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Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study

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Abstract

Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14–7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.

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Abbreviations

MSSA:

Methicillin-susceptible Staphylococcus aureus

MRSA:

Methicillin-resistant Staphylococcusaureus

CRB:

Catheter-related bacteremia

CB:

Complicated bacteremia

CCs:

Clonal complexes

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Authors and Affiliations

  1. Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital “12 de Octubre” (i+12), Universidad Complutense, Avenida de Córsoba, s/n, 28041, Madrid, Spain

    R. San-Juan, A. Lalueza, E. Resino-Foz, M. A. Morales-Cartagena, M. Fernández-Ruiz, F. López-Medrano & J. M. Aguado

  2. Department of Microbiology, University Hospital 12 de Octubre, Instituto de Investigación Hospital “12 de Octubre” (i+12), Universidad Complutense, Madrid, Spain

    D. Pérez-Montarelo, E. Viedma, M. Fernández de Mera, M. Á. Orellana & F. Chaves

  3. Department of Infectious Diseases, University Hospital Ramón y Cajal, Madrid, Spain

    J. Fortún

  4. Department of Microbiology, University Hospital Ramón y Cajal, Madrid, Spain

    E. Loza

  5. Department of Infectious Diseases, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain

    M. Pujol

  6. Department of Microbiology, University Hospital Bellvitge, Universidad de Barcelona-IDIBELL, Barcelona, Spain

    C. Ardanuy

  7. Department of Infectious Diseases, University Hospital Virgen de la Macarena, Seville, Spain

    I. Morales

  8. Department of Microbiology, University Hospital Virgen de la Macarena, Seville, Spain

    M. de Cueto

  9. Unit of Infectious Diseases, University Hospital La Paz, Madrid, Spain

    A. Rico

  10. Department of Microbiology, University Hospital La Paz, Madrid, Spain

    M. P. Romero

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  1. R. San-Juan
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  2. D. Pérez-Montarelo
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  3. E. Viedma
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  4. A. Lalueza
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  6. E. Loza
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  7. M. Pujol
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  8. C. Ardanuy
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  9. I. Morales
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  11. E. Resino-Foz
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  12. M. A. Morales-Cartagena
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  13. M. Fernández-Ruiz
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  14. A. Rico
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  16. M. Fernández de Mera
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  17. F. López-Medrano
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  18. M. Á. Orellana
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  19. J. M. Aguado
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  20. F. Chaves
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Corresponding author

Correspondence to R. San-Juan.

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Funding sources

This study was supported by the Health Research Fund (FIS), Department of Health, Spain; Agency for Health Technology Assessment and Research (PS11/01229, PI12/01205 and PI15/02013) and Plan Nacional de I+D+i 2008–2011 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), co-financed by European Development Regional Fund “A way to achieve Europe” ERDF. E.V. and M.F.R. hold clinical research contracts, “Rio Hortega” (CM15/00183) and “Juan Rodés” (JR14/00036), respectively, from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III.

Potential conflicts of interest

The authors of the present manuscript do not have other commercial or other associatiosn that might pose a conflict of interest (e.g., pharmaceutical stock ownership, consultancy, advisory board membership, or relevant patents). There was not any specific financial support for the research described in the present manuscript.

Ethical approval and informed consent

All included patients signed a study-specific informed consent. The study and the informed consent were approved by the Ethics Committee Institutional Research Boards in all the participating centers (Ethics Committee Institutional Research Board of Hospital Universitario 12 de Octubre, University Hospital Ramón y Cajal, University Hospital Bellvitge, University Hospital Virgen de la Macarena, and University Hospital La Paz, respectively).

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Highlights

• More than 30% of episodes of MSSA catheter-related bacteremia (MSSA-CRB) are complicated mainly with endovascular infection.

• The detection of specific genes and the identification of particular CCs could identify a subgroup of MSSA isolates more frequently related with the development of complicated bacteremia.

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San-Juan, R., Pérez-Montarelo, D., Viedma, E. et al. Pathogen-related factors affecting outcome of catheter-related bacteremia due to methicillin-susceptible Staphylococcus aureus in a Spanish multicenter study. Eur J Clin Microbiol Infect Dis 36, 1757–1765 (2017). https://doi.org/10.1007/s10096-017-2989-5

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