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Bergenman O, Nilson B, Rasmussen M. Risk of infective endocarditis and complicated infection in Staphylococcus aureus bacteremia - a retrospective cohort study on the role of bacteriuria. Eur J Clin Microbiol Infect Dis 2024; 43:1419-1426. [PMID: 38771404 PMCID: PMC11271437 DOI: 10.1007/s10096-024-04850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE S. aureus bacteremia (SAB) is a common and severe infection with high mortality and morbidity. The clinical relevance of the finding of concurrent S. aureus bacteriuria (SABU) is debated. The goal of this study was to analyze whether a concurrent SABU is associated with complicated SAB, infective endocarditis (IE) and mortality. METHODS We conducted a retrospective cohort study, reviewing medical charts of all episodes of SAB in patients > 18 years in the region of Skåne, Sweden, between 1st of January and 31st of June 2020. Episodes where a concurrent urine culture was performed were included for analysis. An episode was considered as complicated SAB if there was either attributable mortality, recurrent infection, embolic stroke, or occurrence of a complicated focus of infection. RESULTS During the study period, there were 279 episodes of SAB. 154 episodes met the eligibility criteria, of whom 37 (24%) had concurrent SABU. In 78 episodes (51%), the patients had a complicated SAB. There was a significantly lower proportion of complicated SAB for episodes with concurrent SABU (32%), compared to episodes without concurrent SABU (56%), p-value 0.014. Moreover, in the cohort there were 11 episodes (7.1%) of IE and a 30 days mortality rate of 16%, with no difference between the groups with or without SABU. CONCLUSIONS There is an association between concurrent SABU and a decreased risk for complicated SAB among patients with SAB. This study found no significant association between SABU and neither IE nor mortality for patients with SAB.
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Affiliation(s)
- Oskar Bergenman
- Kalmar Regional Hospital, Kalmar, Sweden.
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14 SE-221 84, Lund, Sweden.
| | - Bo Nilson
- Clinical Microbiology, Office for Medical Services, Infection Prevention and Control, Region Skåne, Lund, Sweden
- Division of Medical Microbiology, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14 SE-221 84, Lund, Sweden.
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
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Papadimitriou-Olivgeris M, Jacot D, Senn L, Guery B. Clinical significance of concomitant bacteriuria in patients with Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect Dis 2023; 42:379-382. [PMID: 36725816 PMCID: PMC9899163 DOI: 10.1007/s10096-023-04559-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
This retrospective study, conducted at Lausanne University Hospital (2015-2021), compared Staphylococcus aureus bacteraemia (SABA) patients with or without concomitant bacteriuria (SABU). Among 448 included bacteraemic patients, 62 (13.8%) had S. aureus concurrently isolated from urine. In multivariate analysis, there was a significant difference in the odds of community-onset bacteraemia (P 0.030), malignancy (P 0.002), > 1 pair of positive blood cultures (P 0.037), and persistent bacteraemia for at least 48 h (P 0.045) in patients with concurrent SABU. No difference concerning mortality was found. On the other hand, SABU was associated with higher rates of SABA recurrence after antibiotic cessation.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland.
| | - Damien Jacot
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland
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Mason CY, Sobti A, Goodman AL. Staphylococcus aureus bacteriuria: implications and management. JAC Antimicrob Resist 2023; 5:dlac123. [PMID: 36644414 PMCID: PMC9833284 DOI: 10.1093/jacamr/dlac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/09/2022] [Indexed: 01/12/2023] Open
Abstract
Background Staphylococcus aureus is isolated in around 0.2%-4% of positive urinary cultures, more commonly in the contexts of long-term care, urological abnormalities and procedures, male sex, older age and comorbidities. Isolation may represent contamination, colonization, urinary tract infection or bacteraemic seeding from another site, and may be linked to S. aureus bacteraemia. However, there is little guidance on investigation and management of S. aureus bacteriuria. We performed a retrospective analysis of cases in our service, including clinical characteristics, investigations and treatment. Methods Data were collected on all urine samples taken from adult patients over a 5-year period from which S. aureus was isolated. Detailed analysis including investigations and management was conducted in those collected over a 1-year period. Results From 511 patients, 668 urine cultures positive for S. aureus were identified; 6.5% of cases were positive for MRSA. Of 93 patients who had blood cultures taken, there were 6 cases of S. aureus bacteraemia, 4 of which were associated with urological instrumentation. Of 94 cases analysed in detail, 57% were treated with antibiotics, and 49% had repeat urine cultures. Factors associated with recurrence were urinary catheterization, urological abnormality, diabetes and inpatient status. Conclusions Our experience does not support the routine taking of blood cultures or treatment of asymptomatic bacteriuria in well patients with S. aureus bacteriuria in this setting. However, repeat urine culture, and investigation and treatment of higher risk patients, for example, prior to bladder instrumentation, may be warranted. We propose a simple algorithm to guide clinicians.
