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Identifying the source of Staphylococcus aureus bacteremia (SAB) is essential for selecting appropriate treatment and preventing complications.
In selected patients with initially unknown-source Staphylococcus aureus bacteremia, dental consultation is beneficial to identify suspected oral infection foci and improve source investigation.
Identifying the source of Staphylococcus aureus bacteremia (SAB) is essential for selecting appropriate treatment and preventing complications. However, the contribution of dental consultation to source investigation, particularly in patients with initially unknown-source SAB, remains poorly understood. This study explored the utilization, timing, diagnostic yield, and clinical impact of dental consultation, along with associated oral findings and treatment recommendations.
This exploratory retrospective single-center cohort study included 72 adults hospitalized with blood culture-confirmed SAB during 2025. Patients were classified as having either an alternative-presumed source or an initially unknown source of bacteremia. Dental consultations were reviewed to identify clinically active oral infections through structured intraoral examinations.
In the absence of microbiological confirmation, these findings were considered possible portals of bacterial entry in unknown-source cases or concurrent oral pathology in patients with another presumed source. Transesophageal echocardiography (TEE), documented infective endocarditis, and blinded dental re-adjudication of oral findings and treatment recommendations were also evaluated.
Among 72 eligible subjects, 53 (73.6%) had an alternative-presumed source of SAB, while 19 (26.4%) had an initially unknown source. TEE was carried out in 54 subjects (75.0%), and infective endocarditis was detected in 9 subjects (12.5%), with comparable rates between both groups. Dental consultation was requested in 17 subjects (23.6%), including 6 of 19 subjects (31.6%) with initially unknown-source SAB.
A possible dental focus was detected in 5 of these 6 consulted unknown-source subjects (83.3%), compared with 4 of 11 subjects (36.4%) with an alternative-presumed source who underwent dental evaluation. This diagnostic yield reflected only consultation-selected subjects and was not representative of the broader unknown-source population.
Combined cardiac and dental assessment contributed to source clarification in 6 of 19 subjects (31.6%) with initially unknown-source SAB. Structured blinded re-adjudication demonstrated that oral findings were predominantly chronic structural dental disease with active inflammatory changes rather than acute odontogenic infections. Active dental intervention was advised for 11 of 17 subjects (64.7%) evaluated by dental specialists, including all those with initially unknown-source SAB.
Dental consultation was underutilized in patients with SAB (bloodstream infection) but frequently identified clinically suspected oral infection foci in consultation-selected patients with initially unknown-source disease and resulted in actionable treatment recommendations. These findings complemented echocardiographic assessment and highlighted the potential role of oral evaluation in source investigation.
Antibiotics
Dental Consultation in Initially Unknown-Source Staphylococcus aureus Bacteremia: A Retrospective Single-Center Cohort Study
Laura Isabell Werneburg et al.
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