NEW research suggests that persistent fever beyond 72 hours in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is strongly associated with increased mortality, reinforcing its role as a key risk stratification criterion.
This study conducted a secondary analysis of the CAMERA2 trial, which enrolled hospitalised adults with MRSA bacteraemia and prospectively collected daily data on body temperature, white blood cell (WBC) count, and C-reactive protein (CRP) levels. Researchers assessed the prognostic relevance of each parameter by calculating crude and adjusted odds ratios for 90-day all-cause mortality, comparing patients with abnormal values to those with normal parameters on each day of illness.
Among 345 patients included in the analysis, 63 (18.3%) died within 90 days. Fever (≥38.0°C) from day 4 onwards was associated with significantly increased odds of mortality, with risk rising further as fever persisted. On day 4, the adjusted odds ratio for mortality was 3.70 (95% CI: 1.58–8.67), increasing to 8.78 (95% CI: 2.78–27.7) by day 7. In contrast, WBC and CRP levels showed no consistent or temporal association with mortality, limiting their utility for risk stratification in this cohort.
These findings support existing recommendations that persistent fever should remain a key criterion for classifying MRSA bacteraemia cases as high-risk or complicated, while WBC and CRP may have limited additional predictive value in clinical decision-making.
Ada Enesco, EMJ
Reference
Ong SWX et al; Combination Antibiotics for MEthicillin Resistant Staphylococcus aureus (CAMERA2) Study Group. Association of daily body temperature, white blood cell count, and c-reactive protein with mortality and persistent bacteremia in patients with Staphylococcus aureus bacteremia: a post hoc analysis of the CAMERA2 randomized clinical trial. Open Forum Infect Dis. 2025;12(2):ofaf063.
