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

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dc.contributor.author Forsblom, E.
dc.contributor.author Nurmi, A.-M.
dc.contributor.author Ruotsalainen, E.
dc.contributor.author Järvinen, A.
dc.date.accessioned 2016-04-04T13:50:01Z
dc.date.available 2016-04-04T13:50:01Z
dc.date.issued 2016-03
dc.identifier.citation 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
dc.identifier.other PURE: 61463558
dc.identifier.other PURE UUID: ebcb3313-28f5-4c55-9086-43a8cc334bd7
dc.identifier.other WOS: 000371434200018
dc.identifier.other Scopus: 84959487498
dc.identifier.uri http://hdl.handle.net/10138/161084
dc.description.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. en
dc.format.extent 9
dc.language.iso eng
dc.relation.ispartof European Journal of Clinical Microbiology & Infectious Diseases
dc.rights.uri info:eu-repo/semantics/openAccess
dc.subject CHRONIC SUBDURAL-HEMATOMA
dc.subject SEPTIC SHOCK
dc.subject SEVERE SEPSIS
dc.subject CLINICAL-TRIAL
dc.subject MORTALITY
dc.subject METAANALYSIS
dc.subject HYDROCORTISONE
dc.subject VANCOMYCIN
dc.subject REVERSAL
dc.subject COHORT
dc.subject 3121 General medicine, internal medicine and other clinical medicine
dc.title Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia? en
dc.type Article
dc.contributor.organization Clinicum
dc.contributor.organization Infektiosairauksien yksikkö
dc.contributor.organization Department of Medicine
dc.description.reviewstatus Peer reviewed
dc.relation.doi https://doi.org/10.1007/s10096-015-2563-y
dc.relation.issn 0934-9723
dc.rights.accesslevel openAccess
dc.type.version publishedVersion

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