scholarly journals Changing Characteristics of Staphylococcus aureus Bacteremia: Results From a 21-Year, Prospective, Longitudinal Study

2019 ◽  
Vol 69 (11) ◽  
pp. 1868-1877 ◽  
Author(s):  
Maria Souli ◽  
Felicia Ruffin ◽  
Seong-Ho Choi ◽  
Lawrence P Park ◽  
Shengli Gao ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Longitudinal Study ◽  
Medical Center ◽  
Spa Typing ◽  
Prospective Longitudinal Study ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia ◽  
Multivariable Regression Models ◽  
Changes Over Time ◽  
Prospective Longitudinal

Abstract Background We conducted a longitudinal study to evaluate changes in the clinical presentation and epidemiology of Staphylococcus aureus bacteremia (SAB) in an academic, US medical center. Methods Consecutive patients with monomicrobial SAB were enrolled from January 1995 to December 2015. Each person’s initial bloodstream S. aureus isolate was genotyped using spa typing. Clonal complexes (CCs) were assigned using Ridom StaphType software. Changes over time in both the patient and bacterial characteristics were estimated with linear regression. Associations between genotypes or clinical characteristics and complications were estimated using multivariable regression models. Results Among the 2348 eligible participants, 54.2% had an implantable, foreign body of some type. This proportion increased significantly during the 21-year study period, by 0.96% annually (P = .002), as did comorbid conditions and acquisition outside of the hospital. Rates of any metastatic complication also significantly increased, by 0.94% annually (P = .019). Among the corresponding bloodstream S. aureus isolates, spa-CC012 (multi-locus sequence type [MLST] CC30), -CC004 (MLST CC45), -CC189 (MLST CC1), and -CC084 (MLST CC15) all significantly declined during the study period, while spa-CC008 (MLST CC8) significantly increased. Patients with SAB due to spa-CC008 were significantly more likely to develop metastatic complications in general, and abscesses, septic emboli, and persistent bacteremia in particular. After adjusting for demographic, racial, and clinical variables, the USA300 variant of spa-CC008 was independently associated with metastatic complications (odds ratio 1.42; 95% confidence interval 1.02–1.99). Conclusions Systematic approaches for monitoring complications of SAB and genotyping the corresponding bloodstream isolates will help identify the emergence of hypervirulent clones and likely improve clinical management of this syndrome.

scholarly journals Evaluation of early achievement of an AUC/MIC of >400 for Vancomycin in children with methicillin-resistant Staphylococcus aureus bacteremia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S293-S294
Author(s):  
Takemi Murai ◽  
Hiroshi Higuchi ◽  
Junichi Suwa ◽  
Hanako Funakoshi ◽  
Ryuu Yoneda ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Area Under The Curve ◽  
Interquartile Range ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Microdilution Method ◽  
Persistent Bacteremia

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia causes morbidity and mortality in children. The standard treatment for MRSA bacteremia is vancomycin, which should achieve a 24 hour area under the curve over the minimum inhibitory concentration ratio (AUC/ MIC) of >400. Whether or not attaining AUC/ MIC >400 early in the disease course improves outcomes in children is controversial. The aim of our study was to determine whether early achievement of AUC/ MIC >400 improved outcomes in children with MRSA bacteremia. Methods Children whose blood culture grew MRSA between March 2010 and April 2017 at Tokyo Metropolitan Children’s Medical Center were enrolled. The exclusion criteria were no vancomycin administration, use of extracorporeal membrane oxygenation, no data on dosage and vancomycin MIC, and cases of contamination. Susceptibility testing was performed by a microdilution method. The outcomes of patients who achieved an AUC/MIC >400 at the first assessment prior to the Fourth or Fifth vancomycin dose were compared with those of patients who did not. The clinical outcomes were persistent bacteremia on Days 3 and 7, mortality at 30 days, and the recurrence of MRSA bacteremia. Results In total 175 MRSA isolates from 50 children were identified. Of these 56 episodes were eligible for enrollment. Forty-one subjects (73.2%) were boys. The median age was 9 months (interquartile range: 1.8–120.5 months). The median initial dose of vancomycin was 40 mg/kg (interquartile range: 30–44.3 mg/kg). Among MRSA isolates, vancomycin MIC of < 0.5 mcg/mL, 1 mcg/mL and 2 mcg/mL were 1 (1.8%), 53 (94.6%) and 2 (3.6%), respectively. Fifteen patients (26.8%) achieved AUC/MIC >400 early. The two groups did not differ significantly in terms of persistent bacteremia on Days 3 (P = 0.96) or 7 (P = 0.82), mortality at 30 days (P = 0.47), or the recurrence of MRSA bacteremia (P = 1.0). Conclusion Children with bacteremia who achieved AUC/ MIC>400 early did not differ significantly from children who did not in terms of their clinical outcomes. Disclosures All authors: No reported disclosures.

