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Narula K, Rajpal S, Bhakta S, Kulanthaivel S, Mishra P. Rationally designed protein A surface molecularly imprinted magnetic nanoparticles for the capture and detection of Staphylococcus aureus. J Mater Chem B 2024; 12:5699-5710. [PMID: 38757517 DOI: 10.1039/d4tb00392f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Staphylococcus aureus (S. aureus), a commensal organism found on the human skin, is commonly associated with nosocomial infections and exhibits virulence mediated by toxins and resistance to antibiotics. The global threat of antibiotic resistance has necessitated antimicrobial stewardship to improve the safe and appropriate use of antimicrobials; hence, there is an urgent demand for the advanced, cost-effective, and rapid detection of specific bacteria. In this regard, we aimed to selectively detect S. aureus using surface molecularly imprinted magnetic nanoparticles templated with a well-known biomarker protein A, specific to S. aureus. Herein, a highly selective surface molecularly imprinted polymeric thin layer was created on ∼250 nm magnetic nanoparticles (MNPs) through the immobilization of protein A to aldehyde functionalized MNPs, followed by monomer polymerization and template washing. This study employs the rational selection of monomers based on their computationally predicted binding affinity to protein A at multiple surface residues. The resulting MIPs from rationally selected monomer combinations demonstrated an imprinting factor as high as ∼5. Selectivity studies revealed MIPs with four-fold higher binding capacity (BC) to protein A than other non-target proteins, such as lysozyme and serum albumin. In addition, it showed significant binding to S. aureus, whereas negligible binding to other non-specific Gram-negative, i.e. Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), and Gram-positive, i.e. Bacillus subtilis (B. subtilis), bacteria. This MIP was employed for the capture and specific detection of fluorescently labeled S. aureus. Quantitative detection was performed using a conventional plate counting technique in a linear detection range of 101-107 bacterial cells. Remarkably, the MIPs also exhibited approximately 100% cell recovery from milk samples spiked with S. aureus (106 CFU mL-1), underscoring its potential as a robust tool for sensitive and accurate bacterial detection in dairy products. The developed MIP exhibiting high affinity and selective binding to protein A finds its potential applications in the magnetic capture and selective detection of protein A as well as S. aureus infections and contaminations.
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Affiliation(s)
- Kritika Narula
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, India.
| | - Soumya Rajpal
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, India.
| | - Snehasis Bhakta
- Department of Chemistry, Cooch Behar College, West Bengal, India
| | - Senthilguru Kulanthaivel
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, India.
| | - Prashant Mishra
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, New Delhi, India.
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Deguchi N, Ishikawa K, Tokioka S, Kobayashi D, Mori N. Relationship between blood culture time to positivity, mortality rate, and severity of bacteremia. Infect Dis Now 2024; 54:104843. [PMID: 38043910 DOI: 10.1016/j.idnow.2023.104843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES We investigated the association between patient severity or mortality and time to positivity in bacteremia caused by various pathogens. PATIENTS AND METHODS This single-center retrospective study included patients with positive blood culture results. RESULTS Longer time to positivity was associated with 30-day mortality for Staphylococcus aureus (221 cases, time to positivity: 17.4 h in the 30-day mortality group vs. 14.1 h in the survival group). Age, chronic kidney disease, cerebrovascular disease, hypertensive drug use, consciousness disorder, and minimal systolic blood pressure were significant predictors of 30-day mortality. For S. aureus, mortality within 30 days was significantly higher when time to positivity was > 24 h (p = 0.04). The time to positivity of Streptococcus pneumoniae, α, β-hemolytic Streptococcus, Enterococcus sp., Enterobacteriaceae, glucose-nonfermenting Gram-negative rods, Candida sp., and anaerobe was not significantly associated with 30-day mortality. CONCLUSIONS Among various pathogens, time to positivity > 24 h was associated with 30-day mortality for S. aureus.
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Affiliation(s)
- N Deguchi
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
| | - K Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
| | - S Tokioka
- Department of Cardiovascular Medicine, Sendai Medical Center, Sendai, Japan
| | - D Kobayashi
- Department of Primary Care and General Medicine Tokyo Medical University Ibaraki Medical Center, Japan
| | - N Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
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Fan Y, Zhang K, Chen M, Li N, Liu X, Yang M, Liang X, Wu J, Guo B, Zheng H, Zhu Y, Zhang F, Hang J, Zhang H, Wang R, Yuan Q, Song X, Wu S, Shen B, Zhang J. Comparative efficacy of vancomycin in treating ST5 and ST764 methicillin-resistant Staphylococcus aureus infections in adult patients. mSphere 2023; 8:e0045723. [PMID: 37905831 PMCID: PMC10732099 DOI: 10.1128/msphere.00457-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/24/2023] [Indexed: 11/02/2023] Open
Abstract
IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that is resistant to multiple drugs and can cause serious infections. In recent years, one of the most widespread strains of MRSA worldwide has been the clonal complex 5 (CC5) type. Sequence type 5 (ST5) and ST764 are two prevalent CC5 strains. Although ST5 and ST764 are genotypically identical, ST764 is classified as a hybrid variant of ST5 with characteristics of community-associated MRSA (CA-MRSA). In contrast to ST5, ST764 lacks the tst and sec genes but carries the staphylococcal enterotoxin B (seb) gene. Vancomycin is commonly used as the first-line treatment for MRSA infections. However, it is currently unclear whether the genetic differences between the ST5 and ST764 strains have any impact on the efficacy of vancomycin in treating MRSA infections. We conducted a prospective observational study comparing the efficacy of vancomycin against ST5-MRSA and ST764-MRSA in five hospitals in China. There were significant differences in bacteriological efficacy between the two groups, with virulence genes, such as the tst gene, being a risk factor for bacterial persistence (adjusted odds ratio, 4.509; 95% confidence interval, 1.216 to 16.724; P = 0.024). In the future, it may be necessary to consider personalized vancomycin treatment strategies based on the genetic characteristics of MRSA isolates.
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Affiliation(s)
- Yaxin Fan
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Kaiting Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengting Chen
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Nanyang Li
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofen Liu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Minjie Yang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Liang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jufang Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Phase I Clinical Research Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Beining Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huajun Zheng
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China
| | - Yongqiang Zhu
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai and Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai, China
| | - Fengying Zhang
- Department of Pulmonary Medicine, Shanghai Putuo District People’s Hospital, Shanghai, China
| | - Jingqing Hang
- Department of Pulmonary Medicine, Shanghai Putuo District People’s Hospital, Shanghai, China
| | - Huifang Zhang
- Emergency and Critical Care Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruilan Wang
- Emergency and Critical Care Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Yuan
- Department of Respiratory and Critical Care Medicine, Tenth People’s Hospital of Tongji University, Shanghai, China
| | - Xiaolian Song
- Department of Respiratory and Critical Care Medicine, Tenth People’s Hospital of Tongji University, Shanghai, China
| | - Shengbin Wu
- Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai, China
| | - Jing Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Population and Family Planning Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Fidalgo B, Morata L, Cardozo C, Del Río A, Morales J, Fernández-Pittol M, Martínez JA, Mensa J, Vila J, Soriano A, Casals-Pascual C. Information Delay of Significant Bloodstream Isolates and Patient Mortality: A Retrospective Analysis of 6225 Adult Patients With Bloodstream Infections. Clin Infect Dis 2023; 77:680-686. [PMID: 37099685 DOI: 10.1093/cid/ciad243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/08/2023] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Our aim in this study was to evaluate the clinical and prognostic impact of communicating microbiological information in real time for adult patients with bloodstream infections (BSIs). METHODS We retrospectively reviewed 6225 clinical episodes of bacteremia in a teaching hospital from January 2013 to December 2019. Bacteremia-associated mortality was compared when blood culture results were relayed to the infectious diseases specialist (IDS) in real time and periods when results were relayed the following morning. The impact of information availability using mortality at 30 days was used as the main outcome of the study. RESULTS The initial analysis (all microorganisms included) did not show an association of mortality and information delay to the IDS (odds ratio [OR], 1.18; 95% confidence interval [CI], .99-1.42). However, information delay of BSIs caused by fast-growing microorganisms such as Enterobacterales was associated with a significant increase in the odds of death at 30 days both in the univariate (OR, 1.76; 95% CI, 1.30-2.38) and multivariate analysis (OR, 2.22; 95% CI, 1.50-3.30). Similar results were found with mortality at 14 days and 7 days in the univariate (OR, 1.54; 95% CI, 1.08-2.20 and OR, 1.56; 95% CI, 1.03-2.37, respectively) and the multivariate analysis (OR, 2.05; 95% CI, 1.27-3.32 and OR, 1.92; 95% CI, 1.09-3.40, respectively). CONCLUSIONS Information delivered in real time has prognostic relevance and is likely to improve survival of patients with documented BSIs. Future studies should address the prognostic impact of adequate resource allocation (microbiologist/IDS with 24/7 coverage) in BSIs.
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Affiliation(s)
- Berta Fidalgo
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - Laura Morata
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Celia Cardozo
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Ana Del Río
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Javier Morales
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - Mariana Fernández-Pittol
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
| | - José Antonio Martínez
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Josep Mensa
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
| | - Jordi Vila
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
- Institute for Global Health, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Alex Soriano
- Institut d'Investigacions Biomèdiques Agust Pi i Sunyer, Barcelona, Spain
- Department of Infectious Diseases, Hospital Clínic of Barcelona-University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
| | - Climent Casals-Pascual
- Department of Clinical Microbiology, CDB, Hospital Clínic de Barcelona. Universitat de Barcelona, Departament de Fonaments Clínics, Facultat de Medicina, Barcelona, Spain
- Institute for Global Health, Barcelona, Spain
- CIBER de Enfermedades Infecciosas, Instituto Salud Carlos III, Madrid, Spain
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Martins FS, Martins JES, Severino P, Annaert P, Sy SKB. Physiologically based pharmacokinetic modelling to inform combination dosing regimens of ceftaroline and daptomycin in special populations. Br J Clin Pharmacol 2023; 89:2726-2738. [PMID: 37005335 DOI: 10.1111/bcp.15731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023] Open
Abstract
AIMS The combination of daptomycin and ceftaroline used as salvage therapy is associated with higher survival and decreased clinical failure in complicated methicillin-resistant Staphylococcus aureus (MRSA) infections that are resistant to standard MRSA treatment. This study aimed to evaluate dosing regimens for coadministration of daptomycin and ceftaroline in special populations including paediatrics, renally impaired (RI), obese and geriatrics that generate sufficient coverage against daptomycin-resistant MRSA. METHODS Physiologically based pharmacokinetic models were developed from pharmacokinetic studies of healthy adults, geriatric, paediatric, obese and RI patients. The predicted profiles were used to evaluate joint probability of target attainment (PTA), as well as tissue-to-plasma ratios. RESULTS The adult dosing regimens of 6 mg/kg every (q)24h or q48h daptomycin and 300-600 mg q12h ceftaroline fosamil by RI categories achieved ≥90% joint PTA when the minimum inhibitory concentrations in the combination are at or below 1 and 4 μg/mL against MRSA. In paediatrics, wherein there is no recommended daptomycin dosing regimen for S. aureus bacteraemia, ≥90% joint PTA is achieved when the minimum inhibitory concentrations in the combination are up to 0.5 and 2 μg/mL for standard paediatric dosing regimens of 7 mg/kg q24h daptomycin and 12 mg/kg q8h ceftaroline fosamil. Model predicted tissue-to-plasma ratios of 0.3 and 0.7 in the skin and lung, respectively, for ceftaroline and 0.8 in the skin for daptomycin. CONCLUSION Our work illustrates how physiologically based pharmacokinetic modelling can inform appropriate dosing of adult and paediatric patients and thereby enable prediction of target attainment in the patients during multitherapies.
