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Eleftheriotis G, Marangos M, Lagadinou M, Bhagani S, Assimakopoulos SF. Oral Antibiotics for Bacteremia and Infective Endocarditis: Current Evidence and Future Perspectives. Microorganisms 2023; 11:3004. [PMID: 38138148 PMCID: PMC10745436 DOI: 10.3390/microorganisms11123004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Bacteremia and endocarditis are two clinical syndromes that, for decades, were managed exclusively with parenteral antimicrobials, irrespective of a given patient's clinical condition, causative pathogen, or its antibiotic susceptibility profile. This clinical approach, however, was based on low-quality data and outdated expert opinions. When a patient's condition has improved, gastrointestinal absorption is not compromised, and an oral antibiotic regimen reaching adequate serum concentrations is available, a switch to oral antibacterials can be applied. Although available evidence has reduced the timing of the oral switch in bacteremia to three days/until clinical improvement, there are only scarce data regarding less than 10-day intravenous antibiotic therapy in endocarditis. Many standard or studied oral antimicrobial dosages are smaller than the approved doses for parenteral administration, which is a risk factor for treatment failure; in addition, the gastrointestinal barrier may affect drug bioavailability, especially when the causative pathogen has a minimum inhibitory concentration that is close to the susceptibility breakpoint. A considerable number of patients infected by such near-breakpoint strains may not be potential candidates for oral step-down therapy to non-highly bioavailable antibiotics like beta-lactams; different breakpoints should be determined for this setting. This review will focus on summarizing findings about pathogen-specific tailoring of oral step-down therapy for bacteremia and endocarditis, but will also present laboratory and clinical data about antibiotics such as beta-lactams, linezolid, and fosfomycin that should be studied more in order to elucidate their role and optimal dosage in this context.
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Affiliation(s)
- Gerasimos Eleftheriotis
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Rion, 26504 Patras, Greece; (G.E.); (M.M.); (M.L.)
| | - Markos Marangos
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Rion, 26504 Patras, Greece; (G.E.); (M.M.); (M.L.)
| | - Maria Lagadinou
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Rion, 26504 Patras, Greece; (G.E.); (M.M.); (M.L.)
| | - Sanjay Bhagani
- Department of Infectious Diseases and HIV Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, UK;
| | - Stelios F. Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, Medical School, University of Patras, University Hospital of Patras, Rion, 26504 Patras, Greece; (G.E.); (M.M.); (M.L.)
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Chastain DB, Covert KL, Tu PJ, McDougal S, White BP, Cluck D. Therapeutic Options for Adult Patients With Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Narrative Review. Ann Pharmacother 2023; 57:1312-1327. [PMID: 36946576 DOI: 10.1177/10600280231158809] [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] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To compare the efficacy of antimicrobial therapies used in the management of persistent methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. DATA SOURCES A literature search using the PubMed database (inception to December 2022) was conducted using the search terms "Staphylococcus aureus bacteremia," "methicillin-susceptible Staphylococcus aureus bacteremia," "persistent methicillin-susceptible Staphylococcus aureus bacteremia," and "refractory methicillin-susceptible Staphylococcus aureus bacteremia ." In addition, therapeutic agents which could be used as treatment for MSSA including "nafcillin," "oxacillin," "cefazolin," "ceftaroline," "gentamicin," "rifampin," and "daptomycin" were also combined with the aforementioned search terms to capture data using these agents. STUDY SELECTION/DATA EXTRACTION Clinical data were limited to those published in the English language. Articles and abstracts were considered for inclusion in addition to ongoing trials identified through ClinicalTrials.gov. DATA SYNTHESIS A total of 78 articles were reviewed including 17 in vitro or animal model studies and 39 studies including patient data. The remaining 22 articles included guidelines, review articles, and editorials. Recent data evaluating use of dual β-lactam regimens for persistent MSSA bacteremia were limited to 8 case reports or case series. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE At present, there is little guidance on how to best manage patients with persistent MSSA bacteremia. This narrative review collates the available data to assist clinicians in selecting the best possible antimicrobial regimen when facing this clinical conundrum. CONCLUSIONS Modification of antimicrobial therapy, in conjunction with source control and infectious diseases consultation, may all be necessary to sterilize blood cultures in patients with persistent MSSA bacteremia.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical & Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, GA, USA
| | - Kelly L Covert
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
| | - Patrick J Tu
- Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Steven McDougal
- Department of Pharmacy Services, University of Utah Hospital, Salt Lake City, UT, USA
| | | | - David Cluck
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA
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3
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Cacace E, Kim V, Varik V, Knopp M, Tietgen M, Brauer-Nikonow A, Inecik K, Mateus A, Milanese A, Mårli MT, Mitosch K, Selkrig J, Brochado AR, Kuipers OP, Kjos M, Zeller G, Savitski MM, Göttig S, Huber W, Typas A. Systematic analysis of drug combinations against Gram-positive bacteria. Nat Microbiol 2023; 8:2196-2212. [PMID: 37770760 PMCID: PMC10627819 DOI: 10.1038/s41564-023-01486-9] [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: 12/23/2022] [Accepted: 08/30/2023] [Indexed: 09/30/2023]
Abstract
Drug combinations can expand options for antibacterial therapies but have not been systematically tested in Gram-positive species. We profiled ~8,000 combinations of 65 antibacterial drugs against the model species Bacillus subtilis and two prominent pathogens, Staphylococcus aureus and Streptococcus pneumoniae. Thereby, we recapitulated previously known drug interactions, but also identified ten times more novel interactions in the pathogen S. aureus, including 150 synergies. We showed that two synergies were equally effective against multidrug-resistant S. aureus clinical isolates in vitro and in vivo. Interactions were largely species-specific and synergies were distinct from those of Gram-negative species, owing to cell surface and drug uptake differences. We also tested 2,728 combinations of 44 commonly prescribed non-antibiotic drugs with 62 drugs with antibacterial activity against S. aureus and identified numerous antagonisms that might compromise the efficacy of antimicrobial therapies. We identified even more synergies and showed that the anti-aggregant ticagrelor synergized with cationic antibiotics by modifying the surface charge of S. aureus. All data can be browsed in an interactive interface ( https://apps.embl.de/combact/ ).
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Affiliation(s)
- Elisabetta Cacace
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Vladislav Kim
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
- Collaboration for joint PhD degree between EMBL and Heidelberg University, Faculty of Biosciences, Heidelberg, Germany
| | - Vallo Varik
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Michael Knopp
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Manuela Tietgen
- Goethe University Frankfurt, University Hospital, Institute for Medical Microbiology and Infection Control, Frankfurt am Main, Germany
| | | | - Kemal Inecik
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - André Mateus
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Alessio Milanese
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany
- Department of Biology, Institute of Microbiology, and Swiss Institute of Bioinformatics, ETH Zurich, Zurich, Switzerland
| | - Marita Torrissen Mårli
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Karin Mitosch
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Joel Selkrig
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
- Institute of Medical Microbiology, University Hospital of RWTH, Aachen, Germany
| | - Ana Rita Brochado
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
- Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany
- Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, Tübingen, Germany
| | - Oscar P Kuipers
- Department of Molecular Genetics, Groningen Molecular Biology and Biotechnology Institute, University of Groningen, Groningen, the Netherlands
| | - Morten Kjos
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
| | - Georg Zeller
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany
| | - Mikhail M Savitski
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Stephan Göttig
- Goethe University Frankfurt, University Hospital, Institute for Medical Microbiology and Infection Control, Frankfurt am Main, Germany
| | - Wolfgang Huber
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany
| | - Athanasios Typas
- European Molecular Biology Laboratory, Genome Biology Unit, Heidelberg, Germany.
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany.
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4
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Wang J, Xu X, Zhao X, Xu S, Wang M. hptA Mutation May Mediate Fosfomycin Resistance in Methicillin-Resistant Staphylococcus aureus Clinical Isolates. Microb Drug Resist 2023; 29:497-503. [PMID: 37603296 DOI: 10.1089/mdr.2022.0173] [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] [Indexed: 08/22/2023] Open
Abstract
Fosfomycin can be used alone or in combination to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. However, fosfomycin resistance has been observed in MRSA. In S. aureus, fosfomycin resistance is mediated by the fosfomycin-modifying enzyme FosB, or mutations in the target enzyme MurA. Mutations in the chromosomal glpT and uhpT genes, which encode fosfomycin transporters, also result in fosfomycin resistance. The three-component regulatory system HptRSA mediates the expression of uhpT and glpT in S. aureus. This study aimed to investigate the role of hptRSA mutation in fosfomycin resistance in MRSA clinical isolates. We found that hptRSA mutations were common in MRSA strains isolated from our hospital. Most mutations were amino acid substitutions and widely distributed in fosfomycin-sensitive and fosfomycin-resistant strains. However, HptA-truncated mutations were only found in fosB-negative fosfomycin-resistant strains with wild-type uhpT and glpT genes. Quantitative real-time PCR results showed that the transcription level of uhpT decreased by 13.7-25.6-fold in the HptA-truncated strains. Concordantly, the fosfomycin minimum inhibitory concentration (MIC) of HptA-truncated strains was 64-128 μg/mL, while SA240 was 2 μg/mL. The low transcription level of uhpT and high increase in MIC suggest that hptA mutation may lead to fosfomycin resistance in MRSA. We complemented hptA in one of the HptA-truncated clinical strains (SA179), showing reversal of fosfomycin resistance (from 128 to 32 μg/mL). Then we knocked out hptA in S. aureus Newman; fosfomycin MIC increased from 4 to 64 μg/mL, suggesting that HptA mutation may play an important role in fosfomycin resistance.
