scholarly journals Correlations of Host and Bacterial Characteristics with Clinical Parameters and Survival in Staphylococcus aureus Bacteremia

2021 ◽  
Vol 10 (7) ◽  
pp. 1371
Author(s):  
Hannah Wächter ◽  
Erdal Yörük ◽  
Karsten Becker ◽  
Dennis Görlich ◽  
Barbara C. Kahl
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Age Groups ◽  
Nuclease Activity ◽  
Initial Therapy ◽  
University Hospital ◽  
Severe Condition ◽  
Staphylococcus Aureus Bacteremia ◽  
Infection Focus ◽  
Clinical Departments

Staphylococcus aureus bacteremia (SAB) is a frequent, severe condition that occurs in patients of all age groups and affects clinical departments of all medical fields. It is associated with a high mortality rate of 20–30%. In this study, we analyzed patient mortality associated with SAB at our tertiary care university hospital, assessed the clinical management in terms of administered antimicrobial therapy, and determined which factors have an impact on the clinical course and outcome of patients with this disease. We collected clinical data and blood culture isolates of 178 patients diagnosed with SAB between May 2013 and July 2015. For this study, bacteria were cultured and analyzed concerning their phenotype, hemolysis activity, biofilm formation, nuclease activity, prevalence of toxin genes, spa and agr type. Overall mortality was 24.2% and 30-day mortality was 14.6%. Inadequate initial therapy was administered to 26.2% of patients and was associated with decreased survival (p = 0.041). Other factors associated with poor survival were patient age (p = 0.003), agr type 4 (p ≤ 0.001) and pathological leukocyte counts (p = 0.029 if elevated and p = 0.003 if lowered). The type of infection focus, spa clonal complex and enterotoxin genes seg and sei had an impact on severity of inflammation. Our results indicate that mortality and burden of disease posed by SAB are high at our university hospital.

Methicillin-Resistant Staphylococcus aureus in Two Tertiary-Care Centers in Jeddah, Saudi Arabia

2001 ◽  
Vol 22 (4) ◽  
pp. 211-216 ◽  
Author(s):  
Tariq A. Madani ◽  
Nabeela A. Al-Abdullah ◽  
Ali A. Al-Sanousi ◽  
Tawfik M. Ghabrah ◽  
Shadia Z. Afandi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Saudi Arabia ◽  
Tertiary Care ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Total Mortality ◽  
Control Measures ◽  
Methicillin Resistant ◽  
Mrsa Infection ◽  
Tertiary Care Hospitals

AbstractObjective:To review clinical experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary-care hospitals in Jeddah, Saudi Arabia.Design:Retrospective review for the year 1998.Setting:Two tertiary-care hospitals.Methods:Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the microbiology laboratories' records. Charts of patients were reviewed, with standardized data collection.Results:Of 673 S aureus isolates identified, 222 (33%, or 6.8 isolates/1,000 admissions) were MRSA Overall MRSA prevalence was 2% in 1988. Nosocomial acquisition occurred in 84.2% of cases. All age groups were affected, and 52% of patients had at least one comorbidity. MRSA prevalence was highest in the intensive care units (26.6% of all isolates), the medical wards (24.8%), and the surgical wards (19.8%). Seventy-three percent of isolates caused infection; the rest represented colonization. Surgical wounds (35.2%), the chest (29%), and central venous catheters (13%) were the most common sites of infection. Bacteremia occurred in 15.4% of patients. Local signs (84%) and fever (75.9%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 30.2% and 13.6% of cases, respectively. Of 162 patients with MRSA infection and 60 patients with MRSA colonization, 95.7% and 70% received antibiotics in the preceding 6 weeks, respectively (P<.0001). The total mortality of patients with MRSA infection was 53.7%: 36.4% as a result of MRSA infection and 17.3% as a result of other causes.Conclusions:The prevalence of MRSA is high and rapidly increasing in the two hospitals, as it is worldwide. Control measures to prevent die spread of MRSA in hospitals should continue, with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.

scholarly journals Is Cefazolin Inferior to Nafcillin for Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia?

