Risk Factors for Recurrent Staphylococcus aureus Bacteremia.

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2021-06

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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.

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Humans, Staphylococcus aureus, Bacteremia, Staphylococcal Infections, Risk Factors, Methicillin Resistance

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https://hdl.handle.net/10161/24330

Published Version (Please cite this version)

10.1093/cid/ciaa801

Publication Info

Choi, Seong-Ho, Michael Dagher, Felicia Ruffin, Lawrence P Park, Batu K Sharma-Kuinkel, Maria Souli, Alison M Morse, Emily M Eichenberger, et al. (2021). Risk Factors for Recurrent Staphylococcus aureus Bacteremia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 72(11). pp. 1891–1899. 10.1093/cid/ciaa801 Retrieved from https://hdl.handle.net/10161/24330.

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Ruffin

Felicia Ruffin

Research Program Leader, Tier 1
Fowler

Vance Garrison Fowler

Florence McAlister Distinguished Professor of Medicine

Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia
Antibacterial Resistance
Pathogenesis of Bacterial Infections
Tropical medicine/International Health

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