PLoS ONE (Jan 2015)

Staphylococcus aureus Bloodstream Infection and Endocarditis--A Prospective Cohort Study.

  • Vincent Le Moing,
  • François Alla,
  • Thanh Doco-Lecompte,
  • François Delahaye,
  • Lionel Piroth,
  • Catherine Chirouze,
  • Pierre Tattevin,
  • Jean-Philippe Lavigne,
  • Marie-Line Erpelding,
  • Bruno Hoen,
  • François Vandenesch,
  • Xavier Duval,
  • VIRSTA study group

DOI
https://doi.org/10.1371/journal.pone.0127385
Journal volume & issue
Vol. 10, no. 5
p. e0127385

Abstract

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To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.