Staphylococcus aureus hitchhiking from colonization to bacteremia via Candida within ICU infection prevention studies: a proof of concept modelling

AbstractWhetherCandida within the patient microbiome drives the pathogenesis ofStaphylococcus aureus bacteremia, described as microbial hitchhiking, cannot be directly studied. Group-level observations from studies of various decontamination and non-decontamination-based ICU infection prevention interventions and studies without study interventions (observational  groups) collectively enable tests of this interaction within causal models. Candidate models of the propensity forStaphylococcus aureus bacteremia to arise with versus without various antibiotic, anti-septic, and antifungal exposures, each identified as singleton exposures, were tested using generalized structural equation modelling (GSEM) techniques withCandida andStaphylococcus aureus colonization appearing as latent variables within the models. Each model was tested by confrontation against blood and respiratory isolate data, obtained from 467 groups within 284 infection prevention studies. Introducing an interaction term betweenCandida colonization andStaphylococcus aureus colonization substantially improved GSEM model fit. Model-derived coefficients for singular exposure to anti-septic agents ( − 1.28; 95% confidence interval; − 2.05 to − 0.5), amphotericin (− 1.49; − 2.3 to − 0.67), and topical antibiotic prophylaxis (TAP; + 0.93; + 0.15 to + 1.71) as direct effects versusCandida colonization were similar in magnitude but contrary in direction. By contrast, the coef...
Source: European Journal of Clinical Microbiology and Infectious Diseases - Category: Microbiology Source Type: research