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Affiliation(s)
- C Y Mason
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - A Sobti
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - A L Goodman
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
- Department of Population Health, Medical Research Council Clinical Trials Unit, London, UK
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Abdullahi IN, Issaoui R, Usman Y. Prevalence and genetic lineages of Staphylococcus aureus nasal colonization and urinary tract infection among people living with HIV/AIDS in Nigeria: A systematic review. IJID REGIONS 2022; 4:17-24. [PMID: 36093365 PMCID: PMC9453218 DOI: 10.1016/j.ijregi.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/14/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
To provide an empirical insight on Staphylococcus aureus (S. aureus) nasal colonization and urinary tract infection (UTI) among people living with HIV/AIDS (PLWHA) in Nigeria, a quantitative synthesis and systematic review were executed. A comprehensive bibliometric search was conducted for published articles using the keywords 'nasal S. aureus carriage', 'Urinary S. aureus', 'nasal MRSA', 'staphylococci-HIV coinfection', 'urinary MRSA' and 'all states of Nigeria'. Eligible studies and the number of subjects (n) were analysed according to the PRISMA criteria. Out of the 79 examined studies, only 6 (n=1181) and 6 (n= 1350) on nasal and urine samples, respectively, were eligible. The pooled prevalence of nasal carriage and UTI of S. aureus were 29.6% and 6.8%, respectively. However, the pooled nasal MRSA carriage was 13.4%. The pooled prevalence of luk-F/S-PV-carrying S. aureus among nasal samples was 13.0%. Molecular typing from 3 studies showed MRSA-ST8-t064 and MSSA-ST15-t084 as the predominant genetic lineages. The S. aureus isolates from both sample types had the highest (>50%) resistance to penicillin, sulfamethoxazole-trimethoprim, erythromycin, and tetracycline. Multi-drug resistance was not significantly higher among S. aureus isolates from urine than nasal samples (60% versus 40.0% of eligible studies) (p= 0.5271). A moderate and high pooled prevalence of genetically diverse MRSA and luk-F/S-PV-carrying S. aureus were obtained from PLWHA, respectively. These findings emphasize the importance of routine screening for MRSA among PLWHA in Nigeria and other HIV endemic countries.
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Affiliation(s)
- Idris Nasir Abdullahi
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, PMB 05 Zaria, Nigeria
| | - Rabeb Issaoui
- Department of Biology, University of Tunis El-Manar, Tunis, Tunisia
| | - Yahaya Usman
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, College of Medical Sciences, Ahmadu Bello University, PMB 05 Zaria, Nigeria
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Duncan DB, Vincent YM, Main C. Purposeful microbiology comment added to urine cultures with Staphylococcus aureus increases orders for follow-up blood cultures. Access Microbiol 2021; 3:000224. [PMID: 34151175 PMCID: PMC8208763 DOI: 10.1099/acmi.0.000224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/27/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction Patients with Staphylococcus aureus bacteriuria (SABU) often have underlying invasive disease, including S. aureus bacteremia (SAB). It has been proposed that most patients with SABU should have a blood culture done to rule out SAB. A preliminary audit suggested that our local hospitals had a low rate of follow-up blood culture orders for patients with SABU. In response to this, our microbiology laboratory changed the comment appended to urine cultures with growth of S. aureus to make a more assertive link between SABU and SAB and to recommend follow-up blood cultures. Aim We designed a retrospective quasi-experimental study to see if the change in microbiology comment wording had an effect on clinician behaviour. We hypothesized that this simple comment change to make a more assertive link between SABU and SAB would lead to an increase in follow-up blood culture orders. Methodology We used microbiology records to identify adult patients with urine cultures positive for Staphylococcus aureus at three acute-care hospitals in Hamilton, Ontario, Canada, for 1 year pre- and post-intervention. We recorded urine and blood culture results, timing, patient demographics, and in-hospital mortality. Results A total of 243 adult patients with urine cultures with S. aureus were identified for inclusion. The primary outcome was met, as there was a significant increase in blood culture orders between the pre-intervention and post-intervention groups (66.9 % vs 80.4 %). This difference was mainly driven by an increase for emergency department and urgent care patients (30.6 % vs 63.6 %). The inpatient group had a high baseline rate of blood culture orders that did not change significantly (80.0 % vs 84.7 %). There was no significant change in detection of SAB (23.5 % vs 32.7 %) or inpatient mortality (18.0 % vs 24.7 %). Conclusion Our study shows that a simple, purposeful comment appended to urine cultures with S. aureus leads to a significant increase in follow-up blood culture orders.
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Affiliation(s)
- Donald Brody Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Cheryl Main
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.,Hamilton Regional Laboratory Medicine Program, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Schuler F, Barth PJ, Niemann S, Schaumburg F. A Narrative Review on the Role of Staphylococcus aureus Bacteriuria in S. aureus Bacteremia. Open Forum Infect Dis 2021; 8:ofab158. [PMID: 34189162 PMCID: PMC8233567 DOI: 10.1093/ofid/ofab158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
Staphylococcus aureus bacteriuria (SABU) can occur in patients with S. aureus bacteremia (SAB). However, little is known on the (molecular) pathomechanisms of the renal passage of S. aureus. This review discusses the epidemiology and pathogenesis of SABU in patients with SAB and identifies knowledge gaps. The literature search was restricted to the English language. The prevalence of SABU in patients with SAB is 7.8%-39% depending on the study design. The main risk factor for SABU is urinary tract catheterization. SABU in SAB patients is associated with increased mortality. Given present evidence, hematogenous seeding-as seen in animal models-and the development of micro-abscesses best describe the translocation of S. aureus from blood to urine. Virulence factors that might be involved are adhesion factors, sortase A, and coagulase, among others. Other potential routes of bacterial translocation (eg, transcytosis, paracytosis, translocation via "Trojan horses") were identified as knowledge gaps.
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Affiliation(s)
- Franziska Schuler
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Peter J Barth
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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Schuler F, Froböse N, Schaumburg F. Prevalence and risk factors for bacteremia in patients with Staphylococcus aureus bacteriuria: A retrospective cohort study. Int J Infect Dis 2020; 98:467-469. [PMID: 32717397 DOI: 10.1016/j.ijid.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/15/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Staphylococcus 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. METHODS We 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. RESULTS In 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. CONCLUSION The 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.
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Affiliation(s)
- Franziska Schuler
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Neele Froböse
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Frieder Schaumburg
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
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