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Affiliation(s)
| | | | - Patricia Severino
- Technology and Research Institute (ITP), Tiradentes University (UNIT), Aracaju, Brazil
| | - Pieter Annaert
- Drug Delivery and Disposition, KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Sherwin K B Sy
- Department of Statistics, State University of Maringá, Maringá, Brazil
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Kim NH, Choi Y, Kwon K, Park JS, Park KU, Moon SM, Song KH, Kim ES, Park WB, Kim HB. Anti-Alpha-Toxin Antibody Responses and Clinical Outcomes of Staphylococcus aureus Bacteremia. J Korean Med Sci 2023; 38:e129. [PMID: 37096312 PMCID: PMC10125797 DOI: 10.3346/jkms.2023.38.e129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/09/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Alpha-toxin (AT), a major virulence factor of Staphylococcus aureus, is an important immunotherapeutic target to prevent or treat invasive S. aureus infections. Previous studies have suggested that anti-AT antibodies (Abs) may have a protective role against S. aureus bacteremia (SAB), but their function remains unclear. Therefore, we aimed to investigate the association between serum anti-AT Ab levels and clinical outcomes of SAB. METHODS Patients from a prospective SAB cohort at a tertiary-care medical center (n = 51) were enrolled in the study from July 2016 to January 2019. Patients without symptoms or signs of infection were enrolled as controls (n = 100). Blood samples were collected before the onset of SAB and at 2- and 4-weeks post-bacteremia. Anti-AT immunoglobin G (IgG) levels were measured using an enzyme-linked immunosorbent assay. All clinical S. aureus isolates were tested for the presence of hla using polymerase chain reaction. RESULTS Anti-AT IgG levels in patients with SAB before the onset of bacteremia did not differ significantly from those in non-infectious controls. Pre-bacteremic anti-AT IgG levels tended to be lower in patients with worse clinical outcomes (7-day mortality, persistent bacteremia, metastatic infection, septic shock), although the differences were not statistically significant. Patients who needed intensive care unit care had significantly lower anti-AT IgG levels at 2 weeks post-bacteremia (P = 0.020). CONCLUSION The study findings suggest that lower anti-AT Ab responses before and during SAB, reflective of immune dysfunction, are associated with more severe clinical presentations of infection.
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Affiliation(s)
- Nak-Hyun Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yunjung Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyungmi Kwon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Meredith EM, Harven LT, Berti AD. Antimicrobial Efficacy against Antibiotic-Tolerant Staphylococcus aureus Depends on the Mechanism of Antibiotic Tolerance. Antibiotics (Basel) 2022; 11:antibiotics11121810. [PMID: 36551467 PMCID: PMC9774428 DOI: 10.3390/antibiotics11121810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Bacteria can adapt to a changing environment by adopting alternate metabolic states favoring small molecule synthesis and resilience over growth. In Staphylococcus aureus, these states are induced by factors present during infection, including nutritional limitations, host responses and competition with other bacteria. Isogenic "tolerant" populations have variable responses to antibiotics and can remain viable. In this study, we compared the capability of antibiotics to reduce the viability of S. aureus made tolerant by different mechanisms. Tolerance was induced with mupirocin, HQNO, peroxynitrite or human serum. Tolerant cultures were exposed to ceftaroline, daptomycin, gentamicin, levofloxacin, oritavancin or vancomycin at physiological concentrations, and the viability was assessed by dilution plating. The minimum duration for 3-log viability reduction and 24 h viability reduction were calculated independently for each of three biological replicates. Each tolerance mechanism rendered at least one antibiotic ineffective, and each antibiotic was rendered ineffective by at least one mechanism of tolerance. Further studies to evaluate additional antibiotics, combination therapy and different tolerance inducers are warranted.
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Affiliation(s)
- Emily M. Meredith
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Lauren T. Harven
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Andrew D. Berti
- Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
- Department of Biochemistry, Microbiology and Immunology, College of Medicine, Wayne State University, Detroit, MI 48201, USA
- Correspondence: ; Tel.: +1-313-577-3565
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Aratani T, Tsukamoto H, Higashi T, Kodawara T, Yano R, Hida Y, Iwasaki H, Goto N. Association of methicillin resistance with mortality of hospital-acquired Staphylococcus aureus bacteremia. J Int Med Res 2021; 49:3000605211058872. [PMID: 34826374 PMCID: PMC8647257 DOI: 10.1177/03000605211058872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB. Methods We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis. Results Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome. Conclusions Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.
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Affiliation(s)
- Tomonori Aratani
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Hitoshi Tsukamoto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan.,Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Takashi Higashi
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Takaaki Kodawara
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
| | - Ryoichi Yano
- Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, Osaka, Japan
| | - Yukio Hida
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan.,Clinical Laboratory, University of Fukui Hospital, Fukui, Japan
| | - Hiromichi Iwasaki
- Infection Control and Prevention, University of Fukui Hospital, Fukui, Japan
| | - Nobuyuki Goto
- Department of Pharmacy, University of Fukui Hospital, Fukui, Japan
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Daptomycin versus Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection with or without Endocarditis: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2021; 10:antibiotics10081014. [PMID: 34439067 PMCID: PMC8389004 DOI: 10.3390/antibiotics10081014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/05/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of invasive infections, mainly bloodstream infections (BSI) with or without endocarditis. The purpose of this meta-analysis was to compare vancomycin, the mainstay treatment, with daptomycin as therapeutic options in this context. Materials: PubMed, Embase and the Cochrane Database were searched from their inception to 15 February 2020. The primary outcome was all-cause mortality. Secondary outcomes included clinical failure, infection recurrence, persistence of infection, length-of-stay, antibiotic discontinuation due to adverse events (AEs) and 30-day re-admission. This study was registered with PROSPERO, CRD42020169413. Results: Eight studies (1226 patients, 554 vs. 672 in daptomycin vs. vancomycin, respectively) were included. No significant difference in terms of overall mortality was observed [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.40–1.33, I2 = 67%]. Daptomycin was associated with a significantly reduced risk of clinical failure (OR 0.58, 95% CI 0.38–0.89, I2 = 60%), as confirmed by pooling adjusted effect sizes (adjusted OR against the use of vancomycin 1.94, 95%CI 1.33–1.82, I2 = 41%), and was linked with fewer treatment-limiting AEs (OR 0.15, 95%CI 0.06–0.36, I2 = 19%). No difference emerged between the two treatments as secondary outcomes. Results were not robust to unmeasured confounding (E-value lower than 95% CI 1.00 for all-cause mortality). Conclusions: Against MRSA BSI, with or without endocarditis, daptomycin seems to be associated with a lower risk of clinical failure and treatment-limiting AEs compared with vancomycin. Further studies are needed to better characterize the differences between the two drugs.
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Clegg J, Soldaini E, McLoughlin RM, Rittenhouse S, Bagnoli F, Phogat S. Staphylococcus aureus Vaccine Research and Development: The Past, Present and Future, Including Novel Therapeutic Strategies. Front Immunol 2021; 12:705360. [PMID: 34305945 PMCID: PMC8294057 DOI: 10.3389/fimmu.2021.705360] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus is one of the most important human pathogens worldwide. Its high antibiotic resistance profile reinforces the need for new interventions like vaccines in addition to new antibiotics. Vaccine development efforts against S. aureus have failed so far however, the findings from these human clinical and non-clinical studies provide potential insight for such failures. Currently, research is focusing on identifying novel vaccine formulations able to elicit potent humoral and cellular immune responses. Translational science studies are attempting to discover correlates of protection using animal models as well as in vitro and ex vivo models assessing efficacy of vaccine candidates. Several new vaccine candidates are being tested in human clinical trials in a variety of target populations. In addition to vaccines, bacteriophages, monoclonal antibodies, centyrins and new classes of antibiotics are being developed. Some of these have been tested in humans with encouraging results. The complexity of the diseases and the range of the target populations affected by this pathogen will require a multipronged approach using different interventions, which will be discussed in this review.
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Affiliation(s)
- Jonah Clegg
- GSK, Siena, Italy
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Rachel M. McLoughlin
- Host Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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11
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Alosaimy S, Lagnf AM, Morrisette T, Jorgensen SCJ, Trinh TD, Zasowski EJ, Scipione MR, Zhao JJ, Mynatt R, Herbin S, Dhar S, Chopra T, Janisse J, Rebold N, Pogue JM, Rybak MJ. Standardized Treatment and Assessment Pathway Improves Mortality in Adults With Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH Study. Open Forum Infect Dis 2021; 8:ofab261. [PMID: 34258313 PMCID: PMC8271135 DOI: 10.1093/ofid/ofab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/21/2021] [Indexed: 12/12/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN) and daptomycin (DAP) are combined with beta-lactams (BLs), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality. Methods The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard of care (VAN or DAP) and a mandatory Infectious Diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013 and 2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables. Results Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared with prepathway (PRE) patients (n = 379), those treated postpathway (POST; n = 434) had a significant reduction in 30-day and 90-day mortality: 9.7% in POST vs 15.6% in PRE (P = .011) and 12.2% in POST vs 19.0% in PRE (P = .007), respectively. The incidence of acute kidney injury (AKI) was higher in the PRE compared with the POST group: 9.6% vs 7.2% (P = .282), respectively. After adjusting for confounding variables including Infectious Diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% CI, 0.375–0.986). Conclusions Implementation of an MRSA BSI treatment pathway with early use of BL reduced mortality with no increased rate of AKI. Further prospective evaluation of this pathway approach is warranted.
