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Kaasch AJ, Barlow G, Edgeworth JD, Fowler VG, Hellmich M, Hopkins S, Kern WV, Llewelyn MJ, Rieg S, Rodriguez-Baño J, Scarborough M, Seifert H, Soriano A, Tilley R, Tőrők ME, Weiß V, Wilson APR, Thwaites GE. Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies. J Infect 2013; 68:242-51. [PMID: 24247070 DOI: 10.1016/j.jinf.2013.10.015] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/17/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome. METHODS We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States. RESULTS The median age of participants was 64 years (interquartile range 50-75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001). CONCLUSION The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
| | - Gavin Barlow
- Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham, NC, USA
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Susan Hopkins
- Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Winfried V Kern
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Martin J Llewelyn
- Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Siegbert Rieg
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Jesús Rodriguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena; Department of Medicine, University of Seville, Seville, Spain
| | - Matthew Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Robert Tilley
- Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - M Estée Tőrők
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Verena Weiß
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - A Peter R Wilson
- Department of Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Guy E Thwaites
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
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Sullivan KV, Turner NN, Roundtree SS, McGowan KL. Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) using the KeyPath MRSA/MSSA blood culture test and the BacT/ALERT system in a pediatric population. Arch Pathol Lab Med 2013; 137:1103-5. [PMID: 23899068 DOI: 10.5858/arpa.2012-0422-oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Timely initiation of directed antimicrobial therapy for Staphylococcus aureus bacteremia is dependent on rapid identification of S. aureus to ascertain methicillin-susceptibility status. OBJECTIVES To investigate the performance of the rapid KeyPath (MicroPhage, Inc, Longmont, Colorado) methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) blood culture test (MMBT). DESIGN Positive BacT/ALERT Pediatric FAN (fastidious antibiotic neutralization) blood culture bottles (bioMérieux, Inc, Durham, North Carolina) were tested prospectively using MMBT and routine bacterial identification and antibiotic susceptibility testing procedures as the gold standard. The MMBT uses an S. aureus-specific bacteriophage cocktail that infects bacterial cells and replicates them, resulting in cellular lysis. Bacteriophage-specific antibodies detect the increase in bacteriophage concentration in an immunoassay device. Phage amplification, in both the presence and absence of cefoxitin, indicates the presence of MRSA. The sensitivity, specificity, positive predictive value, and negative predictive value of MMBT in detecting S. aureus, MSSA, and MRSA were calculated. RESULTS Of 188 positive blood cultures tested, 199 (63%) had Gram-positive cocci in clusters, 46 (24%) grew S. aureus (26 MSSA [57%], 20 MRSA [43%]) with the MMBT detecting 40 of 46 (87%). The sensitivity, specificity, positive predictive value, and negative predictive value among blood cultures with Gram-positive cocci in clusters were 87%, 100%, 100%, and 92% for S. aureus; 81%, 100%, 100%, and 95% for MSSA; and 95%, 100%, 100%, and 99% for MRSA. All blood cultures without growth of S. aureus tested negative by MMBT. CONCLUSIONS The MMBT detected MSSA and MRSA directly from positive BacT/ALERT PF bottles with positive predictive values of 100%, suggesting that positive results could be reported immediately, but the sensitivity of this assay limited immediate reporting of negative results.
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Affiliation(s)
- Kaede V Sullivan
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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103
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Ok HS, Lee HS, Park MJ, Kim KH, Kim BK, Wi YM, Kim JM. Predictors and clinical outcomes of persistent methicillin-resistant Staphylococcus aureus bacteremia: a prospective observational study. Korean J Intern Med 2013; 28:678-86. [PMID: 24307843 PMCID: PMC3846993 DOI: 10.3904/kjim.2013.28.6.678] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/24/2011] [Accepted: 08/21/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/AIMS The high mortality attributable to persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in spite of glycopeptide treatment has heightened the need for early detection and intervention with alternative agents. The purpose of this study was to determine the clinical characteristics of and risk factors for persistent MRSA bacteremia. METHODS All first episodes of significant MRSA bacteremia at a 710-bed academic medical center from November 2009 through August 2010 were recorded. Blood cultures were conducted at 3 days and every 2 to 3 days thereafter until clearance. Clinical characteristics and outcomes were compared between persistent MRSA bacteremia (≥ 7 days) and nonpersistent MRSA bacteremia (≤ 3 days). RESULTS Of 79 patients with MRSA bacteremia during the study period, 31 (39.2%) had persistent MRSA bacteremia. The persistent MRSA bacteremia group had significantly higher 30-day mortality than the nonpersistent MRSA bacteremia group (58.1% vs. 16.7%, p < 0.001). Multivariate analysis indicated that metastatic infection at presentation (odds ratio [OR], 14.57; 95% confidence interval [CI], 3.52 to 60.34; p < 0.001) and delayed catheter removal in catheter-related infection (OR, 3.80; 95% CI, 1.04 to 13.88; p = 0.004) were independent predictors of persistent MRSA bacteremia. Patients with a time to blood culture positivity (TTP) of < 11.8 hours were at increased risk of persistent MRSA bacteremia (29.0% vs. 8.3%, p = 0.029). CONCLUSIONS High mortality in patients with persistent MRSA bacteremia was noted. Early detection of metastatic infection and early removal of infected intravascular catheters should be considered to reduce the risk of persistent MRSA bacteremia. Further studies are needed to evaluate the role of TTP for predicting persistent MRSA bacteremia.
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Affiliation(s)
- Hea Sung Ok
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyoun Soo Lee
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Man Je Park
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ki Hoon Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Byeong Ki Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Yu Mi Wi
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
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104
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Tamma PD, Turnbull AE, Harris AD, Milstone AM, Hsu AJ, Cosgrove SE. Less is more: combination antibiotic therapy for the treatment of gram-negative bacteremia in pediatric patients. JAMA Pediatr 2013; 167:903-10. [PMID: 23921724 PMCID: PMC6857628 DOI: 10.1001/jamapediatrics.2013.196] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Definitive combination antibiotic therapy with a β-lactam and an aminoglycoside for the treatment of gram-negative bacteremia is commonly prescribed in pediatric patients; however, its efficacy and toxicity relative to β-lactam monotherapy are unknown. OBJECTIVE To determine whether definitive combination antibiotic therapy affects mortality and nephrotoxicity in pediatric patients with gram-negative bacteremia. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study including pediatric patients (aged ≤18 years) with gram-negative bacteremia hospitalized at the Johns Hopkins Children's Center between 2002 and 2011. MAIN OUTCOMES AND MEASURES Outcomes included 30-day mortality and nephrotoxicity classified according to the pediatric RIFLE (risk for renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, and end-stage renal disease) criteria. To account for nonrandom assignment of combination therapy, propensity score weighting was combined with multivariable logistic regression to estimate the effect of combination therapy on mortality and nephrotoxicity. RESULTS Of the 879 eligible pediatric patients with bacteremia, 537 (61.1%) received combination therapy. After propensity score adjustment, baseline demographic and clinical characteristics between the groups were well balanced. There was no association between combination therapy and 30-day mortality (odds ratio, 0.98; 95% CI, 0.93-1.02; P = .27). There were 170 patients (19.3%) with evidence of acute kidney injury, including 135 (25.1%) and 35 (10.2%) in the combination therapy and monotherapy arms, respectively. Patients receiving combination therapy had approximately twice the odds of nephrotoxicity compared with those receiving monotherapy (odds ratio, 2.15; 95% CI, 2.09-2.21). CONCLUSIONS AND RELEVANCE The use of β-lactam monotherapy for gram-negative bacteremia in pediatric patients reduces subsequent nephrotoxicity without compromising survival.