2011 ◽  
Vol 55 (11) ◽  
pp. 5122-5126 ◽  
Author(s):  
Shinwon Lee ◽  
Pyoeng Gyun Choe ◽  
Kyoung-Ho Song ◽  
Sang-Won Park ◽  
Hong Bin Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Propensity Scores ◽  
Tertiary Care ◽  
Care Hospital ◽  
Clinical Failure ◽  
Content Type ◽  
Staphylococcus Aureus Bacteremia ◽  
Matched Case ◽  
Control Study

ABSTRACTAbout 20% of methicillin-susceptibleStaphylococcus aureus(MSSA) isolates have a substantial inoculum effect with cefazolin, suggesting that cefazolin treatment may be associated with clinical failure for serious MSSA infections. There are no well-matched controlled studies comparing cefazolin with nafcillin for the treatment of MSSA bacteremia. A retrospective propensity-score-matched case-control study was performed from 2004 to 2009 in a tertiary care hospital where nafcillin was unavailable from August 2004 to August 2006. The cefazolin group (n= 49) included MSSA-bacteremic patients treated with cefazolin during the period of nafcillin unavailability, while the nafcillin group (n= 84) comprised those treated with nafcillin. Treatment failure was defined as a composite outcome of a change of antibiotics due to clinical failure, relapse, and mortality. Of 133 patients, 41 patients from each group were matched by propensity scores. There were no significant differences in baseline characteristics between the matched groups. The treatment failure rates were not significantly different at 4 or 12 weeks (10% [4/41] versus 10% [4/41] at 4 weeks [P> 0.99] and 15% [6/41] versus 15% [6/41] at 12 weeks [P> 0.99]). Cefazolin treatment was interrupted less frequently than nafcillin treatment due to drug adverse events (0% versus 17%;P= 0.02). Cefazolin had clinical efficacy similar to that of nafcillin and was more tolerable than nafcillin for the treatment of MSSA bacteremia.

scholarly journals A Comparison of Cefazolin Versus Ceftriaxone for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia in a Tertiary Care VA Medical Center

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Dustin R Carr ◽  
Usha Stiefel ◽  
Robert A Bonomo ◽  
Christopher J Burant ◽  
Sharanie V Sims
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Failure ◽  
Medical Center ◽  
Tertiary Care ◽  
Skilled Nursing Facility ◽  
Suppressive Therapy ◽  
Published Data ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Population Potential

Abstract Background Cefazolin and ceftriaxone are frequently used to treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, especially in the realm of outpatient parenteral antimicrobial therapy. Both antimicrobials have been associated with favorable clinical outcomes for mixed MSSA infections. However, limited published data exist specifically comparing the use of these agents for the treatment of MSSA bacteremia. Methods We conducted a retrospective cohort study of Veteran patients with MSSA bacteremia who received ≥14 days of cefazolin or ceftriaxone between 2009 and 2014. Rates of treatment failure were compared between both groups. Treatment failure was defined as therapy extension, incomplete therapy, unplanned oral suppressive therapy, relapse of infection, or hospital admission or surgery within 90 days. Results Out of 71 patients, 38 received treatment with cefazolin and 33 with ceftriaxone. The overall rate of treatment failure was 40.8%, with significantly more failures among patients receiving ceftriaxone (54.5% versus 28.9%; P = .029). Factors associated with treatment failure included longer duration of parenteral therapy, heart failure, and treatment in an external skilled nursing facility as compared with treatment in the Department of Veterans Affairs attached Community Living Center. Conclusions Ceftriaxone had a higher rate of treatment failure than cefazolin for the treatment of MSSA bacteremia in a Veteran population. Potential reasons for this could include the higher protein binding of ceftriaxone, ultimately resulting in lower serum concentrations of free drug, or other unknown factors. Further studies are warranted to confirm these results.

scholarly journals 184. Staphylococcus aureus Bacteremia Management and Outcomes Following Infectious Disease Consult Over Time at a Tertiary Care Center in Canada

