title: Low-Dose Acetylsalicylic Acid Treatment and Impact on Short-Term Mortality in Staphylococcus aureus Bloodstream Infection: A Propensity Score-Matched Cohort Study.
abstract: OBJECTIVE
  Staphylococcus aureus bloodstream infection is associated with considerable mortality. Experimental models suggest a direct antistaphylococcal effect of acetylsalicylic acid, but evidence from human studies is scarce. We aimed to estimate the effect of low-dose acetylsalicylic acid therapy on mortality in bloodstream infections caused by S. aureus compared with Escherichia coli.
  
  
  METHODS
  Retrospective cohort study based on observational data from 838 and 602 episodes of S. aureus and E. coli bloodstream infection, respectively.
  
  
  METHODS
  Swiss tertiary referral center.
  
  
  METHODS
  Adult patients with S. aureus and E. coli bloodstream infection, respectively, categorized according to low-dose acetylsalicylic acid therapy as outpatient or inpatient before bacteremia.
  
  
  METHODS
  None.
  
  
  RESULTS
  Thirty-day all-cause mortality was analyzed in a total of 314 propensity score-matched S. aureus bloodstream infection and in 268 E. coli bloodstream infection patients, respectively (1:1 match of low-dose acetylsalicylic acid users and nonusers). S. aureus bloodstream infection cases and controls were equally matched for relevant confounders except treatment with statins, which was strongly associated with a low-dose acetylsalicylic acid use (p < 0.001). At day 30, 12.1% of cases and 27.4% of controls had died (hazard ratio, 0.40; p < 0.001). Low-dose acetylsalicylic acid use was associated with a reduced 30-day all-cause mortality in multivariate analysis (hazard ratio, 0.38; 95% CI, 0.21-0.69; p = 0.001) of matched patients and also of the entire cohort (n = 689) after adjustment for the propensity score (hazard ratio, 0.58, 95% CI, 0.34-0.98; p = 0.04). In contrast, low-dose acetylsalicylic acid use was not associated with the primary endpoint in patients with E. coli bloodstream infection (hazard ratio, 0.78; 95% CI, 0.40-1.55; p = 0.8).
  
  
  CONCLUSIONS
  Low-dose acetylsalicylic acid at the time of bloodstream infection was strongly associated with a reduced short-term mortality in patients with S. aureus bloodstream infection. Future studies are required to investigate if early low-dose acetylsalicylic acid is a suitable treatment in patients with S. aureus bloodstream infection.
authors.affiliation: 1Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland. 2Division of Clinical Microbiology, Departments of Medicine and Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Osthoff
authors.forename: Jan A
authors.initials: JA
authors.lastname: Sidler
authors.forename: Botond
authors.initials: B
authors.lastname: Lakatos
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Marc
authors.initials: M
authors.lastname: Dangel
authors.forename: Maja
authors.initials: M
authors.lastname: Weisser
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy / Q000517:prevention & control; D003428:Cross Infection / Q000401:mortality; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000097:blood / Q000188:drug therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013557:Switzerland
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin