Jesper Smit1,2,3, Siegbert R Rieg4, Andreas F Wendel5, Winfried V Kern4, Harald Seifert6,7, Henrik C Schønheyder1,8, Achim J Kaasch9. 1. Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark. 2. Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark. 3. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 4. Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, University of Freiburg, Freiburg im Breisgau, Germany. 5. Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University, Düsseldorf, Germany. 6. Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany. 7. German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany. 8. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 9. Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University, Düsseldorf, Germany. Achim.Kaasch@hhu.de.
Abstract
PURPOSE: Data on the systemic dissemination in Staphylococcus aureus bloodstream infection (SAB) remain sparse. We investigated the timing and the sequence of clinical symptoms, diagnostic confirmation, and occurrence of multiple infective foci in relation to three major infective foci. METHODS: From 2006 to 2011, all adult patients with first-time SAB in Cologne and Freiburg, Germany were followed prospectively. The study was restricted to patients with short-term central venous catheter (CVC)-related SAB, vertebral osteomyelitis (VO), and infective endocarditis (IE). The collection date of the first positive blood culture was used as reference point for determining time to onset of clinical symptoms, microbiological findings, imaging results compatible with focal infection, and occurrence of additional infective foci. RESULTS: We included 266 patients with first-time SAB. Among patients with CVC-related SAB, clinical onset, collection of the first positive blood culture, and microbiological confirmation almost coincided. In contrast, among patients with VO or IE, the onset of clinical symptoms most often preceded the collection of the first positive blood culture, and imaging and microbiological confirmation were most frequently obtained subsequent to the SAB diagnosis. CVC-related SAB was infrequently associated with further foci (n = 15/15.5%). Conversely, more than one infective focus was observed in 44 (56.4%) patient with VO and 68 (64.8%) patients with IE. CONCLUSIONS: The sequence of clinical symptoms, diagnostic confirmation, and occurrence of multiple infective foci varied considerably with different infective foci in SAB. Based on these results, we propose a pragmatic and evidence-based terminology for the clinical course of SAB and suggest the terms "portal of entry", "infective focus", "multiple infective foci", and "dominant infective focus".
PURPOSE: Data on the systemic dissemination in Staphylococcus aureus bloodstream infection (SAB) remain sparse. We investigated the timing and the sequence of clinical symptoms, diagnostic confirmation, and occurrence of multiple infective foci in relation to three major infective foci. METHODS: From 2006 to 2011, all adult patients with first-time SAB in Cologne and Freiburg, Germany were followed prospectively. The study was restricted to patients with short-term central venous catheter (CVC)-related SAB, vertebral osteomyelitis (VO), and infective endocarditis (IE). The collection date of the first positive blood culture was used as reference point for determining time to onset of clinical symptoms, microbiological findings, imaging results compatible with focal infection, and occurrence of additional infective foci. RESULTS: We included 266 patients with first-time SAB. Among patients with CVC-related SAB, clinical onset, collection of the first positive blood culture, and microbiological confirmation almost coincided. In contrast, among patients with VO or IE, the onset of clinical symptoms most often preceded the collection of the first positive blood culture, and imaging and microbiological confirmation were most frequently obtained subsequent to the SAB diagnosis. CVC-related SAB was infrequently associated with further foci (n = 15/15.5%). Conversely, more than one infective focus was observed in 44 (56.4%) patient with VO and 68 (64.8%) patients with IE. CONCLUSIONS: The sequence of clinical symptoms, diagnostic confirmation, and occurrence of multiple infective foci varied considerably with different infective foci in SAB. Based on these results, we propose a pragmatic and evidence-based terminology for the clinical course of SAB and suggest the terms "portal of entry", "infective focus", "multiple infective foci", and "dominant infective focus".
Authors: M L H Cuijpers; F J Vos; C P Bleeker-Rovers; P F M Krabbe; P Pickkers; A P J van Dijk; G J A Wanten; P D Sturm; W J G Oyen; B J Kullberg Journal: Eur J Clin Microbiol Infect Dis Date: 2007-02 Impact factor: 3.267
Authors: Achim J Kaasch; Gavin Barlow; Jonathan D Edgeworth; Vance G Fowler; Martin Hellmich; Susan Hopkins; Winfried V Kern; Martin J Llewelyn; Siegbert Rieg; Jesús Rodriguez-Baño; Matthew Scarborough; Harald Seifert; Alex Soriano; Robert Tilley; M Estée Tőrők; Verena Weiß; A Peter R Wilson; Guy E Thwaites Journal: J Infect Date: 2013-11-16 Impact factor: 6.072