Staphylococcus aureus is a virulent gram-positive organism, which rarely involves the biliary tract. This study aimed to analyze the clinical characteristics and outcomes of S. aureus bacteremia (SAB) originating from the biliary tract by comparing them with those of catheter-related SAB and biliary Klebsiella pneumoniae bacteremia. A matched case-control study within a prospective observational cohort of patients with SAB was conducted. Biliary SAB was defined as the isolation of S. aureus from blood cultures with symptoms and signs of biliary infection. Biliary SAB patients were matched (1:3) with the control groups: patients with catheter-related SAB and biliary Klebsiella pneumoniae bacteremia. Out of 1818 patients with SAB enrolled in the cohort, 42 (2%) had biliary SAB. Majority of these patients had solid tumors involving the pancreaticobiliary tract or liver, biliary drainage stent, and/or recent broad-spectrum antibiotic exposure. Patients with biliary SAB were more likely to have community-onset SAB, solid tumors, and lower APACHE II score than those with catheter-related SAB. They were less likely to have community-acquired infection and solid tumors and more likely to have lower Charlson comorbidity index and higher APACHE II score as compared with biliary K. pneumoniae bacteremia. The 12-week mortality in the biliary SAB group was higher than those in other control groups (60% vs. 20% and 14%). After adjusting for confounding factors, biliary SAB was independently associated with higher mortality. Biliary SAB is relatively rare. When it is clinically suspected, early aggressive treatment should be considered due to high mortality.

金黄色葡萄球菌是一种毒性革兰氏阳性生物，很少累及胆道。本研究旨在通过将其与与导管相关的SAB和胆汁性肺炎克雷伯菌进行比较，分析源自胆道的金黄色葡萄球菌菌血症（SAB）的临床特征和结局。在前瞻性观察性SAB患者队列中进行了匹配的病例对照研究。胆道SAB被定义为从具有症状和胆道感染迹象的血液培养物中分离出金黄色葡萄球菌。胆道SAB患者与对照组匹配（1：3）：导管相关SAB和胆汁性肺炎克雷伯菌患者菌血症。在该队列的1818名SAB患者中，有42名（2％）患有胆道SAB。这些患者大多数患有实体胰肿瘤，涉及胰胆道或肝脏，胆汁引流支架和/或近期广谱抗生素暴露。胆管SAB的患者比导管相关SAB的患者更有可能发生社区发作的SAB，实体瘤和APACHE II评分较低。与胆汁性肺炎克雷伯菌相比，他们不太可能发生社区获得性感染和实体瘤，更有可能具有较低的查尔森合并症指数和较高的APACHE II评分菌血症。胆道SAB组的12周死亡率高于其他对照组（60％比20％和14％）。调整混杂因素后，胆汁SAB独立与更高的死亡率相关。胆道SAB相对较少。当临床怀疑时，由于高死亡率，应考虑早期积极治疗。