Search

Background: Staphylococcus aureus is an uncommon cause of community-acquired bacterial meningitis. We aimed to describe patients with this disease. Methods: We evaluated clinical characteristics and outcome of adults with community-acquired S. aureus meningitis from prospective nationwide cohort studies from Denmark (2015-2020) and the Netherlands (2006-2021). Whole genome sequencing of S. aureus isolates was performed to evaluate the potential association between clonal complex and clinical characteristics. Results: We evaluated 111 episodes of community-acquired S. aureus meningitis: 65 from Denmark and 46 from the Netherlands. The median age was 66 years (interquartile range [IQR] 50-74) and 43 of 111 patients were female (39%). Concomitant infectious foci were found in 95 of 107 patients (89%), most commonly endocarditis (53 of 109 [49%]) and spondylodiscitis (43 of 109 [39%]). The triad of neck stiffness, altered mental status (Glasgow Coma Scale score

OBJECTIVES: An association between infection and arterial thromboembolic events (ATE) has been suggested. Here we examined the risk of myocardial infarction (MI), stroke and other ATE after Staphylococcus aureus bacteremia (SAB).METHODS: Danish register-based nation-wide observational cohort study between 1995 and 2008 with matched control subjects from the general population.RESULTS: Within a year, 278 of 15669 SAB patients and 2570 of 156690 controls developed MI, stroke or another ATE. The incidence rates among SAB patients were highest within the first 30 days and decreased over a year. The adjusted relative risk of MI, stroke and other ATE during the first 30 days after SAB in patients compared to controls were 2.2 (95% CI: 1.6-3.1), 5.5 (95% CI: 3.8-8.3) and 15.5 (95% CI: 6.9-35), respectively. Compared to controls, the increased adjusted relative risk persisted for 30 days for MI, 180 days for stroke and one year for other ATE. Increasing age, hypertension, atrial flutter/fibrillation, prior ATE and endocarditis in SAB patients were associated with an increased risk of ATE.CONCLUSIONS: SAB was associated with a short-term increased risk of ATE that persisted longer dependent on type of event. Studies are warranted to investigate treatment strategies to diminish ATE after SAB.

Summary Background Data on risk factors and rates of reinfection associated with Staphylococcus aureus bacteraemia (SAB) are sparse. Methods We conducted a nationwide cohort study of cases of SAB diagnosed between 1995 and 2008. Reinfection was defined as an episode of SAB more than 90 days after the initial episode of SAB. Comorbidity was evaluated by the Charlson Comorbidity Index (CCI). Cox proportional hazards modelling was used to estimate hazard rates (HR). Results Of 10,891 eligible patients, 774 (7.1%) experienced reinfection a median of 458 days (range 90–5021 days) after their primary SAB episode corresponding to a reinfection rate of 1459 (95% confidence interval (CI): 1357–1562) per 100,000 personyears. In multivariate analysis, sex, origin, a vascular or peritoneal device, endocarditis and comorbidity were associated with reinfection. The association was more than two-fold higher among patients in dialysis and for patients with severe comorbidity (CCI≥2). HIV infection (Hazard ratio (HR) 6.18, 95% CI: 4.17–9.16), renal disease (HR 3.92, 95% CI: 3.22–4.78), diabetes with complications (HR 2.11, 95% CI: 1.69–2.62), diabetes without complications (HR 1.61, 95% CI: 1.34–1.93), mild (HR: 1.94, 95% CI: 1.36–2.76) and severe liver disease (HR 2.08, 95% CI: 1.08–4.03), peptic ulcer (HR 1.33, 95% CI: 1.03–1.72), and paraplegia (HR 2.15, 95% CI: 1.02–4.54) were each associated with an increased risk of reinfection. Conclusions Patients with previous SAB have a 60-fold higher risk of SAB compared to the general population. Patients with HIV infection, renal disease, diabetes, liver disease, peptic ulcer and paraplegia had the highest rates of reinfection.

The publisher would like to apologise for any inconvenience caused. Abstract Objectives: To determine the long-term mortality and the causes of death after Staphylococcus aureus spondylodiscitis. Methods: Nationwide, population-based cohort study using national registries of adults diagnosed with nonpostoperative S. aureus spondylodiscitis from 1994e2009 and alive 1 year after diagnosis (n Z 313). A comparison cohort from the background population individually matched on sex and age was identified (n Z 1565). KaplaneMeier survival curves were constructed and Poisson regression analyses used to estimate mortality rate ratios (MRR) adjusted for comorbidity. Results: 88 patients (28.1%) and 267 individuals from the population-based comparison cohort (17.1%) died. Un-adjusted MRR for S. aureus spondylodiscitis patients was 1.77 (95% CI, 1.39e2.25) and 1.32 (95% CI, 1.02e1.71) after adjustment for comorbidity. We observed increased mortality due to infectious (MRR 8.57; 95% CI, 2.80e26.20), endocrine (MRR 3.57; 95% CI, 1.01e12.66), cardiovascular (MRR 1.59; 95% CI, 1.02e2.49), gastrointestinal (MRR 3.21; 95% CI, 1.17e8.84) and alcohol and drug abuse-related (MRR 10.71; 95% CI, 3.23e35.58) diseases. Conclusions: Patients diagnosed with S. aureus spondylodiscitis have substantially increased long-term mortality, mainly due to comorbidity. To improve survival after S. aureus spondylodiscitis these patients should be screened for comorbidity and substance abuse predisposing to the disease.