Polymicrobial Staphylococcus aureus bacteremia: Frequency, distinguishing characteristics and outcome

Staphylococcus aureus bacteremia (SAB) is usually monomicrobial (M-SAB). We reviewed SAB in adults (≥18 years old) over a 13 year-period and compared polymicrobial (P-SAB) and M-SAB. We encountered 93 P-SAB among 1537 SAB cases (6.1%). The source distribution was comparable; however, source-specified differences were apparent. P-SAB was noted in 12/58 (20.7%) necrotizing soft tissue infections/sacral decubiti and foot gangrene vs. 1/122 (0.8%) cellulitis/abscesses (P < 0.001), in 7/64 (10.9%) femoral intravascular catheters (IVC) vs.16/376 (4.3%) IVC in other sites (P = 0.03) and 15/134 (11.2%) healthcare-associated pneumonia (HAP) vs. 1/33 (3.0%) community-associated cases (P = 0.1). Methicillin-resistance frequency was similar but community-associated SCCmec types (IV/V) were infrequent (17.9% vs. 34.2%; P = 0.04). P-SAB was associated with higher mortality (50.5% vs. 24.2%; P < 0.001) across nearly all sources. In summary, P-SAB is infrequent, usually encountered in necrotizing soft tissue infections/decubiti, femoral IVC and possibly HAP. The actual incidence of S. aureus in these infections should be defined.