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Affiliation(s)
- Jue Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Xiaogang Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyu Zhao
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Su Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
| | - Minggui Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Clinical Pharmacology of Antibiotics, National Health Commission, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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5
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McCreary EK, Johnson MD, Jones TM, Spires SS, Davis AE, Dyer AP, Ashley ED, Gallagher JC. Antibiotic Myths for the Infectious Diseases Clinician. Clin Infect Dis 2023; 77:1120-1125. [PMID: 37310038 DOI: 10.1093/cid/ciad357] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023] Open
Abstract
Antimicrobials are commonly prescribed and often misunderstood. With more than 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious and optimal use of these drugs is paramount to advancing patient care. This narrative will focus on myths relevant to nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety of antibiotics.
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Affiliation(s)
- Erin K McCreary
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa D Johnson
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - Travis M Jones
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - S Shaefer Spires
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - Angelina E Davis
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - April P Dyer
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network, Duke University Medical Center, Durham, North Carolina, USA
| | - Jason C Gallagher
- School of Pharmacy, Temple University, Philadelphia, Pennsylvania, USA
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6
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Tran NN, Morrisette T, Jorgensen SCJ, Orench-Benvenutti JM, Kebriaei R. Current therapies and challenges for the treatment of Staphylococcus aureus biofilm-related infections. Pharmacotherapy 2023; 43:816-832. [PMID: 37133439 DOI: 10.1002/phar.2806] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 05/04/2023]
Abstract
Staphylococcus aureus is a major cause of nosocomial and community-acquired infections and contributes to significant increase in morbidity and mortality especially when associated with medical devices and in biofilm form. Biofilm structure provides a pathway for the enrichment of resistant and persistent phenotypes of S. aureus leading to relapse and recurrence of infection. Minimal diffusion of antibiotics inside biofilm structure leads to heterogeneity and distinct physiological activity. Additionally, horizontal gene transfer between cells in proximity adds to the challenges associated with eradication of biofilms. This narrative review focuses on biofilm-associated infections caused by S. aureus, the impact of environmental conditions on biofilm formation, interactions inside biofilm communities, and the clinical challenges that they present. Conclusively, potential solutions, novel treatment strategies, combination therapies, and reported alternatives are discussed.
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Affiliation(s)
- Nikki N Tran
- Department of Pharmacy, The Ohio State University Wexner Medical Center - The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Taylor Morrisette
- Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina College of Pharmacy, Charleston, South Carolina, USA
- Department of Pharmacy Services, Medical University of South Carolina Shawn Jenkins Children's Hospital, Charleston, South Carolina, USA
| | - Sarah C J Jorgensen
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - José M Orench-Benvenutti
- P3 Research Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
| | - Razieh Kebriaei
- P3 Research Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University, Columbus, Ohio, USA
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Gatica S, Fuentes B, Rivera-Asín E, Ramírez-Céspedes P, Sepúlveda-Alfaro J, Catalán EA, Bueno SM, Kalergis AM, Simon F, Riedel CA, Melo-Gonzalez F. Novel evidence on sepsis-inducing pathogens: from laboratory to bedside. Front Microbiol 2023; 14:1198200. [PMID: 37426029 PMCID: PMC10327444 DOI: 10.3389/fmicb.2023.1198200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Sepsis is a life-threatening condition and a significant cause of preventable morbidity and mortality globally. Among the leading causative agents of sepsis are bacterial pathogens Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pyogenes, along with fungal pathogens of the Candida species. Here, we focus on evidence from human studies but also include in vitro and in vivo cellular and molecular evidence, exploring how bacterial and fungal pathogens are associated with bloodstream infection and sepsis. This review presents a narrative update on pathogen epidemiology, virulence factors, host factors of susceptibility, mechanisms of immunomodulation, current therapies, antibiotic resistance, and opportunities for diagnosis, prognosis, and therapeutics, through the perspective of bloodstream infection and sepsis. A list of curated novel host and pathogen factors, diagnostic and prognostic markers, and potential therapeutical targets to tackle sepsis from the research laboratory is presented. Further, we discuss the complex nature of sepsis depending on the sepsis-inducing pathogen and host susceptibility, the more common strains associated with severe pathology and how these aspects may impact in the management of the clinical presentation of sepsis.
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Affiliation(s)
- Sebastian Gatica
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Brandon Fuentes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Elizabeth Rivera-Asín
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Paula Ramírez-Céspedes
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Javiera Sepúlveda-Alfaro
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo A. Catalán
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Susan M. Bueno
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alexis M. Kalergis
- Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Millennium Institute on Immunology and Immunotherapy, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Simon
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Claudia A. Riedel
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
| | - Felipe Melo-Gonzalez
- Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile
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Adema JL, Ahiskali A, Fida M, Mediwala Hornback K, Stevens RW, Rivera CG. Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis. Pathogens 2023; 12:703. [PMID: 37242373 PMCID: PMC10223386 DOI: 10.3390/pathogens12050703] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals' experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides.
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Affiliation(s)
- Jennifer L. Adema
- Department of Pharmacy, East Carolina University Health, Greenville, NC 27834, USA
| | - Aileen Ahiskali
- Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Krutika Mediwala Hornback
- Department of Pharmacy, Medical University of South Carolina (MUSC) Health, Charleston, SC 29425, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55902, USA
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Bae S, Kim ES, Lee YW, Jung J, Kim MJ, Chong YP, Kim SH, Choi SH, Lee SO, Kim YS. Clinical and microbiological characteristics of rifampicin-resistant MRSA bacteraemia. J Antimicrob Chemother 2023; 78:531-539. [PMID: 36537200 DOI: 10.1093/jac/dkac428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The clinical significance of rifampicin resistance in Staphylococcus aureus infections has not been demonstrated. Here, we evaluated the clinical characteristics of rifampicin-resistant S. aureus infection. METHODS Data were collected from adult patients who were hospitalized with MRSA bacteraemia between March 2007 and May 2020 at a tertiary hospital in South Korea. The clinical characteristics and treatment outcomes of patients infected with rifampicin-resistant MRSA were compared with those of rifampicin-susceptible isolates. All-cause death and recurrence of MRSA infection were assessed for 90 days. RESULTS Of the 961 patients with MRSA bacteraemia, 61 (6.3%) were infected by rifampicin-resistant isolates. The type of infection focus and duration of bacteraemia did not significantly differ between the two groups. Rifampicin-resistant MRSA isolates were more likely to have multidrug resistance and a higher vancomycin MIC relative to the rifampicin-susceptible isolates. The 90-day recurrence rate was higher in the patients infected with rifampicin-resistant MRSA compared with those with rifampicin-susceptible MRSA (18.0% versus 6.2%, P < 0.001), whereas the 90-day mortality was comparable between the two groups (27.9% versus 29.2%, P = 0.94). After adjusting for potential confounding factors, rifampicin resistance was significantly associated with 90-day recurrence (subdistributional HR: 2.31; 95% CI: 1.05-5.10; P = 0.04). CONCLUSIONS Rifampicin-resistant MRSA isolates showed distinct microbiological features in terms of multidrug resistance and a high vancomycin MIC. Although the management of MRSA bacteraemia was not significantly different between the two groups, recurrence was significantly more common in the rifampicin-resistant group. Rifampicin resistance may play a significant role in infection recurrence.
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Affiliation(s)
- Seongman Bae
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Sil Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yun Woo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiwon Jung
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, Republic of Korea
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10
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Camp J, Filla T, Glaubitz L, Kaasch AJ, Fuchs F, Scarborough M, Kim HB, Tilley R, Liao CH, Edgeworth J, Nsutebu E, López-Cortés LE, Morata L, Llewelyn MJ, Fowler VG, Thwaites G, Seifert H, Kern WV, Rieg S. Impact of neutropenia on clinical manifestations and outcome of Staphylococcus aureus bloodstream infection - A propensity score-based overlap weight analysis in two large, prospectively evaluated cohorts. Clin Microbiol Infect 2022; 28:1149.e1-1149.e9. [PMID: 35339677 DOI: 10.1016/j.cmi.2022.03.018] [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: 08/28/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether neutropenia influenced mortality and long-term outcome of Staphylococcus aureus bloodstream infection (SAB). METHODS Data from two prospective, multicentre cohort studies (INSTINCT and ISAC) conducted in 20 tertiary care hospitals in 6 countries between 2006 and 2015 were analysed. Neutropenic and severely neutropenic patients (defined by the proxy of total white blood cell count <1000/μl and <500/μl, respectively, at onset of SAB) were compared to a control group using a propensity score model and overlap weights to adjust for baseline characteristics. Overall survival and time to SAB-related late complications (SAB recurrence, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analysed by Cox regression and competing risk analyses, respectively. RESULTS Of 3,187 patients, 102 were neutropenic and 70 were severely neutropenic at onset of SAB. Applying overlap weights yielded two groups of 83 neutropenic and 220 non-neutropenic patients, respectively. Baseline characteristics of these groups were exactly balanced. In the Cox regression analysis, we observed no significant difference in survival between the two groups (death during follow-up: 36.1 % in neutropenic vs. 30.6 % in non-neutropenic patients, hazard ratio 1.21 (95 % CI 0.79-1.83)). This finding remained unchanged when we considered severely neutropenic patients (hazard ratio 1.08 [0.60; 1.94]). Competing risk analysis showed a cause-specific hazard ratio (CSHR) of 0.39 (95 % CI 0.11-1.39) for SAB-related late-complications in neutropenic patients. CONCLUSIONS Neutropenia was not associated with a higher survival during follow-up. The lower rate of SAB-related late complications in neutropenic patients should be validated in other cohorts.
