Staphylococcus aureus Bloodstream Infection and Endocarditis―A Prospective Cohort Study

Vincent Le Moing (1) , François Alla (2, 3) , Thanh Doco-Lecompte (4) , François Delahaye (5) , Lionel Piroth (6, 7) , Catherine Chirouze (8, 9) , Pierre Tattevin (10, 11) , Jean-Philippe Lavigne (12) , Marie-Line Erpelding (3, 2) , Bruno Hoen (13) , François Vandenesch (14, 15) , Xavier Duval (16, 17)

1 CHU de Montpellier
2 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
3 Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy
4 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
5 Hopital Cardio-Thoracique et Vasculaire Louis Pradel
6 Département d'infectiologie (CHU de Dijon)
7 Agroécologie [Dijon]
8 LCE - Laboratoire Chrono-environnement (UMR 6249)
9 Service des maladies infectieuses et tropicales
10 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
11 Fonction, structure et inactivation d'ARN bactériens
12 VBMI - Virulence bactérienne et maladies infectieuses
13 CHU Pointe-à-Pitre/Abymes [Guadeloupe]
14 StaPath - Pathogénie des Staphylocoques – Staphylococcal Pathogenesis
15 Centre National de Reference des Staphylocoques
16 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
17 CIC Hôpital Bichat

OBJECTIVES: To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).METHODS: All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. RESULTS: 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%).CONCLUSION: 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

Mots clés: Adult; Aged; Staphylococcus aureus; Staphylococcal; Female; France; Prospective Studies; Risk Factors; Bacteremia; 80 and over; Endocarditis; Bacterial; Middle Aged; Pneumonia; Hospital Mortality; Male; Humans

Domaines: Maladies infectieuses; Santé publique et épidémiologie

Vincent Le Moing, François Alla, Thanh Doco-Lecompte, François Delahaye, Lionel Piroth, et al.. Staphylococcus aureus Bloodstream Infection and Endocarditis―A Prospective Cohort Study. PLoS ONE, 2015, 10 (5), pp.e0127385. ⟨10.1371/journal.pone.0127385⟩. ⟨hal-01299980⟩