Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 28, Issue 8, Pages 1076-1084Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2022.03.015
Keywords
Staphylococcus aureus; Bacteraemia; Mortality; Meta-analysis
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Funding
- McMaster Medicine Specialty Resident and Fellows Research Grant
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The mortality rate of Staphylococcus aureus bacteremia has decreased over the past three decades, but one in four patients still die within three months. Methicillin-resistant Staphylococcus aureus infection is associated with a higher mortality rate, while more recent time periods have shown lower mortality rates.
Background: Precise estimates of mortality in Staphylococcus aureus bacteraemia (SAB) are important to convey prognosis and guide the design of interventional studies. Objectives: We performed a systematic review and meta-analysis to estimate all-cause mortality in SAB and explore mortality change over time. Data sources: The MEDLINE and Embase databases, as well as the Cochrane Database of Systematic Reviews, were searched from January 1, 1991 to May 7, 2021. Study eligibility criteria: Human observational studies on patients with S. aureus bloodstream infection were included. Participants: The study analyzed data of patients with a positive blood culture for S. aureus. Methods: Two independent reviewers extracted study data and assessed risk of bias using the Newcastle eOttawa Scale. A generalized, linear, mixed random effects model was used to pool estimates. Results: A total of 341 studies were included, describing a total of 536,791 patients. From 2011 onward, the estimated mortality was 10.4% (95% CI, 9.0%-12.1%) at 7 days, 13.3% (95% CI, 11.1%-15.8%) at 2 weeks, 18.1% (95% CI,16.3%-20.0%) at 1 month, 27.0% (95% CI, 21.5%-33.3%) at 3 months, and 30.2% (95% CI, 22.4%-39.3%) at 1 year. In a meta-regression model of 1-month mortality, methicillin-resistant S. aureus had a higher mortality rate (adjusted OR (aOR): 1.04; 95% CI, 1.02-1.06 per 10% increase in methicillin-resistant S. aureus proportion). Compared with prior to 2001, more recent time periods had a lower mortality rate (aOR: 0.88; 95% CI, 0.75-1.03 for 2001-2010; aOR: 0.82; 95% CI, 0.69-0.97 for 2011 onward). Conclusions: SAB mortality has decreased over the last 3 decades. However, more than one in four patients will die within 3 months, and continuous improvement in care remains necessary. (C) 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
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