Table 3.
Bivariate Comparison of Baseline Demographics and Clinical Criteria Between Patients With 30-Day Mortality and Patients With No 30-Day Mortality
| Criteria | 30-Day Mortality (n = 101) | No 30-Day Mortality (n = 712) | P Value |
|---|---|---|---|
| Demographics | |||
| Age, y | 71 (62–80) | 59 (46–68) | .006 |
| Age ≥65 y | 71 (70.3) | 224 (31.5) | <.001 |
| Race | .365 | ||
| African American | 78 (78.0) | 535 (75.7) | .610 |
| Caucasian | 19 (19.0) | 137 (19.4) | .929 |
| Others | 4 (3.9) | 40 (5.6) | |
| BMI ≥30 | 30 (30.0) | 243 (34.2) | .408 |
| Comorbid conditions | |||
| AKI | 41 (40.6) | 175 (24.6) | .001 |
| Cerebrovascular diseasea | 18 (17.8) | 107 (15.0) | .466 |
| Chronic pulmonary diseaseb | 36 (35.6) | 176 (24.7) | .019 |
| Chronic kidney disease | |||
| Moderate to severe chronic kidney disease or on chronic dialysis | 44 (43.6) | 218 (30.6) | .009 |
| Chronic dialysisc | 18 (17.8) | 170 (23.9) | .177 |
| Connective tissue diseased | 14 (13.9) | 61 (8.6) | .085 |
| Dementia | 18 (17.8) | 55 (7.7) | .001 |
| Diabetes disease, any | 35 (34.7) | 291 (40.9) | .233 |
| Without end organ damage | 5 (5.0) | 82 (11.5) | .046 |
| With end organ damage | 30 (29.7) | 210 (29.5) | .966 |
| Heart failure | 35 (34.7) | 151 (21.2) | .003 |
| Hemiplegia | 3 (3.0) | 13 (1.8) | .438 |
| Immunodeficiency, any | 9 (8.9) | 37 (5.2) | .131 |
| AIDS (CD4 <200) | 2 (2.0) | 16 (2.2) | .864 |
| HIV | 2 (2.0) | 31 (4.4) | .258 |
| Leukemia | 0 (0) | 2 (0.3) | .594 |
| Lymphoma | 2 (2.0) | 7 (1.0) | .370 |
| Tumor, any | 13 (12.9) | 28 (3.9) | <.001 |
| Without metastasis | 4 (4.0) | 10 (1.4) | .065 |
| With metastasis | 9 (8.9) | 18 (2.5) | .001 |
| Liver disease, any | 10 (9.9) | 84 (11.8) | .577 |
| Milde | 7 (6.9) | 67 (9.4) | .418 |
| Moderate or severef | 3 (3.0) | 17 (2.4) | .724 |
| Myocardial infarction | 16 (15.8) | 46 (6.5) | .001 |
| No conditions | 3 (3.0) | 51 (7.2) | .113 |
| Peptic ulcer disease | 2 (2.0) | 5 (0.7) | .193 |
| Peripheral vascular diseaseg | 19 (18.8) | 116 (16.3) | .524 |
| Prior hospitalization for 48 h in 90 d before index culture | 43 (42.6) | 238 (33.4) | .070 |
| Prior MRSA in 365 d preceding index culture | 9 (8.9) | 76 (10.7) | .588 |
| Prior MSSA in 365 d preceding index culture | 0 (0) | 5 (0.7) | .398 |
| Prior surgery in 30 d preceding index culture | 3 (3.0) | 29 (4.1) | .594 |
| PWID | 4 (4.0) | 107 (15.0) | .002 |
| Sources of bacteremiah | |||
| Bone and joint | 1 (1.0) | 115 (16.2) | <.001 |
| Endovascular | 1 (1.0) | 3 (0.4) | .445 |
| Central nervous system abscess | 0 (0.0) | 8 (1.1) | .284 |
| Infective endocarditis | 11 (10.9) | 94 (13.2) | .517 |
| Intraabdominal | 1 (1.0) | 12 (1.7) | .602 |
| Intravenous catheter | 9 (8.9) | 125 (17.6) | .028 |
| Invasive prosthetic device | 3 (3.0) | 25 (3.5) | .780 |
| Other | 6 (5.9) | 75 (10.5) | .149 |
| Pneumonia | 41 (40.6) | 128 (18.0) | <.001 |
| Skin and soft tissue | 12 (11.9) | 189 (26.5) | <.001 |
| Urinary | 5 (5.0) | 21 (2.9) | .285 |
| Unknown | 15 (14.9) | 52 (7.3) | .010 |
| Vertebral abscess | 1 (1.0) | 8 (1.1) | .904 |
| Others factors | |||
| APACHE II | 24 (18–31) | 16 (10–22) | <.001 |
| APACHE ≥30 | 33 (33.0) | 58 (8.2) | <.001 |
| CCI | 4 (2–6) | 3 (1–5) | <.001 |
| CCI ≥5 | 47 (46.5) | 179 (25.1) | <.001 |
| Intensive care settingi | 32 (32.3) | 111 (15.7) | <.001 |
| Infectious Diseases consult | 87 (86.1) | 667 (93.7) | .006 |
| Source controlj | 19 (19.6) | 306 (44.7) | <.001 |
