title: Risk factors for hematogenous complications of intravascular catheter-associated Staphylococcus aureus bacteremia.
abstract: BACKGROUND
  The role of both host and pathogen characteristics in hematogenous seeding following Staphylococcus aureus bacteremia is incompletely understood.
  
  
  METHODS
  Consecutive patients with intravascular catheter-associated Staphylococcus aureus bacteremia were prospectively recruited over a 91-month period. The corresponding bloodstream isolates were examined for the presence of 35 putative virulence determinants. Patient and bacterial characteristics associated with the development of hematogenous complications (HCs) (i.e., septic arthritis, vertebral osteomyelitis, or endocarditis) were defined.
  
  
  RESULTS
  HC occurred in 42 (13%) of 324 patients. Patient characteristics at diagnosis that were associated with HC included community onset (relative risk [RR], 2.25; 95% confidence interval [CI], 1.24-4.07; P=.007), increased symptom duration (odds ratio for each day, 1.14; 95% CI, 1.06-1.2; P<.001), presence of a long-term intravascular catheter or noncatheter prosthesis (RR, 4.02; 95% CI, 1.74-9.27; P<.001), hemodialysis dependence (RR, 3.84; 95% CI, 2.08-7.10; P<.001), and higher APACHE II score (P=.02). Bacterial characteristics included sea (RR, 2.03; 95% CI, 1.16-3.55; P=.011) and methicillin-resistant S. aureus (MRSA) (RR, 2.09; 95% CI, 1.19-3.67; P=.015). Subsequent failure to remove a catheter was also associated with HC (RR, 2.28; 95% CI, 1.22-4.27; P=.011). On multivariable analysis, symptom duration, hemodialysis dependence, presence of a long-term intravascular catheter or a noncatheter device, and infection with MRSA remained significantly associated with HC.
  
  
  CONCLUSIONS
  This investigation identifies 4 host- and pathogen-related risk factors for hematogenous bacterial seeding and reaffirms the importance of prompt catheter removal.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. vance.fowler@duke.edu
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: Anita
authors.initials: A
authors.lastname: Justice
authors.forename: Catrin
authors.initials: C
authors.lastname: Moore
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.forename: Steven
authors.initials: S
authors.lastname: Campbell
authors.forename: L Barth
authors.initials: LB
authors.lastname: Reller
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Nicholas P J
authors.initials: NP
authors.lastname: Day
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000150:complications*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications* / Q000209:etiology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D037521:Virulence Factors / Q000235:genetics
chemical_list: D037521:Virulence Factors