Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 206, Issue 10, Pages 1604-1611Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jis552
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Funding
- Sharp Healthcare Foundation (San Diego, CA)
- Astellas
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Background. Staphylococcus aureus bacteremia (SaB) carries considerable morbidity and mortality. We examined the predictive value of serum concentrations of interleukin (IL)-10, proinflammatory cytokines, and terminal complement on patient survival and SaB duration. Methods. Clinical information on consecutive patients with SaB at a tertiary medical center were collected prospectively. Patient serum samples obtained at the day of clinical presentation were assayed for tumor necrosis factor-alpha, IL-1 beta, IL-10, and complement membrane attack complex C5b-9 concentrations using enzyme-linked immunoassay. Logistic regression identified predictors of mortality and duration of bacteremia. Results. In 59 patients with SaB, 14% died and 17% had prolonged bacteremia (>4 days). Elevated IL-10 serum concentrations (>7.8 pg/mL) identified all 8 patients who died, whereas there were no deaths in patients with normal IL-10 (P = .016). The lack of an IL-1 beta response (<= 0.45 pg/mL) defined all patients with SaB >4 days. In multivariate analysis, patient age (odds ratio [OR], 1.16; P = .022), duration of bacteremia (OR, 1.16; P = .031), and serum IL-10 (OR, 1.05; P = .014) were identified as independent predictors of patient mortality. Conclusions. SaB mortality was confined strictly to patients with elevated IL-10 concentrations. We recommend that future clinical trials of SaB stratify patients according to IL-10 and IL-1 beta serum concentrations in order to better evaluate the impact of therapeutic interventions on patient outcome.
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