Fatality of Staphylococcus aureus infections in a Greek university hospital: role of inappropriate empiric treatment, methicillin resistance, and toxin genes’ presence

  • Ioanna Katsarou
  • Nefeli-Marina Paraskevopoulou
  • Matthaios Papadimitriou-Olivgeris
  • Nikolaos Giormezis
  • Maria Militsopoulou
  • Fevronia Kolonitsiou
  • Markos Marangos
  • Evangelos D. Anastassiou
  • Iris SpiliopoulouEmail author
Original Article


The aim of the present study was to identify predictors of fatality among patients with S. aureus infections requiring hospitalization. Cases hospitalized with S. aureus infections at the University General Hospital of Patras, Greece, during a 4-year period (2013–2016) were studied. mecA, lukS/lukF-PV (Panton-Valentine leukocidin, PVL), tst (toxic shock syndrome toxin), fnbA (fibronectin-binding protein A), eta, and etb (epidermolytic toxins) genes’ carriage was detected by PCR in 149 selected patients. Among 464 patients, 346 were included (118 with missing data). Primary bacteremia predominated (44.2%), followed by lower respiratory tract infections (13.6%), deep seated infections (9.8%), osteoarticular (9.5%), and catheter-related bloodstream infections (6.1%). Methicillin-resistant S. aureus (MRSA) represented 33.8% of infections and were less likely to receive appropriate empiric treatment (79.5% versus 97.4%; P < 0.001). Thirty-day fatality was 14.5%. Multivariate analysis revealed that development of septic shock, Charlson Comorbidity Index, lower respiratory tract infection, bacteremia (primary or secondary), MRSA, and CRP was significantly associated with fatality. Appropriate empiric treatment was a predictor of good prognosis. Thirty-two out of 149 S. aureus (21.5%) carried lukS/lukF-PV genes, whereas, 14 (9.4%), 133 (78.7%), four (2.7%), and one (0.7%) carried tst, fnbA, eta, and etb genes, respectively. No difference was found among toxin genes’ presence and mortality. PVL was significantly more frequently found among MRSA as compared to MSSA (45.1% versus 9.2%; P < 0.001). MRSA represented one third of the infections requiring hospitalization and were independently associated with fatality, probably since were more likely to receive inappropriate antibiotic treatment as compared to MSSA.


Staphylococcus aureus MRSA Bacteremia Pneumonia PVL Toxic shock syndrome toxin (TSST-1) Fatality 


Funding information

This work received no specific grant from any funding agency and was supported by internal funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Ethics Committee of the University General Hospital of Patras and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Ioanna Katsarou
    • 1
  • Nefeli-Marina Paraskevopoulou
    • 1
  • Matthaios Papadimitriou-Olivgeris
    • 2
    • 3
  • Nikolaos Giormezis
    • 4
  • Maria Militsopoulou
    • 1
  • Fevronia Kolonitsiou
    • 1
  • Markos Marangos
    • 2
  • Evangelos D. Anastassiou
    • 1
  • Iris Spiliopoulou
    • 1
    • 4
    Email author
  1. 1.Department of Microbiology, School of MedicineUniversity of PatrasPatrasGreece
  2. 2.Division of Infectious Diseases, School of MedicineUniversity of PatrasPatrasGreece
  3. 3.Department of Infectious DiseasesUniversity Hospital of LausanneLausanneSwitzerland
  4. 4.National Reference Laboratory for Staphylococci, School of MedicineUniversity of PatrasPatrasGreece

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