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Affiliation(s)
- Sara Alosaimy
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Abdalhamid M Lagnf
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Taylor Morrisette
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Sarah C J Jorgensen
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Trang D Trinh
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Evan J Zasowski
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Marco R Scipione
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Jing J Zhao
- Harper University Hospital, Detroit, Michigan, USA
| | - Ryan Mynatt
- University of Kentucky, Lexington, Kentucky, USA
| | - Shelbye Herbin
- Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| | - Sorabh Dhar
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Division of Infectious Diseases, John D. Dingell, Veterans Administration Medical Center, Detroit, Michigan, USA
| | - Teena Chopra
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Detroit Medical Center, Detroit, Michigan, USA
| | - James Janisse
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Nicholas Rebold
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Jason M Pogue
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA.,Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, Michigan, USA
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12
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Johnson TM, Molina KC, Miller MA, Kiser TH, Huang M, Mueller SW. Combination ceftaroline and daptomycin salvage therapy for complicated methicillin-resistant Staphylococcus aureus bacteraemia compared with standard of care. Int J Antimicrob Agents 2021; 57:106310. [PMID: 33609718 DOI: 10.1016/j.ijantimicag.2021.106310] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/20/2021] [Accepted: 02/14/2021] [Indexed: 01/03/2023]
Abstract
Complicated methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs), particularly those with delayed culture clearance, are associated with high mortality. Combination therapy with daptomycin and ceftaroline (DAP+CPT) represents a novel therapeutic approach to MRSA-BSI owing to synergistic bactericidal activity. This study aimed to compare DAP+CPT with historical standard of care (SoC) for treatment of complicated MRSA-BSI. This single-centre retrospective cohort study included patients with complicated MRSA-BSI at University of Colorado Hospital. Patients receiving DAP+CPT for ≥48 h between November 2013 and March 2020 or SoC with vancomycin or DAP ± gentamicin and/or rifampicin from November 2011 to December 2013 were compared. The primary outcome was clinical failure defined as a composite of MRSA-related mortality and recurrent infection at 60 days. A total of 60 patients received DAP+CPT (n = 30) or SoC (n = 30). Median age was 56 years and median Pitt bacteremia score was 3. Common infectious sites were endovascular (63%) and musculoskeletal (40%). DAP+CPT was associated with a numerically lower incidence of clinical failure compared with SoC (20% vs. 43%; P = 0.052). Multivariable analysis controlling for immunocompromised status (OR, 6.90, 95% CI 1.08-44.15), Charlson comorbidity index (OR, 1.12, 95% CI 0.90-1.39) and source control (OR, 0.35, 95% CI 0.08-1.46) associated DAP+CPT with 77% lower odds of clinical failure (OR, 0.23, 95% CI 0.06-0.89). In patients with complicated MRSA-BSI with delayed clearance, DAP+CPT trended towards lower rates of clinical failure than SoC and was significantly associated with decreased clinical failure after adjustment for baseline differences.
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Affiliation(s)
- Tanner M Johnson
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Kyle C Molina
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Matthew A Miller
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Tyree H Kiser
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Misha Huang
- Department of Medicine-Infectious Diseases, University of Colorado Hospital, Aurora, CO, USA; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott W Mueller
- Department of Pharmacy, University of Colorado Hospital, Aurora, CO, USA; Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.
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13
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Wozniak JM, Mills RH, Olson J, Caldera JR, Sepich-Poore GD, Carrillo-Terrazas M, Tsai CM, Vargas F, Knight R, Dorrestein PC, Liu GY, Nizet V, Sakoulas G, Rose W, Gonzalez DJ. Mortality Risk Profiling of Staphylococcus aureus Bacteremia by Multi-omic Serum Analysis Reveals Early Predictive and Pathogenic Signatures. Cell 2020; 182:1311-1327.e14. [PMID: 32888495 PMCID: PMC7494005 DOI: 10.1016/j.cell.2020.07.040] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022]
Abstract
Staphylococcus aureus bacteremia (SaB) causes significant disease in humans, carrying mortality rates of ∼25%. The ability to rapidly predict SaB patient responses and guide personalized treatment regimens could reduce mortality. Here, we present a resource of SaB prognostic biomarkers. Integrating proteomic and metabolomic techniques enabled the identification of >10,000 features from >200 serum samples collected upon clinical presentation. We interrogated the complexity of serum using multiple computational strategies, which provided a comprehensive view of the early host response to infection. Our biomarkers exceed the predictive capabilities of those previously reported, particularly when used in combination. Last, we validated the biological contribution of mortality-associated pathways using a murine model of SaB. Our findings represent a starting point for the development of a prognostic test for identifying high-risk patients at a time early enough to trigger intensive monitoring and interventions.
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Affiliation(s)
- Jacob M Wozniak
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA
| | - Robert H Mills
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA; Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Joshua Olson
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - J R Caldera
- Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Gregory D Sepich-Poore
- Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Marvic Carrillo-Terrazas
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA
| | - Chih-Ming Tsai
- Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Fernando Vargas
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Division of Biological Sciences, University of California, San Diego, La Jolla, CA 92093, USA
| | - Rob Knight
- Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA; Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093, USA; Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA 92093, USA
| | - Pieter C Dorrestein
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA
| | - George Y Liu
- Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Victor Nizet
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - George Sakoulas
- Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093, USA
| | - Warren Rose
- School of Pharmacy, School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI 53705, USA; Department of Medicine, School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI 53705, USA
| | - David J Gonzalez
- Department of Pharmacology, University of California, San Diego, La Jolla, CA 92093, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093, USA; Collaborative to Halt Antibiotic-Resistant Microbes, University of California, San Diego, La Jolla, CA 92093, USA; Center for Microbiome Innovation, University of California, San Diego, La Jolla, CA 92093, USA.
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Huang G, Huang Q, Zhang G, Jiang H, Lin Z. Point-prevalence surveys of hospital-acquired infections in a Chinese cancer hospital: From 2014 to 2018. J Infect Public Health 2020; 13:1981-1987. [PMID: 32280033 DOI: 10.1016/j.jiph.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Both hospital-acquired infection (HAI) and cancer represents major health concerns worldwide, but there is a paucity of data describing HAI in Chinese cancer patients. The objective of this study is to demonstrate the prevalence, causative agents, antimicrobial use and risk factors for HAI in a cancer hospital in Southwestern China. METHODS We use the criteria of the Ministry of Health of the People's Republic of China to define hospital-acquired infections. One-day cross-sectional surveys were annually conducted from 2014 to 2018. Trained staff collected hospital-acquired infections, antimicrobial use and clinical characteristics data of inpatients. Multivariate logistic regression was used to determine the potential risk factors associated with HAIs. RESULTS Of the 6717 patients surveyed, there were 140 patients (2.1%, 95% confidence interval, 1.7-2.4%) with 144 distinct HAIs. Lower respiratory tract infections (47, 32.6%) and surgical-site infections (29, 20.1%) were the most common HAIs. Escherichia coli was the most common pathogen (29.6%). Risk factors for HAI included younger age (<18 years) or older age (>65 years), hospitalization in the intensive care unit, presence of central catheter and undergoing surgery in the previous 30 days. The overall prevalence of patients receiving antimicrobial agents was 15.2%. CONCLUSION To control hospital-acquired infections in cancer patients, surveillance and prevention strategies to infections associated with central catheters or related to surgery should be augmented.
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Affiliation(s)
- Guyu Huang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Qianqian Huang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Guoqiang Zhang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Hu Jiang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Zhen Lin
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China.
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15
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Joo EJ, Park DA, Kang CI, Chung DR, Song JH, Lee SM, Peck KR. Reevaluation of the impact of methicillin-resistance on outcomes in patients with Staphylococcus aureus bacteremia and endocarditis. Korean J Intern Med 2019; 34:1347-1362. [PMID: 29347812 PMCID: PMC6823568 DOI: 10.3904/kjim.2017.098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/08/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in hospitals, and has recently emerged in the community. The impact of methicillin-resistance on mortality and medical costs for patients with S. aureus bacteremia (SAB) requires reevaluation. METHODS We searched studies with SAB or endocarditis using electronic databases including Ovid-Medline, Embase-Medline, and Cochrane Library, as well as five local databases for published studies during the period January 2000 to September 2011. RESULTS A total of 2,841 studies were identified, 62 of which involved 17,563 adult subjects and were selected as eligible. A significant increase in overall mortality associated with MRSA, compared to that with methicillin-susceptible S. aureus (MSSA), was evidenced by an odds ratio (OR) of 1.95 (95% confidence interval [CI], 1.73 to 2.21; p < 0.01). In 13 endocarditis studies, MRSA increased the risk of mortality, with an OR of 2.65 (95% CI, 1.46 to 4.80). When three studies, which compared mortality rates between CA-MRSA and CA-MSSA, were combined, the risk of methicillin-resistance increased 3.23-fold compared to MSSA (95% CI, 1.25 to 8.34). The length of hospital stay in the MRSA group was 10 days longer than that in the MSSA group (95% CI, 3.36 to 16.70). Of six studies that reported medical costs, two were included in the analysis, which estimated medical costs to be $9,954.58 (95% CI, 8,951.99 to 10,957.17). CONCLUSION MRSA is still associated with increased mortality, longer hospital stays and medical costs, compared with MSSA in SAB in studies published since the year 2000.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Ah Park
- Office of Health Technology Evaluation, National Evidence-based Healthcare Collaboration Agency, Seoul, Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Moo Lee
- Office of Health Technology Evaluation, National Evidence-based Healthcare Collaboration Agency, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Correspondence to Kyong Ran Peck, M.D. Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-0329 Fax: +82-2-3410-0064 E-mail:
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Geriak M, Haddad F, Rizvi K, Rose W, Kullar R, LaPlante K, Yu M, Vasina L, Ouellette K, Zervos M, Nizet V, Sakoulas G. Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia. Antimicrob Agents Chemother 2019; 63:e02483-18. [PMID: 30858203 PMCID: PMC6496065 DOI: 10.1128/aac.02483-18] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/03/2019] [Indexed: 12/24/2022] Open
Abstract
Vancomycin (VAN) and daptomycin (DAP) are approved as a monotherapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. A regimen of daptomycin plus ceftaroline (DAP+CPT) has shown promise in published case series of MRSA salvage therapy, but no comparative data exist to compare up-front DAP+CPT head-to-head therapy versus standard monotherapy as an initial treatment. In a pilot study, we evaluated 40 adult patients who were randomized to receive 6 to 8 mg/kg of body weight per day of DAP and 600 mg intravenous (i.v.) CPT every 8 h (q8h) (n = 17) or standard monotherapy (n = 23) with vancomycin (VAN; dosed to achieve serum trough concentrations of 15 to 20 mg/liter; n = 21) or 6 to 8 mg/kg/day DAP (n = 2). Serum drawn on the first day of bacteremia was sent to a reference laboratory post hoc for measurement of interleukin-10 (IL-10) concentrations and correlation to in-hospital mortality. Sources of bacteremia, median Pitt bacteremia scores, Charlson comorbidity indices, and median IL-10 serum concentrations were similar in both groups. Although the study was initially designed to examine bacteremia duration, we observed an unanticipated in-hospital mortality difference of 0% (0/17) for combination therapy and 26% (6/23) for monotherapy (P = 0.029), causing us to halt the study. Among patients with an IL-10 concentration of >5 pg/ml, 0% (0/14) died in the DAP+CPT group versus 26% (5/19) in the monotherapy group (P = 0.057). Here, we share the full results of this preliminary (but aborted) assessment of early DAP+CPT therapy versus standard monotherapy in MRSA bacteremia, hoping to encourage a more definitive clinical trial of its potential benefits against this leading cause of infection-associated mortality. (The clinical study discussed in this paper has been registered at ClinicalTrials.gov under identifier NCT02660346.).
