Department of Medicine, Immunology and Infectious Diseases, University of Calgary, Alberta.
Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Alberta.
Clin Infect Dis. 2019 Aug 30;69(6):963-969. doi: 10.1093/cid/ciy1000.
Staphylococcus aureus bacteriuria (SABU) may represent multiple processes ranging from asymptomatic colonization to a marker of S. aureus bacteremia (SAB). Our objective was to describe SABU at a population-based level and determine patient characteristics associated with SAB.
A retrospective study was performed using electronic databases. All urine cultures positive for S. aureus between 2010 and 2013 within the Calgary Health Zone were included. Patient characteristics were compared among patients with and without SAB and risk factors identified using multiple logistic regression modeling.
A total of 2540 urine cultures positive for S. aureus from 2054 patients were analyzed. The incidence of SABU was greatest among geriatric males with multiple comorbidities. SAB occurred in 175 (6.9%) of SABU patients. Those with SAB were more likely to be hospitalized, male, have a recent urinary procedure, have pure S. aureus culture in urine, and have laboratory findings suggesting systemic infection. Patients with isolated SABU were more likely to be ≥65 years, have dementia, and have abnormal urinalyses with pyuria and urine nitrites. In-hospital mortality in patients with SABU and SABU+SAB was 9.2% and 17.5%, respectively. Patients with SABU detected ≥48 hours before SAB had the highest risk of death.
Less than 7% of patients with SABU have or will develop SAB. Characteristics associated with SABU were identified that established higher risk for systemic infection. Investigating SABU patients with these characteristics for systemic infection is warranted because a delay in diagnosis is associated with increased mortality.
金黄色葡萄球菌菌尿症（SABU）可能代表多种不同的过程，从无症状定植到金黄色葡萄球菌菌血症（SAB）的标志物不等。我们的目的是描述基于人群的 SABU，并确定与 SAB 相关的患者特征。
使用电子数据库进行回顾性研究。纳入 2010 年至 2013 年间卡尔加里健康区所有尿液培养物中分离出金黄色葡萄球菌的患者。比较 SABU 患者和无 SAB 患者的患者特征，并使用多因素逻辑回归模型确定危险因素。
共分析了 2054 例患者的 2540 份金黄色葡萄球菌尿液培养物。老年男性伴有多种合并症的 SABU 发病率最高。SABU 患者中发生 SAB 的有 175 例（6.9%）。有 SAB 的患者更有可能住院、男性、最近有尿路手术、尿液中为单纯金黄色葡萄球菌培养、实验室检查提示全身感染。孤立性 SABU 患者更有可能≥65 岁、有痴呆症、尿液分析异常有脓尿和尿液亚硝酸盐。SABU 和 SABU+SAB 患者的院内死亡率分别为 9.2%和 17.5%。在 SAB 发生前≥48 小时检测到 SABU 的患者死亡风险最高。
不到 7%的 SABU 患者有或将会发展为 SAB。确定了与 SABU 相关的特征，这些特征表明发生全身感染的风险更高。对具有这些特征的 SABU 患者进行全身感染的调查是合理的，因为诊断延迟与死亡率增加有关。