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Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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105
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Freixas N, Bella F, Limón E, Pujol M, Almirante B, Gudiol F. Impact of a multimodal intervention to reduce bloodstream infections related to vascular catheters in non-ICU wards: a multicentre study. Clin Microbiol Infect 2013; 19:838-44. [DOI: 10.1111/1469-0691.12049] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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106
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Rieg S, Jonas D, Kaasch AJ, Porzelius C, Peyerl-Hoffmann G, Theilacker C, Küpper MF, Schneider C, Seifert H, Kern WV. Microarray-based genotyping and clinical outcomes of Staphylococcus aureus bloodstream infection: an exploratory study. PLoS One 2013; 8:e71259. [PMID: 23967176 PMCID: PMC3743874 DOI: 10.1371/journal.pone.0071259] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/28/2013] [Indexed: 02/05/2023] Open
Abstract
The clinical course of Staphylococcus aureus bacteremia varies extensively. We sought to determine the relationship between genetic characteristics of the infecting pathogen and clinical outcomes in an exploratory study. In two study centers, 317 blood culture isolates were analyzed by DNA microarray and spa genotyping. By uni- and multivariate regression analyses associations of genotype data with 30-day all-cause mortality, severe sepsis/septic shock, disseminated disease, endocarditis, and osteoarticular infection were investigated. Univariate analysis showed significant association between S. aureus genes/gene-clusters or clonal complexes and clinical endpoints. For example CC15 was associated with 30-day mortality and CC22 with osteoarticular infection. In multivariate analysis methicillin resistance (mecA, OR 4.8 [1.43–16.06]) and the beta-lactamase-gene (bla, OR 3.12 [1.17–8.30]) remained independently associated with 30-day mortality. The presence of genes for enterotoxins (sed/sej/ser) was associated with endocarditis (OR 5.11 [1.14–18.62]). Host factors such as McCabe classification (OR 4.52 [2.09–9.79] for mortality), age (OR 1.06 [1.03–1.10] per year), and community-acquisition (OR 3.40 [1.31–8.81]) had a major influence on disease severity, dissemination and mortality. Individual genotypes and clonal complexes of S. aureus can only partially explain clinical features and outcomes of S. aureus bacteremia. Genotype-phenotype association studies need to include adjustments for host factors like age, comorbidity and community-acquisition.
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Affiliation(s)
- Siegbert Rieg
- Department of Medicine, Center for Infectious Diseases and Travel Medicine and IFB-Center for Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany.
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107
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López-Cortés LE, Del Toro MD, Gálvez-Acebal J, Bereciartua-Bastarrica E, Fariñas MC, Sanz-Franco M, Natera C, Corzo JE, Lomas JM, Pasquau J, Del Arco A, Martínez MP, Romero A, Muniain MA, de Cueto M, Pascual A, Rodríguez-Baño J. Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 57:1225-33. [PMID: 23929889 DOI: 10.1093/cid/cit499] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB. METHODS A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided. RESULTS A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78-4.49), early source control (OR, 4.56; 95% CI, 2.12-9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15-2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24-3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI, .26-.85 and OR, 0.56; 95% CI, .34-.93, respectively). CONCLUSIONS A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality.
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Affiliation(s)
- Luis E López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla
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108
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Early response assessment to guide management of methicillin-resistant Staphylococcus aureus bloodstream infections with vancomycin therapy. Clin Ther 2013; 35:995-1004. [PMID: 23829982 DOI: 10.1016/j.clinthera.2013.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/17/2013] [Accepted: 05/24/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND A subset of vancomycin-treated patients with methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) developed persistent positive blood cultures. Treatment eventually failed. METHODS A retrospective study was conducted to determine whether early response on day 3 after initiation of vancomycin therapy for MRSA BSI was associated with reduced rates of persistent bacteremia, end-of-treatment failure, and infection-related mortality. Patients' medical charts were reviewed. Susceptibility testing and molecular characterization of bacterial isolates were performed. RESULTS In this elderly cohort (n = 111; median age 70 years, interquartile range: 57-80 years), early response was observed in 62% of patients and was significantly (P < 0.0001) associated with lower rates of end-of-treatment failure (19% vs 57%) and infection-related death (1% vs 29%), but not with persistent bacteremia (17% vs 29%, P = 0.23). Nearly half (46%; 46 of 100 patients) remained on vancomycin therapy for the entire treatment course; those who continued despite lack of early response had a trend toward a higher risk of death than those who were switched to alternative therapy (38% vs 10%, P = NS). Most (68%) isolates had vancomycin MIC of >1 µg/mL, whereas 10% showed heterogeneous glycopeptide-intermediate Staph aureus (hGISA) phenotype. Nearly half (47%) were typed with staphylococcal cassette chromosome mec IV or V. In a multivariate logistic regression model, lack of response at day 3 was the strongest predictor for end-of-treatment failure, after adjustment for confounders such as age, Acute Physiology And Chronic Health Evaluation II score, intensive care unit admission, vancomycin MIC >1 µg/mL, unbound trough concentration <4 to 5× MIC, and continued vancomycin therapy without change. CONCLUSIONS Early response assessment after initiation of vancomycin therapy appeared to be useful for considering further diagnostic workup or a switch to alternative therapy to affect a positive outcome in patients with MRSA BSI.
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109
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Keynan Y, Rubinstein E. Staphylococcus aureus Bacteremia, Risk Factors, Complications, and Management. Crit Care Clin 2013; 29:547-62. [DOI: 10.1016/j.ccc.2013.03.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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110
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Shomali W, Hachem R, Chaftari AM, Bahu R, Helou GE, Jiang Y, Hanania AN, Hanania A, Reitzel R, Raad I. Can procalcitonin differentiate Staphylococcus aureus from coagulase-negative staphylococci in clustered gram-positive bacteremia? Diagn Microbiol Infect Dis 2013; 76:158-61. [PMID: 23578976 DOI: 10.1016/j.diagmicrobio.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/25/2013] [Accepted: 03/04/2013] [Indexed: 12/28/2022]
Abstract
Procalcitonin (PCT) and pro-adrenomedullin (ProADM) have been proposed as diagnostic and prognostic biomarkers of infection. Between July 2009 and January 2012, we studied the role of these biomarkers in 163 patients with clustered gram-positive and gram-negative bacteremia. PCT levels were significantly higher in patients with Staphylococcus aureus and gram-negative bacteremia than those with coagulase-negative staphylococci (CoNS) isolated from blood cultures (P = 0.29 and <0.001, respectively). ProADM levels were only significantly higher in patients with gram-negative bacteremia (median 1.46 nmol/L) than those with CoNS (median 1.01 nmol/L) (P = 0.04). Among patients with CoNS, PCT, and ProADM, levels failed to differentiate blood contamination (medians 0.24 ng/mL and 0.97 nmol/L) from true bacteremia (medians 0.26 ng/mL and 1.14 nmol/L) (P = 0.51 and 0.57, respectively). In cancer patients, PCT (and to a lesser extent, ProADM) was useful in differentiating CoNS from S. aureus and gram-negative bacteremia.
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Affiliation(s)
- William Shomali
- UT MD Anderson Cancer Center, Dept. of Infectious Diseases, Infection Control & Employee Health, Houston, TX 77030, USA
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111
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Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K. Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. BMJ Open 2013; 3:bmjopen-2012-002412. [PMID: 23533214 PMCID: PMC3612742 DOI: 10.1136/bmjopen-2012-002412] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To examine the incidence of vertebral osteomyelitis (VO) and the clinical features of VO focusing on risk factors for death using a Japanese nationwide administrative database. DESIGN Retrospective observational study. SETTING Hospitals adopting the Diagnosis Procedure Combination system during 2007-2010. PARTICIPANTS We identified 7118 patients who were diagnosed with VO (International Classification of Diseases, 10th Revision codes: A18.0, M46.4, M46.5, M46.8, M46.9, M48.9 and M49.3, checked with the detailed diagnoses in each case and all other codes indicating the presence of a specific infection) and hospitalised between July and December, 2007-2010, using the Japanese Diagnosis Procedure Combination database. MAIN OUTCOME MEASURES The annual incidence of VO was estimated. Logistic regression analysis was performed to analyse factors affecting in-hospital mortality in the VO patients. Dependent variables included patient characteristics (age, sex and comorbidities), procedures (haemodialysis and surgery) and hospital factors (type of hospital and hospital volume). RESULTS Overall, 58.9% of eligible patients were men and the average age was 69.2 years. The estimated incidence of VO increased from 5.3/100 000 population per year in 2007 to 7.4/100 000 population per year in 2010. In-hospital mortality was 6%. There was a linear trend between higher rates of in-hospital mortality and greater age. A higher rate of in-hospital mortality was significantly associated with haemodialysis use (ORs, 10.56 (95% CI 8.12 to 13.74)), diabetes (2.37 (1.89 to 2.98)), liver cirrhosis (2.63 (1.49 to 4.63)), malignancy (2.68, (2.10 to 3.42)) and infective endocarditis (3.19 (1.80 to 5.65)). CONCLUSIONS Our study demonstrates an increasing incidence of VO, and defines risk factors for death with a nationwide database. Several comorbidities were significantly associated with higher rates of in-hospital death in VO patients.
