Choi Seong-Ho, Dagher Michael, Ruffin Felicia, Park Lawrence P, Sharma-Kuinkel Batu K, Souli Maria, Morse Alison M, Eichenberger Emily M, Hale Lauren, Kohler Celia, Warren Bobby, Hansen Brenda, Medie Felix Mba, McIntyre Lauren M, Fowler Vance G
Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.
Clin Infect Dis. 2021 Jun 1;72(11):1891-1899. doi: 10.1093/cid/ciaa801.
To understand the clinical, bacterial, and host characteristics associated with recurrent Staphylococcus aureus bacteremia (R-SAB), patients with R-SAB were compared to contemporaneous patients with a single episode of SAB (S-SAB).
All SAB isolates underwent spa genotyping. All isolates from R-SAB patients underwent pulsed-field gel electrophoresis (PFGE). PFGE-indistinguishable pairs from 40 patients underwent whole genome sequencing (WGS). Acute phase plasma from R-SAB and S-SAB patients was matched 1:1 for age, race, sex, and bacterial genotype, and underwent cytokine quantification using 25-analyte multiplex bead array.
R-SAB occurred in 69 (9.1%) of the 756 study patients. Of the 69 patients, 30 experienced relapse (43.5%) and 39 reinfection (56.5%). Age, race, hemodialysis dependence, presence of foreign body, methicillin-resistant Staphyloccus aureus, and persistent bacteremia were individually associated with likelihood of recurrence. Multivariate risk modeling revealed that black hemodialysis patients were nearly 2 times more likely (odds ratio [OR] = 9.652 [95% confidence interval [CI], 5.402-17.418]) than white hemodialysis patients (OR = 4.53 [95% CI, 1.696-10.879]) to experience R-SAB. WGS confirmed PFGE interpretations in all cases. Median RANTES (regulated on activation, normal T cell expressed and secreted) levels in acute phase plasma from the initial episode of SAB were higher in R-SAB than in matched S-SAB controls (P = .0053, false discovery rate < 0.10).
This study identified several risk factors for R-SAB. The largest risk for R-SAB is among black hemodialysis patients. Higher RANTES levels in R-SAB compared to matched controls warrants further study.
为了解与复发性金黄色葡萄球菌菌血症（R-SAB）相关的临床、细菌和宿主特征，将R-SAB患者与同期单次金黄色葡萄球菌菌血症（S-SAB）患者进行比较。
所有金黄色葡萄球菌菌血症分离株均进行spa基因分型。R-SAB患者的所有分离株均进行脉冲场凝胶电泳（PFGE）。40例患者中PFGE无法区分的菌株对进行全基因组测序（WGS）。R-SAB和S-SAB患者的急性期血浆在年龄、种族、性别和细菌基因型方面进行1:1匹配，并使用25种细胞因子多重珠阵列进行细胞因子定量分析。
756例研究患者中有69例（9.1%）发生R-SAB。在这69例患者中，30例复发（43.5%），39例再次感染（56.5%）。年龄、种族、血液透析依赖、异物存在、耐甲氧西林金黄色葡萄球菌和持续性菌血症分别与复发可能性相关。多变量风险模型显示，黑人血液透析患者发生R-SAB的可能性几乎是白人血液透析患者的2倍（比值比[OR]=9.652[95%置信区间[CI]，5.402-17.418]）（OR=4.53[95%CI，1.696-10.879]）。WGS在所有病例中均证实了PFGE的结果。SAB初始发作时急性期血浆中调节激活正常T细胞表达和分泌因子（RANTES）的中位数水平在R-SAB中高于匹配的S-SAB对照组（P=0.0053，错误发现率<0.10）。
本研究确定了R-SAB的几个危险因素。R-SAB的最大风险人群是黑人血液透析患者。与匹配对照组相比，R-SAB中RANTES水平较高值得进一步研究。
