The clinical significance of concurrent Staphylococcus aureus bacteriuria in patients with S. aureus bacteremia

Objective: To investigate the clinical significance of Staphylococcus aureus bacteriuria (SABU) in patients with S. aureus bacteremia (SAB). Methods: We reviewed clinical data for 203 patients with SAB from January 2006 to July 2007 in a tertiary care hospital. In all patients, blood and urine cultures were performed concurrently. Among these cases, we compared clinical data between patients with and without SABU. To rule out mere colonization of S. aureus through indwelling urinary catheters (IDUC), we excluded patients using IDUC and then repeated the analyses. Results: Concurrent SABU was observed in 31 of 203 patients (15.3%). In patients without an IDUC, 25 of 128 (19.5%) were positive for SABU. Concurrent SABU was associated with methicillin-susceptibte, community-onset SAB, urinary tract obstruction/surgery, urinary tract infection, and vertebral osteomyelitis in patients with SAB. In patients without an IDUC, methicillin-susceptible SAB, urinary tract obstruction, urinary tract infection, and vertebral. osteomyelitis were associated with concurrent SABU. Finally, concurrent SABU was not associated with the severity and fatality of SAB. Conclusion: We found that SABU was not a result of colonization via IDUC, but instead is a frequent concomitant of SAB. In septic conditions, especially without IDUC, SABU may indicate SAB with foci of infection in the urinary tract or the vertebral column. (c) 2009 The British Infection Society. Published by Elsevier Ltd. All rights reserved.