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Affiliation(s)
- Toru Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromasa Horiguchi
- Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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112
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In vivo efficacy of daptomycin against methicillin-resistant Staphylococcus aureus in a mouse model of hematogenous pulmonary infection. Antimicrob Agents Chemother 2013; 57:2841-4. [PMID: 23507279 DOI: 10.1128/aac.02331-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Daptomycin is inactivated by pulmonary surfactant, but its effectiveness in hematogenous pulmonary infection has been poorly studied. The potential therapeutic application was evaluated in a methicillin-resistant Staphylococcus aureus (MRSA) hematogenous pulmonary infection mouse model. Compared with control results, daptomycin improved survival (P < 0.001) and decreased the number of abscesses and bacteria in the lungs (P < 0.01). Daptomycin may be an effective therapeutic option for MRSA hematogenous pulmonary infection.
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113
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The value of combining blood culture and SeptiFast data for predicting complicated bloodstream infections caused by Gram-positive bacteria or Candida species. J Clin Microbiol 2013; 51:1130-6. [PMID: 23363819 DOI: 10.1128/jcm.02882-12] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Management of complicated bloodstream infections requires more aggressive treatment than uncomplicated bloodstream infections. We assessed the value of follow-up blood culture in bloodstream infections caused by Staphylococcus aureus, Enterococcus spp., Streptococcus spp., and Candida spp. and studied the value of persistence of DNA in blood (using SeptiFast) for predicting complicated bloodstream infections. Patients with bloodstream infections caused by these microorganisms were enrolled prospectively. After the first positive blood culture, samples were obtained every third day to perform blood culture and SeptiFast analyses simultaneously. Patients were followed to detect complicated bloodstream infection. The study sample comprised 119 patients. One-third of the patients developed complicated bloodstream infections. The values of persistently positive tests to predict complicated bloodstream infections were as follows: SeptiFast positive samples (sensitivity, 56%; specificity, 79.5%; positive predictive value, 54%; negative predictive value, 80.5%; accuracy, 72.3%) and positive blood cultures (sensitivity, 30.5%; specificity, 92.8%; positive predictive value, 64%; negative predictive value, 75.5%; accuracy, 73.9%). Multivariate analysis showed that patients with a positive SeptiFast result between days 3 and 7 had an almost 8-fold-higher risk of developing a complicated bloodstream infection. In S. aureus, the combination of both techniques to exclude endovascular complications was significantly better than the use of blood culture alone. We obtained a score with variables selected by the multivariate model. With a cutoff of 7, the negative predictive value for complicated bloodstream infection was 96.6%. Patients with a positive SeptiFast result between days 3 and 7 after a positive blood culture have an almost 8-fold-higher risk of developing complicated bloodstream infections. A score combining clinical data with the SeptiFast result may improve the exclusion of complicated bloodstream infections.
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114
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Lewis SS, Sexton DJ. Metastatic Complications of Bloodstream Infections in Hemodialysis Patients. Semin Dial 2012; 26:47-53. [DOI: 10.1111/sdi.12031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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115
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Treatment duration for uncomplicated Staphylococcus aureus bacteremia to prevent relapse: analysis of a prospective observational cohort study. Antimicrob Agents Chemother 2012; 57:1150-6. [PMID: 23254436 DOI: 10.1128/aac.01021-12] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Practice guidelines recommend at least 14 days of antibiotic therapy for uncomplicated Staphylococcus aureus bacteremia (SAB). However, these recommendations have not been formally evaluated in clinical studies. To evaluate the duration of therapy for uncomplicated SAB, we analyzed data from our prospective cohort of patients with SAB. A prospective observational cohort study was performed in patients with SAB at a tertiary-care hospital in Korea between August 2008 and September 2010. All adult patients with SAB were prospectively enrolled and observed over a 12-week period. Uncomplicated SAB was defined as follows: negative results of follow-up blood cultures at 2 to 4 days, defervescence within 72 h of therapy, no evidence of metastatic infection, and catheter-related bloodstream infection or primary bacteremia without evidence of endocarditis on echocardiography. Of 483 patients with SAB, 111 met the study criteria for uncomplicated SAB. Fifty-three (47.7%) had methicillin-resistant SAB. When short-course therapy (<14 days) and intermediate-course therapy (≥14 days) were compared, the treatment failure rates (10/38 [26.3%] versus 16/73 [21.9%]) and crude mortality (7/38 [18.4%] versus 16/73 [21.9%]) did not differ significantly between the two groups. However, short-course therapy was significantly associated with relapse (3/38 [7.9%] versus 0/73; P = 0.036). In multivariate analysis, primary bacteremia was associated with a trend toward increased treatment failure (P = 0.06). Therefore, in the treatment of uncomplicated SAB, it seems reasonable to consider at least 14 days of antibiotic therapy to prevent relapse, as practice guidelines recommend. Because of its poor prognosis, primary bacteremia, even with a low risk of complication, should not be treated with short-course therapy.
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116
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Wangjirapan A, Kongthavonsakul K, Oberdorfer P. An 8-year-old boy with severe disseminated Staphylococcus aureus infection. BMJ Case Rep 2012; 2012:bcr-2012-007398. [PMID: 23239772 DOI: 10.1136/bcr-2012-007398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report an 8-year-old boy who developed high fever and low-back pain. He was diagnosed as having a paravertebral abscess with severe disseminated Staphylococcus aureus infection. He received intravenous antibiotics and drainage of the abscess. Afterwards, he developed thrombosis, endocarditis and empyema thoracis. He received further intravenous antibiotics and proper drainages for his conditions. He eventually recovered well. This case highlights the need for rapid diagnosis and appropriate treatment of severe S aureus infection to prevent serious complications.
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Iinuma Y, Matsumura M, Baba H, Aoki H. [Report from the 13th Hokuriku Chapter Open Conference for the fellow of the Japanese Society of Internal Medicine: a case of 70-year-old woman who complained of fever and lumbago]. ACTA ACUST UNITED AC 2012; 101:3261-7. [PMID: 23342602 DOI: 10.2169/naika.101.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Japan
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118
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Priest NK, Rudkin JK, Feil EJ, van den Elsen JMH, Cheung A, Peacock SJ, Laabei M, Lucks DA, Recker M, Massey RC. From genotype to phenotype: can systems biology be used to predict Staphylococcus aureus virulence? Nat Rev Microbiol 2012; 10:791-7. [PMID: 23070558 PMCID: PMC7097209 DOI: 10.1038/nrmicro2880] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
With the advent of high-throughput whole-genome sequencing, it is now possible to sequence a bacterial genome in a matter of hours. However, although the presence or absence of a particular gene can be determined, we do not yet have the tools to extract information about the true virulence potential of an organism from sequence data alone. Here, we focus on the important human pathogen Staphylococcus aureus and present a framework for the construction of a broad systems biology-based tool that could be used to predict virulence phenotypes from S. aureus genomic sequences using existing technology.
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Affiliation(s)
- Nicholas K. Priest
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
| | - Justine K. Rudkin
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
| | - Edward J. Feil
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
| | - Jean M. H. van den Elsen
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
| | - Ambrose Cheung
- Ambrose Cheung is at Dartmouth Medical School, Vail Building - HB 7550, Hanover, New Hampshire 03755, USA.,
| | - Sharon J. Peacock
- Sharon J. Peacock is at the Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.,
| | - Maisem Laabei
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
| | - David A. Lucks
- David A. Lucks is at Western Infectious Disease Consultants, PC, 3885 Upham Street Suite 200, Wheat Ridge, Colorado 80033, USA.,
| | - Mario Recker
- Mario Recker is at the Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK.,
| | - Ruth C. Massey
- Maisem Laabei and Ruth C. Massey are at the Department of Biology and Biochemistry, Nicholas K. Priest, Justine K. Rudkin, Edward J. Feil, Jean M. H. van den Elsen, University of Bath, Bath BA2 7AY, UK.,
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Lebeaux D, Larroque B, Gellen-Dautremer J, Leflon-Guibout V, Dreyer C, Bialek S, Froissart A, Hentic O, Tessier C, Ruimy R, Pelletier AL, Crestani B, Fournier M, Papo T, Barry B, Zarrouk V, Fantin B. Clinical outcome after a totally implantable venous access port-related infection in cancer patients: a prospective study and review of the literature. Medicine (Baltimore) 2012; 91:309-318. [PMID: 23117849 DOI: 10.1097/md.0b013e318275ffe1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Morbidity and mortality after a totally implantable venous access port (TIVAP)-related infection in oncology patients have rarely been studied. We conducted this study to assess the incidence and factors associated with the following outcome endpoints: severe sepsis or septic shock at presentation, cancellation of antineoplastic chemotherapy, and mortality at week 12. We conducted a prospective single-center observational study including all adult patients with solid cancer who experienced a TIVAP-related infection between February 1, 2009, and October 31, 2010. Patients were prospectively followed for 12 weeks. Among 1728 patients receiving antineoplastic chemotherapy during the inclusion time, 72 had an episode of TIVAP-related infection (4.2%) and were included in the study (median age, 60 yr; range, 28-85 yr). The incidence of complications was 18% for severe sepsis or septic shock (13/72 patients), 30% for definitive cancellation of antineoplastic chemotherapy (14/46 patients who still had active treatment), and 46% for death at week 12 (33/72 patients). Factors associated with severe sepsis or septic shock were an elevated C-reactive protein (CRP) level and an infection caused by Candida species; 4 of the 13 severe episodes (31%) were due to coagulase-negative staphylococci (CoNS). Factors associated with death at week 12 were a low median Karnofsky score, an elevated Charlson comorbidity index, the metastatic evolution of cancer, palliative care, and an elevated CRP level at presentation. Hematogenous complications (that is, infective endocarditis, septic thrombophlebitis, septic pulmonary emboli, spondylodiscitis, septic arthritis, or organ abscesses) were found in 8 patients (11%). In conclusion, patients' overall condition (comorbidities and autonomy) and elevated CRP level were associated with an unfavorable clinical outcome after a TIVAP-related infection. Candida species and CoNS were responsible for severe sepsis or septic shock.
