Documented Dental Disease in Patients With Staphylococcus aureus Bacteremia
- 1Penn State University
Abstract
ImportanceClinicians often look for a dental source in Staphylococcus aureus bacteremia (SAB), but how often dental disease is found, compared with other bacteremias, is unclear.
ObjectiveTo compare documented dental disease in adults with SAB, Escherichia coli bacteremia, and a general population cohort.
Design, Setting, and ParticipantsRetrospective cohort study in the Protege database of 48 975 adults with bacteremia from January 1, 2015, through December 31, 2023, assigned by earliest in-window organism, and 81 945 general population adults.
ExposuresSAB, with E coli bacteremia as the primary comparator and the general population as the secondary comparator.
Main Outcomes and MeasuresDocumented dental disease from 7 days before through 30 days after index, defined by a qualifying dental procedure or disease-specific note text and adjusted for age, sex, race, and documentation intensity.
ResultsDental disease occurred in 528 of 16 435 patients with SAB (3.21%) and 179 of 24 942 patients with E coli bacteremia (0.72%). The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). By the pathology-only definition, disease occurred in 517 patients with SAB (3.15%) and 399 general population patients (0.49%). The adjusted odds ratio was 3.71 (95% CI, 3.08 to 4.46). Within SAB, rates were highest with prior infective endocarditis (9.8%), opioid use disorder (6.2%), injection drug use (5.3%), and prosthetic valve (5.0%). Prevalence ranged from 0.49% in the general population to 7.98% in other streptococcal bacteremia. Of 437 patients with SAB and an assignable first finding date, 333 (76.2%) had the finding after the index date.
Conclusions and RelevanceDental disease was documented more often in SAB than in E coli bacteremia after adjustment. Most findings were first recorded after bacteremia was recognized, during SAB evaluation. These data do not show that dental disease caused the bacteremia.
Key PointsO_ST_ABSQuestionC_ST_ABSIs dental disease documented more often in Staphylococcus aureus bacteremia (SAB) than in Escherichia coli bacteremia or a general-population cohort?
FindingsIn 16 435 adults with SAB and 24 942 with E coli bacteremia, documented dental disease occurred in 3.21% and 0.72%, respectively. The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). Among SAB patients with an assignable date, 76.2% had the first finding after the index date.
MeaningDental disease was documented more often with SAB than with a nonoral bacteremia. This supports focused oral assessment during source evaluation, but does not establish the mouth as the source.
Related
- Cefazolin for Methicillin-Susceptible Staphylococcus aureus Bacteremia
- Acute Transverse Myelitis and Cervical Spondylodiscitis Associated With Staphylococcus aureus Bacteremia: A Case Report
- From Heart Murmur to Bone Involvement: Tricuspid Valve Endocarditis With First-Rib Osteomyelitis in a Patient With Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia
- Documented Dry Eye Disease in Patients Receiving Topical Antiglaucoma Therapy: Associations with Treatment Characteristics
- Persistent Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia Due to Pelvic Pyomyositis and Abscesses With Extension Through the Sciatic Notch: A Case Report.
BibTeX
@misc{ssentongo2026documented,
title = {{Documented Dental Disease in Patients With Staphylococcus aureus Bacteremia}},
author = {P. Ssentongo and W. F. Peacock and J. C. Durieux and C. Colovos},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.18.26365833},
url = {https://www.medrxiv.org/content/10.64898/2026.10.18.26365833v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Documented Dental Disease in Patients With Staphylococcus aureus Bacteremia
AU - P. Ssentongo
AU - W. F. Peacock
AU - J. C. Durieux
AU - C. Colovos
PY - 2026
DA - 2026/10/18
PB - medRxiv
DO - 10.64898/2026.10.18.26365833
UR - https://www.medrxiv.org/content/10.64898/2026.10.18.26365833v1
AB - ImportanceClinicians often look for a dental source in Staphylococcus aureus bacteremia (SAB), but how often dental disease is found, compared with other bacteremias, is unclear. ObjectiveTo compare documented dental disease in adults with SAB, Escherichia coli bacteremia, and a general population cohort. Design, Setting, and ParticipantsRetrospective cohort study in the Protege database of 48 975 adults with bacteremia from January 1, 2015, through December 31, 2023, assigned by earliest in-window organism, and 81 945 general population adults. ExposuresSAB, with E coli bacteremia as the primary comparator and the general population as the secondary comparator. Main Outcomes and MeasuresDocumented dental disease from 7 days before through 30 days after index, defined by a qualifying dental procedure or disease-specific note text and adjusted for age, sex, race, and documentation intensity. ResultsDental disease occurred in 528 of 16 435 patients with SAB (3.21%) and 179 of 24 942 patients with E coli bacteremia (0.72%). The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). By the pathology-only definition, disease occurred in 517 patients with SAB (3.15%) and 399 general population patients (0.49%). The adjusted odds ratio was 3.71 (95% CI, 3.08 to 4.46). Within SAB, rates were highest with prior infective endocarditis (9.8%), opioid use disorder (6.2%), injection drug use (5.3%), and prosthetic valve (5.0%). Prevalence ranged from 0.49% in the general population to 7.98% in other streptococcal bacteremia. Of 437 patients with SAB and an assignable first finding date, 333 (76.2%) had the finding after the index date. Conclusions and RelevanceDental disease was documented more often in SAB than in E coli bacteremia after adjustment. Most findings were first recorded after bacteremia was recognized, during SAB evaluation. These data do not show that dental disease caused the bacteremia. Key PointsO_ST_ABSQuestionC_ST_ABSIs dental disease documented more often in Staphylococcus aureus bacteremia (SAB) than in Escherichia coli bacteremia or a general-population cohort? FindingsIn 16 435 adults with SAB and 24 942 with E coli bacteremia, documented dental disease occurred in 3.21% and 0.72%, respectively. The adjusted odds ratio was 3.86 (95% CI, 3.23 to 4.63). Among SAB patients with an assignable date, 76.2% had the first finding after the index date. MeaningDental disease was documented more often with SAB than with a nonoral bacteremia. This supports focused oral assessment during source evaluation, but does not establish the mouth as the source.
ER -