Dataset Information

Elevated serum interleukin-10 at time of hospital admission is predictive of mortality in patients with Staphylococcus aureus bacteremia.

ABSTRACT:

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-?, IL-1?, 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? 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? serum concentrations in order to better evaluate the impact of therapeutic interventions on patient outcome.

SUBMITTER: Rose WE

PROVIDER: S-EPMC6281403 | biostudies-literature | 2012 Nov

REPOSITORIES: biostudies-literature

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Publications

Elevated serum interleukin-10 at time of hospital admission is predictive of mortality in patients with Staphylococcus aureus bacteremia.

Rose Warren E WE Eickhoff Jens C JC Shukla Sanjay K SK Pantrangi Madhulatha M Rooijakkers Suzan S Cosgrove Sara E SE Nizet Victor V Sakoulas George G

The Journal of infectious diseases 20120910 10

<h4>Background</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 22966128

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Project description:Several management strategies may improve outcomes in patients with Staphylococcus aureus bacteremia.To review evidence of management strategies for S. aureus bacteremia to determine whether transesophageal echocardiography is necessary in all adult cases and what is the optimal antibiotic therapy for methicillin-resistant S. aureus (MRSA) bacteremia.A PubMed search from inception through May 2014 was performed to identify studies addressing the role of transesophageal echocardiography in S. aureus bacteremia. A second search of PubMed, EMBASE, and the Cochrane Library from January 1990 through May 2014 was performed to find studies addressing antibiotic treatment for MRSA bacteremia. Studies reporting outcomes from antibiotic therapy for MRSA bacteremia were included. All searches, which were limited to English and focused on adults, were augmented by review of bibliographic references from included studies. The quality of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation system with consensus of independent evaluations by at least 2 of the authors.In 9 studies with a total of 4050 patients, use of transesophageal echocardiography was associated with higher rates of a diagnosis of endocarditis (14%-28%) compared with transthoracic echocardiography (2%-15%). In 4 studies, clinical or transthoracic echocardiography findings did not predict subsequent transesophageal echocardiography findings of endocarditis. Five studies identified clinical or transthoracic echocardiography characteristics associated with low risk of endocarditis (negative predictive values from 93% to 100%). Characteristics associated with a low risk of endocarditis include absence of a permanent intracardiac device, sterile follow-up blood cultures within 4 days after the initial set, no hemodialysis dependence, nosocomial acquisition of S. aureus bacteremia, absence of secondary foci of infection, and no clinical signs of infective endocarditis. Of 81 studies of antibiotic therapy for MRSA bacteremia, only 1 high-quality trial was identified. In that study of 246 patients with S. aureus bacteremia, daptomycin was not inferior to vancomycin or an antistaphylococcal penicillin, each in combination with low-dose, short-course gentamicin (clinical success rate, 44.2% [53/120] vs 41.7% [48/115]; absolute difference, 2.4% [95% CI, -10.2% to 15.1%]).All adult patients with S. aureus bacteremia should undergo echocardiography. Characteristics of low-risk patients with S. aureus bacteremia for whom transesophageal echocardiography can be safely avoided have been identified. Vancomycin and daptomycin are the first-line antibiotic choices for MRSA bacteremia. Well-designed studies to address the management of S. aureus bacteremia are needed.

Dataset Information

Elevated serum interleukin-10 at time of hospital admission is predictive of mortality in patients with Staphylococcus aureus bacteremia.

Background

Methods

Results

Conclusions

Publications

Elevated serum interleukin-10 at time of hospital admission is predictive of mortality in patients with Staphylococcus aureus bacteremia.

Similar Datasets

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