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Affiliation(s)
- Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Tim Filla
- Institute of Medical Biometry and Bioinformatics, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lina Glaubitz
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Faculty of Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg
| | - Frieder Fuchs
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Matt Scarborough
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation, Oxford, UK
| | - Hong Bin Kim
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Robert Tilley
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Chun-Hsing Liao
- Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, Taiwan
| | - Jonathan Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Emmanuel Nsutebu
- Tropical & Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, SpainInstituto de Biomedicina de Sevilla/Departamento de Medicina, Universidad de Sevilla/CSIC, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Madrid, Spain
| | - Laura Morata
- Service of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Martin J Llewelyn
- Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Vance G Fowler
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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11
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The Effect of Combination Therapy on Mortality and Adverse Events in Patients with Staphylococcus aureus Bacteraemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Infect Dis Ther 2021; 10:2643-2660. [PMID: 34596881 PMCID: PMC8572899 DOI: 10.1007/s40121-021-00539-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction The findings of randomized controlled trials (RCTs), observational studies, and meta-analyses vary regarding the effectiveness and safety of combination therapy for patients with Staphylococcus aureus bacteraemia (SAB). We aimed to identify the effectiveness and safety of combination therapy in patients with SAB compared with those of monotherapy. Methods We performed a systematic review and meta-analysis to compare combination therapy versus monotherapy in patients with SAB. Two authors independently searched PubMed, Embase, and the Cochrane Library of clinical trials until 17 February 2021. Any RCT comparing mortality or adverse events (AEs) of combination therapy versus monotherapy for patients with SAB was eligible. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were evaluated using a random-effects model. The primary outcome was all-cause mortality at any time point. This meta-analysis is registered with the PROSPERO database (CRD42020188176) and reported according to PRISMA guidelines. Results In total, 1906 articles were identified and screened, and 14 studies (2367 patients) were included in the meta-analysis. There was no significant difference in the risk of all-cause mortality between the two groups (RR = 1.00; 95% CI 0.83–1.20; P = 0.99; I2 = 0%). Similar results were obtained by subgroup analysis of mortality recording time, endocarditis, pathogen resistance, article publication time, number of patients, and adjuvant antibiotics. Notably, combination treatment might significantly increase the risk of drug-related AEs (RR = 1.68; 95% CI 1.06–2.66; P = 0.03; I2 = 67%) and nephrotoxicity (RR = 2.30; 95% CI 1.68–3.16; P < 0.00001; I2 = 0%), although the occurrences of AEs leading to treatment discontinuation and serious AEs were not significantly different between the two groups. Conclusions The meta-analysis suggested that combination therapy could not reduce mortality but might increase the risk of drug-related AEs and nephrotoxicity and should be applied very cautiously. Future studies on combined drug therapy for SAB need careful and rigorous design for specific antibiotic combinations. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00539-y.
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12
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Grillo S, Cuervo G, Carratala J, San-Juan R, Aguado JM, Morata L, Gomez-Zorrilla S, López-Contreras J, Gasch O, Gomila-Grange A, Iftimie S, Garcia-Pardo G, Calbo E, Boix-Palop L, Oriol I, Jover-Sáenz A, López-Cortés LE, Euba G, Aguirregabiria M, Garcia-Pais MJ, Gioia F, Paño JR, Pedro-Botet ML, Benítez RM, Pérez-Rodríguez MT, Meije Y, Loeches-Yagüe MB, Horna G, Berbel D, Domínguez MÁ, Padullés A, Cobo S, Hereu P, Videla S, Tebe C, Pallarés N, Miro JM, Pujol M. Multicentre, randomised, open-label, phase IV-III study to evaluate the efficacy of cloxacillin plus fosfomycin versus cloxacillin alone in adult patients with methicillin-susceptible Staphylococcus aureus bacteraemia: study protocol for the SAFO trial. BMJ Open 2021; 11:e051208. [PMID: 34353808 PMCID: PMC8344278 DOI: 10.1136/bmjopen-2021-051208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a frequent condition, with high mortality rates. There is a growing interest in identifying new therapeutic regimens able to reduce therapeutic failure and mortality observed with the standard of care of beta-lactam monotherapy. In vitro and small-scale studies have found synergy between cloxacillin and fosfomycin against S. aureus. Our aim is to test the hypothesis that cloxacillin plus fosfomycin achieves higher treatment success than cloxacillin alone in patients with MSSA bacteraemia. METHODS We will perform a superiority, randomised, open-label, phase IV-III, two-armed parallel group (1:1) clinical trial at 20 Spanish tertiary hospitals. Adults (≥18 years) with isolation of MSSA from at least one blood culture ≤72 hours before inclusion with evidence of infection, will be randomly allocated to receive either cloxacillin 2 g/4-hour intravenous plus fosfomycin 3 g/6-hour intravenous or cloxacillin 2 g/4-hour intravenous alone for 7 days. After the first week, sequential treatment and total duration of antibiotic therapy will be determined according to clinical criteria by the attending physician.Primary endpoints: (1) Treatment success at day 7, a composite endpoint comprising all the following criteria: patient alive, stable or with improved quick-Sequential Organ Failure Assessment score, afebrile and with negative blood cultures for MSSA at day 7. (2) Treatment success at test of cure (TOC) visit: patient alive and no isolation of MSSA in blood culture or at another sterile site from day 8 until TOC (12 weeks after randomisation).We assume a rate of treatment success of 74% in the cloxacillin group. Accepting alpha risk of 0.05 and beta risk of 0.2 in a two-sided test, 183 subjects will be required in each of the control and experimental groups to obtain statistically significant difference of 12% (considered clinically significant). ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Bellvitge University Hospital (AC069/18) and from the Spanish Medicines and Healthcare Product Regulatory Agency (AEMPS, AC069/18), and is valid for all participating centres under existing Spanish legislation. The results will be presented at international meetings and will be made available to patients and funders. TRIAL REGISTRATION NUMBER The protocol has been approved by AEMPS with the Trial Registration Number EudraCT 2018-001207-37. ClinicalTrials.gov Identifier: NCT03959345; Pre-results.
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Affiliation(s)
- Sara Grillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Jordi Carratala
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- University of Barcelona, Barcelona, Spain
| | - Rafael San-Juan
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Jose M Aguado
- Department of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Silvia Gomez-Zorrilla
- Department of Infectious Diseases, Consorci Parc de Salut MAR de Barcelona, Barcelona, Spain
- Institut de Recerca Hospital del Mar, IMIM, Barcelona, Spain
| | - Joaquín López-Contreras
- Department of Infectious diseases, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Spain
| | - Oriol Gasch
- Infectious Diseases Department, Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
| | - Aina Gomila-Grange
- Institut d'Investigació i Innovació Parc Taulí, I3PT, Sabadell, Spain
- Consorcio Corporación Sanitaria Parc Taulí, Sabadell, Spain
| | - Simona Iftimie
- Department of Infection and Immunity, Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Graciano Garcia-Pardo
- Departament of Preventive Medicine, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Lucía Boix-Palop
- Infectious Diseases Unit, Hospital Universitari MutuaTerrassa, Terrassa, Spain
- Fundació per la Docència i Recerca MútuaTerrassa, Terrassa, Spain
| | - Isabel Oriol
- Department of Internal Medicine, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Lleida, Spain
- Institut de Recerca Biomèdica de Lleida, IRBLLEIDA, Lleida, Spain
| | - Luis Eduardo López-Cortés
- Department of Infectious diseases, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Gorane Euba
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Malen Aguirregabiria
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Microbiology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | - Maria Jose Garcia-Pais
- Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francesca Gioia
- Department of Infectious diseases, Hospital Universitario Ramon y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Jose Ramón Paño
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Maria Luisa Pedro-Botet
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Rosa Maria Benítez
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | | | - Yolanda Meije
- Hospital de Barcelona, Barcelona, Spain
- Societat Cooperativa d'Instal·lacions Assistencials Sanitàries, Barcelona, Spain
| | | | - Gertrudis Horna
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
| | - Damaris Berbel
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Maria Ángeles Domínguez
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Microbiology and Parassitology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ariadna Padullés
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sara Cobo
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Pharmacy Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pilar Hereu
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sebastian Videla
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Cristian Tebe
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Natàlia Pallarés
- University of Barcelona, Barcelona, Spain
- Biostatistics Unit, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep M Miro
- Department of Infectious Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, IDIBAPS, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Bellvitge Institute for Biomedical Research, IDIBELL, Barcelona, Spain
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13
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Rieg S, Ernst A, Peyerl-Hoffmann G, Joost I, Camp J, Hellmich M, Kern WV, Kaasch AJ, Seifert H. Combination therapy with rifampicin or fosfomycin in patients with Staphylococcus aureus bloodstream infection at high risk for complications or relapse: results of a large prospective observational cohort. J Antimicrob Chemother 2021; 75:2282-2290. [PMID: 32355950 DOI: 10.1093/jac/dkaa144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/17/2020] [Accepted: 03/23/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin. METHODS In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs). RESULTS A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46-0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35-0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36-0.91). Upon agent-specific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions. CONCLUSIONS In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Insa Joost
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine, University of Cologne, 50924 Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, 50937 Cologne, Germany.,German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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14
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Le Bot A, Lecomte R, Gazeau P, Benezit F, Arvieux C, Ansart S, Boutoille D, Le Berre R, Chabanne C, Lesouhaitier M, Dejoies L, Flecher E, Chapplain JM, Tattevin P, Revest M. Is Rifampin Use Associated With Better Outcome in Staphylococcal Prosthetic Valve Endocarditis? A Multicenter Retrospective Study. Clin Infect Dis 2021; 72:e249-e255. [PMID: 32706879 DOI: 10.1093/cid/ciaa1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE. METHODS An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000-2018. Primary outcome measurement was 1-year mortality. RESULTS We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30-6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47-34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34-27.26, P = .019), were associated with 1-year mortality. CONCLUSIONS A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.
