title: Microarray-based genotyping and clinical outcomes of Staphylococcus aureus bloodstream infection: an exploratory study.
abstract: The clinical course of Staphylococcus aureus bacteremia varies extensively. We sought to determine the relationship between genetic characteristics of the infecting pathogen and clinical outcomes in an exploratory study. In two study centers, 317 blood culture isolates were analyzed by DNA microarray and spa genotyping. By uni- and multivariate regression analyses associations of genotype data with 30-day all-cause mortality, severe sepsis/septic shock, disseminated disease, endocarditis, and osteoarticular infection were investigated. Univariate analysis showed significant association between S. aureus genes/gene-clusters or clonal complexes and clinical endpoints. For example CC15 was associated with 30-day mortality and CC22 with osteoarticular infection. In multivariate analysis methicillin resistance (mecA, OR 4.8 [1.43-16.06]) and the beta-lactamase-gene (bla, OR 3.12 [1.17-8.30]) remained independently associated with 30-day mortality. The presence of genes for enterotoxins (sed/sej/ser) was associated with endocarditis (OR 5.11 [1.14-18.62]). Host factors such as McCabe classification (OR 4.52 [2.09-9.79] for mortality), age (OR 1.06 [1.03-1.10] per year), and community-acquisition (OR 3.40 [1.31-8.81]) had a major influence on disease severity, dissemination and mortality. Individual genotypes and clonal complexes of S. aureus can only partially explain clinical features and outcomes of S. aureus bacteremia. Genotype-phenotype association studies need to include adjustments for host factors like age, comorbidity and community-acquisition.
authors: Department of Medicine, Center for Infectious Diseases and Travel Medicine and IFB-Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany. siegbert.rieg@uniklinik-freiburg.de
authors: Siegbert
authors: S
authors: Rieg
authors: Daniel
authors: D
authors: Jonas
authors: Achim J
authors: AJ
authors: Kaasch
authors: Christine
authors: C
authors: Porzelius
authors: Gabriele
authors: G
authors: Peyerl-Hoffmann
authors: Christian
authors: C
authors: Theilacker
authors: Marc-Fabian
authors: MF
authors: Küpper
authors: Christian
authors: C
authors: Schneider
authors: Harald
authors: H
authors: Seifert
authors: Winfried V
authors: WV
authors: Kern
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D001808:Blood Vessels / Q000382:microbiology; D001850:Bone Diseases, Infectious / Q000175:diagnosis / Q000382:microbiology; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D007592:Joint Diseases / Q000382:microbiology; D008297:Male; D020411:Oligonucleotide Array Sequence Analysis; D011379:Prognosis; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics* / Q000254:growth & development / Q000502:physiology*; D018523:Tropism / Q000235:genetics
references: Clin Microbiol Infect. 2008 Jun;14(6):534-45
references: 18373691
references: Clin Microbiol Infect. 2011 Jul;17(7):1020-6
references: 20977540
references: Arch Intern Med. 2003 Sep 22;163(17):2066-72
references: 14504120
references: J Bacteriol. 2006 Jan;188(2):669-76
references: 16385056
references: J Clin Invest. 2004 Dec;114(12):1732-40
references: 15599398
references: Curr Opin Infect Dis. 2010 Aug;23(4):346-58
references: 20592532
references: Infect Immun. 2002 Sep;70(9):4987-96
references: 12183545
references: J Clin Microbiol. 2007 Aug;45(8):2669-80
references: 17537946
references: PLoS One. 2011 Apr 26;6(4):e18673
references: 21541311
references: Clin Infect Dis. 2005 Sep 15;41(6):771-7
references: 16107972
references: J Bacteriol. 2003 Jun;185(11):3307-16
references: 12754228
references: J Infect Dis. 2012 Jun 15;205(12):1840-8
references: 22492857
references: J Infect. 2009 Oct;59(4):232-9
references: 19654021
references: Eur J Clin Microbiol Infect Dis. 2009 Sep;28(9):1159-65
references: 19434432
references: Clin Infect Dis. 2005 Mar 1;40(5):695-703
references: 15714415
references: J Infect Dis. 2005 Oct 1;192(7):1196-200
references: 16136462
references: Nat Rev Microbiol. 2012 Nov;10(11):791-7
references: 23070558
references: Clin Microbiol Infect. 2007 Nov;13(11):1131-3
references: 17727671
references: PLoS Med. 2010 Jan 12;7(1):e1000215
references: 20084094
references: J Infect Dis. 2007 Sep 1;196(5):738-47
references: 17674317
references: Infection. 2011 Jun;39(3):281-2
references: 21431340
references: J Infect Dis. 2011 Sep 1;204(5):704-13
references: 21844296
references: Eur J Clin Microbiol Infect Dis. 2010 Apr;29(4):457-63
references: 20186451
references: Clin Microbiol Rev. 2012 Apr;25(2):362-86
references: 22491776
references: Nat Rev Microbiol. 2009 Sep;7(9):629-41
references: 19680247
references: Clin Microbiol Infect. 2006 Apr;12(4):345-52
references: 16524411
references: J Clin Microbiol. 2010 Jan;48(1):292-4
references: 19846649
references: FEMS Immunol Med Microbiol. 2008 Jul;53(2):237-51
references: 18507678
references: Proteomics. 2010 Apr;10(8):1634-44
references: 20186749
references: J Infect Dis. 2009 Jan 15;199(2):201-8
references: 19086913