Risk Factors For Hematogenous Complications of Intravascular Catheter--Associated Staphylococcus aureus Bacteremia
Open Access
- 1 March 2005
- journal article
- Published by Oxford University Press (OUP) in Clinical Infectious Diseases
- Vol. 40 (5), 695-703
- https://doi.org/10.1086/427806
Abstract
Background. The role of both host and pathogen characteristics in hematogenous seeding following Staphylococcus aureus bacteremia is incompletely understood. Methods. Consecutive patients with intravascular catheter—associated Staphylococcus aureus bacteremia were prospectively recruited over a 91-month period. The corresponding bloodstream isolates were examined for the presence of 35 putative virulence determinants. Patient and bacterial characteristics associated with the development of hematogenous complications (HCs) (i.e., septic arthritis, vertebral osteomyelitis, or endocarditis) were defined. Results. HC occurred in 42 (13%) of 324 patients. Patient characteristics at diagnosis that were associated with HC included community onset (relative risk [RR], 2.25; 95% confidence interval [CI], 1.24–4.07; P = .007), increased symptom duration (odds ratio for each day, 1.14; 95% CI, 1.06–1.2; P < .001), presence of a long-term intravascular catheter or noncatheter prosthesis (RR, 4.02; 95% CI, 1.74–9.27; P < .001), hemodialysis dependence (RR, 3.84; 95% CI, 2.08–7.10; P < .001), and higher APACHE II score (P = .02). Bacterial characteristics included sea (RR, 2.03; 95% CI, 1.16–3.55; P = .011) and methicillin-resistant S. aureus (MRSA) (RR, 2.09; 95% CI, 1.19–3.67; P = .015). Subsequent failure to remove a catheter was also associated with HC (RR, 2.28; 95% CI, 1.22–4.27; P = .011). On multivariable analysis, symptom duration, hemodialysis dependence, presence of a long-term intravascular catheter or a noncatheter device, and infection with MRSA remained significantly associated with HC. Conclusions. This investigation identifies 4 host- and pathogen-related risk factors for hematogenous bacterial seeding and reaffirms the importance of prompt catheter removal.This publication has 55 references indexed in Scilit:
- Comparison of Community- and Health Care–Associated Methicillin-Resistant Staphylococcus aureus InfectionJAMA, 2003
- Clinical Identifiers of Complicated Staphylococcus aureus BacteremiaArchives of Internal Medicine, 2003
- Use of Multiplex PCR To Identify Staphylococcus aureus Adhesins Involved in Human Hematogenous InfectionsJournal of Clinical Microbiology, 2003
- Community-Acquired Methicillin-ResistantStaphylococcus aureusCarrying Panton-Valentine Leukocidin Genes: Worldwide EmergenceEmerging Infectious Diseases, 2003
- Health Care–Associated Bloodstream Infections in Adults: A Reason To Change the Accepted Definition of Community-Acquired InfectionsAnnals of Internal Medicine, 2002
- Outcome and Attributable Mortality in Critically Ill Patients With Bacteremia Involving Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureusArchives of Internal Medicine, 2002
- Virulent Combinations of Adhesin and Toxin Genes in Natural Populations of Staphylococcus aureusInfection and Immunity, 2002
- Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patientsThe Lancet, 2002
- Relationships between Staphylococcus aureus Genetic Background, Virulence Factors, agr Groups (Alleles), and Human DiseaseInfection and Immunity, 2002
- New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findingsAmerican Journal Of Medicine, 1994