2234. Clinical Significance of Staphylococcus aureus Bacteriuria without Bacteremia

Abstract

Abstract Background Staphylococcus aureus urinary tract infection (UTI) is uncommon. Staphylococcus aureus bacteriuria (SABU) can occur in patients with urinary tract instrumentation, urinary calculi, or S. aureus bacteremia (SAB) and is associated with development of invasive diseases and death. Thus, SABU is often treated with a prolonged course of antimicrobial therapy similar to SAB. However, little is known about the significance of SABU in patients without SAB and recent urinary tract instrumentation. Methods We conducted a retrospective study of patients with SABU in the Veterans Affairs (VA) system nation-wide from 2017 to 2019. Patients with concomitant SAB, recent history of urinary tract instrumentation, or overt urologic abnormalities were excluded. The primary outcome was development of invasive S. aureus infections or death within 12 months. The secondary outcome was recurrent SABU within 12 months. Results 133 patients met the inclusion criteria. 102 patients (76%) received antimicrobial treatment for SABU. The duration of treatment ranged from 3-30 (mean = 8.5) days. Compared with the non-treated group, patients treated with antimicrobials had significantly more urinary tract symptoms (p = 0.0001), microscopic pyuria (p = 0.002), and hematuria (p = 0.035). Of those treated, 11 (7.3%) died within 12 months of SABU compared to 4 patients (13%) who did not receive treatment (p = 0.749). Three percent of patients from both groups (n = 3 vs 1) developed invasive S. aureus infections within 12 months (p = 1.00). 16% of patients in the treatment group (n = 17) and non-treatment group (n = 5) were found to have recurrent SABU within 12 months (p = 1.00). Conclusion Patients without recent urinary tract instrumentation, overt urologic abnormalities, and SAB who were treated for SABU did not have significant differences in death, invasive diseases, or recurrent SABU at 12 months compared to those who did not receive treatment. Untreated patients did not appear to have frequent complications; however, our numbers were small and our analysis did not take confounding into account. Further analysis into SABU treatment may be warranted. Disclosures All Authors: No reported disclosures.