title: Risk factors for recurrence after Staphylococcus aureus bacteraemia. A retrospective matched case-control study.
abstract: OBJECTIVE
  We sought to identify risk factors for recurrence of Staphylococcus aureus bacteraemia (SAB) by auditing compliance with guidelines on its treatment in our hospital.
  
  
  METHODS
  We retrospectively identified patients over the preceding 8 years whose SAB had recurred, matching each to a control patient with non-recurrent SAB.
  
  
  RESULTS
  40/1870 patients with SAB had suffered recurrent disease (2.1%), 33 of whom were available for study. Where 2, 4 and 6 weeks of intravenous therapy were recommended, 78%, 29% and 25% of patients received it, and there was no association with recurrence. Glycopeptide use in patients with methicillin sensitive SAB (MSSA) was significantly associated with recurrence (p=0.015). Where the source of the bacteraemia was a peripheral venous catheter the odds of recurrence were less than where an SAB originated at another site (p=0.047). All patients with SAB in whom a central venous catheter was not removed suffered recurrence.
  
  
  CONCLUSIONS
  We found the recurrence rate after SAB was low despite poor compliance with guidelines on treatment duration. Glycopeptide therapy for MSSA bacteraemia was more likely to result in recurrent SAB than beta-lactam therapy. Recurrence was significantly less likely in patients where the source of the SAB was a peripheral line than in those with another source.
authors.affiliation: Department Microbiology and Infectious Disease, John Radcliffe Hospital, Oxford, OX3 9DU, UK. timothywalker77@gmail.com
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Walker
authors.forename: Ian C J W
authors.initials: IC
authors.lastname: Bowler
authors.forename: Philip
authors.initials: P
authors.lastname: Bejon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006020:Glycopeptides / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D047090:beta-Lactams