Szubert, AJ;
Bailey, SL;
Cooke, GS;
Peto, TEA;
Llewelyn, MJ;
Edgeworth, JD;
Walker, A;
(2019)
Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial.
Journal of Infection
, 79
(4)
pp. 332-340.
10.1016/j.jinf.2019.08.001.
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Abstract
Objectives: Adjunctive rifampicin did not reduce failure/recurrence/death as a composite endpoint in the ARREST trial of Staphylococcus aureus bacteraemia, but did reduce recurrences. We investigated clinically-defined 14-day treatment failure, and recurrence and S. aureus-attributed/unattributed mortality by 12-weeks to further define their predictors. Methods: A post-hoc exploratory analysis using competing risks models was conducted to identify sub-groups which might benefit from rifampicin. A points-based recurrence risk score was developed and used to compare rifampicin's benefits. Results: Recurrence was strongly associated with liver and renal failure, diabetes and immune-suppressive drugs (p < 0.005); in contrast, failure and S. aureus-attributed mortality were associated with older age and higher neutrophil counts. Higher SOFA scores predicted mortality; higher Charlson scores and deep-seated initial infection focus predicted failure. Unexpectedly, recurrence risk increased with increasing BMI in placebo (p = 0.04) but not rifampicin (p = 0.60) participants (pheterogeneity = 0.06). A persistent focus was judged the primary reason for recurrence in 23(74%). A 5-factor risk score based on BMI, Immunosuppression, Renal disease, Diabetes, Liver disease (BIRDL) strongly predicted recurrence (p < 0.001). Conclusions: Rifampicin reduces recurrences overall; those with greatest absolute risk reductions were identified using a simple risk score. Source control and adequate duration of antibiotic therapy remain essential to prevent recurrence and improve outcomes.
| Type: | Article |
|---|---|
| Title: | Predictors of recurrence, early treatment failure and death from Staphylococcus aureus bacteraemia: observational analyses within the ARREST trial |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jinf.2019.08.001 |
| Publisher version: | https://doi.org/10.1016/j.jinf.2019.08.001 |
| Language: | English |
| Additional information: | Copyright © 2019 The Author(s).Published by Elsevier Ltd on behal fof The British Infection Association.This is an open access article under the CCBY-NC-ND license.(http://creativecommons.org/licenses/by-nc-nd/4.0/) |
| Keywords: | BacteraemiaStaphylococcus aureusMortalityRecurrenceRifampicin |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10079326 |
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