Risk stratification and source classification in Staphylococcus aureus bloodstream infections: high mortality linked to mrsa, biomarkers, and treatment efficacy
Abstract
Staphylococcus aureus bloodstream infection (SAB) carries a high mortality rate. This study aims to develop a source-specific classification framework to guide management and improve outcomes.
Methods: We conducted a retrospective study of 321 S. aureus bloodstream infection patients (2012-2025), using ROC analysis, survival curves, and SPSS to evaluate 12-month in-hospital mortality and its predictors.
Results: Among 3,516 bloodstream infections, 321 episodes of S. aureus bacteremia (SAB) were identified (9.12%). The median time to positivity was 14 hours. The most common infection sources were the lungs (26.8%), catheter-related infections (24.3%), and skin/soft tissue infections (23.4%). Hemodialysis was the predominant comorbidity (21.2%). Biomarker analysis showed high diagnostic accuracy for PCT (AUC 0.957), WBC (AUC 1.000), and neutrophil percentage (AUC 0.913). MRSA accounted for 38% of isolates. Both MRSA and MSSA exhibited >50% resistance to penicillin, erythromycin, and clindamycin, but none to linezolid, vancomycin, or tigecycline. Overall, in-hospital mortality was 30.2%, significantly higher in MRSA (38%) than in MSSA (26%) (p=0.048). Notably, 36.1% of deaths occurred within 24 hours, and 58.7% within 7 days. The 10-day survival rate was lower in MRSA (0.609 vs. 0.759, p=0.029). Healthcare-associated infections (58%) showed no significant association with MRSA prevalence after Bonferroni correction. Independent mortality predictors included qSOFA score ≥2 (OR…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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