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Coagulase-Negative Staphylococcal Bacteremia: Mortality and Hospital Stay

Michael A. Martin, MD; Michael A. Pfaller, MD; and Richard P. Wenzel, MD, MSc
[+] Article, Author, and Disclosure Information

Grant Support: Dr. Martin was supported in part by a National Foundation for Infectious Diseases Fellowship in Nosocomial Infection Research.

Requests for Reprints: Richard P. Wenzel, MD, MSc, Division of Clinical Epidemiology, Department of Medicine, University of Iowa College of Medicine, Iowa City, Iowa 52242.

Current Author Addresses: Dr. Martin: University of Maryland Hospital, Box 243, 22 South Greene Street, Baltimore, MD 21201.

Dr. Wenzel: University of Iowa Hospitals and Clinics, C 41-S GH, Iowa City, IA 52242.

Dr. Pfaller: University of Iowa Hospitals and Clinics, 273 Medical Research Center, Iowa City, IA 52242.

© 1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;110(1):9-16. doi:10.7326/0003-4819-110-1-9
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Objective: To determine the attributable mortality and the excess length of hospital stay resulting from coagulase-negative staphylococcal bacteremia.

Design: Matched historical cohort study.

Setting: Large university-based tertiary care center.

Patients: Of 171 patients with hospital-acquired coagulase-negative staphylococcal bacteremia identified by prospective surveillance of nosocomial infections from 1 July 1984 to 30 June 1987, 118 met criteria for the study and were matched to a control patient by age, sex, primary diagnose, operative procedures, and date of admission.

Measurements and Results: Success was achieved in 621 of 650 (96%) variables used for matching. Staphylococcus epidermidis accounted for 92% of the bacteremias. Twenty cases (17%) had evidence of septic shock, and 10 had disseminated intravascular coagulation. The mortality rate in cases was 36 of 118 (30.5%) compared with 20 of 118 (16.9%) in controls. The attributable mortality was 13.6% (95% CI, 4.2 to 22.9) and the risk ratio for dying was 1.8 (95% CI, 1.2 to 2.7; P = 0.006). The median length of stay was 46 days for cases and 37.5 for controls (P = 0.0002).

Conclusions: Coagulase-negative staphylococci, the leading organisms causing hospital-acquired bacteremias, are associated with mortality in excess of that due to the underlying diseases alone. Moreover, they significantly prolong the length of hospital stay. These findings show the importance of coagulase-negative staphylococcal bacteremia in hospitalized patients.





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