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Affiliation(s)
| | - Fadi Haddad
- Sharp Grossmont Hospital, La Mesa, California, USA
| | | | - Warren Rose
- University of Wisconsin School of Pharmacy, Madison, Wisconsin, USA
| | | | - Kerry LaPlante
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | - Marie Yu
- Sharp Grossmont Hospital, La Mesa, California, USA
| | - Logan Vasina
- Sharp Memorial Hospital, San Diego, California, USA
| | | | | | - Victor Nizet
- University of Rhode Island College of Pharmacy, Kingston, Rhode Island, USA
| | - George Sakoulas
- Sharp Memorial Hospital, San Diego, California, USA
- University of California San Diego School of Medicine, La Jolla, California, USA
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17
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Würstle S, Göß A, Spinner CD, Huber W, Algül H, Schlag C, Schmid RM, Weber A, Obermeier A, Schneider J. A retrospective clinical and microbial analysis of 32 patients with bilomas. BMC Gastroenterol 2019; 19:50. [PMID: 30947689 PMCID: PMC6450004 DOI: 10.1186/s12876-019-0968-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bilomas are defined collections of bile fluids mainly caused by iatrogenic injuries of the bile duct system. Owing to the infrequency of this disease, studies addressing bilomas are rare. METHODS By using an endoscopic database, this retrospective study identified 32 patients with bilomas treated between 2004 to 2015, in order to analyse aetiology, clinical presentation, spectrum of pathogens, and resolution rate of bilomas. RESULTS 65.6% of the study population (21/32) developed bilomas after surgery and 21.9% (7/32) after endoscopic retrograde cholangiography (ERC). Icterus, fever, and abdominal pain were the leading symptoms. 93.9% (46/49) of microbiological bile cultures revealed a positive microbiology. The predominant microorganisms were the group of Enterobacteriaceae (43.0%, 52/121), followed by Enterococcus spp. (32.2%, 39/121), and Candida spp. (9.1%, 11/121). Multiresistant bacteria like Enterobacteriaceae were isolated from one quarter of all patients. Single or multimodal treatment resulted in an overall complication rate of 4.8% (9/188). Clinical follow-up analysis showed a complete resolution rate of 78.3% for interventional therapy and 80% in the non-interventional group. CONCLUSIONS Pathogen spectrum of bilomas mainly comprises the group of Enterobacteriacae and Enterococcus spp., with a high proportion of multiresistant bacteria. Different interventional approaches are available for biloma drainage, which seem to be safe and effective for most patients. TRIAL REGISTRATION German Clinical Trials Register DRKS00015208 , retrospectively registered.
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Affiliation(s)
- S Würstle
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany.
| | - A Göß
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - C D Spinner
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - W Huber
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - H Algül
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - C Schlag
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - R M Schmid
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - A Weber
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
| | - A Obermeier
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Implantat-assoziierte Infektforschung, Munich, Germany
| | - J Schneider
- Klinikum rechts der Isar, Technische Universität München, Innere Medizin II, Ismaningerstrasse 22, 81675, Munich, Germany
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Seas C, Garcia C, Salles MJ, Labarca J, Luna C, Alvarez-Moreno C, Mejía-Villatoro C, Zurita J, Guzmán-Blanco M, Rodríguez-Noriega E, Reyes J, Arias CA, Carcamo C, Gotuzzo E. Staphylococcus aureus bloodstream infections in Latin America: results of a multinational prospective cohort study. J Antimicrob Chemother 2018; 73:212-222. [PMID: 29045648 DOI: 10.1093/jac/dkx350] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background Substantial heterogeneity in the epidemiology and management of Staphylococcus aureus bacteraemia (SAB) occurs in Latin America. We conducted a prospective cohort study in 24 hospitals from nine Latin American countries. Objectives To assess the clinical impact of SAB in Latin America. Patients and methods We evaluated differences in the 30 day attributable mortality among patients with SAB due to MRSA compared with MSSA involving 84 days of follow-up. Adjusted relative risks were calculated using a generalized linear model. Results A total of 1030 patients were included. MRSA accounted for 44.7% of cases with a heterogeneous geographical distribution. MRSA infection was associated with higher 30 day attributable mortality [25% (78 of 312) versus 13.2% (48 of 363), adjusted RR: 1.94, 95% CI: 1.38-2.73, P < 0.001] compared with MSSA in the multivariable analysis based on investigators' assessment, but not in a per-protocol analysis [13% (35 of 270) versus 8.1% (28 of 347), adjusted RR: 1.10, 95% CI: 0.75-1.60, P = 0.616] or in a sensitivity analysis using 30 day all-cause mortality [36% (132 of 367) versus 27.8% (123 of 442), adjusted RR: 1.09, 95% CI: 0.96-1.23, P = 0.179]. MRSA infection was not associated with increased length of hospital stay. Only 49% of MSSA bloodstream infections (BSI) received treatment with β-lactams, but appropriate definitive treatment was not associated with lower mortality (adjusted RR: 0.93, 95% CI: 0.70-1.23, P = 0.602). Conclusions MRSA-BSIs in Latin America are not associated with higher 30 day mortality or longer length of stay compared with MSSA. Management of MSSA-BSIs was not optimal, but appropriate definitive therapy did not appear to influence mortality.
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Affiliation(s)
- Carlos Seas
- Hospital Cayetano Heredia, Lima, Peru, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Coralith Garcia
- Hospital Cayetano Heredia, Lima, Peru, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mauro J Salles
- Division of Infectious Diseases, Department of Internal Medicine, Santa Casa de Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Jaime Labarca
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Carlos Luna
- Pulmonary Division, Department of Medicine, Jose de San Martin Hospital, University of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Alvarez-Moreno
- Grupo de Investigación en Enfermedades Infecciosas, Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | | | - Jeannete Zurita
- Hospital Vozandes, Facultad de Medicina, Pontificia Universidad Catolica del Ecuador, Quito, Ecuador
| | | | - Eduardo Rodríguez-Noriega
- Hospital Civil de Guadalajara, Fray Antonio Alcalde, and Instituto de Patologia Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Cesar A Arias
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Center for Antimicrobial Resistance and Microbial Genomics, University of Texas, McGovern School of Medicine at Houston, Houston, TX, USA
| | - Cesar Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eduardo Gotuzzo
- Hospital Cayetano Heredia, Lima, Peru, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Staphylococcus aureus bacteremia in immunosuppressed patients: a multicenter, retrospective cohort study. Eur J Clin Microbiol Infect Dis 2017; 36:1231-1241. [PMID: 28251359 DOI: 10.1007/s10096-017-2914-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) causes significant morbidity and mortality. We assessed the disease severity and clinical outcomes of SAB in patients with pre-existing immunosuppression, compared with immunocompetent patients. A retrospective cohort investigation studied consecutive patients with SAB hospitalized across six hospitals in Toronto, Canada from 2007 to 2010. Patients were divided into immunosuppressed (IS) and immunocompetent (IC) cohorts; the IS cohort was subdivided into presence of one and two or more immunosuppressive conditions. Clinical parameters were compared between cohorts and between IS subgroups. A competing risk model compared in-hospital mortality and time to discharge. A total of 907 patients were included, 716 (79%) were IC and 191 (21%) were IS. Within the IS cohort, 111 (58%) had one immunosuppressive condition and 80 (42%) had two or more conditions. The overall in-hospital mortality was 29%, with no differences between groups (IS 32%, IC 28%, p = 0.4211). There were no differences in in-hospital mortality (sub-distribution hazard ratio [sHR] 1.17, 95% confidence interval [CI] 0.88-1.56, p = 0.2827) or time to discharge (sHR 0.94, 95% CI 0.78-1.15, p = 0.5570). Independent mortality predictors for both cohorts included hypotension at 72 h (IS: p < 0.0001, IC: p < 0.0001) and early embolic stroke (IS: p < 0.0001, IC: p = 0.0272). Congestive heart failure was a mortality predictor in the IS cohort (p = 0.0089). Fever within 24 h (p = 0.0092) and early skin and soft tissue infections (p < 0.0001) were survival predictors in the IS cohort. SAB causes significant mortality regardless of pre-existing immune status, but immunosuppressed patients do not have an elevated risk of mortality relative to immunocompetent patients.
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Antimicrobial Peptide P60.4Ac-Containing Creams and Gel for Eradication of Methicillin-Resistant Staphylococcus aureus from Cultured Skin and Airway Epithelial Surfaces. Antimicrob Agents Chemother 2016; 60:4063-72. [PMID: 27114278 DOI: 10.1128/aac.03001-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/20/2016] [Indexed: 12/28/2022] Open
Abstract
We previously found the LL-37-derived peptide P60.4Ac to be effective against methicillin-resistant Staphylococcus aureus (MRSA) on human epidermal models (EMs). The goal of this study was to identify the preferred carrier for this peptide for topical application on skin and mucosal surfaces. We prepared P60.4Ac in three formulations, i.e., a water-in-oil cream with lanolin (Softisan 649), an oil-in-water cream with polyethylene glycol hexadecyl ether (Cetomacrogol), and a hydroxypropyl methylcellulose (hypromellose) 4000 gel. We tested the antimicrobial efficacy of the peptide in these formulations against mupirocin-resistant and -sensitive MRSA strains on EMs and bronchial epithelial models (BEMs). The cytotoxic effects of formulated P60.4Ac on these models were determined using histology and WST-1 and lactate dehydrogenase assays. Moreover, we assessed the stability of the peptide in these formulations with storage for up to 3 months. Killing of MRSA by P60.4Ac in the two creams was less effective than that by P60.4Ac in the hypromellose gel. In agreement with those findings, P60.4Ac in the hypromellose gel was highly effective in eradicating the two MRSA strains from EMs. We found that even 0.1% (wt/wt) P60.4Ac in the hypromellose gel killed >99% of the viable planktonic bacteria and >85% of the biofilm-associated bacteria on EMs. Hypromellose gels containing 0.1% and 0.5% (wt/wt) P60.4Ac effectively reduced the numbers of viable MRSA cells from BEMs by >90%. No cytotoxic effects of P60.4Ac in the hypromellose gel with up to 2% (wt/wt) P60.4Ac on keratinocytes in EMs and in the hypromellose gel with up to 0.5% (wt/wt) P60.4Ac on epithelial cells in BEMs were observed. High-performance liquid chromatography analysis showed that P60.4Ac was stable in the Softisan cream and the hypromellose gel but not in the Cetomacrogol cream. We conclude that P60.4Ac formulated in hypromellose gel is both stable and highly effective in eradicating MRSA from colonized EMs and BEMs.
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Yilmaz M, Elaldi N, Balkan İİ, Arslan F, Batırel AA, Bakıcı MZ, Gozel MG, Alkan S, Çelik AD, Yetkin MA, Bodur H, Sınırtaş M, Akalın H, Altay FA, Şencan İ, Azak E, Gündeş S, Ceylan B, Öztürk R, Leblebicioglu H, Vahaboglu H, Mert A. Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study. Ann Clin Microbiol Antimicrob 2016; 15:7. [PMID: 26860463 PMCID: PMC4748515 DOI: 10.1186/s12941-016-0122-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/01/2016] [Indexed: 12/20/2022] Open
Abstract
Background Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. Methods Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010–2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. Results A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. Conclusions The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.
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Affiliation(s)
- Mesut Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Nazif Elaldi
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - İlker İnanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Ayşe Alga Batırel
- Department of Infectious Diseases and Clinical Microbiology, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Mustafa Zahir Bakıcı
- Department of Medical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - Mustafa Gokhan Gozel
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Aygül Doğan Çelik
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Trakya University, Edirne, Turkey.
| | - Meltem Arzu Yetkin
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Hürrem Bodur
- Department of Infectious Diseases and Clinical Microbiology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
| | - Melda Sınırtaş
- Department of Medical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey.