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Affiliation(s)
- David Lebeaux
- From the Service de Médecine Interne (DL, JGD, AF, VZ, BF), Unité d'Epidémiologie et de Recherche Clinique (BL), Service de Microbiologie (VLG, SB),Service d'Oncologie Médicale (CD), Service d'Hépatologie et Gastroentérologie (OH), and Service d'Anesthésie-Réanimation (CT), Hôpital Beaujon, AP-HP, Clichy; and Service de Microbiologie (RR), Service d'Hépatologie etGastroentérologie (ALP), Service de Pneumologie (BC, MF), Service de Médecine Interne (TP), and Service d'Oto-rhino Laryngologie (BB), Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Park KH, Lee YM, Hong HL, Kim T, Park HJ, Park SY, Moon SM, Chong YP, Kim SH, Lee SO, Choi SH, Jeong JY, Kim MN, Woo JH, Kim YS. Persistent catheter-related Staphylococcus aureus bacteremia after catheter removal and initiation of antimicrobial therapy. PLoS One 2012; 7:e46389. [PMID: 23115627 PMCID: PMC3480347 DOI: 10.1371/journal.pone.0046389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 08/29/2012] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Catheter-related Staphylococcus aureus bacteremia (CRSAB) occasionally persists despite catheter removal and initiation of appropriate antimicrobial therapy. The aim of this study was to determine the incidence, risk factors, and outcomes of persistent CRSAB after catheter removal and initiation of antimicrobial therapy. METHODS Consecutive patients with CRSAB were prospectively included from over a 41-month period. We compared the clinical features, 40 bacterial virulence genes, and outcomes between patients with persistent CRSAB (i.e., bacteremia for >3 days after catheter removal and initiation of appropriate antimicrobial therapy) and non-persistent CRSAB. RESULTS Among the 220 episodes of CRSAB, the catheter was kept in place in 17 (6%) and removed in 203 (94%) cases. In 43 (21%) of the 203 episodes, bacteremia persisted for >3 days after catheter removal and initiation of antimicrobial therapy. Methicillin resistance (Odds ratio [OR], 9.01; 95% confidence interval [CI], 3.05-26.61; P<0.001), non-catheter prosthetic devices (OR, 5.37; 95% CI, 1.62-17.80; P=0.006), and renal failure (OR, 3.23; 95% CI, 1.48-7.08; P=0.003) were independently associated with persistent CRSAB. Patients with persistent CRSAB were more like to experience complication than were those with non-persistent CRSAB (72% vs. 15%; P<0.001). Among all episodes due to methicillin-resistant S. aureus, persistent CRSAB isolates were associated with accessory gene regulator (agr) group II (P= .04), but presence of other bacterial virulence genes, distribution of vancomycin minimum inhibitory concentration distribution, and frequency of vancomycin heteroresistance did not differ between the groups. CONCLUSIONS In patients with CRSAB, bacteremia persisted in 21% of cases despite catheter removal and initiation of antimicrobial therapy. Methicillin resistance, renal failure, and non-catheter prosthetic devices were independent risk factors for persistent CRSAB, which was associated with a higher rate of complications.
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Affiliation(s)
- Ki-Ho Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Hyo-Lim Hong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Tark Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Hyun Jung Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - So-Youn Park
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Song Mi Moon
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Jin-Yong Jeong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan, Seoul, Republic of Korea
- * E-mail:
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agr dysfunction and persistent methicillin-resistant Staphylococcus aureus bacteremia in patients with removed eradicable foci. Infection 2012; 41:111-9. [DOI: 10.1007/s15010-012-0348-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 09/25/2012] [Indexed: 01/25/2023]
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122
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Full and broad-spectrum in vivo eradication of catheter-associated biofilms using gentamicin-EDTA antibiotic lock therapy. Antimicrob Agents Chemother 2012; 56:6310-8. [PMID: 23027191 DOI: 10.1128/aac.01606-12] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Biofilms that develop on indwelling devices are a major concern in clinical settings. While removal of colonized devices remains the most frequent strategy for avoiding device-related complications, antibiotic lock therapy constitutes an adjunct therapy for catheter-related infection. However, currently used antibiotic lock solutions are not fully effective against biofilms, thus warranting a search for new antibiotic locks. Metal-binding chelators have emerged as potential adjuvants due to their dual anticoagulant/antibiofilm activities, but studies investigating their efficiency were mainly in vitro or else focused on their effects in prevention of infection. To assess the ability of such chelators to eradicate mature biofilms, we used an in vivo model of a totally implantable venous access port inserted in rats and colonized by either Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, or Pseudomonas aeruginosa. We demonstrate that use of tetrasodium EDTA (30 mg/ml) as a supplement to the gentamicin (5 mg/ml) antibiotic lock solution associated with systemic antibiotics completely eradicated Gram-positive and Gram-negative bacterial biofilms developed in totally implantable venous access ports. Gentamicin-EDTA lock was able to eliminate biofilms with a single instillation, thus reducing length of treatment. Moreover, we show that this combination was effective for immunosuppressed rats. Lastly, we demonstrate that a gentamicin-EDTA lock is able to eradicate the biofilm formed by a gentamicin-resistant strain of methicillin-resistant S. aureus. This in vivo study demonstrates the potential of EDTA as an efficient antibiotic adjuvant to eradicate catheter-associated biofilms of major bacterial pathogens and thus provides a promising new lock solution.
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123
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Palraj BR, Sohail MR. Appropriate use of echocardiography in managing Staphylococcus aureus bacteremia. Expert Rev Anti Infect Ther 2012; 10:501-8. [PMID: 22512758 DOI: 10.1586/eri.12.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) is increasing, both in the community and in healthcare settings. Accurate and timely diagnosis of underlying infective endocarditis (IE) is critical for optimal management of SAB cases as it has significant management and prognostic implications. Reported prevalence of IE in patients with SAB varies depending on the study population, and ranges from 10 to 30%. As clinical presentation of IE can be nonspecific, echocardiography is usually recommended in SAB cases to 'rule out' IE. Due to its poor sensitivity (<50%), especially for diagnosing prosthetic valve IE, transthoracic echocardiography is considered inadequate in this setting and clinicians have to rely on transesophageal echocardiography (TEE) to confirm or exclude endocarditis in SAB cases. Although some experts recommend TEE in all patients presenting with SAB, it is believed that the use of TEE could be guided by individual patient risk factors, mode of acquisition of SAB and clinical presentation. In this article, published data regarding the use of TEE in the SAB population are reviewed and a simplified algorithm to guide use of TEE in SAB cases is proposed.
