Clin Infect Dis. 2020 Aug 14:ciaa1197. doi: 10.1093/cid/ciaa1197. Online ahead of print.
BACKGROUND: The relationship between acute myocardial infarction and infection was recognised in the early 20th century during influenza epidemics. Most recently, a case control and self-control design study have identified an association between Staphylococcus aureus infection and acute myocardial infarction. We assessed the association of Community acquired Staphylococcus aureus bloodstream infection (CA-SABSI) with myocardial infarction in the 365 days following blood culture.
METHODS: This was a cohort study design assessing incidence of myocardial infarction 365 days after blood culture for Staphylococcus aureus. Culture negative patients had blood cultures collected at hospital attendance and were matched to the CA-SABSI by sex, 5 year age strata and year of culture collection. Pathology information was linked to hospital administrative data and index of relative socio-economic advantage and disadvantage (ISRAD).
RESULTS: The study included 5157 CA-SABSI cases matched to 10146 blood culture negative cases. Mortality was significantly higher in the CA-SABSI group at 10.9% (562/5157) compared to culture negative cases, 5·1% (521/10146) at 365 days (p &0·0001). In the seven days following index blood culture, excluding recurrent events, there were 89 (1·7%) and 37 (0·4%) myocardial infarction diagnoses in the CA-SABSI and culture negative cases respectively.Multivariable logistic regression for myocardial infarction demonstrated CA-SABSI remained significantly associated after adjusting for known risk factors (OR 5, 3·3 to 7·5, p &0·0001). Myocardial infarctions occurring in this short term risk period were associated with all-cause mortality in Cox proportional hazard model (OR 1·7, 95% CI 1·2-2·4, p&0<005).
CONCLUSIONS: CA-SABSI is associated with an increased short term risk of myocardial infarction which is associated with subsequent mortality.