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Risk Factors for Recurrent Staphylococcus aureus Bacteremia.

Seong-Ho Choi1,2, Michael Dagher1, Felicia Ruffin1

  • 1Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 22, 2020
PubMed
Summary

Recurrent Staphylococcus aureus bacteremia (R-SAB) is linked to specific patient factors, especially in black hemodialysis patients. Higher RANTES levels during initial Staphylococcus aureus bacteremia may predict R-SAB risk.

Keywords:
Staphylococcus aureusbacteremiahealth disparityrecurrencewhole genome sequencing

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Immunology

Background:

  • Recurrent Staphylococcus aureus bacteremia (R-SAB) presents a significant clinical challenge.
  • Understanding the factors contributing to R-SAB is crucial for effective patient management.
  • This study compares clinical, bacterial, and host characteristics of patients with R-SAB versus single S-SAB.

Purpose of the Study:

  • To identify clinical, bacterial, and host factors associated with recurrent Staphylococcus aureus bacteremia (R-SAB).
  • To compare patients with R-SAB to those with a single episode of S-SAB.
  • To investigate the role of host immune response, specifically cytokine profiles, in R-SAB.

Main Methods:

  • Spa genotyping and pulsed-field gel electrophoresis (PFGE) were used for bacterial isolate characterization.
  • Whole genome sequencing (WGS) confirmed PFGE findings in select cases.
  • Cytokine levels in acute phase plasma were quantified using multiplex bead arrays and compared between R-SAB and S-SAB groups.

Main Results:

  • Recurrent Staphylococcus aureus bacteremia (R-SAB) occurred in 9.1% of patients.
  • Black hemodialysis patients exhibited a significantly higher risk of R-SAB compared to white hemodialysis patients.
  • Elevated RANTES levels were observed in the acute phase plasma of R-SAB patients compared to S-SAB controls.

Conclusions:

  • Key risk factors for R-SAB include age, race, hemodialysis dependence, presence of foreign bodies, methicillin-resistant Staphylococcus aureus, and persistent bacteremia.
  • Black race and hemodialysis dependence are identified as major risk factors for R-SAB.
  • Higher RANTES levels in the initial Staphylococcus aureus bacteremia episode suggest a potential role in recurrence, warranting further investigation.