Staphylococcus aureus Bacteremia in Community-Dwelling Older Adults

Background Staphylococcus aureus bacteremia (SAB) is associated with a significant morbidity and mortality. The aim of this study is to assess the impact of the degree of hyperglycemia on inhospital mortality and discharge destination in community-dwelling older adults with SAB. Methods A retrospective cohort study of 100 community-dwelling older adults with SAB was carried out at 2 hospitals. A stepwise logistic regression analysis was performed for both inhospital mortality and discharge destination. Results During the follow-up period from admission till discharge, 23 (23%) patients died. Ten (14.3%) of 70 patients with 7 days post-SAB mean blood glucose less than 170 mg/dL died while 13 (43.3%) of 30 patients with 7 days post-SAB mean blood glucose of 170 mg/dL or greater died (P = 0.004). Multivariate analysis identified 3 independent determinants of death; Simplified Acute Physiology Score (SAPS) score at onset of SAB greater than 45 (odds ratio [OR], 9.4; 95% confidence interval [95% CI], 2.4–37.3; P = 0.002), 7 days post-SAB mean blood glucose of 170 mg/dL or greater (OR, 6.7; 95% CI, 1.8–24.5; P = 0.004), and altered mental status at the onset of SAB (OR, 3.9; 95% CI, 1.1–14.3; P = 0.04). Thirty (39%) of the survived patients were discharged to long-term care facility or inpatient rehabilitation unit. Older adults with blood glucose level of 170 mg/dL or greater in the first 7 days post-SAB (OR, 4.1; P = 0.02) and hospital stay longer than 10 days (OR, 5.2; P = 0.01) were more likely to be discharged to a long-term care facility or inpatient rehabilitation unit. Conclusions Hyperglycemia is associated with increased inhospital mortality and discharge to destination other than home in older adults with SAB.