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Affiliation(s)
- Bharath Raj Palraj
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Infectious Disease Consultation for Staphylococcus aureus Bacteremia Improves Patient Management and Outcomes. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012; 20:261-267. [PMID: 23049234 DOI: 10.1097/ipc.0b013e318255d67c] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND: Staphylococcus aureus bacteremia (SAB) is a common, severe infectious disease with accepted standards of care. METHODS: A retrospective cohort study of all 233 SAB cases at the Minneapolis Veterans Affairs Medical Center (MVAMC) between October 2004 and February 2008 was performed to measure the impact of Infectious Disease (ID) consultation on conformance to standards and patient outcomes. Outcomes were classified as survived without relapse, relapsed, or died without relapse. ID involvement was classified as consultation, curbside, or no involvement. RESULTS: ID involvement occurred in 179/233 cases (77%). Management conformed to accepted standards in 162/197 cases (82%) evaluable for conformance. ID involvement was associated with increased conformance in univariable analysis and multivariable analysis adjusted for propensity for ID consultation (OR 5.9, 95% CI 2.5 - 13.8). Relapse occurred in 14/156 cases (9%) in which therapy conformed to standards compared with 8/35 cases (23%) in which therapy did not conform to standards (p=0.045). Relapse was more common in older patients (OR 1.05, CI 1.01-1.09) and in cases without ID involvement (OR 3.02, CI 1.003-9.1). Death was associated with greater Charlson Index scores (OR 1.89, CI 1.4-2.5). Of 111 cases with definitely or possibly infected devices, relapse occurred in 9/92 cases (9.8%) in which the device was wholly or partially removed compared with 6/19 cases (32%) in which the device was left in place (p=0.02). CONCLUSIONS: ID involvement in SAB cases was associated with increased adherence to accepted standards and fewer relapses. ID consultation should be performed for all SAB cases.
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Retirada sistemática de los catéteres venosos periféricos: ¿salva vidas o incrementa costes? Med Clin (Barc) 2012; 139:203-5. [DOI: 10.1016/j.medcli.2012.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/23/2012] [Indexed: 11/23/2022]
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Roig IL, Darouiche RO, Musher DM, Trautner BW. Device-related infective endocarditis, with special consideration of implanted intravascular and cardiac devices in a predominantly male population. ACTA ACUST UNITED AC 2012; 44:753-60. [PMID: 22681242 DOI: 10.3109/00365548.2012.678882] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The relationship between invasive medical devices and infective endocarditis (IE) has not been comprehensively assessed. We describe our experience of patients with IE, with particular attention to the role of pre-existing intravascular catheters and implanted cardiac devices in the pathogenesis. METHODS We performed a retrospective review of hospital records over a 10-y period (1997-2007), and included patients with 'definite' or 'possible' IE as per the modified Duke criteria. The complete electronic medical record was reviewed for the presence of intravascular devices prior to the onset of IE, including intravascular catheters and implanted cardiac devices (defibrillators and pacemakers). RESULTS We identified 155 patients with IE. Infection involved a native valve in 124 (80%) patients and a prosthetic valve in 15 (9.7%). In the remaining 16 (10.3%) patients, infection was attributed to an implanted cardiac device. The most commonly identified source of infection was a central venous catheter, accounting for 17.4% of patients, followed by an implanted cardiac device in 10.3% of patients. Staphylococcus aureus was the most commonly isolated organism in catheter-associated IE and cardiac device-associated IE (31.9% and 62.5%, respectively). Thirty-five (22.5%) patients died within 90 days. Mortality was 31.9% in patients with IE caused by methicillin-resistant S. aureus (MRSA). CONCLUSIONS Intravascular catheters and cardiac implantable devices are common sources of infection leading to IE, and the intracardiac devices themselves often become infected, with MRSA as the predominant pathogen.
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Affiliation(s)
- Ingrid L Roig
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, BCM 286, N1319, Houston, TX 77030, USA.
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Hady WA, Bayer AS, Xiong YQ. Experimental endocarditis model of methicillin resistant Staphylococcus aureus (MRSA) in rat. J Vis Exp 2012:e3863. [PMID: 22711072 DOI: 10.3791/3863] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Endovascular infections, including endocarditis, are life-threatening infectious syndromes. Staphylococcus aureus is the most common world-wide cause of such syndromes with unacceptably high morbidity and mortality even with appropriate antimicrobial agent treatments. The increase in infections due to methicillin-resistant S. aureus (MRSA), the high rates of vancomycin clinical treatment failures and growing problems of linezolid and daptomycin resistance have all further complicated the management of patients with such infections, and led to high healthcare costs. In addition, it should be emphasized that most recent studies with antibiotic treatment outcomes have been based in clinical settings, and thus might well be influenced by host factors varying from patient-to-patient. Therefore, a relevant animal model of endovascular infection in which host factors are similar from animal-to-animal is more crucial to investigate microbial pathogenesis, as well as the efficacy of novel antimicrobial agents. Endocarditis in rat is a well-established experimental animal model that closely approximates human native valve endocarditis. This model has been used to examine the role of particular staphylococcal virulence factors and the efficacy of antibiotic treatment regimens for staphylococcal endocarditis. In this report, we describe the experimental endocarditis model due to MRSA that could be used to investigate bacterial pathogenesis and response to antibiotic treatment.
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Affiliation(s)
- Wessam Abdel Hady
- Department of Medicine, Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, USA
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Song Y, Tai JH, Bartsch SM, Zimmerman RK, Muder RR, Lee BY. The potential economic value of a Staphylococcus aureus vaccine among hemodialysis patients. Vaccine 2012; 30:3675-82. [PMID: 22464963 PMCID: PMC3371356 DOI: 10.1016/j.vaccine.2012.03.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/20/2012] [Accepted: 03/15/2012] [Indexed: 01/08/2023]
Abstract
Staphylococcus aureus infections are a substantial problem for hemodialysis patients. Several vaccine candidates are currently under development, with hemodialysis patients being one possible target population. To determine the potential economic value of an S. aureus vaccine among hemodialysis patients, we developed a Markov decision analytic computer simulation model. When S. aureus colonization prevalence was 1%, the incremental cost-effectiveness ratio (ICER) of vaccination was ≤$25,217/quality-adjusted life year (QALY). Vaccination became more cost-effective as colonization prevalence, vaccine efficacy, or vaccine protection duration increased or vaccine cost decreased. Even at 10% colonization prevalence, a 25% efficacious vaccine costing $100 prevented 29 infections, 21 infection-related hospitalizations, and 9 inpatient deaths per 1000 vaccinated HD patients. Our results suggest that an S. aureus vaccine would be cost-effective (i.e., ICERs ≤ $50,000/QALY) among hemodialysis patients over a wide range of S. aureus prevalence, vaccine costs and efficacies, and vaccine protection durations and delineate potential target parameters for such a vaccine.
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Affiliation(s)
- Yeohan Song
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Julie H.Y. Tai
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Sarah M. Bartsch
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Richard K. Zimmerman
- Department of Family Medicine, University of Pittsburgh School of Medicine, 3518 Fifth Avenue, Pittsburgh, PA 15261, USA
| | - Robert R. Muder
- Division of Infectious Diseases, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240, USA
| | - Bruce Y. Lee
- Public Health Computational and Operations Research (PHICOR), University of Pittsburgh 3520 Forbes Avenue, First Floor Pittsburgh, PA 15213, USA
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Pittsburgh, PA 15260, USA
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, PA 15261, USA
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129
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Chauhan A, Lebeaux D, Decante B, Kriegel I, Escande MC, Ghigo JM, Beloin C. A rat model of central venous catheter to study establishment of long-term bacterial biofilm and related acute and chronic infections. PLoS One 2012; 7:e37281. [PMID: 22615964 PMCID: PMC3353920 DOI: 10.1371/journal.pone.0037281] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 04/17/2012] [Indexed: 12/27/2022] Open
Abstract
Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP) surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections.