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Affiliation(s)
- Audrey Le Bot
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Raphaël Lecomte
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, Nantes, France
| | - Pierre Gazeau
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France
| | - François Benezit
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Cédric Arvieux
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Séverine Ansart
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, Nantes, France
| | - Rozenn Le Berre
- Department of Internal Medecine and pneumology, La Cavale Blanche University Hospital, Brest, France
| | - Céline Chabanne
- Department of thoracic and cardiovascular surgery, Pontchaillou University Hospital, Rennes, France
| | - Matthieu Lesouhaitier
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Loren Dejoies
- Department of bacteriology, Pontchaillou University Hospital, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_1230, France
| | - Erwan Flecher
- Department of thoracic and cardiovascular surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Marc Chapplain
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_1230, France.,CIC-Inserm 1414, Pontchaillou University Hospital, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.,University of Rennes, Inserm, BRM (Bacterial Regulatory RNAs and Medicine), UMR_1230, France.,CIC-Inserm 1414, Pontchaillou University Hospital, Rennes, France
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15
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Leung YKS, Ledergerber B, Eberhard N, Mestres CA, Rancic Z, Zimmermann A, Zbinden R, Brugger SD, Zinkernagel AS, Hasse B. Open wounds and rifampicin therapy are associated with rifampicin resistance among staphylococcal vascular graft/endograft infections. JAC Antimicrob Resist 2021; 3:dlab041. [PMID: 34223108 PMCID: PMC8209986 DOI: 10.1093/jacamr/dlab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Optimal timing for rifampicin combination therapy in patients with staphylococcal vascular graft/endograft infection (S-VGEI) is unknown. Experts recommend adding rifampicin after lowering bacterial load by surgery and wound closure. Objectives To assess predictors of rifampicin resistance among staphylococci isolated from patients in the Vascular Graft Infection Cohort Study. Methods We included prospective patients with S-VGEI diagnosis from 1 January 2002 to 30 June 2020. We retrospectively assessed determinants of rifampicin resistance using exact logistic regression and described survival with Kaplan–Meier curves. Results We analysed 513 Staphylococcus spp. among 143 predominantly male (82%) patients with a median age of 68 years (IQR 60–75). Thereof, 82 (57%) received a rifampicin combination therapy and 61 (43%) received an antimicrobial therapy without rifampicin. Among 82 patients with rifampicin, 26/26 patients with any rifampicin resistance had open wounds with a strong association of rifampicin resistance with rifampicin treatment while having open wounds (OR 37, 95% CI 6.1 to ∞). Among 75 patients with a rifampicin combination therapy and rifampicin-susceptible staphylococci at S-VGEI diagnosis, 12/12 patients with a secondary rifampicin-resistant isolate had an open wound (OR 14, 95% CI 2.1 to ∞). Conclusions Rifampicin should be started after wound closure due to increased risk of rifampicin resistance observed while having open wounds or second-look surgeries among patients with S-VGEI.
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Affiliation(s)
- Yau Kei Stefan Leung
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Nadia Eberhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Carlos A Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Zoran Rancic
- Clinic for Vascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Alexander Zimmermann
- Clinic for Vascular Surgery, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28, Zurich, Switzerland
| | - Silvio D Brugger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich, Switzerland
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16
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Holland TL, Davis JS. Combination Therapy for MRSA Bacteremia: To ß or Not to ß? Clin Infect Dis 2021; 71:11-13. [PMID: 31404470 DOI: 10.1093/cid/ciz750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 01/09/2023] Open
Affiliation(s)
- Thomas L Holland
- Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Northern Territory.,Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
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17
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Kimmig A, Hagel S, Weis S, Bahrs C, Löffler B, Pletz MW. Management of Staphylococcus aureus Bloodstream Infections. Front Med (Lausanne) 2021; 7:616524. [PMID: 33748151 PMCID: PMC7973019 DOI: 10.3389/fmed.2020.616524] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.
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Affiliation(s)
- Aurelia Kimmig
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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18
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Renz N, Trampuz A, Zimmerli W. Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified? Antibiotics (Basel) 2021; 10:antibiotics10020165. [PMID: 33562821 PMCID: PMC7916064 DOI: 10.3390/antibiotics10020165] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 01/04/2023] Open
Abstract
Rifampin is a potent antibiotic against staphylococcal implant-associated infections. In the absence of implants, current data suggest against the use of rifampin combinations. In the past decades, abundant preclinical and clinical evidence has accumulated supporting its role in biofilm-related infections.In the present article, experimental data from animal models of foreign-body infections and clinical trials are reviewed. The risk for emergence of rifampin resistance and multiple drug interactions are emphasized. A recent randomized controlled trial (RCT) showing no beneficial effect of rifampin in patients with acute staphylococcal periprosthetic joint infection treated with prosthesis retention is critically reviewed and data interpreted. Given the existing strong evidence demonstrating the benefit of rifampin, the conduction of an adequately powered RCT with appropriate definitions and interventions would probably not comply with ethical standards.
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Affiliation(s)
- Nora Renz
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
- Department of Infectious Diseases, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany;
- Correspondence:
| | - Werner Zimmerli
- Interdisciplinary Unit of Orthopaedic Infections, Kantonsspital Baselland, 4410 Liestal, Switzerland;
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19
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Neuhaus GF, Loesgen S. Antibacterial Drimane Sesquiterpenes from Aspergillus ustus. JOURNAL OF NATURAL PRODUCTS 2021; 84:37-45. [PMID: 33346651 DOI: 10.1021/acs.jnatprod.0c00910] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Bioactivity-guided isolation of Aspergillus ustus led to the discovery of five new drimane sesquiterpenes, named ustusal A, ustusolate F and G, and ustusoic acid A and B, 1-5 respectively. Structural elucidation of these fungal terpenes relied on 1D and 2D NMR techniques, high-resolution mass spectrometry, and chiroptical properties. Their relative configurations were determined by NMR methods, while the absolute configurations were established using comparative analyses of computed and experimental NMR chemical shifts and ECD spectra. The sesquiterpenes exhibited weak activity against the clinically relevant pathogens vancomycin-resistant Enterococcus faecium and multidrug-resistant Staphylococcus aureus; however, the activity of 5 was drastically enhanced when equal amounts of stromemycin (6), a known metabolite coisolated from the same fraction from A. ustus, was added.
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Affiliation(s)
- George F Neuhaus
- Department of Chemistry, Oregon State University, Corvallis, Oregon 97331, United States
| | - Sandra Loesgen
- Department of Chemistry, Oregon State University, Corvallis, Oregon 97331, United States
- Whitney Laboratory for Marine Bioscience, Department of Chemistry, University of Florida, St. Augustine, Florida 32080, United States
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20
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Hennigs A, Jochum J. [Rational antimicrobial therapy - recommendations for common infections]. Dtsch Med Wochenschr 2020; 145:1673-1682. [PMID: 33202451 DOI: 10.1055/a-1114-3946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Infectious diseases are a frequent reason for medical consultations both in the inpatient and outpatient setting. Inadequate management is associated with increased costs, morbidity and mortality. In times of rising antibiotic resistance rational therapy and antimicrobial stewardship are of utmost importance. While it is crucial to avoid excessively broad antimicrobial coverage and unnecessary therapies, serious conditions must be treated effectively. The article highlights common infections and gives recommendations for empiric and targeted antibiotic treatment. Discussed are pulmonary, abdominal, urinary tract, skin and soft tissue infections, as well as sepsis and staphylococcal bloodstream infections. The recommendations consider national and international guidelines, recent publications and current antimicrobial resistance in Germany.
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21
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[Infections due to multidrug-resistant pathogens : Pathogens, resistance mechanisms and established treatment options]. Anaesthesist 2020; 68:711-730. [PMID: 31555833 DOI: 10.1007/s00101-019-00645-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The increase in resistant pathogens has long been a global problem. Complicated life-threatening infections due to multidrug-resistant pathogens (MRD) meanwhile occur regularly in intensive care medicine. An important and also potentially modifiable factor of the rapid spread of resistance is the irrational use of broad spectrum antibiotics in human medicine. In addition to many other resistance mechanisms, beta-lactamases play an important role in Gram-negative pathogens. They are not uncommonly the leading reason of difficult to treat infections and the failure of known routinely used broad spectrum antibiotics, such as cephalosporins, (acylamino)penicillins and carbapenems. Strategies for containment of MRDs primaríly target the rational use of antibiotics. In this respect interdisciplinary treatment teams, e.g. antibiotic stewardship (ABS) and infectious diseases stewardship (IDS) play a major role.
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22
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Ye C, Wang Z, Hu Y, Deng C, Liao L, Sun L, Wang C. Systematic review and meta-analysis of the efficacy and safety of vancomycin combined with β-lactam antibiotics in the treatment of methicillin-resistant Staphylococcus aureus bloodstream infections. J Glob Antimicrob Resist 2020; 23:303-310. [PMID: 33045437 DOI: 10.1016/j.jgar.2020.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 09/14/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Vancomycin combined with β-lactams (Combo therapy) has been encouraged in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) in recent years, but its efficacy and safety have not been systematically evaluated. This is a systematic review and meta-analysis to clarify the efficacy and safety of Combo therapy in patients with MRSA BSIs. METHODS Relevant articles reporting on the clinical or microbiology outcomes of Combo treatment in adult patients with MRSA bacteraemia throughout November 2019 were searched in PubMed, EMBASE and Cochrane Library databases. Summary odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were evaluated using a fixed- or random-effects model. RESULTS Six articles (806 patients) consisting of one RCT and five retrospective cohort studies were included in this study. The pooled data showed that Combo therapy could significantly reduce the risk of microbiological failure (OR = 0.54, 95% CI 0.35-0.83, I2 40%, P = 0.005) and persistent bacteraemia (OR=0.48, 95% CI 0.30-0.77, I2 13%, P = 0.002), as well as shorten the duration of bacteraemia (MD = -1.06, 95% CI -1.53 to -0.60, I2 0%, P < 0.00001). In addition, it did not significantly increase the incidence of nephrotoxicity (OR = 1.17, 95% CI 0.64-2.13, I2 0%, P = 0.61). However, no significant difference was detected between the groups regarding 28/30-day mortality, MRSA-related mortality, bacteraemia relapse or length of hospitalization. CONCLUSIONS These results demonstrate that Combo therapy clears the pathogenic bacteria of MRSA bacteraemia but does not improve the clinical prognosis. As the sample size was small and most of the studies were retrospective cohort studies with substantial heterogeneity, there is a need for further studies encompassing large-scale multicentre RCTs to validate our results.
