Documented Dental Disease in Patients With Staphylococcus aureus Bacteremia

Importance Clinicians often look for a dental source in Staphylococcus aureus bacteremia (SAB), but how often dental disease is found, compared with other bacteremias, is unclear. Objective To compare documented dental disease in adults with SAB, Escherichia coli bacteremia, and a general population cohort. Design, Setting, and Participants Retrospective cohort study in the Protégé 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. Exposures SAB, with E coli bacteremia as the primary comparator and the general population as the secondary comparator. Main Outcomes and Measures Documented 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. Results Dental 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 Relevance Dental 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 Points Question Is dental disease documented more often in Staphylococcus aureus bacteremia (SAB) than in Escherichia coli bacteremia or a general-population cohort? Findings In 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. Meaning Dental 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.