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S200-S201
Author(s):  
Mark McAllister ◽  
Justin Chen ◽  
Stephanie Smith ◽  
Arienne King ◽  
Tanis C Dingle ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Morbidity ◽  
University Of Alberta ◽  
Staphylococcus Aureus Bacteremia ◽  
Over Time

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality. Infectious disease consultation (IDC) is associated with increased adherence to guideline management and improved patient outcomes. We describe the IDC rate over time and impact of IDC on the management and outcomes of patients with SAB. Methods This retrospective chart review includes adult patients (≥ 18 years) hospitalized at the University of Alberta Hospital, Edmonton, Canada who had at least 1 blood culture growing Staphylococcus aureus during two time periods (A: Jan 2010 to Dec 2012; B: Jan to Oct 2020). Patients who died or were made palliative within 48hrs following bacteremia were excluded. Descriptive statistics were used to compare appropriateness of SAB management and outcomes in patients receiving IDC and those who did not (NIDC). Results 325 patients in period A and 129 in period B were included. Baseline demographics were similar. IDC rate increased from 63% to 88% (p&lt; 0.001) between the study periods. IDC was associated with increased odds of receiving an echocardiogram (OR=3.56, 95% CI 2.22 – 5.57; OR=20.4, 95% 4.13 – 110.6, p&lt; 0.001) and appropriate duration of antimicrobial therapy (OR=6.74, 95% 3.93 – 11.54; OR=43.2, 95% 5.72 – 529.5, p&lt; 0.001) between study periods. Mean length of stay decreased in patients receiving IDC (44.8 vs 28.1 days, p=0.005) and increased in NIDC patients (19.9 vs 28.7 days, p=0.216). IDC was associated with lower 30-day mortality in period A (OR=3.53, 95% 1.95 – 6.36), however this association was not observed in period B (OR=1.43, 95% 0.40 – 5.56). There was a trend towards decreased odds of mortality in patients receiving early IDC (≤2 days from bacteremia, n=65) compared to late IDC (≥3 days from bacteremia, n=45) (OR=2.59, 95% 0.95 – 7.10, p=0.077). Conclusion Our centre’s IDC rate for SAB increased over time without specific intervention. IDC increased the odds of appropriate SAB management and was associated with decreased length of stay in period B. IDC was associated with lower 30-day mortality in period A and trended towards lower mortality in period B. Specifically, early IDC decreased odds of 30-day mortality compared to late IDC. These results suggest that routine early IDC be part of SAB management. Disclosures All Authors: No reported disclosures

Improved mortality in Staphylococcus aureus bacteremia with the involvement of antimicrobial stewardship team and infectious disease consultation

2019 ◽  
Vol 40 (8) ◽  
pp. 932-935 ◽  
Author(s):  
Jacqueline E. Sherbuk ◽  
Dayna McManus ◽  
Jeffrey E. Topal ◽  
Maricar Malinis
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Retrospective Study ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Disease Consultation ◽  
Academic Center ◽  
Infectious Diseases Consultation

AbstractA retrospective study was conducted to evaluate the value of the antimicrobial stewardship team (AST) combined with infectious diseases consultation (IDC) on management and outcomes of Staphylococcus aureus bacteremia (SAB) in a tertiary-care academic center. Involvement of AST or IDC was associated with reduced mortality of SAB.

Mupirocin for Controlling Methicillin-ResistantStaphylococcus Aureus: Lessons From a Decade of Use at a University Hospital

2005 ◽  
Vol 26 (7) ◽  
pp. 662-667 ◽  
Author(s):  
Adriana M. Vivoni ◽  
Kátia R. N. Santos ◽  
Márcia P. de-Oliveira ◽  
Marcia Giambiagi-deMarval ◽  
Adriana L. P. Ferreira ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Molecular Epidemiology ◽  
Gel Electrophoresis ◽  
Tertiary Care ◽  
Pulsed Field Gel Electrophoresis ◽  
University Hospital ◽  
Incidence Density ◽  
Mupirocin Resistance ◽  
Restricted Use ◽  
Over Time

