The skip phenomenon in Staphylococcus aureus bacteremia: clinical implications

Area of Science:

• Infectious Diseases
• Clinical Microbiology

Background:

• Serial blood cultures (BCs) are vital for managing Staphylococcus aureus bacteremia (SAB), assessing complications, and monitoring treatment.
• The 'skip phenomenon' (SP), characterized by intermittent negative BCs during SAB, is recognized, with recommendations for additional cultures to confirm clearance.

Purpose of the Study:

• To investigate the clinical significance of the skip phenomenon in patients with Staphylococcus aureus bacteremia.
• To identify patient characteristics and outcomes associated with the occurrence of SP during SAB treatment.

Main Methods:

• Retrospective analysis of patients diagnosed with SAB.
• Comparison of clinical characteristics and outcomes between patients with and without the skip phenomenon (SP).

Main Results:

• Patients with SP exhibited higher rates of injection drug use and community-onset SAB.
• Longer SAB duration, high-grade SAB, and complicated bacteremia were more prevalent in the SP cohort.
• While not statistically significant, SP was associated with a trend towards higher in-hospital mortality; no differences in relapse or long-term mortality were observed in survivors.

Conclusions:

• The skip phenomenon in SAB is associated with more severe disease and potentially worse outcomes.
• Serial blood cultures are essential for confirming bacterial clearance in SAB patients, particularly those exhibiting the skip phenomenon.