AUTHOR=Karer Matthias , Kussmann Manuel , Ratzinger Franz , Obermueller Markus , Reischer Veronika , Winkler Heidemarie , Kriz Richard , Burgmann Heinz , Jilma Bernd , Lagler Heimo 

TITLE=Different Types of Coagulase Are Associated With 28-Day Mortality in Patients With Staphylococcus aureus Bloodstream Infections

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2020.00236

DOI=10.3389/fcimb.2020.00236

ISSN=2235-2988

ABSTRACT=<p><bold>Background:</bold><italic>Staphylococcus aureus (S. aureus)</italic>, a leading cause of bacteremia and infective endocarditis, exploits the human coagulation system by using a wide range of specific virulence factors. However, the impact of these host-pathogen interactions on the outcome of patients with <italic>Staphylococcus aureus</italic> bacteremia (SAB) remains unclear.</p><p><bold>Methods:</bold> A total of 178 patients with <italic>S. aureus</italic> bacteremia were included and analyzed regarding bacterial factors (<italic>coa</italic> gene size, <italic>vWbp, clfA, clfB, fnbA, fnbB, fib)</italic> and clinical parameters. A stepwise multivariate Cox regression model and a Partitioning Around Medoids (PAM) cluster algorithm were used for statistical analysis.</p><p><bold>Results:</bold> Patients' risk factors for 28-day mortality were creatinine (OR 1.49, <italic>p</italic> &lt; 0.001), age (OR 1.9, <italic>p</italic> &lt; 0.002), fibrinogen (OR 0.44, <italic>p</italic> &lt; 0.004), albumin (OR 0.63, <italic>p</italic> &lt; 0.02), hemoglobin (OR 0.59, <italic>p</italic> &lt; 0.03), and CRP (OR 1.72, <italic>p</italic> &lt; 0.04). Five distinct bacterial clusters with different mortality rates were unveiled, whereof two showed a 2-fold increased mortality and an accumulation of specific coagulase gene sizes, 547-base pairs and 660-base pairs.</p><p><bold>Conclusions:</bold> Based on the data obtained in the present study an association of coagulase gene size and <italic>fib</italic> regarding 28-day mortality was observed in patients with <italic>S. aureus</italic> bloodstream infections. Further animal and prospective clinical studies are needed to confirm our preliminary findings.</p>