Staphylococcus aureus bacteremia among patients with health care-associated fever.
BACKGROUND
Although Staphylococcus aureus bacteremia is a common, serious infection, accurately identifying febrile patients with this diagnosis at the time of initial evaluation is difficult. The purpose of this investigation was to define clinical characteristics present at the time of the initial recognition of fever that were associated with the presence of any bloodstream infection and, in particular, with S. aureus bacteremia.


METHODS
All patients > or =18 years of age with a new episode of health care-associated fever (temperature > or =38 degrees C) and at least one blood culture drawn were eligible for enrollment into this prospective multicenter cohort study. Multivariable analyses were conducted and internally validated scoring systems were developed to categorize the risk of bacteremia.


RESULTS
Of 1015 patients enrolled, 181 patients (17.8%) had clinically significant bacteremia, including 77 patients (7.6%) with S. aureus bacteremia. Clinical characteristics associated with S. aureus bacteremia were the presence of a hemodialysis graft or shunt (odds ratio [OR] 3.22; 95% confidence interval [CI], 1.85-5.61), chills (OR 2.38; 95% CI, 1.43-3.98), and a history of S. aureus infection (OR 2.68; 95% CI, 1.38-5.20). Peripheral vascular catheters were inversely associated with S. aureus bacteremia (OR 0.42; 95% CI, 0.26-0.69). Clinical characteristics associated with any bloodstream infection were central venous access, chills, history of S. aureus infection, and hemodialysis access.


CONCLUSIONS
Among patients with health care-associated fever, the presence of easily recognizable clinical characteristics at the time of obtaining the initial blood cultures can help to identify patients at increased risk for any bloodstream infection, in particular for S. aureus bacteremia.
Stryjewski
Martin E
ME
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. stryj001@mc.duke.edu
Kanafani
Zeina A
ZA
Chu
Vivian H
VH
Pappas
Paul A
PA
Harding
Tina
T
Drew
Laura A
LA
Benjamin
Daniel K
DK
Reller
L Barth
LB
Lee
Benjamin A
BA
Corey
G Ralph
GR
Fowler
Vance G
VG
D000368:Aged; D016470:Bacteremia / Q000382:microbiology*; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology*; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*