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Affiliation(s)
- Chao Ye
- Department of Pharmacy, People's Hospital of Ningxiang City Affiliated to Hunan University of Chinese Medicine, Changsha, 410600, Hunan, China
| | - Zhaohui Wang
- Department of Pharmacy, People's Hospital of Ningxiang City Affiliated to Hunan University of Chinese Medicine, Changsha, 410600, Hunan, China
| | - Ying Hu
- Department of Pharmacy, People's Hospital of Ningxiang City Affiliated to Hunan University of Chinese Medicine, Changsha, 410600, Hunan, China
| | - Chao Deng
- Department of Pharmacy, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, 431800, Hubei, China
| | - Linglong Liao
- Gastroenterology, Zengcheng District People's Hospital of Guangzhou, Guangzhou, 511300, Guangdong, China
| | - Linli Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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23
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Luque Paz D, Lakbar I, Tattevin P. A review of current treatment strategies for infective endocarditis. Expert Rev Anti Infect Ther 2020; 19:297-307. [PMID: 32901532 DOI: 10.1080/14787210.2020.1822165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Infective endocarditis is one of the most difficult-to-treat infectious diseases. AREAS COVERED We restricted this review to the anti-infective treatment of the main bacteria responsible for infective endocarditis, i.e. staphylococci, streptococci, enterococci, and Gram-negative bacilli, including HACEK. Specific topics of major interest in treatment strategy are covered as well, including empirical treatment, oral switch, and treatment duration. We searched in the MEDLINE database to identify relevant studies, trials, reviews, or meta-analyses until May 2020. EXPERT OPINION The use of aminoglycosides for the treatment of endocarditis has been dramatically reduced over the last 20 years. It should be administered once daily, and no longer than 2 weeks. For staphylococcal endocarditis, recent data reinforced the role of anti-staphylococcal penicillins, for methicillin-susceptible isolates (alternative, cefazolin), and vancomycin for methicillin-resistant isolates (alternative, daptomycin). For staphylococcal prosthetic-valve endocarditis, these treatments will be reinforced by the addition of gentamicin during the first 2 weeks, and rifampin throughout the whole treatment duration, i.e. 6 weeks. The optimal duration of antibacterial treatment is 4 weeks for most native valve endocarditis, and 6 weeks for prosthetic-valve endocarditis. The oral switch is safe in patients stabilized after the initial intravenous course.
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Affiliation(s)
- David Luque Paz
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Ines Lakbar
- Anaesthesiology and Critical Care Department, University Hospital of Toulouse, Toulouse, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
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24
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Grillo S, Cuervo G, Carratalà J, Grau I, Pallarès N, Tebé C, Guillem Tió L, Murillo O, Ardanuy C, Domínguez MA, Shaw E, Gudiol C, Pujol M. Impact of β-Lactam and Daptomycin Combination Therapy on Clinical Outcomes in Methicillin-susceptible Staphylococcus aureus Bacteremia: A Propensity Score-matched Analysis. Clin Infect Dis 2020; 69:1480-1488. [PMID: 30615122 DOI: 10.1093/cid/ciz018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/04/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mortality rates from Staphylococcus aureus bacteremia are high and have only modestly improved in recent decades. We compared the efficacies of a β-lactam in combination with daptomycin (BL/D-C) and β-lactam monotherapy (BL-M) in improving clinical outcomes in methicillin-susceptible S. aureus (MSSA) bacteremia. METHODS A retrospective cohort study of MSSA bacteremia was performed in a tertiary hospital from January 2011 to December 2017. Patients receiving BL/D-C and BL-M were compared to assess 7-, 30-, and 90-day mortality rates. A 1:2 propensity score matching analysis was performed. Differences were assessed using Cox regression models. RESULTS Of the 514 patients with MSSA bacteremia, 164 were excluded as they had received combination therapies other than BL/D-C, had pneumonia, or died within 48 hours of admission. Of the remaining 350 patients, 136 and 214 received BL/D-C and BL-M, respectively. BL/D-C patients had higher Pitt scores and persistent bacteremia more often than BL-M patients. In the raw analysis, there were no differences in mortality rates between groups. After propensity score matching, there were no significant differences between the BL/D-C (110 patients) and BL-M (168 patients) groups for all-cause mortality rates at 7 days (8.18% vs 7.74%; P = 1.000), 30 days (17.3% vs 16.1%; P = .922), and 90 days (22.7% vs 23.2%; P = 1.000), even in a subanalysis of patients with high-risk source of infection and in a subgroup excluding catheter-related bacteremia. CONCLUSIONS BL/D-C failed to reduce mortality rates in patients with MSSA bacteremia. Treatment strategies to improve survival in MSSA bacteremia are urgently needed.
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Affiliation(s)
- Sara Grillo
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona
| | - Guillermo Cuervo
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville.,University of Barcelona, Istituto de Salud Carlos III, Madrid
| | - Immaculada Grau
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,University of Barcelona, Istituto de Salud Carlos III, Madrid.,Centro Investigación Biomédica en Red Enfermedades Respiratorias, Istituto de Salud Carlos III, Madrid
| | - Natàlia Pallarès
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Reus.,Basic Clinical Practice Department, University of Barcelona, Reus
| | - Cristian Tebé
- Biostatistics Unit, IDIBELL, L'Hospitalet de Llobregat, Reus.,Basic Clinical Practice Department, Rovira Virgili University, Reus
| | - Lluisa Guillem Tió
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona
| | - Oscar Murillo
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville.,University of Barcelona, Istituto de Salud Carlos III, Madrid
| | - Carmen Ardanuy
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,University of Barcelona, Istituto de Salud Carlos III, Madrid.,Centro Investigación Biomédica en Red Enfermedades Respiratorias, Istituto de Salud Carlos III, Madrid.,Department of Microbiology, Bellvitge University Hospital, Barcelona, Spain
| | - M Angeles Domínguez
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville.,University of Barcelona, Istituto de Salud Carlos III, Madrid.,Department of Microbiology, Bellvitge University Hospital, Barcelona, Spain
| | - Evelyn Shaw
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville
| | - Carlota Gudiol
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville.,University of Barcelona, Istituto de Salud Carlos III, Madrid
| | - Miquel Pujol
- Department of Infectious Diseases, Bellvitge University Hospital, Barcelona.,Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona.,Red Española de Investigación en Patología Infecciosa, Seville
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Mathé PJ, Joost I, Peyerl-Hoffmann G, Schneider C, Kern W, Rieg S. Staphylococcus aureus Bloodstream Infection in Patients with Atopic Dermatitis, or: Think Twice Before Placing a Venous Catheter into Lesional Atopic Skin. J Invest Dermatol 2020; 140:1870-1872. [DOI: 10.1016/j.jid.2020.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
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26
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Rieg S, von Cube M, Kaasch AJ, Bonaventura B, Bothe W, Wolkewitz M, Peyerl-Hoffmann G, Deppe AC, Wahlers T, Beyersdorf F, Seifert H, Kern WV. Investigating the Impact of Early Valve Surgery on Survival in Staphylococcus aureus Infective Endocarditis Using a Marginal Structural Model Approach: Results of a Large, Prospectively Evaluated Cohort. Clin Infect Dis 2020; 69:487-494. [PMID: 30346527 DOI: 10.1093/cid/ciy908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 10/18/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The impact of valve surgery on outcomes of Staphylococcus aureus infective endocarditis (SAIE) remains controversial. We tested the hypothesis that early valve surgery (EVS) improves survival by using a novel approach that allows for inclusion of major confounders in a time-dependent way. METHODS EVS was defined as valve surgery within 60 days. Univariable and multivariable Cox regression analyses were performed. To account for treatment selection bias, we additionally used a weighted Cox model (marginal structural model) that accounts for time-dynamic imbalances between treatment groups. To address survivor bias, EVS was included as a time-dependent variable. Follow-up of patients was 1 year. RESULTS Two hundred and three patients were included in the analysis; 50 underwent EVS. All-cause mortality at day 30 was 26%. In the conventional multivariable Cox regression model, the effect of EVS on the death hazard was 0.85 (95% confidence interval [CI], .47-1.52). Using the weighted Cox model, the death hazard rate (HR) of EVS was 0.71 (95% CI, .34-1.49). In subgroup analyses, no survival benefit was observed in patients with septic shock (HR, 0.80 [CI, .26-2.46]), in NVIE (HR, 0.76 [CI, .33-1.71]) or PVIE (HR, 1.02 [CI, .29-3.54]), or in patients with EVS within 14 days (HR, 0.97 [CI, .46-2.07]). CONCLUSIONS Using both a conventional Cox regression model and a weighted Cox model, we did not find a survival benefit for patients who underwent EVS in our cohort. Until results of randomized controlled trials are available, EVS in SAIE should be based on individualized decisions of an experienced multidisciplinary team. CLINICAL TRIALS REGISTRATION German Clinical Trials registry (DRKS00005045).
