Patient Characteristics, Management, and Predictors of Outcome from Severe Community-Onset Staphylococcal Sepsis in Northeast Thailand: A Prospective Multicenter Study

Abstract

Staphylococcus aureus infection is a persistent threat in resource-restricted settings in southeast Asia but informative data about this disease remain limited. We analyzed characteristics, management, and predictors of outcome in severely septic patients with community-onset S. aureus infection in northeast Thailand. We performed a prospective, multicenter observational cohort study of community-onset S. aureus sepsis in four referral hospitals recruiting patients at least 14 years of age admitted between March 2010 and December 2013. One hundred and nineteen patients with severe staphylococcal sepsis were enrolled. Diabetes was the most common underlying condition. Methicillin-resistant infection was rare. Twenty-eight-day mortality was 20%. Ninety-two percent of patients received appropriate antibiotic therapy and 82% were administered intravenous fluids on the first hospital day, although only 14% were managed in an intensive care unit (ICU). On univariable analysis, clinical variables at enrollment significantly associated with death at 28 days were coagulopathy or respiratory failure. Plasma interleukin (IL)-8 concentration alone accurately predicted mortality (area under the receiver operating curve = 0.82, 95% confidence interval = 0.73–0.90). In multivariable analysis, addition of IL-8 concentration to a mortality prediction model containing clinical variables further improved the predictive ability of the model. We conclude that severe staphylococcal sepsis in northeast Thailand causes significant mortality. Diabetes is a common preexisting condition and most patients are managed outside the ICU even if they receive vasoactive/inotropic agents or mechanical ventilation. While clinical factors apparent on presentation including coagulopathy and respiratory failure predict death, plasma IL-8 improves this prediction.

Risk stratification biomarkers for Staphylococcus aureus bacteraemia

“…Our observations are consistent with other reports that high IL-8 is prognostic for all-cause mortality in SAB patients, 1,[5][6][7]19 including mortality in a cohort with IE caused by a variety of bacteria. 20 The prognostic value of IL-8 for mortality is not specific to SAB, as this has been observed across multiple sepsis cohorts including patients with both Gram-positive and Gramnegative bacterial infections.…”

Host-Based Prognostic Biomarkers to Improve Risk Stratification and Outcome of Febrile Children in Low- and Middle-Income Countries

“…Among them, IL-6 is perhaps the best characterized. Several lines of evidence indicate that high IL-6 levels are correlated with bacterial sepsis, severe malaria, severe dengue, and increased risk of dengue mortality (39, 41, 44,46,48,50,[62][63][64][65][66][67][68]. A study in febrile adults reported IL-6 to be a good predictor analyte between non-survivors and survivors (54).…”

Características epidemiológicas e clínicas da sepse em um hospital público do Paraná

“…No entanto, isso muitas vezes não é possível, pois suas manifestações clínicas podem ser confundidas com quadros virais ou bacterianos inespecíficos ou outros processos não infecciosos e muitas vezes passam despercebidas. 7 Estudos demonstram que a rápida identificação da sepse, associada à terapêutica adequada, traz resultados favoráveis para o paciente. O uso de antimicrobianos específicos na primeira hora, logo após o diagnóstico, contribui substancialmente para um desfecho favorável ao paciente.…”

“…Mas, para que a identificação seja precoce e o tratamento adequado, é fundamental a aplicação efetiva dos protocolos de sepse e o treinamento da equipe multiprofissional, principalmente da equipe de enfermagem, para que os profissionais estejam aptos a identificar os sinais e manifestações clínicas da sepse. 7,8 Justificación y objetivos: La sepsis es un problema de salud públicaque genera impacto clínico y económico. El estudio pretende describir las características epidemiológicas y clínicas de lasepsis en un hospital público.…”