Associated factors and a prognostic model for 28-day mortality in Staphylococcus aureus bloodstream infection: A retrospective cohort study.

Authors

Zhanpeng Yu, Zeyun Lin, Xiaoyan Tian, Zhenle Zhang, Chuyue Zhou, Yuntao He, Huiyan Wu, Yanling Zhang, Liang Peng

Published in

Medicine. Volume 105. Issue 41. Pages e50969. Oct 09, 2026.

Abstract

This study aimed to identify factors associated with Staphylococcus aureus bloodstream infection (S aureus BSI), compare 28-day survival after propensity score matching (PSM), and develop a prognostic model for 28-day mortality. Adult intensive care unit patients with culture-confirmed BSI were identified in Medical Information Mart for Intensive Care IV. Factors associated with S aureus BSI were assessed in the full cohort by univariable logistic regression. Patients with S aureus and non-S aureus BSI were matched 1:1 using nearest-neighbor PSM without a caliper. Survival was examined using Kaplan-Meier analysis and Cox models with matched-pair cluster-robust standard errors. Among patients with S aureus BSI, prognostic variables were screened by clinical domain and best-subset selection using minimum Bayesian Information Criterion; 10-fold cross-validated least absolute shrinkage and selection operator regression served as a sensitivity analysis. Model performance was assessed by bootstrap internal validation and refitting in an external cohort. The cohort included 2221 patients, including 297 with S aureus BSI. Shorter time from admission to confirmed BSI, absence of tumor, shorter invasive ventilation and vascular catheterization, and fewer antibiotic types before BSI were associated with S aureus BSI. After 1:1 PSM, 28-day mortality was 26.9% versus 24.2%, with no significant survival difference (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = .539). The prognostic model included age, maximum red cell distribution width, minimum white blood cell count, minimum activated partial thromboplastin time, and maximum albumin. The apparent C-statistic was 0.816 (95% confidence interval 0.757-0.870), and the optimism-corrected C-statistic was 0.804 (95% confidence interval 0.752-0.861). After refitting in 32 external-cohort patients, the same 5 predictors yielded an apparent C-statistic of 0.778 (95% confidence interval 0.591-0.929). S aureus BSI was associated with a distinct prediagnosis profile, but pathogen group was not associated with 28-day survival after matching. The 5-variable model showed good optimism-corrected discrimination. The original prediction equation requires validation in larger external cohorts.

PMID:
42854039
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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