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Affiliation(s)
- Ashwini Chauhan
- Institut Pasteur, Unité de Génétique des Biofilms, Département de Microbiologie, Paris, France
| | - David Lebeaux
- Institut Pasteur, Unité de Génétique des Biofilms, Département de Microbiologie, Paris, France
| | - Benoit Decante
- Laboratoire de Recherche Chirurgicale, Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Irene Kriegel
- Service Anesthésie-Réanimation-Douleur, Hôpital de l'Institut Curie, Paris, France
| | | | - Jean-Marc Ghigo
- Institut Pasteur, Unité de Génétique des Biofilms, Département de Microbiologie, Paris, France
| | - Christophe Beloin
- Institut Pasteur, Unité de Génétique des Biofilms, Département de Microbiologie, Paris, France
- * E-mail:
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130
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Stevens V, Lodise TP, Tsuji B, Stringham M, Butterfield J, Dodds Ashley E, Brown K, Forrest A, Brown J. The utility of acute physiology and chronic health evaluation II scores for prediction of mortality among intensive care unit (ICU) and non-ICU patients with methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2012; 33:558-64. [PMID: 22561710 DOI: 10.1086/665731] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Bloodstream infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with significant risk of in-hospital mortality. The acute physiology and chronic health evaluation (APACHE) II score was developed and validated for use among intensive care unit (ICU) patients, but its utility among non-ICU patients is unknown. The aim of this study was to determine the ability of APACHE II to predict death at multiple time points among ICU and non-ICU patients with MRSA bacteremia. DESIGN Retrospective cohort study. PARTICIPANTS Secondary analysis of data from 200 patients with MRSA bacteremia at 2 hospitals. METHODS Logistic regression models were constructed to predict overall in-hospital mortality and mortality at 48 hours, 7 days, 14 days, and 30 days using APACHE II scores separately in ICU and non-ICU patients. The performance of APACHE II scores was compared with age adjustment alone among all patients. Discriminatory ability was assessed using the c-statistic and was compared at each time point using χ(2) tests. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. RESULTS APACHE II was a significant predictor of death at all time points in both ICU and non-ICU patients. Discrimination was high in all models, with c-statistics ranging from 0.72 to 0.84, and was similar between ICU and non-ICU patients at all time points. APACHE II scores significantly improved the prediction of overall and 48-hour mortality compared with age adjustment alone. CONCLUSIONS The APACHE II score may be a valid tool to control for confounding or for the prediction of death among ICU and non-ICU patients with MRSA bacteremia.
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Affiliation(s)
- Vanessa Stevens
- Department of Pharmacy Practice, State University of New York School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York, USA
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131
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Liang SY, Khair H, Durkin MJ, Marschall J. Prevention and management of central line-associated bloodstream infections in hospital practice. Hosp Pract (1995) 2012; 40:106-18. [PMID: 22406886 DOI: 10.3810/hp.2012.02.951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this article aimed at hospitalists, we examine the literature on preventive measures for central line-associated bloodstream infections (CLABSIs) and optimal management once a CLABSI has been established. We focus on a number of core preventive measures and the contemporary approach of bundling these measures for maximal impact in reducing infection rates. We then discuss empiric and pathogen-specific antibiotic therapy, including the role of newer antimicrobial agents, as well as the management of an infected central venous catheter.
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Affiliation(s)
- Stephen Y Liang
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110-1093, USA
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132
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Vos FJ, Kullberg BJ, Sturm PD, Krabbe PFM, van Dijk APJ, Wanten GJA, Oyen WJG, Bleeker-Rovers CP. Metastatic infectious disease and clinical outcome in Staphylococcus aureus and Streptococcus species bacteremia. Medicine (Baltimore) 2012; 91:86-94. [PMID: 22391470 DOI: 10.1097/md.0b013e31824d7ed2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Early detection of metastatic infection in patients with Gram-positive bacteremia is important as morbidity and mortality are higher in the presence of these foci, probably due to incomplete eradication of clinically silent foci during initial treatment. We performed a prospective study in 115 patients with Staphylococcus aureus or Streptococcus species bacteremia with at least 1 risk factor for the development of metastatic foci, such as community acquisition, treatment delay, persistently positive blood cultures for >48 hours, and persistent fever >72 hours after initiation of treatment. An intensive search for metastatic infectious foci was performed including ¹⁸F-fluorodeoxyglucose-positron emission tomography in combination with low-dose computed tomography scanning for optimizing anatomical correlation (FDG-PET/CT) and echocardiography in the first 2 weeks of admission. Metastatic infectious foci were detected in 84 of 115 (73%) patients. Endocarditis (22 cases), endovascular infections (19 cases), pulmonary abscesses (16 cases), and spondylodiscitis (11 cases) were diagnosed most frequently. The incidence of metastatic infection was similar in patients with Streptococcus species and patients with S. aureus bacteremia. Signs and symptoms guiding the attending physician in the diagnostic workup were present in only a minority of cases (41%). An unknown portal of entry, treatment delay >48 hours, and the presence of foreign body material were significant risk factors for developing metastatic foci. Mean C-reactive protein levels on admission were significantly higher in patients with metastatic infectious foci (74 vs. 160 mg/L). FDG-PET/CT was the first technique to localize metastatic infectious foci in 35 of 115 (30%) patients. As only a minority of foci were accompanied by guiding signs or symptoms, the number of foci revealed by symptom-guided CT, ultrasound, and magnetic resonance imaging remained low. Mortality tended to be lower in patients without complicated infection compared to those with metastatic foci (16% vs. 25%, respectively). Five of 31 patients (16%) without proven metastatic foci died. In retrospect, 3 of these 5 patients likely had metastatic foci that could not be diagnosed while alive. In patients with Gram-positive bacteremia and a high risk of developing complicated infection, a structured protocol including echocardiography and FDG-PET/CT aimed at detecting metastatic infectious foci can contribute to improved outcome.
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Affiliation(s)
- Fidel J Vos
- From the Departments of Medicine (FJV, BJK, CPBR), Nuclear Medicine (FJV, WJGO), Microbiology (PDS), Cardiology (APJvD), Gastroenterology (GJAW), Radboud University Nijmegen Medical Center, Nijmegen; Nijmegen Institute for Infection, Inflammation and Immunity (N4i) (FJV, BJK, PDS, WJGO, CPBR), Radboud University Nijmegen, and Department of Epidemiology (PFMK), Unit Health Technology Assessment, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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133
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Bagdasarian N, Heung M, Malani PN. Infectious Complications of Dialysis Access Devices. Infect Dis Clin North Am 2012; 26:127-41. [DOI: 10.1016/j.idc.2011.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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134
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Tsai MH, Hsu JF, Lien R, Huang HR, Chiang CC, Chu SM, Liang HF, Huang YC. Catheter management in neonates with bloodstream infection and a percutaneously inserted central venous catheter in situ: removal or not? Am J Infect Control 2012; 40:59-64. [PMID: 21839544 DOI: 10.1016/j.ajic.2011.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/15/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study investigated whether removal of a percutaneously inserted central venous catheter (PICC) is compulsory in neonates with bloodstream infection (BSI), and also examined the risk factors for infectious complications when a PICC is retained in these patients. METHODS This was a cohort study of neonates with a PICC who developed a BSI between 2001 and 2007. BSI was defined according to Centers for Disease Control and Prevention criteria. RESULTS Of the 234 neonates in the cohort, 99 had early removal of PICC (ER-PICC, defined as removal within 3 days after the onset of clinical sepsis), and 135 had late removal of PICC (LR-PICC, defined as retention for more than 3 days after the onset of clinical sepsis). Resolution of clinical sepsis within 2 days was more frequent in the ER-PICC group compared with the LR-PICC group (80.8% vs 57.8%; P < .001). There was no significant difference between the 2 groups in terms of infectious complications and case fatalities, but the LR-PICC group had a significantly higher incidence of recurrence within 1 month after BSI (P = .002). Inappropriate initial antibiotic treatment was the only variable independently associated with infectious complications (odds ratio, 11.4; 95% confidence interval, 3.34∼39.2; P < .001). CONCLUSIONS PICCs should be removed in neonates with BSI, because retention of PICCs for more than 3 days is associated with delayed resolution of clinical sepsis and a higher incidence of recurrence within 1 month.
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135
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Yi J, Park JS, Hong KH, Lee SH, Kim EC. Serum capacity to neutralize superantigens does not affect the outcome of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2012; 31:2061-2068. [PMID: 22290348 DOI: 10.1007/s10096-011-1541-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 12/13/2011] [Indexed: 01/21/2023]
Abstract
Staphylococcal superantigens (SAg) could play an important role in sepsis by activating numerous T cells. We investigated whether serum capacity to neutralize SAgs can be a prognostic factor in Staphylococcus aureus bacteremia (SAB). In a university hospital, 105 consecutive SAB patients were enrolled during a 12-month period. The earliest serum samples prior to SAB onset were stored for a later T cell proliferation assay. Multiplex polymerase chain reaction (PCR) for 19 SAg genes was performed for S. aureus blood isolates. To determine the serum capacity to neutralize SAgs, T cell proliferation by the culture supernatant of each S. aureus isolate was measured in the presence and absence of the corresponding patient's serum. Twenty-six (24.8%) patients died within 4 weeks from SAB onset. Vascular catheter-related infection was associated with survival for ≥4 weeks. Unknown primary focus, Simplified Acute Physiology Score-II (SAPS-II), and specific SAg genes (tst, sec, sel, or sep) were associated with the 4-week mortality. No variables related to T cell proliferation assay showed statistical significance. In the multivariate analysis, SAPS-II ≥33 and tst were independently associated with the 4-week mortality. Serum capacity to neutralize SAg does not significantly affect SAB outcome. SAPS-II ≥33 and tst are independent predictors of the 4-week mortality.
