Risk Factors for Recurrent Staphylococcus aureus Bacteremia.

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Choi, S-H; Dagher, M; Ruffin, F; Park, LP; Sharma-Kuinkel, BK; Souli, M; Morse, AM; Eichenberger, EM; Hale, L; Kohler, C; Warren, B; Hansen, B; Medie, FM; McIntyre, LM; Fowler, VG

Published Date

  • June 1, 2021

Published In

Volume / Issue

  • 72 / 11

Start / End Page

  • 1891 - 1899

PubMed ID

  • 32564065

Pubmed Central ID

  • PMC8315037

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/ciaa801

Language

  • eng

Conference Location

  • United States