relevant pre-bacteraemic thrombocytopaenia predisposing parameters have not been accounted for. We evaluated the prognostic impact of low thrombocyte count in SAB excluding pre-bacteraemic factors potentially causing thrombocytopaenia. This was a multicentre retrospective analysis of methicillin-sensitive SAB (MS-SAB) patients. Thrombocyte count was determined at blood culture collection and at days 3 and 7. Thrombocytopaenia was defined as a thrombocyte count less than 150 ×109/L. Patients with chronic alcoholism, liver diseases and haematologic malignancies were excluded. Altogether, 495 patients were identified. Thrombocytopaenia at blood culture and at day 3 associated to endocarditis (p < 0.05 and p < 0.01) and defervescence (p < 0.001 and p < 0.01). Mortality at 90 days was higher for patients with thrombocytopaenia at blood culture collection (26 vs. 16%, p < 0.05), at day 3 (32 vs. 13%, p < 0.01) and at day 7 (50 vs. 14%, p < 0.001). In receiver operating characteristic analyses, thrombocytopaenia predicted a poor outcome at blood culture collection (p < 0.05), at day 3 (p < 0.001) and at day 7 (p < 0.001). When accounting for all prognostic parameters, thrombocytopaenia at day 3 [hazard ratio (HR), 1.83; p = 0.05] demonstrated a trend towards poor outcome, whereas thrombocytopaenia at day 7 (HR, 3.64; p < 0.001) associated to poor outcome. Thrombocytopaenia at blood culture collection was not a prognostic parameter when all prognostic factors were taken into account. However, thrombocytopaenia at day 3 indicated a poor outcome and thrombocytopaenia at day 7 was a significant independent negative prognostic marker that has not been previously reported in SAB.

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    Authors and Affiliations

    1. Division of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland

      E. Forsblom, I. Tielinen, E. Ruotsalainen & A. Järvinen

    2. Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Aurora Hospital, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029, Helsinki, Finland

      E. Forsblom

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    1. E. Forsblom
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    2. I. Tielinen
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    3. E. Ruotsalainen
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    4. A. Järvinen
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    Correspondence to E. Forsblom.

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    Ethics statement

    The trial was approved by the institutional review board of Helsinki University Central Hospital and the ethical committee of Helsinki University Central Hospital. A written informed consent was provided by each patient.

    Funding

    The study has been supported by grants from the Medical Society of Finland and the foundations Dorothea Olivia, Karl Walter och Jarl Walter Perkléns minne and Svenska Kulturfonden. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

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    E. Forsblom and I. Tielinen contributed equally to this work.

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    Forsblom, E., Tielinen, I., Ruotsalainen, E. et al. Thrombocytopaenia during methicillin-sensitive Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect Dis 36, 887–896 (2017). https://doi.org/10.1007/s10096-016-2877-4

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    • DOI: https://doi.org/10.1007/s10096-016-2877-4

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