A matched prospective cohort study on Staphylococcus aureus and Escherichia coli bloodstream infections: extended perspectives beyond resistance.

ABSTRACT

BACKGROUND: Bacteremias caused by Staphylococcus aureus and Escherichia coli are among the most common bloodstream infections (BSIs) in adults. The aim of the study was to investigate risk factors for infection and clinical outcomes of bacteremias caused by S aureus or E coli. METHODS: We conducted a 1-year matched prospective cohort study including 150 patients with BSI caused by susceptible or resistant S aureus or E coli and 300 controls without BSI caused by these organisms. RESULTS: Of the 150 episodes of bacteremia, 37% were caused by S aureus (including 5 cases of methicillin-resistant S aureus [MRSA]) and 63% were caused by E coli (including 9 cases of extended-spectrum beta lactamase [ESBL]-producing E coli). We identified 4 independent risk factors for acquisition of S aureus bacteremia (emergency, peripheral or central vascular catheter, renal disease) and 6 risk factors for E coli bacteremia (emergency, peripheral or central vascular catheter, malignancy, cytoreductive or immunosuppressive therapy). Both types of bacteremia were associated with an increased length of hospital stay compared with controls. We observed a 5-fold increase in the 30-day mortality rate for bacteremias due to S aureus, and a 2-fold increase in BSI caused by E coli. The in-hospital mortality rate was increased by 6-fold for S aureus and by 3-fold for E coli. CONCLUSION: Longer hospitalization periods and increased mortality of bacteremias caused by S aureus or E coli, irrespective of susceptibility, implicate controlling for risk factors at an early stage.