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Affiliation(s)
- J Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Yangsan, Korea
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136
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Muñoz P, Fernández Cruz A, Usubillaga R, Zorzano A, Rodríguez-Créixems M, Guembe M, Bouza E. Central venous catheter colonization with Staphylococcus aureus is not always an indication for antimicrobial therapy. Clin Microbiol Infect 2011; 18:877-82. [PMID: 21999339 DOI: 10.1111/j.1469-0691.2011.03683.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Whether patients whose catheter tip grows Staphylococcus aureus but who have no concomitant bacteraemia should receive antimicrobials remains an unresolved issue. However, a proportion of patients with catheter tips colonized by S. aureus have no blood cultures taken because of low suspicion of sepsis and the meaning of this microbiological finding is unknown. We have analysed all catheter tips growing S. aureus during a 6-year period and have selected patients without blood cultures taken 7 days before or after central vascular catheter removal. Patient's evolution was classified into good and poor outcome. Poor outcome was defined as S. aureus infection within 3 months after catheter withdrawal or death in the same period with no obvious cause. Patients with good and poor outcomes were compared to assess whether antimicrobial therapy influenced evolution. Sixty-seven patients fulfilled our inclusion criteria and five (7.4%) had a poor outcome. The administration of early anti-staphylococcal therapy had no impact on the outcome of this population (p 0.99). The only factor independently associated with a poor outcome was the presence of clinical signs of sepsis when the catheter was removed (OR 20.8; 95% CI 2.0-206.1; p 0.009). Our data suggest that patients with central vascular catheter tips colonized with S. aureus should be closely monitored for signs and symptoms of ongoing infection, but if these are not present then antimicrobial therapy does not seem justified.
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Affiliation(s)
- P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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137
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Soriano A, Mensa J. Is transesophageal echocardiography dispensable in hospital-acquired Staphylococcus aureus bacteremia? Clin Infect Dis 2011; 53:10-2. [PMID: 21653296 DOI: 10.1093/cid/cir305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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138
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Kaasch AJ, Fowler VG, Rieg S, Peyerl-Hoffmann G, Birkholz H, Hellmich M, Kern WV, Seifert H. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis 2011; 53:1-9. [PMID: 21653295 DOI: 10.1093/cid/cir320] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a severe complication in patients with nosocomial Staphylococcus aureus bacteremia (SAB). We sought to develop and validate criteria to identify patients at low risk for the development of IE in whom transesophageal echocardiography (TEE) might be dispensable. METHODS Consecutive patients with nosocomial SAB from independent cohorts in Europe (Invasive S. aureus Infection Cohort [INSTINCT]) and North America (S. aureus Bacteremia Group [SABG]) were evaluated for the presence of clinical criteria predicting an increased risk for the development of IE (ie, prolonged bacteremia of >4 days' duration, presence of a permanent intracardiac device, hemodialysis dependency, spinal infection, and nonvertebral osteomyelitis). Patients were observed closely for clinical signs and symptoms of IE during hospitalization and a 3-month follow-up period. RESULTS IE was present in 13 (4.3%) of 304 patients in the INSTINCT cohort and in 40 (9.3%) of 432 patients in the SABG cohort. Within 14 days after the first positive blood culture result, echocardiography was performed in 39.8% and 57.4% of patients in the INSTINCT and SABG cohorts, respectively. In patients with IE, the most common clinical prediction criteria present were prolonged bacteremia (69.2% vs 90% for INSTINCT vs SABG, respectively) and presence of a permanent intracardiac device (53.8% vs 32.5%). In total, 13 of 13 patients in the INSTINCT cohort and 39 of 40 patients in the SABG cohort with documented IE fulfilled at least 1 criterion (sensitivity, 100% vs. 97.5%; negative predictive value, 100% vs 99.2%). CONCLUSIONS A simple criteria set for patients with nosocomial SAB can identify patients at low risk of IE. Patients who meet these criteria may not routinely require TEE.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
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139
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Feedback to clinicians on preventable factors can reduce hospital onset Staphylococcus aureus bacteraemia rates. J Hosp Infect 2011; 79:108-14. [DOI: 10.1016/j.jhin.2011.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 04/23/2011] [Indexed: 11/17/2022]
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140
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Gasch O, Ayats J, Ángeles Dominguez M, Tubau F, Liñares J, Peña C, Grau I, Pallarés R, Gudiol F, Ariza J, Pujol M. Epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection: secular trends over 19 years at a university hospital. Medicine (Baltimore) 2011; 90:319-327. [PMID: 21862935 DOI: 10.1097/md.0b013e31822f0b54] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is a cause of concern in health systems all over the world, due to the high incidence rates and the associated undesirable outcomes. In our tertiary 900-bed university hospital, all episodes of MRSA-BSI have been prospectively followed up since the identification of the first episode in 1990. We conducted the current study to report changes in the epidemiology of MRSA-BSI over the 19-year period between 1990 and 2008, comparing 4 periods (1990-1994, 1995-1999, 2000-2004, and 2005-2008). Overall, 524 patients developed MRSA-BSI. Cumulative incidence was 10.0 episodes/100,000 patient days (range, 1.3-17.4). Although no trend in the incidence rate was observed between the 4 consecutive periods, significant upward trends in patient age and comorbidities, health care acquisition, and non-intravascular catheter source were all identified (p < 0.05). While the Iberian clone (ST247/SCCmecI) was dominant during the first and second periods, almost all the strains isolated in the subsequent periods belonged to Clonal Complex 5 (ST125/SCCmecIV and ST228/SCCmecI). A significant downward trend in vancomycin geometric minimum inhibitory concentration (MIC) was also observed from 2.04 mg/L to 0.88 mg/L, coinciding with the clonal replacement and the reduction in the hospital vancomycin prescription. Therefore, no MRSA vancomycin MIC creep was observed since higher MICs were associated with strains belonging to the Iberian clone. Glycopeptides were the most frequently used antibiotics for MRSA-BSI during all 4 periods. No differences in MRSA-BSI outcomes were found, and the mortality rate at 30 days was close to 29% in each of the 4 periods. In conclusion, we identified significant changes in demographic and clinical characteristics and in the molecular epidemiology of MRSA-BSI during the study period, but found no significant trends in cumulative incidence or in overall mortality rate.
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Affiliation(s)
- Oriol Gasch
- From Infectious Diseases Service (OG, CP, IG, RP, FG, J. Ariza, MP) and Microbiology Service (J. Ayats, MAD, FT, JL), IDIBELL, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
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Afshar M, Reilly RF. Spondylodiscitis in a patient on chronic hemodialysis. Nat Rev Nephrol 2011; 7:599-604. [PMID: 21844911 DOI: 10.1038/nrneph.2011.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A 73-year-old man on hemodialysis with a tunneled central venous catheter presented to the emergency room with a fever and severe back pain. INVESTIGATIONS Physical examination, laboratory investigations, chest radiography, lumbar spine radiography, renal ultrasound, lumbosacral spine MRI and transthoracic echocardiography. DIAGNOSIS Spondylodiscitis as a result of methicillin-sensitive Staphylococcus aureus bacteremia. MANAGEMENT Antibiotic therapy with intravenous cefazolin for 6 weeks and oral minocycline for 2 weeks.