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Uludag University, Bursa, Turkey.
| | - Fatma Aybala Altay
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Emel Azak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Sibel Gündeş
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
| | - Recep Öztürk
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Hakan Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Samsun, Turkey.
| | - Haluk Vahaboglu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, TEM Avrupa Otoyolu Göztepe Çıkışı No: 1, Bağcılar, 34214, İstanbul, Turkey.
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Wang JT, Hsu LY, Lauderdale TL, Fan WC, Wang FD. Comparison of Outcomes among Adult Patients with Nosocomial Bacteremia Caused by Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus: A Retrospective Cohort Study. PLoS One 2015; 10:e0144710. [PMID: 26690351 PMCID: PMC4686456 DOI: 10.1371/journal.pone.0144710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/23/2015] [Indexed: 01/19/2023] Open
Abstract
Several studies have shown that patients with bacteremia caused by methicillin-resistant Staphylococcus aureus (MRSA) have worse outcomes than those with bacteremia caused by methicillin-susceptible S. aureus (MSSA). However, only a limited number of studies have stratified the MRSA isolates into healthcare-associated (HA-) and community-associated (CA-) MRSA strains in such a comparison. This three-year retrospective cohort study, enrolling adult patients with nosocomial S. aureus bacteremia (SAB), was designed to investigate whether CA-MRSA and/or HA-MRSA strains were associated with different outcomes in comparison to MSSA in such a setting. The drug susceptibilities and staphylococcal cassette chromosome mec (SCCmec) types were determined for all of the causative isolates available. The MRSA bacteremia was further categorized into those caused by CA-MRSA strains (CA-MRSA-S bacteremia) when the causative isolates carried the type IV or V SCCmec element, those caused by HA-MRSA strains (HA-MRSA-S bacteremia) when the isolates carried the type I, II, or III SCCmec element, or unclassified MRSA bacteremia when the isolates were not available. The relevant demographic, clinical, and laboratory data were collected by reviewing the patients’ charts. The primary outcome was all-cause in-hospital mortality. A total of 353 patients were studied. The overall in-hospital mortality rate was 32.6%, with 23.3% in MSSA, 30.5% in CA-MRSA-S, 47.5% in HA-MRSA-S, and 35.3% in unclassified MRSA bacteremia, respectively. The multivariate analysis showed that HA-MRSA-S, but not CA-MRSA-S, bacteremia was associated with a significantly worse outcome compared with MSSA. The other risk factors independently associated with all-cause in-hospital mortality included the Charlson co-morbidity index, septic shock, thrombocytopenia, and persistent bacteremia. Resistance to linezolid and daptomycin was found among the MRSA isolates. The present study showed that bacteremia caused by HA-MRSA-S, but not CA-MRSA-S, was an independent risk factor for all-cause in-hospital mortality in patients with nosocomial SAB. Continuous monitoring regarding the susceptibilities of MRSA to linezolid and daptomycin is necessary.
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Affiliation(s)
- Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Tsai-Ling Lauderdale
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Chien Fan
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Der Wang
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University School of Medicine, Taipei, Taiwan
- * E-mail:
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Cheng VCC, Wong SCY, Ho PL, Yuen KY. Strategic measures for the control of surging antimicrobial resistance in Hong Kong and mainland of China. Emerg Microbes Infect 2015; 4:e8. [PMID: 26038766 PMCID: PMC4345289 DOI: 10.1038/emi.2015.8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 01/23/2023]
Abstract
Antimicrobial-resistant bacteria are either highly prevalent or increasing rapidly in Hong Kong and China. Treatment options for these bacteria are generally limited, less effective and more expensive. The emergence and dynamics of antimicrobial resistance genes in bacteria circulating between animals, the environment and humans are not entirely known. Nonetheless, selective pressure by antibiotics on the microbiomes of animal and human, and their associated environments (especially farms and healthcare institutions), sewage systems and soil are likely to confer survival advantages upon bacteria with antimicrobial-resistance genes, which may be further disseminated through plasmids or transposons with integrons. Therefore, antibiotic use must be tightly regulated to eliminate such selective pressure, including the illegalization of antibiotics as growth promoters in animal feed and regulation of antibiotic use in veterinary practice and human medicine. Heightened awareness of infection control measures to reduce the risk of acquiring resistant bacteria is essential, especially during antimicrobial use or institutionalization in healthcare facilities. The transmission cycle must be interrupted by proper hand hygiene, environmental cleaning, avoidance of undercooked or raw food and compliance with infection control measures by healthcare workers, visitors and patients, especially during treatment with antibiotics. In addition to these routine measures, proactive microbiological screening of hospitalized patients with risk factors for carrying resistant bacteria, including history of travel to endemic countries, transfer from other hospitals, and prolonged hospitalization; directly observed hand hygiene before oral intake of drugs, food and drinks; and targeted disinfection of high-touch or mutual-touch items, such as bed rails and bed curtains, are important. Transparency of surveillance data from each institute for public scrutiny provides an incentive for controlling antimicrobial resistance in healthcare settings at an administrative level.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China ; Infection Control Team, Queen Mary Hospital , Hong Kong, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong, China ; Department of Clinical Microbiology and Infection Control, Hong Kong University-Shenzhen Hospital , Shenzhen 518053, Guangdong province, China
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Fortuin-de Smidt MC, Singh-Moodley A, Badat R, Quan V, Kularatne R, Nana T, Lekalakala R, Govender NP, Perovic O. Staphylococcus aureus bacteraemia in Gauteng academic hospitals, South Africa. Int J Infect Dis 2014; 30:41-8. [PMID: 25448331 DOI: 10.1016/j.ijid.2014.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/24/2014] [Accepted: 10/25/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) infections are responsible for longer hospital stays, increased hospital costs, and poorer outcomes compared to methicillin-sensitive S. aureus (MSSA) infections. We aimed to describe the epidemiology of S. aureus bacteraemia (SAB) and to determine factors associated with MRSA infection in South Africa. METHODS Cases of SAB were reported from September 2012 to September 2013 from three sentinel sites. A case was defined as the isolation of S. aureus from a blood culture during a 21-day period. Detailed clinical information was collected. Multivariable logistic regression was done to determine factors associated with MRSA infection and mortality. RESULTS There were 442 cases of SAB reported; antimicrobial susceptibility testing was performed on 240 isolates (54%). Thirty-six percent (86/240) of cases had an MRSA infection. A longer hospital stay before positive specimen collection (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.02-1.13, p=0.004), hospitalization in the last year (OR 15.7, 95% CI 2.5-99.5, p=0.003), HIV infection (OR 4.9, 95% CI 1.05-22.90, p=0.044), and antibiotic use in the previous 2 months (OR 0.1, 95% CI 0.01-0.68, p=0.022) were independent predictors of MRSA. Older age, and in particular age 25-44 years (OR 22.2, 95% CI 2.7-185.5, p=0.004, compared to those aged<5 years), was the only independent predictor of mortality amongst cases with SAB. MRSA isolates were non-susceptible to more antimicrobial agents compared to MSSA isolates. CONCLUSIONS HIV infection was an independent risk factor for MRSA infection. The selection of appropriate empirical antimicrobial treatment is essential in patients with MRSA infections because of non-susceptibility to many other antimicrobial classes.
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Affiliation(s)
- Melony C Fortuin-de Smidt
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa
| | - Ashika Singh-Moodley
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rubeina Badat
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa
| | - Vanessa Quan
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa
| | - Ranmini Kularatne
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | - Trusha Nana
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Johannesburg, South Africa
| | - Ruth Lekalakala
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division, National Health Laboratory Service, Gauteng, South Africa
| | - Nelesh P Govender
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Olga Perovic
- National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service (NHLS), Centre for Opportunistic, Tropical and Hospital Infections, Private Bag X4, Sandringham, 2132, Gauteng, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Anantha RV, Jegatheswaran J, Pepe DL, Priestap F, Delport J, Haeryfar SM, McCormick JK, Mele T. Risk factors for mortality among patients with Staphylococcus aureus bacteremia: a single-centre retrospective cohort study. CMAJ Open 2014; 2:E352-9. [PMID: 25553328 PMCID: PMC4270209 DOI: 10.9778/cmajo.20140018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus bacteremia is associated with significant morbidity and mortality. Given the paucity of recent Canadian data, we estimated the mortality rate associated with S. aureus bacteremia in a tertiary care hospital and identified risk factors associated with mortality. METHODS We retrospectively reviewed the records of adults with S. aureus bacteremia admitted to a tertiary care centre in southwestern Ontario between 2008 and 2012. Cox regression analysis was used to evaluate associations between predictor variables and all-cause, in-hospital, and 90-day postdischarge mortality. RESULTS Of the 925 patients involved in the study, 196 (21.2%) died in hospital and 62 (6.7%) died within 90 days after discharge. Risk factors associated with in-hospital and all-cause mortality included age, sepsis (adjusted hazard ratio [adjusted HR] 1.49, 95% confidence interval [CI] 1.08-2.06, p = 0.02), admission to the intensive care unit (adjusted HR 3.78, 95% CI 2.85-5.02, p < 0.0001), hepatic failure (adjusted HR 3.36, 95% CI 1.91-5.90, p < 0.0001) and metastatic cancer (adjusted HR 2.58, 95% CI 1.77-3.75, p < 0.0001). Methicillin resistance, hepatic failure, cerebrovascular disease, chronic obstructive pulmonary disease and metastatic cancer were associated with postdischarge mortality. INTERPRETATION The all-cause mortality rate in our cohort was 27.9%. Identification of predictors of mortality may guide empiric therapy and provide prognostic clarity for patients with S. aureus bacteremia.
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Affiliation(s)
- Ram Venkatesh Anantha
- Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ont
| | | | - Daniel Luke Pepe
- Schulich School of Medicine and Dentistry, Western University, London, Ont
| | - Fran Priestap
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont
| | - Johan Delport
- Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ont
| | - S.M. Mansour Haeryfar
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ont
| | - John K. McCormick
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ont
| | - Tina Mele
- Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Ont
- Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont
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Daniels TL, Talbot TR. Infection control and prevention considerations. Cancer Treat Res 2014; 161:463-83. [PMID: 24706234 DOI: 10.1007/978-3-319-04220-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Due to the nature of their underlying illness and treatment regimens, cancer patients are at increased risk of infection. Though the advent and widespread use of anti-infective agents has allowed for the application of ever-greater immune-suppressing therapies with successful treatment of infectious complications, prevention of infection remains the primary goal. The evolutionary changes of microorganisms, whereby resistance to anti-infective therapy is increasingly common, have facilitated a paradigm shift in the field of healthcare epidemiology. No longer is the focus on "control" of infection once established in a healthcare environment. Rather, the emphasis is on prevention of infection before it occurs. The most basic tenet of infection prevention, and the cornerstone of all well-designed infection prevention and control programs, is hand hygiene. The hands of healthcare workers provide a common potential source for transmission of infectious agents, and effective decontamination of the hands reduces the risk of transmission of infectious material to other patients. Once infection is suspected or established; however, implementation of effective control strategies is important to limit the spread of infection within a healthcare environment. This chapter outlines the basic tenets of infection prevention, principles of isolation precautions and control measures, and elements for a successful infection control and prevention program.