scholarly journals 1060. Risk Factors for Recurrent Staphylococcus aureus Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S317-S317 ◽  
Author(s):  
Seong-Ho Choi ◽  
Felicia Ruffin ◽  
Lawrence Park ◽  
Batu K Sharma-Kuinkel ◽  
Maria Souli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
African American ◽  
Abscess Formation ◽  
First Episode ◽  
Spa Typing ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia ◽  
Independent Risk Factors ◽  
African American Race

Abstract Background Recurrent Staphylococcus aureus bacteremia (Re-SAB) occurs in 2–17% of patients with SAB within 3–12 months after resolution of the first episode. The risk factors for Re-SAB are incompletely understood. Methods Re-SAB was defined as a second episode of SAB after the resolution of the first episode occurring at least 14 days from the date of the last positive blood culture of the first episode. Using the SAB Group Prospective Cohort Study (SABG-PCS) data between January 2008 and May 2015, patients with Re-SAB were selected and compared with those without it. Pulsed-field gel electrophoresis (PFGE) was done for the clinical isolates from the Re-SAB group, and spa typing was for those from both groups. Baseline sera from patients with Re-SAB and age/race/gender matched (1:1) control subjects with SAB but without Recurrence underwent Luminex multiplex cytokine array. Results Seventy patients experienced Re-SAB (9.3%) and 686 SAB patients did not. In the Re-SAB group, 156 episodes of SAB were observed. Median time to Re-SAB was 147.5d (IQR, 76–358). Among 65 PFGE-analyzed pairs of isolates from the first and the subsequent episodes, the time to Re-SAB of <300 days was more commonly found in the PFGE-identical pairs than in the PFGE-different pairs (75.6% vs. 33.8%, P = 0.001). In the comparison of clinical factors between 56 Re-SAB patients with available data and 686 without Re-SAB, African American race, dialysis dependence, the presence of foreign body, persistent bacteremia, metastatic abscess formation, and methicillin-resistant S. aureus (MRSA) were more frequently observed in patients with Re-SAB. In a multivariate analysis to identify risk factors for Re-SAB, African American race, dialysis dependence, metastatic abscess formation, and MRSA were independent risk factors. The distribution of spa types between the two group was presented in Figure 1. Conclusion Re-SAB involves a combination of multiple factors of host, microbe, and treatment. Further laboratory investigation for any determinants in host and microbe is required. Disclosures V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.

scholarly journals Molecular epidemiology of Staphylococcus aureus bacteremia in a single large Minnesota medical center in 2015 as assessed using MLST, core genome MLST and spa typing

PLoS ONE ◽  
2017 ◽  
Vol 12 (6) ◽  
pp. e0179003 ◽  
Author(s):  
Kyung-Hwa Park ◽  
Kerryl E. Greenwood-Quaintance ◽  
James R. Uhl ◽  
Scott A. Cunningham ◽  
Nicholas Chia ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Molecular Epidemiology ◽  
Core Genome ◽  
Medical Center ◽  
Spa Typing ◽  
Staphylococcus Aureus Bacteremia

144: A Prospective Longitudinal Study of Quality of Life Following Radical Perineal Prostatectomy

2004 ◽  
Vol 171 (4S) ◽  
pp. 38-38
Author(s):  
Benjamin K. Yang ◽  
Matthew D. Young ◽  
Brian Calingaert ◽  
Johannes Vieweg ◽  
Brian C. Murphy ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Longitudinal Study ◽  
Prospective Longitudinal Study ◽  
Perineal Prostatectomy ◽  
Prospective Longitudinal
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