Prevalence and risk factors for bacteremia in patients with Staphylococcus aureus bacteriuria: A retrospective cohort study

Franziska Schuler,Neele Froböse,Frieder Schaumburg

doi:10.1016/j.ijid.2020.07.022

Franziska Schuler, Neele Froböse + Show 1 more

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https://doi.org/10.1016/j.ijid.2020.07.022

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Abstract

ObjectivesStaphylococcus aureus bacteriuria (SABU) is rare but can be an indicator of S. aureus bacteremia (SAB). The objective of this study was to assess the proportion of SAB in patients with SABU and identify risk factors in a hospital-based population. MethodsWe used electronic databases to identify eligible patients to be enrolled in a retrospective cohort study. Inclusion criteria were (i) SABU, (ii) ≥18 years of age, and (iii) ≥1 blood culture sampled ±3 months of SABU. Patients with missing values for demographic (e.g., age, sex) or clinical characteristics (e.g., comorbidities) and laboratory analyses were excluded. ResultsIn total, 245 patients attending the University Hospital Münster, Germany, between 1 January 2012 and 31 December 2019 met the inclusion/exclusion criteria. Of the 245 patients with SABU, 66 had a concomitant SAB (26.9%). Elevated C-reactive protein (CRP) levels were associated with SAB. Other parameters (e.g., leukocytes, comorbidities) were not associated with SAB in a multivariate analysis. ConclusionThe frequency of SAB in patients with SABU was high and warrants active screening for bloodstream infections in hospitalized patients, particularly if CRP levels are elevated.

Highlights

IntroductionStaphylococcus aureus bacteriuria (SABU) is rare (0.8–4.3%) and can be associated with asymptomatic colonization, primary catheter-associated urinary tract infection and hematogenous seeding in patients with S. aureus bacteremia (SAB) (Al Mohajer et al, 2013; Kramer et al, 2020; Lee et al, 1978).The rates of SAB in patients with SABU vary from 9% to 17.2% (Al Mohajer et al, 2013; Arpi and Renneberg, 1984; Demuth et al, 1979; Saidel-Odes et al, 2009; Sheth and DiNubile, 1997; Stokes et al, 2019)
We identified 1120 laboratory reports with Staphylococcus aureus bacteriuria (SABU) (Figure S1)
A concomitant S. aureus bacteremia (SAB) was detected in 66 patients of our cohort (SABU + SAB, 26.9%), while no SAB was detected in the remaining 179 patients (73.1%, Table 1)

Summary

Introduction

Staphylococcus aureus bacteriuria (SABU) is rare (0.8–4.3%) and can be associated with asymptomatic colonization, primary catheter-associated urinary tract infection and hematogenous seeding in patients with S. aureus bacteremia (SAB) (Al Mohajer et al, 2013; Kramer et al, 2020; Lee et al, 1978).The rates of SAB in patients with SABU vary from 9% to 17.2% (Al Mohajer et al, 2013; Arpi and Renneberg, 1984; Demuth et al, 1979; Saidel-Odes et al, 2009; Sheth and DiNubile, 1997; Stokes et al, 2019). Staphylococcus aureus bacteriuria (SABU) is rare (0.8–4.3%) and can be associated with asymptomatic colonization, primary catheter-associated urinary tract infection and hematogenous seeding in patients with S. aureus bacteremia (SAB) (Al Mohajer et al, 2013; Kramer et al, 2020; Lee et al, 1978). Numerous studies assessed the proportion and risk factors for SAB in SABU, but they differed in inclusion/exclusion criteria or included only selected populations. Stokes et al recently reported a prevalence of 6.9% of SAB in SABU and defined risk factors for SAB (i.e., inpatient status, urinary procedures, male sex, pure S. aureus culture) in a population-based study (Canada) (Stokes et al, 2019)

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