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Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | - Maja von Cube
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf
| | - Bastian Bonaventura
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | - Wolfgang Bothe
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center.,Department of Cardiovascular Surgery, Heart Center, Medical Center, University of Freiburg
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital of Cologne
| | - Friedhelm Beyersdorf
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center.,Department of Cardiovascular Surgery, Heart Center, Medical Center, University of Freiburg
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne.,German Centre for Infection Research, Partner Site Bonn-Cologne, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine and Medical Center
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27
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Monnier AA, Tacconelli E, Årdal C, Cavaleri M, Gyssens IC. A case study on Staphylococcus aureus bacteraemia: available treatment options, antibiotic R&D and responsible antibiotic-use strategies. JAC Antimicrob Resist 2020; 2:dlaa034. [PMID: 34222996 PMCID: PMC8210125 DOI: 10.1093/jacamr/dlaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives This case study addresses: (i) antibiotic treatment options for Staphylococcus aureus bacteraemia (SAB), for both empirical and targeted therapy; (ii) the current status of and priorities for the antibiotic pipeline to ensure access of effective antibiotics for SAB; and (iii) strategies for responsible antibiotic use relevant to the clinical management of SAB. Methods Evidence to address the aims was extracted from the following information sources: (i) EUCAST and CLSI recommendations, summaries of product characteristics (SPCs), antibiotic treatment guidelines and the textbook Kucers’ The Use of Antibiotics; (ii) the www.clinicaltrial.gov database; and (iii) quality indicators for responsible antibiotic use. Results Current monotherapy treatment options for SAB include only three drug classes (β-lactams, glycopeptides and lipopeptides), of which two also cover MRSA bacteraemia (glycopeptides and lipopeptides). The analysis of the antibiotic pipeline and ongoing clinical trials revealed that several new antibiotics with S. aureus (including MRSA) coverage were developed in the past decade (2009–19). However, none belonged to a new antibiotic class or had superior effectiveness and their added clinical value for SAB remains to be proven. Responsible antibiotic use for the treatment of SAB was illustrated using 11 quality indicators. Conclusions Awareness of the problem of a limited antibiotic arsenal, together with incentives (e.g. push incentives), is needed to steer the R&D landscape towards the development of novel and effective antibiotics for treating SAB. In the meantime, responsible antibiotic use guided by quality indicators should preserve the effectiveness of currently available antibiotics for treating SAB.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Christine Årdal
- Norwegian Institute of Public Health, Antimicrobial Resistance Centre, Oslo, Norway
| | | | - Inge C Gyssens
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
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Timsit JF, Ruppé E, Barbier F, Tabah A, Bassetti M. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med 2020; 46:266-284. [PMID: 32047941 PMCID: PMC7223992 DOI: 10.1007/s00134-020-05950-6] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/23/2020] [Indexed: 02/07/2023]
Abstract
Bloodstream infection (BSI) is defined by positive blood cultures in a patient with systemic signs of infection and may be either secondary to a documented source or primary—that is, without identified origin. Community-acquired BSIs in immunocompetent adults usually involve drug-susceptible bacteria, while healthcare-associated BSIs are frequently due to multidrug-resistant (MDR) strains. Early adequate antimicrobial therapy is a key to improve patient outcomes, especially in those with criteria for sepsis or septic shock, and should be based on guidelines and direct examination of available samples. Local epidemiology, suspected source, immune status, previous antimicrobial exposure, and documented colonization with MDR bacteria must be considered for the choice of first-line antimicrobials in healthcare-associated and hospital-acquired BSIs. Early genotypic or phenotypic tests are now available for bacterial identification and early detection of resistance mechanisms and may help, though their clinical impact warrants further investigations. Initial antimicrobial dosing should take into account the pharmacokinetic alterations commonly observed in ICU patients, with a loading dose in case of sepsis or septic shock. Initial antimicrobial combination attempting to increase the antimicrobial spectrum should be discussed when MDR bacteria are suspected and/or in the most severely ill patients. Source identification and control should be performed as soon as the hemodynamic status is stabilized. De-escalation from a broad-spectrum to a narrow-spectrum antimicrobial may reduce antibiotic selection pressure without negative impact on mortality. The duration of therapy is usually 5–8 days though longer durations may be discussed depending on the underlying illness and the source of infection. This narrative review covers the epidemiology, diagnostic workflow and therapeutic aspects of BSI in ICU patients and proposed up-to-date expert statements.
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Affiliation(s)
- Jean-François Timsit
- AP-HP, Hôpital Bichat, Medical and Infectious Diseases ICU, 75018, Paris, France. .,Université de Paris, IAME, INSERM, 75018, Paris, France.
| | - Etienne Ruppé
- Université de Paris, IAME, INSERM, 75018, Paris, France.,AP-HP, Hôpital Bichat, Bacteriology Laboratory, 75018, Paris, France
| | | | - Alexis Tabah
- ICU, Redcliffe Hospital, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa and Hospital Policlinico San Martino-IRCCS, Genoa, Italy
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Leikeim RSM, Kesselmeier M, Löffler B, Rödel J, Höring S. Diagnostic accuracy and clinical impact of loop-mediated isothermal amplification for rapid detection of Staphylococcus aureus bacteremia: a retrospective observational study. Eur J Clin Microbiol Infect Dis 2019; 39:679-688. [PMID: 31823147 DOI: 10.1007/s10096-019-03773-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/20/2019] [Indexed: 11/30/2022]
Abstract
The aim of this study was to evaluate the diagnostic accuracy and the clinical impact of isothermal loop-mediated amplification (LAMP; eazyplex® MRSA kits) for rapid diagnosis of Staphylococcus aureus bacteremia (SAB) in comparison with conventional blood culture diagnostics. We performed a retrospective, single-center observational study over the period between November 2016 and December 2018 on patients (and blood cultures) with growth of Gram-positive cocci in clusters in their blood cultures. We quantified diagnostic accuracy with sensitivity and specificity for detection of S. aureus, methicillin-resistant S. aureus (MRSA), and the mecA/C resistance genes in 797 blood cultures. The clinical impact was assessed by time to result reporting, time to appropriate treatment, and length of stay in intensive care unit (ICU) in 190 SAB patients. We observed sensitivity and specificity above 90% for S. aureus detection (sensitivity (95% confidence interval (CI)), 99.57% (97.61%, 99.98%); specificity, 99.12% (97.95%, 99.71%)), for MRSA detection (sensitivity, 100% (89.11%, 100.00%); specificity, 99.72% (99.05, 99.96)), and for mecA/C detection (sensitivity, 94.71% (91.85%, 96.78%); specificity, 95.89% (93.58%, 97.54%)). LAMP testing was associated with shorter median time to result reporting (24.0 h (first and third quartiles (Q1-Q3), 20.0-27.0 h) vs 41.5 h (36.0-46.0 h); p < 0.001) and different distribution of time to appropriate treatment (2.0 days (1.0-3.0) vs 2.0 days (2.0-3.0); p = 0.004). No evidence for differences in length-of-stay in ICU was observed. Our analysis suggests for the application of LAMP (i) a high diagnostic accuracy for detection of S. aureus and the mecA/C genes in blood cultures, (ii) an earlier result reporting, and (iii) a shorter time to appropriate treatment.
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Affiliation(s)
| | - Miriam Kesselmeier
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
- Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Steffen Höring
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany.
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
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Giannella M, Bartoletti M, Gatti M, Viale P. Advances in the therapy of bacterial bloodstream infections. Clin Microbiol Infect 2019; 26:158-167. [PMID: 31733377 DOI: 10.1016/j.cmi.2019.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Advances in the diagnostic and therapeutic management of patients with bloodstream infections (BSIs) have been achieved in the last years, improving clinical outcome. However, mortality associated with some pathogens, such as Staphylococcus aureus and Enterococcus spp., is still high. In addition, the spread of antibiotic resistance, mainly among Gram-negative bacteria, reduces treatment options in some circumstances. Therefore, interest in new drugs, combination regimens and optimal dosing schedules is rising. OBJECTIVES Our aim is to summarize the current evidence on available antibiotic regimens for patients with bacterial BSI, focusing on drug choice, combination regimens and optimal dosing schedules. We selected bacteria that are difficult to manage because of virulence factors (i.e. methicillin-susceptible S. aureus), tolerance to antibiotic activity (i.e. Enterococcus faecalis), and/or susceptibility patterns (i.e. methicillin-resistant S. aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Acinetobacter baumannii). SOURCES MEDLINE search with English language and publication in the last 5 years as limits. CONTENT AND IMPLICATIONS The literature gaps on the use of new drugs, the uncertainties regarding the use of combination regimens, and the need to optimize dosing schedules in some circumstances (e.g. augmented renal clearance, renal replacement therapy, high inoculum BSI sources, and isolation of bacteria showing high MICs) have been revised.