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Affiliation(s)
- Titus L Daniels
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, A2200 MCN, 1161 21 AVE S, Nashville, TN, 37232, USA,
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Tai KP, Kamdar K, Yamaki J, Le VV, Tran D, Tran P, Selsted ME, Ouellette AJ, Wong-Beringer A. Microbicidal effects of α- and θ-defensins against antibiotic-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Innate Immun 2013; 21:17-29. [PMID: 24345876 DOI: 10.1177/1753425913514784] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Antibiotic-resistant bacterial pathogens threaten public health. Because many antibiotics target specific bacterial enzymes or reactions, corresponding genes may mutate under selection and lead to antibiotic resistance. Accordingly, antimicrobials that selectively target overall microbial cell integrity may offer alternative approaches to therapeutic design. Naturally occurring mammalian α- and θ-defensins are potent, non-toxic microbicides that may be useful for treating infections by antibiotic-resistant pathogens because certain defensin peptides disrupt bacterial, but not mammalian, cell membranes. To test this concept, clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA), including vancomycin heteroresistant strains, and ciprofloxacin-resistant Pseudomonas aeruginosa (Cip(R)-PA) were tested for sensitivity to α-defensins Crp-4, RMAD-4 and HNPs 1-3, and to RTD-1, macaque θ-defensin-1. In vitro, 3 μM Crp-4, RMAD-4 and RTD-1 reduced MRSA cell survival by 99%, regardless of vancomycin susceptibility. For PA clinical isolates that differ in fluoroquinolone resistance and virulence phenotype, peptide efficacy was independent of strain ciprofloxacin resistance, site of isolation or virulence factor expression. Thus, Crp-4, RMAD-4 and RTD-1 are effective in vitro antimicrobials against clinical isolates of MRSA and Cip(R)-PA, perhaps providing templates for development of α- and θ-defensin-based microbicides against antibiotic resistant or virulent infectious agents.
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Affiliation(s)
- Kenneth P Tai
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Karishma Kamdar
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Jason Yamaki
- Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
| | - Valerie V Le
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Dat Tran
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Patti Tran
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Michael E Selsted
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - André J Ouellette
- Department of Pathology and Laboratory Medicine, USC Norris Cancer Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Annie Wong-Beringer
- Titus Family Department of Clinical Pharmacy and Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA, USA
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Yang CJ, Chung YC, Chen TC, Chang HL, Tsai YM, Huang MS, Chen YH, Lu PL. The impact of inappropriate antibiotics on bacteremia patients in a community hospital in Taiwan: an emphasis on the impact of referral information for cases from a hospital affiliated nursing home. BMC Infect Dis 2013; 13:500. [PMID: 24156241 PMCID: PMC4015527 DOI: 10.1186/1471-2334-13-500] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/17/2013] [Indexed: 12/19/2022] Open
Abstract
Background Evidence for the impact of inappropriate antimicrobial therapy on bacteremia is mainly from studies in medical centers. We investigated the impact of inappropriate antimicrobial therapy on bacteremia in a community hospital. In particular, patients from the hospital’s affiliated nursing home were sent to the hospital with adequate referral information. Methods We performed a retrospective study to collect data of patients with bacteremia in a community hospital in Taiwan from 2005 to 2007. Results A total of 222 patients with blood stream infection were diagnosed, of whom 104 patients (46.8%) died. The rate of initial inappropriate antibiotic prescriptions was high (59%). Multivariate analysis revealed that patients with initial inappropriate antibiotics, patients with ventilator support and patients requiring ICU care were the independent predictors for inhospital mortality. Patients referred from the hospital-affiliated nursing home and patients with normal WBC counts had better survival outcome. More than 80% cases infected with methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis received initial inappropriate antimicrobial therapy. With the longer delay to administer appropriate antibiotic, a trend of higher mortality rates was observed. Conclusions Bacteremia patients from a hospital-affiliated nursing home had a better prognosis, which may have been due to the adequate referral information. Clinicians should be aware of the commonly ignored drug resistant pathogens, and efforts should be made to avoid delaying the administration of appropriate antibiotic therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Allahverdiyev AM, Bagirova M, Abamor ES, Ates SC, Koc RC, Miraloglu M, Elcicek S, Yaman S, Unal G. The use of platensimycin and platencin to fight antibiotic resistance. Infect Drug Resist 2013; 6:99-114. [PMID: 24082790 PMCID: PMC3785399 DOI: 10.2147/idr.s25076] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infectious diseases are known as one of the most life-threatening disabilities worldwide. Approximately 13 million deaths related to infectious diseases are reported each year. The only way to combat infectious diseases is by chemotherapy using antimicrobial agents and antibiotics. However, due to uncontrolled and unnecessary use of antibiotics in particular, surviving bacteria have evolved resistance against several antibiotics. Emergence of multidrug resistance in bacteria over the past several decades has resulted in one of the most important clinical health problems in modern medicine. For instance, approximately 440,000 new cases of multidrug-resistant tuberculosis are reported every year leading to the deaths of 150,000 people worldwide. Management of multidrug resistance requires understanding its molecular basis and the evolution and dissemination of resistance; development of new antibiotic compounds in place of traditional antibiotics; and innovative strategies for extending the life of antibiotic molecules. Researchers have begun to develop new antimicrobials for overcoming this important problem. Recently, platensimycin - isolated from extracts of Streptomyces platensis - and its analog platencin have been defined as promising agents for fighting multidrug resistance. In vitro and in vivo studies have shown that these new antimicrobials have great potential to inhibit methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and penicillin-resistant Streptococcus pneumoniae by targeting type II fatty acid synthesis in bacteria. Showing strong efficacy without any observed in vivo toxicity increases the significance of these antimicrobial agents for their use in humans. However, at the present time, clinical trials are insufficient and require more research. The strong antibacterial efficacies of platensimycin and platencin may be established in clinical trials and their use in humans for coping with multidrug resistance may be allowed in the foreseeable future.
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Affiliation(s)
| | - Melahat Bagirova
- Department of Bioengineering, Yildiz Technical University, Istanbul, Turkey
| | - Emrah Sefik Abamor
- Department of Bioengineering, Yildiz Technical University, Istanbul, Turkey
| | - Sezen Canim Ates
- Department of Bioengineering, Yildiz Technical University, Istanbul, Turkey
| | - Rabia Cakir Koc
- Department of Biomedical Engineering, Yeni Yuzyil University, Istanbul, Turkey
| | - Meral Miraloglu
- Vocational School of Health Services, Cukurova University, Adana, Turkey
| | - Serhat Elcicek
- Department of Bioengineering, Firat University, Elazig, Turkey
| | - Serkan Yaman
- Department of Bioengineering, Yildiz Technical University, Istanbul, Turkey
| | - Gokce Unal
- Department of Bioengineering, Yildiz Technical University, Istanbul, Turkey
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Calderwood MS, Desjardins CA, Sakoulas G, Nicol R, Dubois A, Delaney ML, Kleinman K, Cosimi LA, Feldgarden M, Onderdonk AB, Birren BW, Platt R, Huang SS. Staphylococcal enterotoxin P predicts bacteremia in hospitalized patients colonized with methicillin-resistant Staphylococcus aureus. J Infect Dis 2013; 209:571-7. [PMID: 24041793 DOI: 10.1093/infdis/jit501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) colonization predicts later infection, with both host and pathogen determinants of invasive disease. METHODS This nested case-control study evaluates predictors of MRSA bacteremia in an 8-intensive care unit (ICU) prospective adult cohort from 1 September 2003 through 30 April 2005 with active MRSA surveillance and collection of ICU, post-ICU, and readmission MRSA isolates. We selected MRSA carriers who did (cases) and those who did not (controls) develop MRSA bacteremia. Generating assembled genome sequences, we evaluated 30 MRSA genes potentially associated with virulence and invasion. Using multivariable Cox proportional hazards regression, we assessed the association of these genes with MRSA bacteremia, controlling for host risk factors. RESULTS We collected 1578 MRSA isolates from 520 patients. We analyzed host and pathogen factors for 33 cases and 121 controls. Predictors of MRSA bacteremia included a diagnosis of cancer, presence of a central venous catheter, hyperglycemia (glucose level, >200 mg/dL), and infection with a MRSA strain carrying the gene for staphylococcal enterotoxin P (sep). Receipt of an anti-MRSA medication had a significant protective effect. CONCLUSIONS In an analysis controlling for host factors, colonization with MRSA carrying sep increased the risk of MRSA bacteremia. Identification of risk-adjusted genetic determinants of virulence may help to improve prediction of invasive disease and suggest new targets for therapeutic intervention.
