Persistent Staphylococcus aureus bacteremia and 30-day mortality: a systematic review and meta-analysis

A substantial proportion of patients with Staphylococcus aureus bacteremia (SAB) continue to have persistent culture positivity. However, the magnitude and consistency of its association with mortality remain uncertain.

Data were extracted from PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library from inception to January 2026. Observational studies comparing 30-day all-cause mortality between S. aureus persistent and non-persistent bacteremia were included. Persistent bacteremia was defined as continued positivity of blood cultures for S. aureus for ≥ 48 h after initiation of appropriate antimicrobial therapy. Risk of bias and quality were evaluated with the ROBINS-E tool. Pooled odds ratios (ORs) for 30-day mortality were estimated using a random-effects meta-analysis model. Heterogeneity was investigated through subgroup analyses, sensitivity analyses, and meta-regression.

Nineteen studies comprising 7,993 patients with SAB met the inclusion criteria. In pooled unadjusted analysis, persistent bacteremia was associated with increased 30 day all-cause mortality (OR 1.97, 95% CI 1.62-2.40, I² = 34%). Adjusted mortality data accounting for additional patient characteristics were available from 9 studies (5,775 patients), and revealed a similar increased mortality rate in persistent bacteremia compared to non-persistent bacteremia (OR 2.81, 95% CI 1.59-4.96, I² = 91%). Meta-regression showed no significant influence of age, proportion of methicillin-resistant S. aureus, or hospital-acquired infection on the pooled mortality. No evidence of publication bias was detected.

In this meta-analysis, patients with S. aureus persistent bacteremia had a higher mortality risk than those with non-persistent bacteremia. Future research should target this high-risk phenotype to improve outcomes in SAB.