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Affiliation(s)
- M Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy.
| | - M Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - M Gatti
- Pharmacology Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
| | - P Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola Malpighi, University of Bologna, Bologna, Italy
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Association between treatment duration and mortality or relapse in adult patients with Staphylococcus aureus bacteraemia: a retrospective cohort study. Clin Microbiol Infect 2019; 26:626-631. [PMID: 31357013 DOI: 10.1016/j.cmi.2019.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim was to evaluate the effect of duration of therapy (DOT) on mortality and relapse for patients with Staphylococcus aureus bacteraemia (SAB). METHODS We performed a retrospective single-centre cohort study including adult patients with SAB. We determined the association between DOT (≤14 days versus >14 days) and mortality by adjusted hazard ratios (aHR) and 95% confidence intervals through Cox regression adjusted for immortal-time bias and confounding by indication, stratified by presence of complicated SAB (any of: endocarditis, implant, duration of SAB >2 days, fever >3 days). The primary outcome was 90-day all-cause mortality, and the secondary outcome was 90-day relapse. RESULTS Between January 2010 and December 2015, we included 530 patients, of whom 94 out of 530 (17.7%) had methicillin-resistant SAB and 305 out of 530 (57.6%) had complicated SAB. Ninety-day mortality was 27.0% (143/530), with no significant trend across the study period; median time to death was 17 days (interquartile range (IQR) 8-30) after onset of SAB. Median DOT was 20 days (IQR 13-39). Patients with complicated SAB had significantly reduced mortality with DOT >14 days (aHR 0.32, 95% CI 0.16-0.64). DOT was not associated with mortality in patients with uncomplicated SAB (aHR 0.85; 0.41-1.78). Eighteen (18/530) patients (3.4%) relapsed; on univariate analysis, DOT was not associated with relapse (HR 1.01; 0.97-1.06). CONCLUSIONS DOT >14 days is associated with higher survival in patients with complicated SAB, but not for patients with uncomplicated SAB. No association was found for relapse, but 90-day relapse was very low in this cohort. Importantly, 90-day mortality remained high across the study period.
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Panjla A, Kaul G, Shukla M, Tripathi S, Nair NN, Chopra S, Verma S. A novel molecular scaffold resensitizes multidrug-resistant S. aureus to fluoroquinolones. Chem Commun (Camb) 2019; 55:8599-8602. [PMID: 31276129 DOI: 10.1039/c9cc03001h] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nosocomial infections arising from opportunistic pathogens, such as Staphylococcus aureus, are growing unabated, compounded by the rapid emergence of antimicrobial resistance. Herein, we demonstrate a new molecular design that exhibits excellent activity against multidrug-resistant S. aureus with no cytotoxicity and resensitizes fluoroquinolones (FQ) towards FQ-resistant methicillin-resistant S. aureus strains, with DNA gyrase B as the likely molecular target as determined by molecular dynamics (MD) simulations.
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Affiliation(s)
- Apurva Panjla
- Department of Chemistry, Indian Institute of Technology, Kanpur, India.
| | - Grace Kaul
- Department of Microbiology, Central Drug Research Institute, Lucknow, India.
| | - Manjulika Shukla
- Department of Microbiology, Central Drug Research Institute, Lucknow, India.
| | | | - Nisanth N Nair
- Department of Chemistry, Indian Institute of Technology, Kanpur, India.
| | - Sidharth Chopra
- Department of Microbiology, Central Drug Research Institute, Lucknow, India.
| | - Sandeep Verma
- Department of Chemistry, Indian Institute of Technology, Kanpur, India.
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Kaasch AJ, Kern WV, Joost I, Hellmich M, Seifert H, Rieg S. Effect of Clinically Uninfected Orthopedic Implants and Pacemakers/AICDs in Low-Risk Staphylococcus aureus Bloodstream Infection on Crude Mortality Rate: A Post Hoc Analysis of a Large Cohort Study. Open Forum Infect Dis 2019; 6:ofz170. [PMID: 31111077 PMCID: PMC6521783 DOI: 10.1093/ofid/ofz170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 01/20/2023] Open
Abstract
Background The standard treatment duration in low-risk Staphylococcus aureus bloodstream (SAB) is 14 days. However, it is unclear whether an extended course of antimicrobial therapy is necessary in patients with clinically uninfected prosthetic joints/osteosyntheses or pacemakers/automated implanted cardioverter-defibrillators (AICDs). Thus, we compared the duration of antimicrobial therapy and outcomes in patients with and those without clinically uninfected foreign bodies. Methods We conducted a post hoc analysis of data from the prospective Invasive Staphylococcus aureus Infection Cohort (INSTINCT) study. Adult low-risk patients who survived ≥4 days were assessed for duration of treatment, SAB-related events (attributable death, relapse, or new deep-seated infection), and survival. Results Of the 1288 patients enrolled, 292 satisfied criteria for low-risk SAB. Forty-three patients (15%) had a clinically uninfected pacemaker/AICD or orthopedic implant. Patients with foreign bodies were significantly older (mean age, 72 vs 62 years for those without; P < .001; P = .9) and had a higher Charlson score (median, 3 vs 2; P = .06). The total duration of antimicrobial therapy (median, 18 vs 17 days, respectively; P = .7), all-cause mortality rate (16% vs 14%; P = .7), and prevalence of SAB-related events within 90 days were similar (2% vs 2%) in the 2 groups. At 1-year follow-up, SAB-related events were more frequent in patients with foreign bodies (7% vs 4% in those without; P = .4) (hazard ratio, 1.41; 95% confidence interval, .35–5.69; in a multivariable Cox model), but this difference was not statistically significant. Conclusions Low-risk patients with clinically uninfected foreign bodies received a similar duration of antimicrobial therapy without a significant impact on mortality rate. The observed higher hazard ratio of SAB-related events within 1 year necessitates additional studies before recommendations concerning treatment duration in this patient subgroup can be adapted or modified.
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Affiliation(s)
- Achim J Kaasch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf
- Correspondence: Achim J. Kaasch, Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf, Universitätsstrasse 1, 40225 Düsseldorf, Germany ()
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg
| | - Insa Joost
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich-Heine-University Düsseldorf
| | | | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne
- German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center, University of Freiburg
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Thwaites GE, Scarborough M, Szubert A, Saramago Goncalves P, Soares M, Bostock J, Nsutebu E, Tilley R, Cunningham R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS. Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia: the ARREST RCT. Health Technol Assess 2019; 22:1-148. [PMID: 30382016 DOI: 10.3310/hta22590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia is a common and frequently fatal infection. Adjunctive rifampicin may enhance early S. aureus killing, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. OBJECTIVES To determine whether or not adjunctive rifampicin reduces bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. Secondary objectives included evaluating the impact of rifampicin on all-cause mortality, clinically defined failure/recurrence or death, toxicity, resistance emergence, and duration of bacteraemia; and assessing the cost-effectiveness of rifampicin. DESIGN Parallel-group, randomised (1 : 1), blinded, placebo-controlled multicentre trial. SETTING UK NHS trust hospitals. PARTICIPANTS Adult inpatients (≥ 18 years) with meticillin-resistant or susceptible S. aureus grown from one or more blood cultures, who had received < 96 hours of antibiotic therapy for the current infection, and without contraindications to rifampicin. INTERVENTIONS Adjunctive rifampicin (600-900 mg/day, oral or intravenous) or placebo for 14 days in addition to standard antibiotic therapy. Investigators and patients were blinded to trial treatment. Follow-up was for 12 weeks (assessments at 3, 7, 10 and 14 days, weekly until discharge and final assessment at 12 weeks post randomisation). MAIN OUTCOME MEASURES The primary outcome was all-cause bacteriological (microbiologically confirmed) failure/recurrence or death through 12 weeks from randomisation. RESULTS Between December 2012 and October 2016, 758 eligible participants from 29 UK hospitals were randomised: 370 to rifampicin and 388 to placebo. The median age was 65 years [interquartile range (IQR) 50-76 years]. A total of 485 (64.0%) infections were community acquired and 132 (17.4%) were nosocomial; 47 (6.2%) were caused by meticillin-resistant S. aureus. A total of 301 (39.7%) participants had an initial deep infection focus. Standard antibiotics were given for a median of 29 days (IQR 18-45 days) and 619 (81.7%) participants received flucloxacillin. By 12 weeks, 62 out of 370 (16.8%) patients taking rifampicin versus 71 out of 388 (18.3%) participants taking the placebo experienced bacteriological (microbiologically confirmed) failure/recurrence or died [absolute risk difference -1.4%, 95% confidence interval (CI) -7.0% to 4.3%; hazard ratio 0.96, 95% CI 0.68 to 1.35; p = 0.81]. There were 4 (1.1%) and 5 (1.3%) bacteriological failures (p = 0.82) in the rifampicin and placebo groups, respectively. There were 3 (0.8%) versus 16 (4.1%) bacteriological recurrences (p = 0.01), and 55 (14.9%) versus 50 (12.9%) deaths without bacteriological failure/recurrence (p = 0.30) in the rifampicin and placebo groups, respectively. Over 12 weeks, there was no evidence of differences in clinically defined failure/recurrence/death (p = 0.84), all-cause mortality (p = 0.60), serious (p = 0.17) or grade 3/4 (p = 0.36) adverse events (AEs). However, 63 (17.0%) participants in the rifampicin group versus 39 (10.1%) participants in the placebo group experienced antibiotic or trial drug-modifying AEs (p = 0.004), and 24 (6.5%) participants in the rifampicin group versus 6 (1.5%) participants in the placebo group experienced drug-interactions (p = 0.0005). Evaluation of the costs and health-related quality-of-life impacts revealed that an episode of S. aureus bacteraemia costs an average of £12,197 over 12 weeks. Rifampicin was estimated to save 10% of episode costs (p = 0.14). After adjustment, the effect of rifampicin on total quality-adjusted life-years (QALYs) was positive (0.004 QALYs), but not statistically significant (standard error 0.004 QALYs). CONCLUSIONS Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S. aureus bacteraemia. FUTURE WORK Given the substantial mortality, other antibiotic combinations or improved source management should be investigated. TRIAL REGISTRATIONS Current Controlled Trials ISRCTN37666216, EudraCT 2012-000344-10 and Clinical Trials Authorisation 00316/0243/001. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Guy E Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Alexander Szubert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | - Jennifer Bostock
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Robert Tilley
- Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - Julia Greig
- Department of Infectious Diseases, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sarah A Wyllie
- Microbiology Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Peter Wilson
- Centre for Clinical Microbiology, University College London Hospital NHS Foundation Trust, London, UK
| | - Cressida Auckland
- Microbiology Department, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Janet Cairns
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Pankaj Lal
- Microbiology Department, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
| | - Achyut Guleri
- Microbiology Department, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil Jenkins
