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1 March 2005

Volume 40, Number 5
Clinical Infectious Diseases 2005;40:695–703
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4005-0008$15.00
DOI: 10.1086/427806
MAJOR ARTICLE

Risk Factors For Hematogenous Complications of Intravascular Catheter–Associated Staphylococcus aureus Bacteremia

Vance G. Fowler, Jr.,1,3

Anita Justice,4

Catrin Moore,4

Daniel K. Benjamin, Jr.,2,3

Christopher W. Woods,1

Steven Campbell,1

L. Barth Reller,1

G. Ralph Corey,1

Nicholas P. J. Day,4 and

Sharon J. Peacock4

Departments of 1Medicine and 2Pediatrics and 3Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; and 4Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom

Background.The role of both host and pathogen characteristics in hematogenous seeding following Staphylococcus aureus bacteremia is incompletely understood.

Methods.Consecutive patients with intravascular catheter–associated Staphylococcus aureus bacteremia were prospectively recruited over a 91‐month period. The corresponding bloodstream isolates were examined for the presence of 35 putative virulence determinants. Patient and bacterial characteristics associated with the development of hematogenous complications (HCs) (i.e., septic arthritis, vertebral osteomyelitis, or endocarditis) were defined.

Results.HC occurred in 42 (13%) of 324 patients. Patient characteristics at diagnosis that were associated with HC included community onset (relative risk [RR], 2.25; 95% confidence interval [CI], 1.24–4.07; ), increased symptom duration (odds ratio for each day, 1.14; 95% CI, 1.06–1.2; ), presence of a long‐term intravascular catheter or noncatheter prosthesis (RR, 4.02; 95% CI, 1.74–9.27; ), hemodialysis dependence (RR, 3.84; 95% CI, 2.08–7.10; ), and higher APACHE II score ( ). Bacterial characteristics included sea (RR, 2.03; 95% CI, 1.16–3.55; ) and methicillin‐resistant S. aureus (MRSA) (RR, 2.09; 95% CI, 1.19–3.67; ). Subsequent failure to remove a catheter was also associated with HC (RR, 2.28; 95% CI, 1.22–4.27; ). On multivariable analysis, symptom duration, hemodialysis dependence, presence of a long‐term intravascular catheter or a noncatheter device, and infection with MRSA remained significantly associated with HC.

Conclusions.This investigation identifies 4 host‐ and pathogen‐related risk factors for hematogenous bacterial seeding and reaffirms the importance of prompt catheter removal.

Received 30 August 2004; accepted 22 October 2004; electronically published 4 February 2005.

Reprints or correspondence: Dr. Vance G. Fowler, Jr., Box 3281, Div. of Infectious Diseases, Duke Univ. Medical Center, Durham, NC 27710 ().

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