| Automated VAN MIC testing performed | 98 (97.0) | 689 (96.8) | .889 |
| 0.5 | 8 (8.2) | 39 (5.7) | .328 |
| 1 | 62 (63.3) | 481 (69.8) | .190 |
| 2 | 28 (28.6) | 169 (24.5) | .387 |
| VAN Etest performed | 49 (48.5) | 388 (54.5) | .613 |
| 1 | 86 (22.2) | 13 (26.5) | .492 |
| 2 | 36 (73.5) | 302 (77.8) | .492 |
| AKIk | 21 (25.3) | 31 (5.7) | <.001 |
| VAN TDM by AUCl | 14 (17.7) | 202 (39.6) | <.001 |
| VAN AUC | 517.5 (358.5–555.4) | 463.0 (380.0–543.4) | .642 |
| On at least 1 nephrotoxic agentm | 18 (21.7) | 77 (14.2) | .077 |
| On VAN | 18 (21.7) | 70 (12.9) | .032 |
| Not on VAN | 5 (6.0) | 45 (8.3) | .476 |
| Other safety outcome | |||
| CPK increasen | 1 (1.0) | 9 (1.3) | .815 |
| Clostridium difficile | 7 (6.9) | 18 (2.5) | .016 |
Data are presented as median (IQR) and/or No. (%).
Abbreviations: AKI, acute kidney injury; APACHE II, Acute Physiology and Chronic Health Evaluation; BMI, body mass index; CCI, Carlson comorbidity index; CD4, cluster of differentiation 4; COPD, chronic obstructive pulmonary disease; CPK, creatinine phosphokinase; DVT, deep venous thrombosis; IQR, interquartile range; MRSA, methicillin-resistant Staphylococcus aureus; MSSA, methicillin-sensitive Staphylococcus aureus; OA, osteoarthritis; PWID, person who injects drugs; Scr, serum creatinine; TDM, therapeutic drug monitoring; TIA, transient ischemic attack; VAN, vancomycin.
aStroke or TIA.
bAsthma or COPD.
cHemodialysis or peritoneal dialysis.
dOA or rheumatic arthritis.
eChronic hepatitis without cirrhosis.
fPortal hypertension or cirrhosis.
gDVT, chronic venous disease.
hSome patients may have had more than 1 source of infection.
iWhen obtaining index culture.
jIn 30-day mortality, intravenous catheter removal (n = 3), incision and drainage (n = 1), debridement (n = 2). In patients with no 30-day mortality, intravenous catheter removal (n = 45), valvular replacement (n = 4), cardiac device removal (n = 7), incision and drainage (n = 36), debridement (n = 21), amputation (n = 3), other (n = 16).
kAmong patients who did not have hemodialysis or peritoneal dialysis (30-day mortality, n = 83, and no 30-day mortality, n = 542). AKI was defined as an increase in serum creatinine (Scr) of ≥0.5 mg/dL or a ≥50% increase of Scr from baseline, whichever is greater, on 2 consecutive measurements from initial VAN dose until 72 hours after the last dose [13, 35].
lAmong the entire population of patients managed with vancomycin for ≥48 hours (30-day mortality, n = 79, and no 30-day mortality, n = 510).
mMost common nephrotoxic agents among patients who were on VAN and in 30-day mortality group were diuretics (n = 11), followed by piperacillin-tazobactam and contrast media (n = 5, each). Among patients who were on VAN and were not in 30-day mortality group, most common were diuretics (n = 25), followed by piperacillin-tazobactam and contrast media (n = 5, each). Among patients who are not on VAN and experienced 30-day mortality group, most common were diuretics, non-steroidal anti-inflammatory drugs, and diuretics (n = 2, each). While among patients who are not on VAN and did not experience 30-day mortality, most were nephrotoxic agents are diuretics (n = 11), followed by angiotensin II converting enzyme inhibitor or angiotensin receptor blocker (n = 3).
nIncreased CPK was defined as increase of CPK to >600 U/L (if baseline <200 U/L) or >1000 U/L (if baseline >200 U/L) from initiation of drug to 72 hours after discontinuation of drug.