Distinct Clinical Endpoints of Staphylococcus aureus Bacteraemia Complicate Assessment of Outcome

Author:

Russell Clark D12,Berry Karla3,Cooper George1,Sim Wynne4,Lee Rui Shian4,Gan Tze Yi4,Donlon William4,Besu Antonia4,Heppenstall Emily2,Tysall Luke2,Robb Andrew5,Dewar Simon23,Smith Andrew56ORCID,Fowler Vance G78

Affiliation:

1. Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh , Edinburgh , United Kingdom

2. Medical Microbiology, Royal Infirmary of Edinburgh , Edinburgh , United Kingdom

3. Clinical Infection Research Group, Western General Hospital , Edinburgh , United Kingdom

4. Edinburgh Medical School, The University of Edinburgh , Edinburgh , United Kingdom

5. Scottish Microbiology Reference Laboratory, New Lister Building , Glasgow , United Kingdom

6. College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow , Glasgow , United Kingdom

7. Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine , Durham, North Carolina , USA

8. Duke Clinical Research Institute , Durham, North Carolina , USA

Abstract

Abstract Background We aimed to test the hypothesis that development of metastatic infection represents a distinct clinical endpoint from death due to Staphylococcus aureus bacteremia (SAB). Methods We conducted a retrospective observational study of adults with SAB between 20 December 2019 and 23 August st2022 (n = 464). Simple logistic regression, odds ratios, and z-scores were used to compare host, clinical, and microbiologic features. Results Co-occurrence of attributable mortality and metastatic infection was infrequent. Charlson Comorbidity Index and age were strongly associated with attributable mortality, but not metastatic infection. We compared patients with fatal SAB (without clinically-apparent metastatic complications, 14.4% of cohort), metastatic SAB (without attributable mortality, 22.2%), neither complication (56.7%), and overlapping fatal/metastatic SAB (6.7%). Compared to SAB without complications, fatal SAB was specifically associated with older age and multi-morbidity. Metastatic SAB was specifically associated with community acquisition, persistent fever, persistent bacteremia, and recurrence. Endocarditis was over-represented in the fatal/metastatic SAB overlap group, which shared patient characteristics with fatal SAB. In contrast to other (predominantly musculoskeletal) metastatic complications, endocarditis was associated with increased mortality, with death occurring in older multi-morbid patients later after SAB onset. Conclusions Patients with SAB experience distinct clinical endpoints: (i) early death, associated with multi-morbidity and age; (ii) metastatic (predominantly musculoskeletal) SAB; (iii) endocarditis, associated with late death occurring in older people with multi-morbidity, and (iv) bacteraemia without complications. These distinctions could be important for selecting appropriate outcomes in clinical trials: different interventions might be required to reduce mortality versus improve clinical response in patients with metastatic SAB.

Funder

National Institutes of Health

Edinburgh Clinical Academic Track

Wellcome Trust

Publisher

Oxford University Press (OUP)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Clinical Subphenotypes of Staphylococcus aureus Bacteremia;Clinical Infectious Diseases;2024-06-25

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