Predictors for true Actinomyces bacteraemia.

Abstract

Introduction. Actinomyces species colonizing the human oropharynx and gastrointestinal and urogenital tract are associated with a wide range of infections. The isolation of Actinomyces spp. from sterile clinical samples is regarded as significant.Gap Statement. Increased use of advanced diagnostics has caused an increased detection of Actinomyces in the bloodstream, the clinical significance of which is unclear.Aim. To investigate the clinical factors associated with true Actinomyces bacteraemia that could aid in differentiating it from transient Actinomyces bacteraemia.Methodology. We conducted a retrospective study of all inpatients with Actinomyces bacteraemia from two tertiary care centres from 1 January 2006 to 26 September 2021. Data were collected on demographic and clinical characteristics, comorbidities, primary source of infection and outcomes. True bacteraemia was defined as Actinomyces bacteraemia with systemic manifestations of infection.Results. A total of 82 cases of positive blood cultures were identified, of which 33 (40.2%) were true bacteraemia, based on clinical criteria. Patients with true bacteraemia were more likely to be older (P=0.007), have chronic skin ulcers (P<0.001), have a history of central line placement within 3 months of their presentation (P=0.04), have had a fever within 72 h of admission (P=0.05) and have presented with an abscess (P<0.001) compared with patients with transient bacteraemia. True bacteraemia was more likely to be associated with positive tissue cultures (P=0.02) and an infectious disease consultation than transient bacteraemia. Skin and soft tissue (27.3%) was the most common source followed by intra-abdominal (21.1%). Among true bacteraemia, the most common species was Actinomyces meyeri with a ratio of 1:8 (transient versus true bacteraemia). All-cause mortality was 30.3% in patients with true bacteraemia compared with 4.1% in patients with transient bacteraemia (P<0.001).Conclusion. Predictors of true Actinomyces bacteraemia included older age, fever within 72 h of admission, presence of abscess and chronic skin disease. Actinomyces species exhibit varying degrees of invasiveness, with A. meyeri potentially showing higher invasive potential. Better awareness and involvement of infectious disease specialists is recommended in determining the clinical significance of transient Actinomyces bacteraemia and can help implement antibiotic stewardship and patient safety and improve outcomes. Further research will help to identify the true importance of these isolates.