1056. Predicting central nervous system complications in Staphylococcus aureus bacteremia using clinical scoring system
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • 김충종_포스터_CNS_181002.pdf (793.3 kB)
  • Background: Central nervous system (CNS) complications occurring in patients with Staphylococcus aureus bacteremia (SAB) are the most severe complications. In this study, we compared clinical data of SAB patients between cases with and without CNS complication, and analyzed the risk factor of CNS complications.

    Methods: Data from cases with SAB occurred during 5 years at 4 hospitals were collected. Presence of CNS complications were confirmed by brain MRI, CT or lumbar puncture. We excluded the cases who already had CNS lesions such as trauma, brain tumor, or cerebrovascular accident. We also excluded the cases who were died or transfer out <7 days of bacteremia onset. Cases were divided into complication group or non-complication group according to presence of CNS complication. We compared the clinical profiles between the groups, and analyzed the risk factor of CNS complications by multivariate logistic regression analysis.

    Results: A total of 1085 cases of SAB patients were included. Among these, 43 (4%) cases were complication group (embolic infarct (n=23), brain hemorrhage (n=8), infarct with hemorrhage (n=8), and brain abscess or meningitis (n=4)), while 810 (74%) cases were non-complication group. Two hundred and forty-one cases were excluded. The results of multivariate analysis were shown in table. When selecting by having less than 3 factors among SOFA > 5, methicillin susceptible, endovascular infection (weight 2), presence of metastatic infection and community onset, it helps to exclude CNS complications (AUC of ROC curve=0.77, p<0.01, sensitivity; 67.5%, specificity: 75.5%, positive predictive value: 12.9%, negative predictive value 97.7%).

    Conclusion: CNS complication could be excluded by using clinical variables.


    Variables

    Complication

    group

    (n=43)

    Non-complication

     group

    (n=801)

    p-value

    Adjusted odds ratio

    P-value

    Sex (m)

    23 (54%)

    499 (62%)

    0.25

    1.4 (0.8-2.8)

    0.28

    Age (mean)

    66 (¡¾17)

    64 (¡¾16)

    0.38

    Community onset

    30 (70%)

    450 (56%)

    0.08

    1.3 (0.7-2.7)

    0.44

    Methicillin susceptible isolates

    27 (63%)

    380 (47%)

    0.05

    1.9 (0.9-3.9)

    0.07

    SOFA score (median)

    6 (3-9)

    3.5 (1-6)

    0.01

    1.1 (1.1-1.2)

    0.01

    Duration of bacteremia (median)

    4 (1-6)

    2 (0-5)

    0.01

    Endovascular involvement of infection

    18 (42%)

    106 (13%)

    <0.01

    3.1 (1.5-6.3)

    0.01

    Presence of any metastatic infection

    20 (47%)

    155 (19%)

    <0.01

    2.3 (1.2-4.7)

    0.02

    90 day-mortality

    11 (34%)

    121 (19%)

    0.03

    Chung-Jong Kim, MD, PhD1, Kyoung-Ho Song, M.D., Ph.D.2, Chang Kyung Kang, MD3, Pyeong Gyun Choe, M.D.4, Ji Yun Bae, MD5, Hee Jung Choi, MD6, Younghee Jung, MD7, Seung Soon Lee, MD8, Wan Beom Park, M.D., Ph.D4, Ji Hwan Bang, M.D.4, Eu Suk Kim, PhD9, Sang Won Park, M.D., Ph.D.4, Nam Joong Kim, M.D., Ph.D.4, Myoung-Don Oh, M.D., Ph.D.4, Hong Bin Kim, M.D., Ph.D.2 and KIND study group, (1)Internal Medicine, Ewha Womans University, Seoul, Korea, Republic of (South), (2)Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea, Republic of (South), (3)Seoul National University College of Medicine, Seoul, Korea, Republic of (South), (4)Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of (South), (5)Department of Internal Medicine, Ewha Womans University mokdong hospital, Seoul, Korea, Republic of (South), (6)Internal Medicine, Ewha Womans University, Mokdong Hospital Dept of Internal Medicine, Seoul, Korea, Republic of (South), (7)Division of Infectious Diseases, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Korea, Republic of (South), (8)Division of Infectious Diseases, Hallym University Sacred Hospital, Hallym University College of Medicine, Anyang-si, Korea, Republic of (South), (9)Seoul National University Bundang Hospital, Seoul, Korea, Republic of (South)

    Disclosures:

    C. J. Kim, None

    K. H. Song, None

    C. K. Kang, None

    P. G. Choe, None

    J. Y. Bae, None

    H. J. Choi, None

    Y. Jung, None

    S. S. Lee, None

    W. B. Park, None

    J. H. Bang, None

    E. S. Kim, None

    S. W. Park, None

    N. J. Kim, None

    M. D. Oh, None

    H. B. Kim, None

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