Staphylococcus aureus bacteraemia mortality: a systematic review and meta-analysis. (August 2022)

• Record Type: Journal Article
• Authors: Bai, Anthony D.; Lo, Carson K.L.; Komorowski, Adam S.; Suresh, Mallika; Guo, Kevin; Garg, Akhil; Tandon, Pranav; Senecal, Julien; Del Corpo, Olivier; Stefanova, Isabella; Fogarty, Clare; Butler-Laporte, Guillaume; McDonald, Emily G.; Cheng, Matthew P.; Morris, Andrew M.; Loeb, Mark; Lee, Todd C.
• Is Part Of: Clinical microbiology and infection. Volume 28:Number 8(2022)
• Page Start: 1076
• Page End: 1084
• Publication Date: 2022-08
• Subjects: Staphylococcus aureus -- Bacteraemia -- Mortality -- Meta-analysis; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2022.03.015
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: 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–Ottawa 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.