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agr functionality affects clinical outcomes in patients with persistent methicillin-resistant Staphylococcus aureus bacteraemia

Cited 21 time in Web of Science Cited 22 time in Scopus
Authors

Kang, C. K.; Kim, Y. K.; Jung, S. -I.; Park, W. B.; Song, K. -H.; Park, K. -H.; Choe, P. G.; Jang, H. -C.; Lee, S.; Kim, Y. -S.; Kwak, Y. G.; Kwon, K. T.; Kiem, S.; Kim, C. -J.; Kim, E. S.; Kim, H. B.

Issue Date
2017-11
Publisher
Springer Verlag
Citation
European Journal of Clinical Microbiology and Infectious Diseases, Vol.36 No.11, pp.2187-2191
Abstract
Methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) often persists despite appropriate antibiotic therapy. It is unclear what microbiological factors contribute to poor clinical outcomes in persistent MRSAB (pMRSAB). We aimed to identify clinical and microbiological risk factors for in-hospital mortality in pMRSAB. We analysed MRSAB cases prospectively collected between 2009 and 2016 at 11 hospitals in Korea, defining cases of pMRSAB as MRSAB lasting ae5 days despite administration of effective antibiotics. The first blood isolates from the pMRSAB cases were tested for staphylococcal cassette chromosome mec type, staphylococcal protein A type, accessary gene regulator (agr) type, genes for Panton-Valentine leukocidin and phenol-soluble modulin-mec, vancomycin minimum inhibitory concentration, vancomycin heteroresistance, and agr functionality. We also collected clinical information for each case. Of 960 MRSAB cases, 152 pMRSAB were finally eligible. Univariable analysis revealed that in-hospital mortality was significantly associated with Charlson's comorbidity-weighted index (CCWI) score, Pitt bacteremia score, sequential organ failure assessment score, presentation with septic shock, pneumonia, agr dysfunction, and vancomycin heteroresistance. Bone and joint infections were negatively associated with in-hospital mortality. Multivariable analysis revealed the following independent risk factors for in-hospital mortality: CCWI score [adjusted odds ratio (aOR), per one point, 1.25; 95% confidence interval (CI), 1.08-1.44; P = 0.003), Pitt bacteremia score (aOR, per one point, 1.33; 95% CI, 1.09-1.62; P = 0.005), non-eradicated foci of infection (aOR, 3.12; 95% CI, 1.18-8.27; P = 0.022), and agr dysfunction (aOR, 2.48; 95% CI, 1.12-5.47; P = 0.025). agr dysfunction is an independent risk factor for in-hospital mortality in pMRSAB.
ISSN
0934-9723
URI
https://hdl.handle.net/10371/199673
DOI
https://doi.org/10.1007/s10096-017-3044-2
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  • College of Medicine
  • Department of Medicine
Research Area Immunology, Infectious Diseases, Vaccination, 감염병, 바이러스질환, 예방접종

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