AbstractBackground:From 1990 to 1995 at Hospital Universitario dementino Fraga Filho, patients colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) were treated with mupirocin to eliminate MRSA carriage. In 1995, 65% of MRSA patients at this hospital had mupirocin-resistant isolates. Starting in 1996, mupirocin use was restricted to patients colonized, but not infected, with MRSA.Objectives:To describe the use of mupirocin for controlling MRSA over a decade and to analyze the molecular epidemiology of mupirocin-resistant MRSA infections at this hospital.Setting:A 490-bed, tertiary-care university hospital.Methods:The incidence densities of patients with MRSA and acquisition of mupirocin by the hospital were calculated for the period 1992–2001.S. aureusisolates from 1999–2000 were analyzed by pulsed-field gel electrophoresis. Mupirocin-resistant MRSA isolates from 1994–1995 and 1999–2000 were analyzed forileS-2gene background polymorphisms.Results:The incidence density of MRSA patients increased slightly over time, whereas the purchase of mupirocin decreased dramatically. Mupirocin-resistant MRSA infections decreased from 65% in 1994–1995 to 15% in 1999–2000. The MRSA Brazilian clone, detected in 1992, was still highly prevalent. The sameileS-2 encoding plasmid found in 1994–1995 persisted in three identical MRSA isolates from 1999–2000 belonging to the Brazilian clone.Conclusions:After mupirocin use decreased, theileS-2 encoding plasmid persisted in only a few Brazilian clone isolates. Our data on mupirocin-resistant MRSA incidence and mupirocin use strongly suggested that restricted use was related to decreased rates of mupirocin resistance at our hospital. (Infect Control Hosp Epidemiol 2005;26:662-667)

scholarly journals Toll-like receptor 2 downregulation and cytokine dysregulation predict mortality in patients with Staphylococcus aureus bacteremia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nak-Hyun Kim ◽  
Ji Yeon Sung ◽  
Yoon Jung Choi ◽  
Su-Jin Choi ◽  
Soyeon Ahn ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Mrna Levels ◽  
Toll Like Receptor ◽  
Tlr2 Expression ◽  
Staphylococcus Aureus Bacteremia ◽  
Tnf Α ◽  
Toll Like Receptor 2 ◽  
Cytokine Dysregulation

Abstract Background Staphylococcus aureus bacteremia (SAB) presents heterogeneously, owing to the differences in underlying host conditions and immune responses. Although Toll-like receptor 2 (TLR2) is important in recognizing S. aureus, its function during S. aureus infection remains controversial. We aimed to examine the association of TLR2 expression and associated cytokine responses with clinical SAB outcomes. Methods Patients from a prospective SAB cohort at two tertiary-care medical centers were enrolled. Blood was sampled at several timepoints (≤5 d, 6–9 d, 10–13 d, 14–19 d, and ≥ 20 d) after SAB onset. TLR2 mRNA levels were determined via real-time PCR and serum tumor necrosis factor [TNF]-α, interleukin [IL]-6, and IL-10 levels were analyzed with multiplex-high-sensitivity electrochemiluminescent ELISA. Results TLR2 levels varied among 59 SAB patients. On days 2–5, TLR2 levels were significantly higher in SAB survivors than in healthy controls (p = 0.040) and slightly but not significantly higher than non-survivors (p = 0.120), and SAB patients dying within 7 d had lower TLR2 levels than survivors (P = 0.077) although statistically insignificant. IL-6 and IL-10 levels were significantly higher in non-survivors than in survivors on days 2–5 post-bacteremia (P = 0.010 and P = 0.021, respectively), and those dying within 7 d of SAB (n = 3) displayed significantly higher IL-10/TNF-α ratios than the survivors did (P = 0.007). Conclusion TLR2 downregulation and IL-6 and IL-10 concentrations suggestive of immune dysregulation during early bacteremia may be associated with mortality from SAB. TLR2 expression levels and associated cytokine reactions during early-phase SAB may be potential prognostic factors in SAB, although larger studies are warranted.

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