Inserm CIC 1435, Centre hospitalier universitaire Dupuytren, F-87042, Limoges, France.
Service d'Accueil des Urgences, Centre hospitalier universitaire Dupuytren, F-87042, Limoges, France.
BMC Infect Dis. 2019 Jun 7;19(1):504. doi: 10.1186/s12879-019-4106-0.
Urinary tract infection (UTI) is frequently diagnosed in the Emergency Department (ED). Staphylococcus aureus (SA) is an uncommon isolate in urine cultures (0.5-6% of positive urine cultures), except in patients with risk factors for urinary tract colonization. In the absence of risk factors, community-acquired SA bacteriuria may be related to deep-seated SA infection including infective endocarditis. We hypothesized that SA bacteriuria could be a warning microbiological marker of unsuspected infective endocarditis in the ED.
This is a retrospective chart review of consecutive adult patients between December 2005 and February 2018. All patients admitted in the ED with both SA bacteriuria (10 CFU/ml SA isolated from a single urine sample) and SA bacteremia, without risk factors for UT colonization (i.e., < 1 month UT surgery, UT catheterization) were analyzed. Diagnosis of infective endocarditis was based on the Duke criteria.
During the study period, 27 patients (18 men; median age: 61 [IQR: 52-73] years) were diagnosed with community-acquired SA bacteriuria and had subsequently documented bacteremia and SA infective endocarditis. Only 5 patients (18%) had symptoms related to UT infection. Median delay between ED admission and SA bacteriuria identification was significantly shorter than that between ED admission and the diagnosis of infective endocarditis (1.4 ± 0.8 vs. 4.3 ± 4.2 days: p = 0.01). Mitral and aortic valves were most frequently involved by infective endocarditis (93%). Mortality on day 60 reached 56%.
This study suggests that community-acquired SA bacteriuria should warn the emergency physician about a potentially associated left-sided infective endocarditis in ED patients without risk factors for UT colonization.
尿路感染（UTI）在急诊科（ED）经常被诊断出来。金黄色葡萄球菌（SA）在尿液培养物中是一种罕见的分离株（阳性尿液培养物的 0.5-6%），除非患者有尿路定植的危险因素。在没有危险因素的情况下，社区获得性 SA 菌尿可能与包括感染性心内膜炎在内的深部 SA 感染有关。我们假设 SA 菌尿可能是 ED 中未被怀疑的感染性心内膜炎的一个警示性微生物学标志物。
这是一项对 2005 年 12 月至 2018 年 2 月期间连续就诊的成年患者的回顾性图表审查。所有在 ED 住院的患者均有 SA 菌尿（从单个尿液样本中分离出 10 CFU/ml 的 SA）和 SA 菌血症，且没有 UT 定植的危险因素（即，<1 个月的 UT 手术，UT 导管插入术），分析。感染性心内膜炎的诊断基于 Duke 标准。
在研究期间，27 例患者（18 例男性；中位年龄：61[IQR：52-73]岁）被诊断为社区获得性 SA 菌尿，并随后记录了菌血症和 SA 感染性心内膜炎。只有 5 例患者（18%）有与 UT 感染相关的症状。ED 入院和 SA 菌尿鉴定之间的中位时间明显短于 ED 入院和感染性心内膜炎诊断之间的中位时间（1.4±0.8 天 vs. 4.3±4.2 天：p=0.01）。感染性心内膜炎最常累及二尖瓣和主动脉瓣（93%）。第 60 天的死亡率达到 56%。
本研究表明，对于没有 UT 定植危险因素的 ED 患者，社区获得性 SA 菌尿应引起急诊医生警惕潜在的左心感染性心内膜炎。
