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Multicenter Study
. 2024 Jul 19;79(1):43-51.
doi: 10.1093/cid/ciae187.

Low-Risk Staphylococcus aureus Bacteremia Patients Do Not Require Routine Diagnostic Imaging: A Multicenter, Retrospective, Cohort Study

Marianne M C Hendriks  1 , Kris S A Schweren  1 , Ayden Kleij  2 , Marvin A H Berrevoets  2 , Emma de Jong  3 , Peter van Wijngaarden  3 , Heidi S M Ammerlaan  4 , Anja Vos  5 , Sander van Assen  5 , Kitty Slieker  6 , Jet H Gisolf  7 , Mihai G Netea  1   8 , Jaap Ten Oever  1 , Ilse J E Kouijzer  1
Affiliations
Multicenter Study

Low-Risk Staphylococcus aureus Bacteremia Patients Do Not Require Routine Diagnostic Imaging: A Multicenter, Retrospective, Cohort Study

Marianne M C Hendriks et al. Clin Infect Dis. .

Abstract

Background: Stratification to categorize patients with Staphylococcus aureus bacteremia (SAB) as low or high risk for metastatic infection may direct diagnostic evaluation and enable personalized management. We investigated the frequency of metastatic infections in low-risk SAB patients, their clinical relevance, and whether omission of routine imaging is associated with worse outcomes.

Methods: We performed a retrospective cohort study at 7 Dutch hospitals among adult patients with low-risk SAB, defined as hospital-acquired infection without treatment delay, absence of prosthetic material, short duration of bacteremia, and rapid defervescence. Primary outcome was the proportion of patients whose treatment plan changed due to detected metastatic infections, as evaluated by both actual therapy administered and by linking a adjudicated diagnosis to guideline-recommended treatment. Secondary outcomes were 90-day relapse-free survival and factors associated with the performance of diagnostic imaging.

Results: Of 377 patients included, 298 (79%) underwent diagnostic imaging. In 15 of these 298 patients (5.0%), imaging findings during patient admission had been interpreted as metastatic infections that should extend treatment. Using the final adjudicated diagnosis, 4 patients (1.3%) had clinically relevant metastatic infection. In a multilevel multivariable logistic regression analysis, 90-day relapse-free survival was similar between patients without imaging and those who underwent imaging (81.0% versus 83.6%; adjusted odds ratio, 0.749; 95% confidence interval, .373-1.504).

Conclusions: Our study advocates risk stratification for the management of SAB patients. Prerequisites are follow-up blood cultures, bedside infectious diseases consultation, and a critical review of disease evolution. Using this approach, routine imaging could be omitted in low-risk patients.

Keywords: Staphylococcus aureus; bacteremia; diagnostics; low risk; risk stratification.

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Conflict of interest statement

Potential conflicts of interest. The 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.
Flowchart of patient inclusion. Abbreviation: SAB, Staphylococcus aureus bacteremia.
See this image and copyright information in PMC

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