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Akridge HD, Rankin SC, Griffeth GC, Boston RC, Callori NE, Morris DO. Evaluation of the affinity of various species and strains ofStaphylococcusto adhere to equine corneocytes. Vet Dermatol 2013; 24:525-e124. [DOI: 10.1111/vde.12061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Heather D. Akridge
- Department of Clinical Studies - Philadelphia; School of Veterinary Medicine; University of Pennsylvania; 3900 Delancey Street; Philadelphia; PA; 19104; USA
| | - Shelley C. Rankin
- Department of Pathobiology - Philadelphia; School of Veterinary Medicine; University of Pennsylvania; 3900 Delancey Street; Philadelphia; PA; 19104; USA
| | - Gregory C. Griffeth
- Red Bank Veterinary Hospital; 197 Hance Avenue; Tinton Falls; NJ; 07724; USA
| | - Raymond C. Boston
- Department of Clinical Studies - New Bolton Center; School of Veterinary Medicine; University of Pennsylvania; 382 West Street Road; Kennett Square; PA; 19348; USA
| | - Nancy E. Callori
- Department of Clinical Studies - Philadelphia; School of Veterinary Medicine; University of Pennsylvania; 3900 Delancey Street; Philadelphia; PA; 19104; USA
| | - Daniel O. Morris
- Department of Clinical Studies - Philadelphia; School of Veterinary Medicine; University of Pennsylvania; 3900 Delancey Street; Philadelphia; PA; 19104; USA
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McConeghy KW, Bleasdale SC, Rodvold KA. The Empirical Combination of Vancomycin and a -Lactam for Staphylococcal Bacteremia. Clin Infect Dis 2013; 57:1760-5. [DOI: 10.1093/cid/cit560] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Theodorou P, Lefering R, Perbix W, Spanholtz TA, Maegele M, Spilker G, Thamm OC. Staphylococcus aureus bacteremia after thermal injury: The clinical impact of methicillin resistance. Burns 2013; 39:404-12. [DOI: 10.1016/j.burns.2012.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/18/2012] [Accepted: 12/03/2012] [Indexed: 11/26/2022]
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Sammon J, Trinh VQ, Ravi P, Sukumar S, Gervais MK, Shariat SF, Larouche A, Tian Z, Kim SP, Kowalczyk KJ, Hu JC, Menon M, Karakiewicz PI, Trinh QD, Sun M. Health care-associated infections after major cancer surgery. Cancer 2013; 119:2317-24. [DOI: 10.1002/cncr.28027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/20/2013] [Accepted: 01/24/2013] [Indexed: 02/03/2023]
Affiliation(s)
- Jesse Sammon
- Vattikuti Urology Institute; Henry Ford Health system; Detroit Michigan
| | - Vincent Q. Trinh
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
| | - Praful Ravi
- Vattikuti Urology Institute; Henry Ford Health system; Detroit Michigan
| | - Shyam Sukumar
- Vattikuti Urology Institute; Henry Ford Health system; Detroit Michigan
| | - Mai-Kim Gervais
- Division of General Surgery; University of Montreal Health Center; Montreal Quebec Canada
| | - Shahrokh F. Shariat
- Department of Urology; Weill Medical College of Cornell University; New York New York
| | - Alexandre Larouche
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
| | - Simon P. Kim
- Department of Urology; Mayo Clinic; Rochester New York
| | - Keith J. Kowalczyk
- Department of Urology; Georgetown University Hospital; Washington District of Columbia
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine; University of California-Los Angeles; Los Angeles California
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Health system; Detroit Michigan
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
| | - Quoc-Dien Trinh
- Vattikuti Urology Institute; Henry Ford Health system; Detroit Michigan
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal Quebec, Montreal Canada
- Department of Public Health; Faculty of Medicine; University of Montreal; Montreal Quebec Canada
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Antimicrobial resistance and molecular typing of Staphylococcus aureus bloodstream isolates from hospitals in Peru. J Infect 2012; 65:406-11. [DOI: 10.1016/j.jinf.2012.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 03/03/2012] [Accepted: 06/07/2012] [Indexed: 11/20/2022]
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Naves KSC, Vaz da Trindade N, Gontijo Filho PP. Methicillin-resistant Staphylococcus aureus bloodstream infection: risk factors and clinical outcome in non-intensive-care units. Rev Soc Bras Med Trop 2012; 45:189-93. [PMID: 22534990 DOI: 10.1590/s0037-86822012000200010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/03/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) is spread out in hospitals across different regions of the world and is regarded as the major agent of nosocomial infections, causing infections such as skin and soft tissue pneumonia and sepsis. The aim of this study was to identify risk factors for methicillin-resistance in Staphylococcus aureus bloodstream infection (BSI) and the predictive factors for death. METHODS A retrospective cohort of fifty-one patients presenting bacteraemia due to S. aureus between September 2006 and September 2008 was analysed. Staphylococcu aureus samples were obtained from blood cultures performed by clinical hospital microbiology laboratory from the Uberlândia Federal University. Methicillinresistance was determined by growth on oxacillin screen agar and antimicrobial susceptibility by means of the disk diffusion method. RESULTS We found similar numbers of MRSA (56.8%) and methicillin-susceptible Staphylococcus aureus (MSSA) (43.2%) infections, and the overall hospital mortality ratio was 47%, predominantly in MRSA group (70.8% vs. 29.2%) (p=0.05). Age (p=0.02) was significantly higher in MRSA patients as also was the use of central venous catheter (p=0.02). The use of two or more antimicrobial agents (p=0.03) and the length of hospital stay prior to bacteraemia superior to seven days (p=0.006) were associated with mortality. High odds ratio value was observed in cardiopathy as comorbidity. CONCLUSIONS Despite several risk factors associated with MRSA and MSSA infection, the use of two or more antimicrobial agents was the unique independent variable associated with mortality.
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Affiliation(s)
- Karinne Spirandelli Carvalho Naves
- Programa de Pós-Graduação em Imunologia e Parasitologia Aplicadas, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, MG.
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Post-discharge mortality in patients hospitalized with MRSA infection and/or colonization. Epidemiol Infect 2012; 141:1187-98. [PMID: 22971269 DOI: 10.1017/s0950268812001963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years, P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31-2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22-3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.
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Chen YY, Chen LY, Lin SY, Chou P, Liao SY, Wang FD. Surveillance on secular trends of incidence and mortality for device-associated infection in the intensive care unit setting at a tertiary medical center in Taiwan, 2000-2008: a retrospective observational study. BMC Infect Dis 2012; 12:209. [PMID: 22963041 PMCID: PMC3458996 DOI: 10.1186/1471-2334-12-209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 09/06/2012] [Indexed: 08/30/2023] Open
Abstract
Background Device–associated infection (DAI) plays an important part in nosocomial infection. Active surveillance and infection control are needed to disclose the specific situation in each hospital and to cope with this problem effectively. We examined the rates of DAI by antimicrobial-resistant pathogens, and 30–day and in–hospital mortality in the intensive care unit (ICU). Methods Prospective surveillance was conducted in a mixed medical and surgical ICU at a major teaching hospital from 2000 through 2008. Trend analysis was performed and logistic regression was used to assess prognostic factors of mortality. Results The overall rate of DAIs was 3.03 episodes per 1000 device–days. The most common DAI type was catheter–associated urinary tract infection (3.76 per 1000 urinary catheter–days). There was a decrease in DAI rates in 2005 and rates of ventilator–associated pneumonia (VAP, 3.18 per 1000 ventilator–days) have remained low since then (p < 0.001). The crude rates of 30–day (33.6%) and in–hospital (52.3%) mortality, as well as infection by antibiotic-resistant VAP pathogens also decreased. The most common antimicrobial-resistant pathogens were methicillin–resistant Staphylococcus aureus (94.9%) and imipenem–resistant Acinetobacter baumannii (p < 0.001), which also increased at the most rapid rate. The rate of antimicrobial resistance among Enterobacteriaceae also increased significantly (p < 0.05). After controlling for potentially confounding factors, the DAI was an independent prognostic factor for both 30–day mortality (OR 2.51, 95% confidence interval [CI] 1.99–3.17, p = 0.001) and in–hospital mortality (OR 3.61, 95% CI 2.10–3.25, p < 0.001). Conclusions The decrease in the rate of DAI and infection by resistant bacteria on the impact of severe acute respiratory syndrome can be attributed to active infection control and improved adherence after 2003.
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Affiliation(s)
- Yin-Yin Chen
- Department of Infection Control, Taipei Veterans General Hospital, Taipei, Taiwan
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Hall RG, Giuliano CA, Haase KK, Hazlewood KA, Frei CR, Forcade NA, Brouse SD, Bell T, Bedimo RJ, Alvarez CA. Empiric guideline-recommended weight-based vancomycin dosing and mortality in methicillin-resistant Staphylococcus aureus bacteremia: a retrospective cohort study. BMC Infect Dis 2012; 12:104. [PMID: 22540223 PMCID: PMC3532187 DOI: 10.1186/1471-2334-12-104] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 04/27/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND No studies have evaluated the effect of guideline-recommended weight-based dosing on in-hospital mortality of patients with methicillin-resistant Staphylococcus aureus bacteremia. METHODS This was a multicenter, retrospective, cohort study of patients with methicillin-resistant Staphylococcus aureus bacteremia receiving at least 48 hours of empiric vancomycin therapy between 01/07/2002 and 30/06/2008. We compared in-hospital mortality for patients treated empirically with weight-based, guideline-recommended vancomycin doses (at least 15 mg/kg/dose) to those treated with less than 15 mg/kg/dose. We used a general linear mixed multivariable model analysis with variables identified a priori through a conceptual framework based on the literature. RESULTS A total of 337 patients who were admitted to the three hospitals were included in the cohort. One-third of patients received vancomycin empirically at the guideline-recommended dose. Guideline-recommended dosing was not associated with in-hospital mortality in the univariable (16% vs. 13%, OR 1.26 [95%CI 0.67-2.39]) or multivariable (OR 0.71, 95%CI 0.33-1.55) analysis. Independent predictors of in-hospital mortality were ICU admission, Pitt bacteremia score of 4 or greater, age 53 years or greater, and nephrotoxicity. CONCLUSIONS Empiric use of weight-based, guideline-recommended empiric vancomycin dosing was not associated with reduced mortality in this multicenter study.
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Affiliation(s)
- Ronald G Hall
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Dallas, TX, USA.
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van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus Bacteremia. Clin Microbiol Rev 2012; 25:362-86. [PMID: 22491776 PMCID: PMC3346297 DOI: 10.1128/cmr.05022-11] [Citation(s) in RCA: 623] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.
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Affiliation(s)
- Sebastian J van Hal
- Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service—Liverpool, South Western Sydney Local Health Network, Sydney, New South Wales, Australia.
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Management of Gram-Positive Bacterial Disease: Staphylococcus aureus, Streptococcal, Pneumococcal and Enterococcal Infections. PRINCIPLES AND PRACTICE OF CANCER INFECTIOUS DISEASES 2011. [PMCID: PMC7120901 DOI: 10.1007/978-1-60761-644-3_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Berger J, Diab-Elschahawi M, Blacky A, Pernicka E, Spertini V, Assadian O, Koller W, Aichberger KJ. A matched prospective cohort study on Staphylococcus aureus and Escherichia coli bloodstream infections: extended perspectives beyond resistance. Am J Infect Control 2010; 38:839-45. [PMID: 20650546 DOI: 10.1016/j.ajic.2010.04.212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/29/2010] [Accepted: 04/02/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bacteremias caused by Staphylococcus aureus and Escherichia coli are among the most common bloodstream infections (BSIs) in adults. The aim of the study was to investigate risk factors for infection and clinical outcomes of bacteremias caused by S aureus or E coli. METHODS We conducted a 1-year matched prospective cohort study including 150 patients with BSI caused by susceptible or resistant S aureus or E coli and 300 controls without BSI caused by these organisms. RESULTS Of the 150 episodes of bacteremia, 37% were caused by S aureus (including 5 cases of methicillin-resistant S aureus [MRSA]) and 63% were caused by E coli (including 9 cases of extended-spectrum beta lactamase [ESBL]-producing E coli). We identified 4 independent risk factors for acquisition of S aureus bacteremia (emergency, peripheral or central vascular catheter, renal disease) and 6 risk factors for E coli bacteremia (emergency, peripheral or central vascular catheter, malignancy, cytoreductive or immunosuppressive therapy). Both types of bacteremia were associated with an increased length of hospital stay compared with controls. We observed a 5-fold increase in the 30-day mortality rate for bacteremias due to S aureus, and a 2-fold increase in BSI caused by E coli. The in-hospital mortality rate was increased by 6-fold for S aureus and by 3-fold for E coli. CONCLUSION Longer hospitalization periods and increased mortality of bacteremias caused by S aureus or E coli, irrespective of susceptibility, implicate controlling for risk factors at an early stage.
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Al-Talib HI, Yean CY, Al-Jashamy K, Hasan H. Methicillin-resistant Staphylococcus aureus nosocomial infection trends in Hospital Universiti Sains Malaysia during 2002-2007. Ann Saudi Med 2010; 30:358-63. [PMID: 20697171 PMCID: PMC2941247 DOI: 10.4103/0256-4947.67077] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide. The aim of the present study was to assess the burden of MRSA nosocomial infection, its association with factors of interest, and its antimicrobial susceptibility. METHODS This was a retrospective analysis of a database of all S aureus that were cultured from patients admitted to the different wards of Hospital Universiti Sains Malaysia (HUSM) over a period of 6 years. RESULTS The MRSA infections rate was 10.0 per 1000 hospital admissions. The incidence density rate of MRSA infections during the study period was 1.8 per 1000 patient-days, with annual rates ranging from 0.95 to 3.47 per 1000 patient-days. Duration of hospitalization, previous antibiotic use, and bedside invasive procedures were significantly higher among MRSA than methicillin-sensitive S aureus patients (P>.05). The highest number of MRSA infections were found in orthopedic wards (25.3%), followed by surgical wards (18.2%) and intensive care units (ICUs) (16.4%). All MRSA isolates were resistant to erythromycin (98.0%), co-trimoxazole (94.0%) and gentamicin (92.0%). Clindamycin was the best antibiotic with only 6% resistance. All MRSA isolates were sensitive to vancomycin. CONCLUSION The rate of nosocomial MRSA infection per 1000 admissions was higher than that in other studies. The three factors associated most significantly with acquired MRSA infections included duration of hospitalization, antibiotic use, and bedside invasive procedures. This study confirmed that vancomycin-resistant S aureus has not yet been established in HUSM.