- Department of Infectious Diseases and Tropical Medicine, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julian Sutton
- Department of Microbiology and Virology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Wiselka
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Clive Graham
- Microbiology Department, North Cumbria University Hospitals NHS Trust, Cumbria, UK
| | - Paul R Chadwick
- Microbiology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Gavin Barlow
- Department of Infection, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - N Claire Gordon
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Meisner
- Microbiology Department, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul McWhinney
- Microbiology Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David A Price
- Department of Infectious Diseases, Newcastle Upon Tyne Hospital NHS Foundation Trust, Newcastle, UK
| | - David Harvey
- Microbiology Department, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Deepa Nayar
- Microbiology Department, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - Dakshika Jeyaratnam
- Department of Microbiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy Planche
- Department of Infectious Diseases and Tropical Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jane Minton
- Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fleur Hudson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Susan Hopkins
- Infectious Diseases Unit, Royal Free London NHS Foundation Trust, London, UK
| | - John Williams
- Department of Infectious Diseases, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - M Estee Török
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Martin J Llewelyn
- Department of Infectious Diseases, Brighton and Sussex Medical School, Brighton, UK
| | - Jonathan D Edgeworth
- Department of Immunology, Infectious and Inflammatory diseases, King's College London, London, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Medical Research Council Clinical Trials Unit, University College London, London, UK
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Holland TL, Raad I, Boucher HW, Anderson DJ, Cosgrove SE, Aycock PS, Baddley JW, Chaftari AM, Chow SC, Chu VH, Carugati M, Cook P, Corey GR, Crowley AL, Daly J, Gu J, Hachem R, Horton J, Jenkins TC, Levine D, Miro JM, Pericas JM, Riska P, Rubin Z, Rupp ME, Schrank J, Sims M, Wray D, Zervos M, Fowler VG. Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial. JAMA 2018; 320:1249-1258. [PMID: 30264119 PMCID: PMC6233609 DOI: 10.1001/jama.2018.13155] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The appropriate duration of antibiotics for staphylococcal bacteremia is unknown. OBJECTIVE To test whether an algorithm that defines treatment duration for staphylococcal bacteremia vs standard of care provides noninferior efficacy without increasing severe adverse events. DESIGN, SETTING, AND PARTICIPANTS A randomized trial involving adults with staphylococcal bacteremia was conducted at 16 academic medical centers in the United States (n = 15) and Spain (n = 1) from April 2011 to March 2017. Patients were followed up for 42 days beyond end of therapy for those with Staphylococcus aureus and 28 days for those with coagulase-negative staphylococcal bacteremia. Eligible patients were 18 years or older and had 1 or more blood cultures positive for S aureus or coagulase-negative staphylococci. Patients were excluded if they had known or suspected complicated infection at the time of randomization. INTERVENTIONS Patients were randomized to algorithm-based therapy (n = 255) or usual practice (n = 254). Diagnostic evaluation, antibiotic selection, and duration of therapy were predefined for the algorithm group, whereas clinicians caring for patients in the usual practice group had unrestricted choice of antibiotics, duration, and other aspects of clinical care. MAIN OUTCOMES AND MEASURES Coprimary outcomes were (1) clinical success, as determined by a blinded adjudication committee and tested for noninferiority within a 15% margin; and (2) serious adverse event rates in the intention-to-treat population, tested for superiority. The prespecified secondary outcome measure, tested for superiority, was antibiotic days among per-protocol patients with simple or uncomplicated bacteremia. RESULTS Among the 509 patients randomized (mean age, 56.6 [SD, 16.8] years; 226 [44.4%] women), 480 (94.3%) completed the trial. Clinical success was documented in 209 of 255 patients assigned to algorithm-based therapy and 207 of 254 randomized to usual practice (82.0% vs 81.5%; difference, 0.5% [1-sided 97.5% CI, -6.2% to ∞]). Serious adverse events were reported in 32.5% of algorithm-based therapy patients and 28.3% of usual practice patients (difference, 4.2% [95% CI, -3.8% to 12.2%]). Among per-protocol patients with simple or uncomplicated bacteremia, mean duration of therapy was 4.4 days for algorithm-based therapy vs 6.2 days for usual practice (difference, -1.8 days [95% CI, -3.1 to -0.6]). CONCLUSIONS AND RELEVANCE Among patients with staphylococcal bacteremia, the use of an algorithm to guide testing and treatment compared with usual care resulted in a noninferior rate of clinical success. Rates of serious adverse events were not significantly different, but interpretation is limited by wide confidence intervals. Further research is needed to assess the utility of the algorithm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01191840.
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Affiliation(s)
- Thomas L. Holland
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Issam Raad
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sara E. Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Vivian H. Chu
- Duke University Medical Center, Durham, North Carolina
| | - Manuela Carugati
- Duke University Medical Center, Durham, North Carolina
- San Gerardo Hospital, Monza, Italy
| | - Paul Cook
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | | | - Jennifer Daly
- University of Massachusetts Medical School, Worcester
| | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ray Hachem
- The University of Texas MD Anderson Cancer Center, Houston
| | - James Horton
- Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Jose M. Miro
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan M. Pericas
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary Rubin
- David Geffen School of Medicine, University of California at Los Angeles
| | | | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston
| | | | - Vance G. Fowler
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Rieg S, Kern WV, Soriano A. Rifampicin in treating S aureus bacteraemia. Lancet 2018; 392:554-555. [PMID: 30152387 DOI: 10.1016/s0140-6736(18)31555-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/27/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany.
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Alex Soriano
- IDIBAPS, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
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Holland TL, Fowler VG. Rifampicin for Staphylococcus aureus bacteraemia: give it ARREST. Lancet 2018; 391:634-636. [PMID: 29249277 DOI: 10.1016/s0140-6736(17)33294-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Thomas L Holland
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Vance G Fowler
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Thwaites GE, Scarborough M, Szubert A, Nsutebu E, Tilley R, Greig J, Wyllie SA, Wilson P, Auckland C, Cairns J, Ward D, Lal P, Guleri A, Jenkins N, Sutton J, Wiselka M, Armando GR, Graham C, Chadwick PR, Barlow G, Gordon NC, Young B, Meisner S, McWhinney P, Price DA, Harvey D, Nayar D, Jeyaratnam D, Planche T, Minton J, Hudson F, Hopkins S, Williams J, Török ME, Llewelyn MJ, Edgeworth JD, Walker AS. Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391:668-678. [PMID: 29249276 PMCID: PMC5820409 DOI: 10.1016/s0140-6736(17)32456-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING UK National Institute for Health Research Health Technology Assessment.
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Affiliation(s)
- Guy E Thwaites
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
| | | | - Alexander Szubert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Robert Tilley
- Plymouth Hospitals National Health Service (NHS) Trust, Plymouth, UK
| | - Julia Greig
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Peter Wilson
- University College London Hospital National Health Service Foundation Trust, London, UK
| | | | - Janet Cairns
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Denise Ward
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Pankaj Lal
- Aintree University Hospital NHS Foundation Trust, Aintree, UK
| | - Achyut Guleri
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Neil Jenkins
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julian Sutton
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Martin Wiselka
- Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Clive Graham
- North Cumbria University Hospitals NHS Trust, Carlisle, UK
| | | | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - N Claire Gordon
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bernadette Young
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Meisner
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Paul McWhinney
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David A Price
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle, UK
| | - David Harvey
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Deepa Nayar
- County Durham and Darlington NHS Foundation Trust, Durham, UK
| | | | - Tim Planche
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Jane Minton
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Fleur Hudson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - John Williams
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - M Estee Török
- University of Cambridge, Department of Medicine, Cambridge, UK
| | | | | | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Medical Research Council Clinical Trials Unit, University College London, London, UK
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Gudiol C, Cuervo G, Shaw E, Pujol M, Carratalà J. Pharmacotherapeutic options for treating Staphylococcus aureus bacteremia. Expert Opin Pharmacother 2017; 18:1947-1963. [DOI: 10.1080/14656566.2017.1403585] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Shaw
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Pujol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
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Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond) 2017; 50:175-192. [PMID: 29105519 DOI: 10.1080/23744235.2017.1392039] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome. Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures. S. aureus is now the leading causes of infective endocarditis (IE) in many regions of the world. It accounts for 15-40% of all IE cases, and the majority of cases in people who inject drugs (PWID). Recently, the incidence of SAE in PWID in Stockholm, Sweden, was found to be 2.5/1000 person-years, with an in-hospital mortality of 2.5% in PWID as compared to 15% in non-drug users. The 30-day mortality associated with SAB amounts to 15-25% among adults in Western countries, but is lower in children (0-9%). Mortality associated with SAE is high (generally 20-30% in-hospital mortality), and symptomatic cerebral embolizations are common (12-35%). The 1-year mortality reported after SAB and SAE is 19-62% and reflects deaths from underlying diseases and complications caused by the infection. In a subset of SAE cases, valvular heart surgery is needed (15-45%), but active intravenous drug use seems to be a reason to refrain from surgery. Despite its importance, there are insufficient data on the optimal management of SAB and SAE, especially on the required duration of antibiotic therapy. Conclusions: The epidemiology of SAB and SAE has been changing in the past decades. They still carry a substantial morbidity and mortality. Intensified studies on treatment are warranted for improving patient outcome.
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Affiliation(s)
- Hilmir Asgeirsson
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Anders Thalme
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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