1254. Blood Glucose Level Predicts 30-Day Mortality in Staphylococcus aureus Bacteremia
Session: Poster Abstract Session: Staphylococcal Resistance and Epidemiology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Few studies have addressed the influence of glucose control on outcomes after S. aureus bacteremia (SAB).  We evaluated the association between blood glucose on the day of positive culture and 30 day mortality of SAB in a large cohort.

Methods: A retrospective single center cohort study was approved by the Institutional Review Board.  For all cases of SAB between 1/1/2000 and 12/31/2008, the first episode was documented, and the following data was collected from the electronic medical record (EMR): age, gender, methicillin susceptibility, duration of bacteremia (defined as time from first positive to last positive culture), and the maximum recorded blood glucose level on the day of first positive culture (D0G).  Hypoglycemia, euglycemia, and hyperglycemia were defined as a D0G <65, 65-135, and >135 mg/dL.  30 day all cause mortality was determined from EMR and social security death index.  Cox proportional hazard modeling and Kaplan meier statistics were used for time to event analyses (JMP 9.0, SAS, NC).

Results:  In the study period, 2959 SAB cases were identified. For 2579 (87%) cases, D0G data was available. 1408 (55%) of these had MRSA, and 58% were male. The median age was 63 years (range 0-104).  Median D0G was 127 mg/dL (range 10-1185).  On the day of first positive blood culture, 57 (2%), 1362 (53%), and 1160 (45%) were hypoglycemic, euglycemic, and hyperglycemic, respectively.  Overall 30-day mortality was 22%.  Hypoglycemia (32% vs. 18%, p<0.01 log-rank) and hyperglycemia (26% vs. 18%, p<0.0001 log-rank) were both associated with increased 30 day mortality when compared to euglycemia.  In the 326 patients who were aged 80 years or older, hyperglycemia was not associated with 30 day mortality (41% vs. 39%, p=0.66 log rank).  In Cox proportional hazard analysis, hyperglycemia (RR 1.35, 95% CI 1.15-1.61), hypoglycemia (RR 1.73, 95% CI 1.03-2.71), age (RR 1.03 per year), and duration of bacteremia (RR 0.95, 95% CI 0.92-0.97) were associated with 30-day mortality.

Conclusion: Blood glucose level on the day of first positive blood culture is a prognostic indicator for patients with SAB.  Of note, hyperglycemia is not associated with mortality in patients 80 years old or older.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

David van Duin, MD, PhD1, Anil Jain, MD2, Susan Rehm, MD2 and Nabin Shrestha, MD2, (1)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH, (2)Cleveland Clinic Foundation, Cleveland, OH

Disclosures:

D. van Duin, Pfizer: Scientific Advisor, Consulting fee
Astellas: Speaker's Bureau, Speaker honorarium

A. Jain, None

S. Rehm, Cubist: Grant Investigator, Grant recipient
pfizer: Scientific Advisor, Consulting fee
merck: Scientific Advisor, Consulting fee
sanofi pasteur: Speaker's Bureau, Speaker honorarium
genetech: Speaker's Bureau, Speaker honorarium

N. Shrestha, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.