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Affiliation(s)
- Hassanain I Al-Talib
- Department of Medical Microbiology, School of Medical Sciences Malaysia, Kubang Kerian, Kelantan, Malaysia
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Wang FD, Chen YY, Chen TL, Lin YT, Fung CP. Risk factors and mortality of nosocomial infections of methicillin-resistant Staphylococcus aureus in an intensive care unit. J Crit Care 2010; 26:82-8. [PMID: 20619599 DOI: 10.1016/j.jcrc.2010.05.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 05/13/2010] [Accepted: 05/24/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Methicillin-resistant Staphylococcus aureus (MRSA) infections are an increasing worldwide problem. We determined risk factors and predictors of mortality of MRSA nosocomial infections (NIs). MATERIALS AND METHODS A prospective cohort study was performed in an adult mixed medical and surgical intensive care unit from 2003 to 2007. Stratified analyses and generalized linear modeling were used to assess risk factors and predictors of infection and mortality. RESULTS A total of 184 infections (3.6% of all infections) were due to S aureus, and 97.8% of these were methicillin resistant. The most common infection sites were respiratory tract (35.6%) and bloodstream (30.6%). Stratified analyses of length of stay (LOS) before onset of MRSA NI and death indicated that MRSA infection (odds ratio [OR], 38.49; 95% confidence interval [CI], 25.53-58.09) and mortality (OR, 4.72; 95% CI, 1.92-11.99) were more likely for LOS more than 15 days than for LOS less than 7 days. After controlling for potentially confounding factors by use of generalized linear modeling analysis, we identified the following as independent risk factors: LOS before onset of MRSA infection (OR, 1.03; 95% CI, 0.01-1.04), serum creatinine (OR, 5.87; 95% CI, 1.37-9.21) level, use of mechanical ventilator (OR, 6.71; 95% CI, 1.58-8.5), and central venous catheter (OR, 1.13; 95% CI, 1.05-1.31). CONCLUSIONS Methicillin resistance is very common with S aureus infection. In our intensive care unit, use of invasive devices/procedures and LOS were the most important risk factors for infection.
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Affiliation(s)
- Fu-Der Wang
- Section of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Fraser S, Brady RR, Graham C, Paterson-Brown S, Gibb AP. Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes. Ann R Coll Surg Engl 2010; 92:311-5. [PMID: 20385046 DOI: 10.1308/003588410x12628812459698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA)-related hospital-acquired infection (HAI) in surgical patients is associated with high morbidity, mortality and financial cost. The identification and characterisation of populations of patients who are at high risk of developing MRSA infection or colonisation could inform the design of more effective strategies to prevent HAIs and reduce transmission of MRSA. PATIENTS AND METHODS An analysis of historical discharge data for the whole of 2005 (7145 surgical in-patients) was performed, for all patients admitted to general surgery at the Royal Infirmary of Edinburgh. Analysis specifically focused on MRSA laboratory data and coding data for patient demographics, medical co-morbidities, and progress of in-patient stay. RESULTS A total of 134 (1.88%) individual patients with colonisation or infection by MRSA were identified from indicated laboratory testing. Univariate analysis identified a significant association of concurrent MRSA-positive status with patients aged over 60 years (P < 0.01), a duration of inpatient stay > 7 days (P < 0.01), presence of a malignant neoplasm (P < 0.01), circulatory disease (P < 0.01), respiratory disease (P < 0.01), central nervous system disease (P < 0.01), renal failure (P < 0.01), and concurrent admission to ITU/HDU (P < 0.01). Multivariate analysis suggested MRSA colonisation or infection was strongest in those with co-morbid malignancy (P < 0.0001) or admission to ITU/HDU (P < 0.0001). CONCLUSIONS This large observational study has identified cancer patients as a UK surgical patient subpopulation which is at significantly higher risk of colonisation by MRSA. These data could inform the development of focused hospital in-patient screening protocols and provide a means to stratify patient risk.
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Affiliation(s)
- Stephanie Fraser
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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McCarthy NL, Sullivan PS, Gaynes R, Rimland D. Risk factors associated with methicillin resistance among Staphylococcus aureus infections in veterans. Infect Control Hosp Epidemiol 2010; 31:36-41. [PMID: 19929688 DOI: 10.1086/649017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance among S. aureus infections have focused on MRSA bacteremia. OBJECTIVE To describe risk factors associated with methicillin resistance among S. aureus infections at different anatomic sites. METHODS We collected information on the demographic and clinical characteristics of patients examined at the Atlanta Veterans Affairs Medical Center with S. aureus infections during the period from June 2007 through May 2008. We used multivariate logistic regression to describe factors significantly associated with methicillin resistance. RESULTS There were 568 cases of S. aureus infection among 528 patients. We identified 352 cases (62%) of MRSA infection and 216 cases (38%) of methicillin-sensitive S. aureus infection. The adjusted odds of methicillin resistance were higher among infections that occurred among patients who had a prior history of MRSA infection (odds ratio [OR], 3.9 [95% confidence interval {CI}, 2.3-6.4]) or resided in a long-term care facility during the past 12 months (OR, 2.0 [95% CI, 1.0-4.0]) but were lower for infections that occurred among patients who had undergone a biopsy procedure during the past 12 months (OR, 0.7 [95% CI, 0.6-0.9]). Most cases of infection were community-onset infections (523 [92%] of 568 cases), and about one-half (278 [49%]) were not healthcare associated. CONCLUSIONS Compared with previous studies of methicillin resistance among patients with S. aureus bacteremia, we found similar factors to be associated with methicillin resistance among S. aureus isolates recovered from more diverse anatomic sites of infection. Of note, nearly one-half of our cases of MRSA infection were not healthcare associated.
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Affiliation(s)
- Natalie L McCarthy
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Rangaraj G, Granwehr BP, Jiang Y, Hachem R, Raad I. Perils of quinolone exposure in cancer patients. Cancer 2010; 116:967-73. [DOI: 10.1002/cncr.24812] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fortaleza CR, Melo ECD, Fortaleza CMCB. Nasopharyngeal colonization with methicillin-resistant staphylococcus aureus and mortality among patients in an intensive care unit. Rev Lat Am Enfermagem 2010; 17:677-82. [PMID: 19967217 DOI: 10.1590/s0104-11692009000500013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 08/03/2009] [Indexed: 11/22/2022] Open
Abstract
Nasopharyngeal colonization with Methicillin-resistant Staphylococcus aureus (MRSA) is common in critically ill patients, but its effect on patient prognosis is not fully elucidated. A retrospective cohort study was carried out enrolling 122 patients from an intensive care unit who were screened weekly for nasopharyngeal colonization with MRSA. The outcomes of interest were: general mortality and mortality by infection. Several exposure variables (severity of illness, procedures, intercurrences and MRSA nasopharyngeal colonization) were analyzed through univariate and multivariable models. Factors significantly associated with mortality in general or due to infection were: APACHE II and lung disease. The performance of surgery predicted favorable outcomes. MRSA colonization did not predict mortality in general (OR=1.02; 95%CI=0.35-3.00; p=0.97) or by infectious causes (OR=0.96; 95%CI=0.33-2.89; p=0.96). The results suggest that, in the absence of severity of illness factors, colonization with MRSA is not associated with unfavorable outcomes.
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Faires MC, Traverse M, Tater KC, Pearl DL, Weese JS. Methicillin-resistant and -susceptible Staphylococcus aureus infections in dogs. Emerg Infect Dis 2010; 16:69-75. [PMID: 20031045 PMCID: PMC2874348 DOI: 10.3201/eid1601.081758] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Risk factors for MRSA include intravenous catheterization and receipt of certain antimicrobial drugs. Methicillin-resistant Staphylococcus aureus (MRSA) has become a pathogen of animals. To compare types of infections, clinical outcomes, and risk factors associated with MRSA in dogs with those associated with methicillin-susceptible Staphylococcus aureus (MSSA) infections, we conducted a case–control study at 3 veterinary referral hospitals in the United States and Canada during 2001–2007. Risk factors analyzed were signalment, medical and surgical history, and infection site. Among 40 dogs with MRSA and 80 with MSSA infections, highest prevalence of both infections was found in skin and ears. Although most (92.3%) dogs with MRSA infections were discharged from the hospital, we found that significant risk factors for MRSA infection were receipt of antimicrobial drugs (odds ratio [OR] 3.84, p = 0.02), β-lactams (OR 3.58, p = 0.04), or fluoroquinolones (OR 5.34, p = 0.01), and intravenous catheterization (OR 3.72, p = 0.02). Prudent use of antimicrobial drugs in veterinary hospitals is advised.
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Affiliation(s)
- Meredith C Faires
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.
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Ho KM, Robinson JO. Risk factors and outcomes of methicillin-resistant Staphylococcus aureus bacteraemia in critically ill patients: a case control study. Anaesth Intensive Care 2009; 37:457-63. [PMID: 19499868 DOI: 10.1177/0310057x0903700320] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is an increasing threat to critically ill patients in many intensive care units. MRSA bacteraemia is an extreme form of MRSA infection and is a significant cause of morbidity and mortality. This case control study aimed to assess the risk factors and outcomes of MRSA bacteraemia compared to methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia. A total of 21 MRSA bacteraemia and 60 randomly selected MSSA bacteraemia episodes, admitted to the intensive care unit at Royal Perth Hospital between 1997 and 2007, were considered. There was a suggestion that hospitalisation within the preceding six months (P = 0.087) and residence in a long-term care facility (P = 0.065) were associated with a higher risk of MRSA bacteraemia. MRSA bacteraemia was more often treated with antibiotics to which the pathogen was not susceptible in vitro (38.1% vs 0%, P = 0.001), resulting in a longer duration of fever (median 7.0 vs 2.0 days, P= 0.009) and bacteraemia (mean 3.2 vs 0.6 days, P = 0.005) and a higher incidence of metastatic seeding of infection (52.4% vs 21.7%, P = 0.012) as compared to MSSA bacteraemia. While in-hospital mortality between MRSA and MSSA was similarly high (47.6% vs 38.3% for MRSA and MSSA respectively, P = 0.607), a significant proportion of the patients who had MRSA bacteraemia died within five years of hospital discharge (36.4%, hazard ratio 26.0, 95% confidence interval 1.90 to 356.7, P = 0.015). Infections contributed to 75% of the deaths after hospital discharge in patients who had an episode of MRSA bacteraemia. MRSA bacteraemia carries a much worse long-term prognosis than MSSA bacteraemia and that could be explained by recurrent MRSA infections and residual confounding.
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Affiliation(s)
- K M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia
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