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. 2023 Apr 3;76(7):1260-1265.
doi: 10.1093/cid/ciac893.

Black and White Patients With Staphylococcus aureus Bacteremia Have Similar Outcomes but Different Risk Factors

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Black and White Patients With Staphylococcus aureus Bacteremia Have Similar Outcomes but Different Risk Factors

Felicia Ruffin et al. Clin Infect Dis. .

Abstract

Background: Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear.

Methods: We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factors independently associated with the outcomes.

Results: Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (median, 56 years vs 63 years; P < .001) and had higher rates of diabetes (47.5% vs 34.5%, P < .001), hemodialysis dependence (40.0% vs 7.3%, P < .001), and human immunodeficiency virus (6.4% vs 0.6%, P < .001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%, P = .020), including the USA300 hypervirulent clone (11.5% vs 8.4%, P = .007). White patients had higher rates of corticosteroid use (22.4% vs 15.8%, P < .0001) and surgery in the preceding 30 days (28.1% vs 18.7%, P < .001). Although the median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (median APS, 9; interquartile range [IQR], 5-14 vs median APS, 7; IQR, 4-12; P < .001), race was not associated with 90-day mortality (risk ratio, 1.02; 95% confidence interval, .93-1.12), and rates of metastatic infection were lower among Black patients (37.2% vs 41.3% White, P = .029).

Conclusions: Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar.

Keywords: Staphylococcus aureus bacteremia; bacterial genotype; hemodialysis; mortality; racial disparities.

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Conflict of interest statement

Potential conflicts of interest. V. G. F. reports personal consulting fees from Novartis, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co, MedImmune, Bayer, Basilea, Affinergy, Janssen, Contrafect, Regeneron, Destiny, Amphliphi Biosciences, Integrated Biotherapeutics; C3J, Armata, Valanbio, Akagera, Aridis, Roche, and Pfizer; grants from NIH, MedImmune, Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Merck, Medical Biosurfaces, Locus, Affinergy, Contrafect, Karius, Genentech, Regeneron, Deep Blue, Basilea, Janssen; royalties from UpToDate; stock options from Valanbio and ArcBio; honoraria from the Infectious Diseases Society of America for service as associate editor of Clinical Infectious Diseases (2017–2022); a patent on sepsis diagnostics pending; and support from Contrafect to present phase 2 data at 2019 European Congress of Clinical Microbiology & Infectious Diseases. All remaining authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Distribution of spa-clonal complexes of Staphylococcus aureus bloodstream isolates among Black and White patients. aIncludes singletons and spa-CCs composing <1% of the total population, bIncludes isolates deemed nontypeable (n = 87), no alignment (n = 12), or excluded (spa region with <5 repeats, n = 66), cIsolates for which genotyping was not performed.
Figure 2.
Figure 2.
Log binomial model predicting 90-day mortality in patients with Staphylococcus aureus bacteremia. Abbreviations: CC, clonal complex; CI, confidence interval; MRSA, Methicillin-resistant Staphylococcus aureus. aReference: endovascular source, bReference: community-acquired, cReference: non-spa-CC08, dPositive blood cultures >5 days, eReference: white race, fReference: Age >65 years.

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