Risk Factors for RecurrentStaphylococcus aureusBacteremia

Abstract

Background To understand the clinical, bacterial, and host characteristics associated with recurrent Staphylococcus aureus bacteremia (R-SAB), patients with R-SAB were compared to contemporaneous patients with a single episode of SAB (S-SAB). Methods All SAB isolates underwent spa genotyping. All isolates from R-SAB patients underwent pulsed-field gel electrophoresis (PFGE). PFGE-indistinguishable pairs from 40 patients underwent whole genome sequencing (WGS). Acute phase plasma from R-SAB and S-SAB patients was matched 1:1 for age, race, sex, and bacterial genotype, and underwent cytokine quantification using 25-analyte multiplex bead array. Results R-SAB occurred in 69 (9.1%) of the 756 study patients. Of the 69 patients, 30 experienced relapse (43.5%) and 39 reinfection (56.5%). Age, race, hemodialysis dependence, presence of foreign body, methicillin-resistant Staphyloccus aureus, and persistent bacteremia were individually associated with likelihood of recurrence. Multivariate risk modeling revealed that black hemodialysis patients were nearly 2 times more likely (odds ratio [OR] = 9.652 [95% confidence interval [CI], 5.402–17.418]) than white hemodialysis patients (OR = 4.53 [95% CI, 1.696–10.879]) to experience R-SAB. WGS confirmed PFGE interpretations in all cases. Median RANTES (regulated on activation, normal T cell expressed and secreted) levels in acute phase plasma from the initial episode of SAB were higher in R-SAB than in matched S-SAB controls (P = .0053, false discovery rate < 0.10). Conclusion This study identified several risk factors for R-SAB. The largest risk for R-SAB is among black hemodialysis patients. Higher RANTES levels in R-SAB compared to matched controls warrants further study.

Staphylococcus aureus bloodstream infection: Secular changes associated with the implementation of a de novo clinical infectious diseases service in a Canadian population

“…Population-based studies conducted in many jurisdictions globally have identified Staphylococcus aureus as the second most common cause of bloodstream infection (BSI) occurring with an annual incidence of approximately 30-40 per 100,000 population and an associated case-fatality rate of 20% (El Atrouni et al, 2009;Huggan et al, 2010;Lam et al, 2019;Laupland et al, 2013;Laupland et al, 2008;Opintan and Newman, 2017). Due in part to a propensity for complications related to metastatic foci, anti-microbial resistance, and risk for relapse, S. aureus BSI is associated with high morbidity and mortality (Choi et al, 2020). To reduce this burden, guidelines and algorithms that involve use of echocardiography, repeat blood cultures, and detailed clinical decision-making including antimicrobial source and route and duration of administration have been developed (Chong et al, 2013;Holland et al, 2018;Liu et al, 2011).…”

Clinical and Microbiological Characteristics of Recurrent Escherichia coli Bacteremia

“…To the best of our knowledge, there are no studies that directly compare the performance of WGS to that of ERIC-PCR, so the quantitative difference in resolution between these two methods is unknown. A study of recurrent Staphylococcus aureus bacteremia showed that the amount of SNP variation by WGS is consistent with the PFGE, and authors concluded that no novel insights were provided by WGS in the study ( 26 ). Although the result may not be applicable to our study because of the difference in the species of bacteria studied, as for repeated bacteremia in a single patient, the result of WGS may be consistent with that of PCR-based typing techniques, which has lower discrimination power compared to WGS.…”

Rapid detection of Staphylococcus aureus and Streptococcus pneumoniae by real-time analysis of volatile metabolites

“…A prompt and accurate identification of the causative pathogens of a bacterial infection is essential for providing patients with adequate treatments to reduce mortality and to prevent antibiotic resistance (1)(2)(3)(4). Bacterial infections caused by the human pathogenic bacteria Staphylococcus aureus and Streptococcus pneumoniae remain highly prevalent (5)(6)(7)(8). Despite the development and availability of antibiotics, mortality remains high, reaching 20 % for S. aureus associated endocarditis and more than one million deaths of children below 5 years of age by S. pneumoniae (5,7).…”

“…Bacterial infections caused by the human pathogenic bacteria Staphylococcus aureus and Streptococcus pneumoniae remain highly prevalent (5)(6)(7)(8). Despite the development and availability of antibiotics, mortality remains high, reaching 20 % for S. aureus associated endocarditis and more than one million deaths of children below 5 years of age by S. pneumoniae (5,7).…”