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J Infect. 2012 Aug;65(2):119-27. doi: 10.1016/j.jinf.2012.02.015. Epub 2012 Mar 9.

Clinical significance and outcome of polymicrobial Staphylococcus aureus bacteremia.

Author information

1
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Abstract

OBJECTIVES:

The clinical significance of polymicrobial Staphylococcus aureus bacteremia (SAB) remains unclear. We therefore compared the clinical features and outcomes of polymicrobial and monomicrobial SAB.

METHODS:

A prospective cohort study of patients with SAB was performed during a 20-months. Polymicrobial SAB was defined as the simultaneous isolation of S. aureus and other microorganisms from blood cultures. However, Corynebacterium spp., Bacillus spp., and coagulase-negative staphylococci were considered contaminants unless they were related to device infection and grew in two or more blood cultures.

RESULTS:

During the study period, 44 (10%) patients had polymicrobial and 412 (90%) had monomicrobial SAB. A total of 54 microorganisms were isolated from the former, with Enterococcus spp. (22%) being the most common. Independent risk factors for polymicrobial SAB included neutropenia (odds ratio [OR] 3.5, p = 0.02), biliary tract catheters (OR 5.0, p = 0.001), and intra-abdominal infection (OR 10.3, p < 0.001). Clinical outcomes were significantly worse among patients with polymicrobial than monomicrobial SAB, including bacteremia-related and 7-day mortality rates. Independent predictors of bacteremia-related mortality were solid tumors (HR 2.0, p = 0.03) and polymicrobial SAB (HR 2.8, p = 0.007).

CONCLUSIONS:

Polymicrobial SAB is associated with more severe illness than monomicrobial SAB, with neutropenia, biliary tract catheters and intra-abdominal infection being significant risk factors for polymicrobial SAB.

PMID:
22410381
DOI:
10.1016/j.jinf.2012.02.015
[Indexed for MEDLINE]

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