Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?

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Forsblom , E , Nurmi , A-M , Ruotsalainen , E & Järvinen , A 2016 , ' Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia? ' , European Journal of Clinical Microbiology & Infectious Diseases , vol. 35 , no. 3 , pp. 471-479 . https://doi.org/10.1007/s10096-015-2563-y

Title: Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia?
Author: Forsblom, E.; Nurmi, A.-M.; Ruotsalainen, E.; Järvinen, A.
Contributor: University of Helsinki, Clinicum
University of Helsinki, Infektiosairauksien yksikkö
University of Helsinki, Department of Medicine
Date: 2016-03
Language: eng
Number of pages: 9
Belongs to series: European Journal of Clinical Microbiology & Infectious Diseases
ISSN: 0934-9723
URI: http://hdl.handle.net/10138/161084
Abstract: The purpose of this study was to examine the prognostic impact of corticosteroids in hemodynamically stabile Staphylococcus aureus bacteremia (SAB). There were 361 hemodynamically stabile methicillin-sensitive SAB patients with prospective follow-up and grouping according to time-point, dose and indication for corticosteroid therapy. To enable analyses without external interfering corticosteroid therapy all patients with corticosteroid therapy equivalent to prednisone > 10 mg/day for >= 1 month prior to positive blood culture results were excluded. Twenty-five percent (92) of patients received corticosteroid therapy of which 11 % (40) had therapy initiated within 1 week (early initiation) and 9 % (31) had therapy initiated 2-4 weeks after (delayed initiation) positive blood culture. Twenty-one patients (6 %) had corticosteroid initiated after 4 weeks and were not included in the analyses. A total of 55 % (51/92) received a weekly prednisone dose > 100 mg. Patients with early initiated corticosteroid therapy had higher mortality compared to patients treated without corticosteroid therapy at 28 days (20 % vs. 7 %) (OR, 3.11; 95% CI, 1.27-7.65; p <0.05) and at 90 days (30 % vs. 10 %) (OR, 4.01; 95% CI, 1.82-8.81; p <0.001). Considering all prognostic markers, early initiated corticosteroid therapy predicted 28-day (HR, 3.75; 95% CI, 1.60-8.79; p = 0.002) and 90-day (HR, 3.10; 95% CI, 1.50-6.39; p = 0.002) mortality in Cox proportional hazards regression analysis. When including only patients receiving early initiated corticosteroid therapy with prednisone >= 100 mg/week the negative prognostic impact on 28-day mortality was accentuated (HR 4.8, p = 0.001). Corticosteroid therapy initiation after 1 week of positive blood cultures had no independent prognostic impact. Early initiation of corticosteroid therapy may be associate to increased mortality in hemodynamically stabile SAB.
Subject: CHRONIC SUBDURAL-HEMATOMA
SEPTIC SHOCK
SEVERE SEPSIS
CLINICAL-TRIAL
MORTALITY
METAANALYSIS
HYDROCORTISONE
VANCOMYCIN
REVERSAL
COHORT
3121 General medicine, internal medicine and other clinical medicine
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