Rationalizing Heterogeneity in Staphylococcus aureus Bacteremia: Current Progress and Future Goals

The Journal of Infectious Diseases, vol. 234, pp. e441–e451

Abstract

Clinical and biological heterogeneity in Staphylococcus aureus bacteremia (SAB) continue to pose significant challenges for the clinical management of individual patients and for research efforts. We contend that investigating SAB as a single disease is impeding the identification of beneficial therapeutic approaches. Recently, three data-driven approaches for patient stratification in SAB have been reported, using routinely available data to identify clinically distinct subphenotypes with differences in mortality, microbiologic outcomes, and response to adjunctive antimicrobial therapies (the Swets et al, FEN-AUREUS, and MRSA-GEIRAS-SEIMC studies). In this review, we compare the methodologies and findings from these studies, discuss their limitations, and identify goals for future research in this space. We expect that transformative advances in SAB management will only be achieved by addressing clinical and biological heterogeneity, enabling progress from observable clinical subphenotypes to mechanism-based endotypes defined by treatable traits.

Authors 9

1. Clark D Russell

   Western General Hospital · Centre for Inflammation Research · University of Edinburgh

   Affiliation as printed

   Baillie Gifford Pandemic Science Hub, Institute for Regeneration and Repair, The University of Edinburgh , Edinburgh ,

   Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh , Edinburgh ,

   Clinical Infection Research Group Edinburgh, Western General Hospital , Edinburgh ,

2. Sofía De la Villa

   Instituto de Salud Carlos III · Hospital General Universitario Gregorio Marañón · Centro de Investigación Biomédica en Red Enfermedades Infecciosas · Instituto de Investigación Sanitaria Gregorio Marañón

   Affiliation as printed

   Biomedical Research Networking Centre for Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,

   Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid/Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid ,

3. Maaike C. Swets

   Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Internal Medicine, Haaglanden Medical Center , The Hague ,

4. Annette C. Westgeest Aachen

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Leiden University Center for Infectious Diseases, Leiden University Medical Center, Leiden University , Leiden ,

5. Giulia Zumbo

   Hospital Universitario Virgen Macarena · Instituto de Biomedicina de Sevilla · Universidad de Sevilla

   Affiliation as printed

   Department of Medicine, University of Seville , Seville ,

   Division of Infectious Diseases and Microbiology, Virgen Macarena University Hospital , Seville ,

   Institute of Biomedicine of Seville (IBiS)/CSIC , Seville ,

6. Patricia Muñóz

   Hospital General Universitario Gregorio Marañón · Instituto de Investigación Sanitaria Gregorio Marañón

   Affiliation as printed

   Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid/Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) , Madrid ,

7. David Harold Dockrell

   Western General Hospital · Centre for Inflammation Research · University of Edinburgh

   Affiliation as printed

   Centre for Inflammation Research, Institute for Regeneration and Repair, The University of Edinburgh , Edinburgh ,

   Clinical Infection Research Group Edinburgh, Western General Hospital , Edinburgh ,

8. Vance G. Fowler

   Duke University · Duke Medical Center

   Affiliation as printed

   Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine , Durham, North Carolina ,

9. Belén Gutiérrez‐Gutiérrez

   Instituto de Salud Carlos III · Hospital Universitario Virgen Macarena · Instituto de Biomedicina de Sevilla · Centro de Investigación Biomédica en Red Enfermedades Infecciosas · Universidad de Sevilla

   Affiliation as printed

   Biomedical Research Networking Centre for Infectious Diseases (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,

   Department of Medicine, University of Seville , Seville ,

   Division of Infectious Diseases and Microbiology, Virgen Macarena University Hospital , Seville ,

   Institute of Biomedicine of Seville (IBiS)/CSIC , Seville ,