title: Staphylococcus aureus Bloodstream Infection and Endocarditis--A Prospective Cohort Study.
abstract: OBJECTIVE
  To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).
  
  
  METHODS
  All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.
  
  
  RESULTS
  SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).
  
  
  CONCLUSIONS
  SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.
authors.affiliation: Maladies infectieuses, CHU de Montpellier, UMI 233 Université Montpellier 1, Institut de Recherche pour le Développement, Montpellier, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Le Moing
authors.affiliation: Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, INSERM, CIC-EC, CIE6, CHU Nancy, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.affiliation: CHU de Nancy, Nancy, France.
authors.forename: Thanh
authors.initials: T
authors.lastname: Doco-Lecompte
authors.affiliation: Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
authors.affiliation: CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Piroth
authors.affiliation: UMR CNRS 6249 Chrono-environnement, Université de Franche-Comté, CHU de Besançon, Besançon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chirouze
authors.affiliation: Hôpital Pontchaillou, INSERM U835, Faculté de Médecine, Université Rennes 1, IFR140, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tattevin
authors.affiliation: CHU Carémeau, INSERM U1047, Université Montpellier 1, Nîmes, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lavigne
authors.affiliation: Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, INSERM, CIC-EC, CIE6, CHU Nancy, Nancy, France.
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Erpelding
authors.affiliation: Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre, Guadeloupe, Service des maladies infectieuses, CHU, Pointe-à-Pitre, Guadeloupe, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.affiliation: Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Centre International de Recherche en Infectiologie, INSERM U1111, Université Lyon 1, CNRS, UMR 5308, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Vandenesch
authors.affiliation: Université Paris Diderot, INSERM, UMR 1137, CIC 1425, AP-HP, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Duval
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000097:blood / Q000382:microbiology / Q000401:mortality; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000097:blood / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D013211:Staphylococcus aureus