Risk Factors for Recurrent Staphylococcus aureus Bacteremia
- Authors
- Choi, Seong-Ho; Dagher, Michael; Ruffin, Felicia; Park, Lawrence P.; Sharma-Kuinkel, Batu K.; Souli, Maria; Morse, Alison M.; Eichenberger, Emily M.; Hale, Lauren; Kohler, Celia; Warren, Bobby; Hansen, Brenda; Medie, Felix Mba; McIntyre, Lauren M.; Fowler, Vance G., Jr.
- Issue Date
- Jun-2021
- Publisher
- OXFORD UNIV PRESS INC
- Keywords
- Staphylococcus aureus; bacteremia; recurrence; whole genome sequencing; health disparity
- Citation
- CLINICAL INFECTIOUS DISEASES, v.72, no.11, pp 1891 - 1899
- Pages
- 9
- Journal Title
- CLINICAL INFECTIOUS DISEASES
- Volume
- 72
- Number
- 11
- Start Page
- 1891
- End Page
- 1899
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/49741
- DOI
- 10.1093/cid/ciaa801
- ISSN
- 1058-4838
1537-6591
- Abstract
- Background. To understand the clinical, bacterial, and host characteristics associated with recurrent Staphylococcus aureus bacteremia (R-SAB), patients with R-SAB were compared to contemporaneous patients with a single episode of SAB (S-SAB). Methods. All SAB isolates underwent spa genotyping. All isolates from R-SAB patients underwent pulsed-field gel electrophoresis (PFGE). PFGE-indistinguishable pairs from 40 patients underwent whole genome sequencing (WGS). Acute phase plasma from R-SAB and S-SAB patients was matched 1:1 for age, race, sex, and bacterial genotype, and underwent cytokine quantification using 25-analyte multiplex bead array. Results. R-SAB occurred in 69 (9.1%) of the 756 study patients. Of the 69 patients, 30 experienced relapse (43.5%) and 39 reinfection (56.5%). Age, race, hemodialysis dependence, presence of foreign body, methicillin-resistant Staphyloccus aureus, and persistent bacteremia were individually associated with likelihood of recurrence. Multivariate risk modeling revealed that black hemodialysis patients were nearly 2 times more likely (odds ratio [OR] = 9.652 [95% confidence interval [CI], 5.402-17.418]) than white hemodialysis patients (OR = 4.53 [95% CI, 1.696-10.879]) to experience R-SAB. WGS confirmed PFGE interpretations in all cases. Median RANTES (regulated on activation, normal T cell expressed and secreted) levels in acute phase plasma from the initial episode of SAB were higher in R-SAB than in matched S-SAB controls (P = .0053, false discovery rate < 0.10). Conclusion. This study identified several risk factors for R-SAB. The largest risk for R-SAB is among black hemodialysis patients. Higher RANTES levels in R-SAB compared to matched controls warrants further study.
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