Epidemiologie, Verlauf und Prognose der Staphylococcus-aureus-Bakteriämie - Erste Ergebnisse der INSTINCT-Kohorte

Zusammenfassung

Hintergrund und Fragestellung: Staphylococcus aureus gehört zu den häufigsten Erregern einer Sepsis, und die S.-aureus-Bakteriämie (SAB) stellt eine der schwersten sowohl ambulant erworbenen als auch nosokomialen Infektionen dar. Die Epidemiologie und Prognose dieser Infektion ist für Deutschland nicht zuverlässig beschreibbar, da prospektiv erhobene Daten fehlen.

Patienten und Methodik: In einer prospektiven Kohortenstudie (Invasive Staphylococcus aureus Infection Cohor t; INSTINCT) werden über eine Internet-basierte Dokumentation multizentrisch und standardisiert Daten zu SAB erfasst und ausgewertet. Die Daten werden von speziell geschultem Personal erhoben. Sie umfassen Angaben zu Vorerkrankungen, Risikofaktoren, Verlauf, Therapie, Komplikationen und Behandlungsergebnis. Den ersten Ergebnissen liegen Daten aus zwei Zentren zugrunde.

Ergebnisse: Vom 1.1.2006 bis zum 31.10.2007 wurden 263 Patienten mit SAB dokumentiert. In 52 % der Fälle handelte es sich um nosokomial erworbene Infektionen, 28 % waren nicht-nosokomiale, jedoch Gesundheitssystem-assoziierte („healthcare-associated”) Infektionen, und 20 % waren ambulant erworbene Infektionen. Das Durchschnittsalter betrug 61 Jahre, 38 % der Patienten waren weiblich. In 62 % lag eine primäre SAB vor, in 38 % der Fälle konnte eine sekundäre Bakteriämie bei gleichzeitiger S. aureus Organinfektion diagnostiziert werden. Die mittlere Bakteriämiedauer betrug 3,3 Tage. Die mittlere Krankenhausverweildauer betrug 27 Tage. Die 7-Tages-Letalität betrug 8 %, die Gesamtletalität während des Krankenhausaufenthaltes lag bei 22 %.

Folgerung: Die SAB ist auch in Deutschland eine häufige Erkrankung mit ernster Prognose.

Summary

Objective: Staphylococcus aureus is a leading cause of bloodstream infection and S. aureus bacteremia (SAB) is one of the most severe infections acquired in hospital or in the community. The epidemiology and prognosis of this infection in Germany is not fully understood because of the lack of prospective data.

Methods: A prospective, multicenter cohort study (INSTINCT, Invasive Staphylococcus aureus Infection Cohort) was initiated to record and analyse data on patients with SAB through an internet-based documentation. Data are being obtained by specially trained personnel. Clinical variables recorded are comorbidities, risk factors, clinical course, therapy, complications and outcome. Prospectively acquired data from 1 January 2006 to 31 October 2007 are now available from two of the study centers.

Results: During this period 263 patients with SAB were identified. 52 % of patients had hospital-acquired infections, 28 % had non-nosocomial but healthcare-associated infections, and 20 % had community-acquired infections. The mean patient age was 61 years, 38 % of patients were female. 62 % of the patients had primary bloodstream infections, while 38 % had a secondary bacteremia, diagnosed on the basis of an underlying organ infection with S. aureus. The mean duration of bacteremia was 3.3 days. Average duration of hospitalization was 27 days. The seven-day mortality was 8 % and in-hospital mortality 22 %.

Conclusions: SAB is a common infection in Germany with a serious prognosis.

Schlüsselwörter

Staphylococcus aureus - Bakteriämie - Sepsis - Antibiotikatherapie - INSTINCT

Key words

staphylococcus aureus - bloodstream infection - complications - antibiotic treatment - INSTINCT

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