Clinical characteristics and outcomes of Staphylococcus aureus bacteremia from a biliary source
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ORIGINAL ARTICLE
Clinical characteristics and outcomes of Staphylococcus aureus bacteremia from a biliary source Eunmi Yang 1 & Jeongsoo Lee 1 & Hyeonji Seo 1 & Hyemin Chung 1 & Sang Hyun Ra 1 & Heungsup Sung 2 & Mi-Na Kim 2 & Jiwon Jung 1 & Min Jae Kim 1 & Sung-Han Kim 1 & Sang-Oh Lee 1 & Sang-Ho Choi 1 & Jun Hee Woo 1 & Yang Soo Kim 1 & Yong Pil Chong 1 Received: 8 January 2020 / Accepted: 2 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Staphylococcus aureus is a virulent gram-positive organism, which rarely involves the biliary tract. This study aimed to analyze the clinical characteristics and outcomes of S. aureus bacteremia (SAB) originating from the biliary tract by comparing them with those of catheter-related SAB and biliary Klebsiella pneumoniae bacteremia. A matched case-control study within a prospective observational cohort of patients with SAB was conducted. Biliary SAB was defined as the isolation of S. aureus from blood cultures with symptoms and signs of biliary infection. Biliary SAB patients were matched (1:3) with the control groups: patients with catheter-related SAB and biliary Klebsiella pneumoniae bacteremia. Out of 1818 patients with SAB enrolled in the cohort, 42 (2%) had biliary SAB. Majority of these patients had solid tumors involving the pancreaticobiliary tract or liver, biliary drainage stent, and/or recent broad-spectrum antibiotic exposure. Patients with biliary SAB were more likely to have communityonset SAB, solid tumors, and lower APACHE II score than those with catheter-related SAB. They were less likely to have community-acquired infection and solid tumors and more likely to have lower Charlson comorbidity index and higher APACHE II score as compared with biliary K. pneumoniae bacteremia. The 12-week mortality in the biliary SAB group was higher than those in other control groups (60% vs. 20% and 14%). After adjusting for confounding factors, biliary SAB was independently associated with higher mortality. Biliary SAB is relatively rare. When it is clinically suspected, early aggressive treatment should be considered due to high mortality. Keywords Staphylococcus aureus . Bacteremia . Biliary infection . Cholangitis
Introduction Staphylococcus aureus is a human commensal and leading cause of serious bacterial infections [1]. S. aureus can cause various types of infections, such as bacteremia, endocarditis, osteomyelitis, septic arthritis, skin and soft tissue infection, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10096-020-03940-6) contains supplementary material, which is available to authorized users. * Yong Pil Chong [email protected] 1
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro43-gil, Songpa-gu, Seoul 05505, Republic of Korea
2
Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
and pneumonia. However, it rarely involves the biliary tract, and
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