ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Associations of baseline thrombocytopenia with definite infective endocarditis and isolated metastatic infection in Staphylococcus aureus bacteremia: a retrospective cohort study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeInfective endocarditis and metastatic infection are complications of Staphylococcus aureus bacteremia (SAB), but platelet-related processes may differ between these conditions. We evaluated associations of baseline thrombocytopenia with these complications, analyzed separately and as a composite.
methodsThis single-center retrospective cohort included SAB episodes during 2015-2024 at a tertiary hospital in Japan. Thrombocytopenia was defined as an index-date platelet count < 100,000/µL. Only definite infective endocarditis under the modified Duke criteria was counted. Metastatic infection was defined as a secondary distant focus distinct from the identified primary focus. Multivariable logistic regression assessed each complication and their composite; Cox regression assessed 30-day mortality.
resultsAmong 588 episodes, 141 (24%) had thrombocytopenia. Definite infective endocarditis occurred in 22 episodes and metastatic infection without endocarditis in 34 of 566 episodes. Thrombocytopenia was associated with definite infective endocarditis (adjusted odds ratio [aOR], 4.34; 95% confidence interval [CI], 1.76-10.71; P = 0.001). Estimates were imprecise for metastatic infection without endocarditis (aOR, 0.79; 95% CI, 0.32-1.99; P = 0.623) and the composite outcome (aOR, 1.66; 95% CI, 0.89-3.09; P = 0.112). Endocarditis frequency increased from 2.3% at platelet counts ≥ 150,000/µL to 14.3% at counts < 50,000/µL (P for trend < 0.001). Thrombocytopenia was also associated with 30-day mortality (adjusted hazard ratio, 2.49; 95% CI, 1.65-3.77; P < 0.001).
conclusionBaseline thrombocytopenia was associated with definite infective endocarditis, whereas the estimate for isolated metastatic infection was imprecise. Separate reporting may improve interpretation. Prospective validation with standardized diagnostic assessment and longitudinal platelet measurements is needed to establish clinical utility.
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