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Affiliation(s)
- Masoud Afshar
- Section of Nephrology, Department of Medicine, VA North Texas Health Care System, The University of Texas Southwestern Medical Center at Dallas, 4500 South Lancaster Road, Dallas, TX 75390-8856, USA
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Hetem DJ, de Ruiter SC, Buiting AGM, Kluytmans JAJW, Thijsen SF, Vlaminckx BJM, Wintermans RGF, Bonten MJM, Ekkelenkamp MB. Preventing Staphylococcus aureus bacteremia and sepsis in patients with Staphylococcus aureus colonization of intravascular catheters: a retrospective multicenter study and meta-analysis. Medicine (Baltimore) 2011; 90:284-288. [PMID: 21694650 DOI: 10.1097/md.0b013e31822403e9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Two previous studies in tertiary care hospitals identified Staphylococcus aureus colonization of intravascular (IV) catheters as a strong predictor of subsequent S. aureus bacteremia (SAB), even in the absence of clinical signs of systemic infection. Bacteremia was effectively prevented by timely antibiotic therapy. We conducted this study to corroborate the validity of these findings in non-university hospitals.Using the laboratory information management systems of the clinical microbiology departments in 6 Dutch hospitals, we identified patients who had IV catheters from which S. aureus was cultured between January 1, 2003, and December 31, 2008. Patients with demonstrated SAB between 7 days before catheter removal and 24 hours after catheter removal were excluded. We extracted clinical and demographic patient data from the patients' medical records. The primary risk factor was initiation of anti-staphylococcal antibiotic therapy within 24 hours, and the primary endpoint was SAB >24 hours after IV catheter removal. Subsequently, we performed a systematic review and meta-analysis of all observational studies evaluating the effect of antibiotic therapy for S. aureus IV catheter tip colonization.In the current study, 18 of the 192 included patients developed subsequent SAB, which was associated with not receiving antibiotic therapy within 24 hours (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.1-15.6) and with documented exit-site infection (OR, 3.3; 95% CI, 1.2-9.3). When we combined these results with results of a previous study in a university hospital, a third risk factor was also associated with subsequent SAB, namely corticosteroid therapy (OR, 2.9; 95% CI, 1.3-6.3). We identified 3 other studies, in addition to the present study, in a systematic review. In the meta-analysis of these studies, antibiotic therapy yielded an absolute risk reduction of 13.6% for subsequent SAB. The number needed to treat to prevent 1 episode of SAB was 7.4.We conclude that early initiation of antibiotic therapy for IV catheters colonized with S. aureus prevents subsequent SAB.
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Affiliation(s)
- David J Hetem
- From Department of Clinical Microbiology (DJH, SCdR, MJMB, MBE), and Julius Center for Health Sciences and Primary Care (MJMB), University Medical Center, Utrecht; Department of Clinical Microbiology (AGMB), Elisabeth Hospital, Tilburg; Department of Clinical Microbiology (JAJWK), Amphia Hospital, Breda; Department of Clinical Microbiology (SFT), Diakonessenhuis, Utrecht; Department of Clinical Microbiology (BJMV), St Antonius Hospital, Nieuwegein; and Department of Clinical Microbiology (RGFW), Franciscus Hospital, Roosendaal; The Netherlands
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Fitzgibbons LN, Puls DL, Mackay K, Forrest GN. Management of Gram-Positive Coccal Bacteremia and Hemodialysis. Am J Kidney Dis 2011; 57:624-40. [DOI: 10.1053/j.ajkd.2010.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 12/13/2010] [Indexed: 11/11/2022]
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145
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Corrah TW, Enoch DA, Aliyu SH, Lever AM. Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients. QJM 2011; 104:201-7. [PMID: 20934976 DOI: 10.1093/qjmed/hcq178] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vertebral osteomyelitis (VO) is associated with considerable morbidity and its incidence seems to be increasing. Haematogenous spread is an important aetiological factor. AIM The objective was to describe a series of patients with VO and to search for a relationship between preceding bacteraemia and subsequent VO with the same pathogen. DESIGN AND METHODS A retrospective study of all treated cases of VO in a tertiary hospital over a 10-year period. RESULTS There were 129 cases of VO (involving 125 patients) that received antimicrobial treatment. Eighty-three (66%) were male and the mean age was 59.5 years (range 1 month to 87 years). The vertebral level involved was lumbar in 66 (53%) cases and thoracic in 35 (28%) cases. Seventy-four cases (59%) had a microbiologically confirmed aetiology. The diagnostic yield from procedures was 46 and 36% from blood culture and bone biopsy, respectively. Staphylococcus aureus was the most common pathogen [38 of 74 (51%) cases]. Nine of 38 (24%) cases of Staphylococcus aureus VO had a preceding bacteraemia with the same pathogen in the previous year. CONCLUSION Staphylococcus aureus is an important pathogen causing bacteraemia with the ability to cause metastatic complications including VO. The high proportion of cases developing VO following a documented bacteraemia, sometimes many months previously, reinforce the importance of adequate aggressive treatment for bacteraemia. VO must be considered in all patients presenting with back pain up to a year after bacteraemia. Previous bacteraemias with relevant pathogens can help guide antibiotic treatment at presentation of VO and if biopsy cannot be obtained.
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Affiliation(s)
- T W Corrah
- Department of Infectious Diseases, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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146
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Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2011; 65 Suppl 3:iii11-24. [PMID: 20876624 DOI: 10.1093/jac/dkq303] [Citation(s) in RCA: 300] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Spondylodiscitis, a term encompassing vertebral osteomyelitis, spondylitis and discitis, is the main manifestation of haematogenous osteomyelitis in patients aged over 50 years. Staphylococcus aureus is the predominant pathogen, accounting for about half of non-tuberculous cases. Diagnosis is difficult and often delayed or missed due to the rarity of the disease and the high frequency of low back pain in the general population. In this review of the published literature, we found no randomized trials on treatment and studies were too heterogeneous to allow comparison. Improvements in surgical and radiological techniques and the discovery of antimicrobial therapy have transformed the outlook for patients with this condition, but morbidity remains significant. Randomized trials are needed to assess optimal treatment duration, route of administration, and the role of combination therapy and newer agents.
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Affiliation(s)
- Theodore Gouliouris
- Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge CB2 0QW, UK.
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147
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Complicated Community-Acquired Staphylococcus Endocarditis and Multiple Lung Abscesses: Case Report and Review of Literature. Case Rep Infect Dis 2011; 2011:981316. [PMID: 22567485 PMCID: PMC3336243 DOI: 10.1155/2011/981316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 06/26/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Isolated tricuspid valve endocarditis in the absence of risk factors in the community setting is very rare and can be easily missed in patients with hitherto normal valves. Case Presentation. We present a case of a 49 year old gentleman who presented with generalized body aches, fever, and jaundice and was initial diagnosed as hepatitis. He subsequently developed recurrent episodes of panic attacks and shortness of breath and later multiple skin abscesses. Further investigations excluded pulmonary embolism but revealed multiple abscesses in the body including the lungs. Blood cultures and culture from abscesses grew S. aureus. An initial transthoracic echocardiogram was normal. A transesophageal echocardiogram subsequently confirmed endocarditis on a normal natural tricuspid valve and multiple lung abscesses. He was successfully treated with appropriate antibiotics. Conclusion. We discuss the pathogenesis of this patient's presentation highlight the need for assessment and proper evaluation of patients with unexplained bacteremia.
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148
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Leonidou L, Gogos CA. Catheter-related bloodstream infections: catheter management according to pathogen. Int J Antimicrob Agents 2010; 36 Suppl 2:S26-32. [PMID: 21129929 DOI: 10.1016/j.ijantimicag.2010.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Central-line access is an essential part of modern healthcare practice; however, catheter-related bloodstream infection is a major problem that causes substantial morbidity and mortality, and excess length of stay and cost. The risk of infection depends on the type of device, the site of insertion, the underlying conditions and the appropriate prevention measures taken during catheter insertion. Management of catheter-related bloodstream infection involves deciding on catheter removal, antimicrobial catheter lock solution and the type and duration of systemic antimicrobial therapy. Systemic antimicrobial use is essential but, although generally effective in controlling sepsis, it often fails to sterilise the line, increasing the incidence of complications or recurrence. The decision regarding whether the catheter should be removed or retained is therefore crucial. One of the major factors to be considered is the type of organism involved in the catheter-related infection. This review outlines the epidemiology, pathogenesis, diagnosis, microbiology and management of catheter-related infections, mainly focusing on the management of the intravascular device according to the pathogen.
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Affiliation(s)
- Leonidia Leonidou
- Department of Infectious Diseases, Patras University Medical School, Patras, Greece
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149
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Complications infectieuses liées aux chambres implantables : caractéristiques et prise en charge. Rev Med Interne 2010; 31:819-27. [DOI: 10.1016/j.revmed.2010.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 06/14/2010] [Accepted: 06/22/2010] [Indexed: 11/21/2022]
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150
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Han Z, Liang SY, Marschall J. Current strategies for the prevention and management of central line-associated bloodstream infections. Infect Drug Resist 2010; 3:147-63. [PMID: 21694903 PMCID: PMC3108742 DOI: 10.2147/idr.s10105] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Indexed: 11/29/2022] Open
Abstract
Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.
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Affiliation(s)
- Zhuolin Han
- Division of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USA
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