Staphylococcus Aureus Bacteremia Among Patients with Health Care-associated Fever
Part of this study was presented as a poster at the 45th Annual Interscience Conference on Antimicrobial Agents & Chemotherapy, Washington, DC, December 18th 2005.
Abstract
Background
Although Staphylococcus aureus bacteremia is a common, serious infection, accurately identifying febrile patients with this diagnosis at the time of initial evaluation is difficult. The purpose of this investigation was to define clinical characteristics present at the time of the initial recognition of fever that were associated with the presence of any bloodstream infection and, in particular, with S. aureus bacteremia.
Methods
All patients ≥18 years of age with a new episode of health care-associated fever (temperature ≥38°C) and at least one blood culture drawn were eligible for enrollment into this prospective multicenter cohort study. Multivariable analyses were conducted and internally validated scoring systems were developed to categorize the risk of bacteremia.
Results
Of 1015 patients enrolled, 181 patients (17.8%) had clinically significant bacteremia, including 77 patients (7.6%) with S. aureus bacteremia. Clinical characteristics associated with S. aureus bacteremia were the presence of a hemodialysis graft or shunt (odds ratio [OR] 3.22; 95% confidence interval [CI], 1.85-5.61), chills (OR 2.38; 95% CI, 1.43-3.98), and a history of S. aureus infection (OR 2.68; 95% CI, 1.38-5.20). Peripheral vascular catheters were inversely associated with S. aureus bacteremia (OR 0.42; 95% CI, 0.26-0.69). Clinical characteristics associated with any bloodstream infection were central venous access, chills, history of S. aureus infection, and hemodialysis access.
Conclusions
Among patients with health care-associated fever, the presence of easily recognizable clinical characteristics at the time of obtaining the initial blood cultures can help to identify patients at increased risk for any bloodstream infection, in particular for S. aureus bacteremia.
aDuke Clinical Research Institute, Duke University Medical Center, Durham, NC
bDepartment of Medicine, Duke University Medical Center, Durham, NC
cDepartment of Pediatrics, Duke University Medical Center, Durham, NC
dDepartment of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Buenos Aires, Argentina
eDivision of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
Requests for reprints should be addressed to Martin E. Stryjewski, MD, MHS, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno”, Azcuenaga 1757, Apt 1C, Capital Federal (C1128AAC), Buenos Aires, Argentina
Funding: This work was supported by a grant from Inhibitex, Inc. Inhibitex did not intervene in: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
Conflicts of Interest: Martin E. Stryjewski has consulted for Astellas (<$10,000), and has received a research grant (>$10,000) and is a consultant for Theravance Inc. (>$10,000/year). Vivian H. Chu has received a research grant from Theravance Inc. Vance G. Fowler has received research funding from Theravance, Merck, Nabi (<US$10,000/year), Inhibitex, Cubist, and the National Institute of Health; is a consultant for Biosynexus, Inhibitex, Merck, Cerexa, and Cubist; and is on the speaker's bureaus for Cubist and Pfizer. G. Ralph Corey has received research funding from Theravance, Cubist, Merck, and Inhibitex; and is a consultant for Cubist, Inhibitex, Cerexa, and Pfizer. Daniel K. Benjamin Jr. has received a research grant from Nabi, Cape Cod Associates, Astellas, MedImmune, Pediatrix, Rockeby, National Institute of Child Health and Human Development, and National Institute of Allergy and Infectious Diseases. Tina Harding, Laura A. Drew, Paul A. Pappas, Benjamin A. Lee, Zeina A. Kanafani, and L. Barth Reller have no conflicts.
Authorship: All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
ABSTRACT
