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Lorenzo-Hernández E, Rivas-Ruiz F, Del Arco-Jiménez A. Consequences of the COVID-19 Pandemic on the Incidence, Management and Outcomes of Staphylococcus aureus Bacteraemia: Experience in a Spanish Hospital. Pathogens 2024; 13:847. [PMID: 39452719 PMCID: PMC11510453 DOI: 10.3390/pathogens13100847] [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: 08/26/2024] [Revised: 09/23/2024] [Accepted: 09/26/2024] [Indexed: 10/26/2024] Open
Abstract
This work aims to assess the impact of the COVID-19 pandemic on the mortality and incidence of complications in patients with bacteraemia due to Staphylococcus aureus (BSA). All episodes of BSA at the Costa del Sol University Hospital (Marbella, Spain) were recorded during the acute phase of the COVID-19 pandemic (March 2020-March 2022) and compared with those in a previous period (February 2018-February 2020). Demographic, clinical and prognostic variables were recorded. The outcomes were measured as 14- and 30-day mortality and the incidence of complications/death. Mortality during the pandemic was 28.7% at 14 days and 35% at 30 days, while in the pre-pandemic group, it was 18.9% and 23.3%, respectively. For overall complications/deaths, the incidence rate was higher in the pandemic group, with 42.7%. No significant differences were observed between groups. Seventeen patients with COVID-19 were identified, with mortality rates of 64.7% and 70.6% at 14 and 30 days. Multivariate analysis established the presence of sepsis at diagnosis as a predictor of mortality, but not BSA, during the pandemic phase. In conclusion, BSA is a disease with high mortality, which was slightly higher during the pandemic phase. No differences were found in adherence to the bundle in our centre.
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Affiliation(s)
| | - Francisco Rivas-Ruiz
- Research Unit, Costa del Sol University Hospital, A-7, Km 187, 29603 Marbella, Malaga, Spain;
| | - Alfonso Del Arco-Jiménez
- Internal Medicine Department, Costa del Sol University Hospital, A-7, Km 187, 29603 Marbella, Malaga, Spain
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Escrihuela-Vidal F, Chico C, Borjabad González B, Vázquez Sánchez D, Lérida A, De Blas Escudero E, Sanmartí M, Linares González L, Simonetti AF, Conde AC, Muelas-Fernandez M, Diaz-Brito V, Quintana SGH, Oriol I, Berbel D, Càmara J, Grillo S, Pujol M, Cuervo G, Carratalà J. Effect of a bundle intervention on adherence to quality-of-care indicators and on clinical outcomes in patients with Staphylococcus aureus bacteraemia hospitalized in non-referral community hospitals. J Antimicrob Chemother 2024:dkae298. [PMID: 39212166 DOI: 10.1093/jac/dkae298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Although a significant number of cases of Staphylococcus aureus bacteraemia (SAB) are managed at non-referral community hospitals, the impact of a bundle-of-care intervention in this setting has not yet been explored. METHODS We performed a quasi-experimental before-after study with the implementation of a bundle of care for the management of SAB at five non-referral community hospitals and a tertiary care university hospital. Structured recommendations for the five indicators selected to assess quality of care were provided to investigators before the implementation of the bundle and monthly thereafter. Primary endpoints were adherence to the bundle intervention and treatment failure, defined as death or relapse at 90 days of follow-up. RESULTS One hundred and seventy patients were included in the pre-intervention period and 103 in the intervention period. Patient characteristics were similar in both periods. Multivariate analysis controlling for potential confounders showed that performance of echocardiography was the only factor associated with improved adherence to the bundle in the intervention period (adjusted OR 2.13; 95% CI 1.13-4.02). Adherence to the bundle, performance of follow-up blood cultures, and adequate duration of antibiotic therapy for complicated SAB presented non-significant improvements. The intervention was not associated with a lower rate of 90 day treatment failure (OR 1.11; 95% CI 0.70-1.77). CONCLUSIONS A bundle-of-care intervention for the management of SAB at non-referral community hospitals increased adherence to quality indicators, but did not significantly reduce rates of 90 day mortality or relapse.
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Affiliation(s)
- Francesc Escrihuela-Vidal
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Chico
- Department of Internal Medicine, Hospital Residència Sant Camil, Sant Pere de Ribes, Barcelona, Spain
| | - Beatriz Borjabad González
- Department of Internal Medicine, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Daniel Vázquez Sánchez
- Department of Microbiology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Lérida
- Department of Internal Medicine, Hospital de Viladecans-Institut Català de la Salut (Àrea Metropolitana Sud), Viladecans, Barcelona, Spain
| | - Elisa De Blas Escudero
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Sanmartí
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu, Sant Boi, Barcelona, Spain
| | - Laura Linares González
- Department of Internal Medicine, Hospital Comarcal de l'Alt Penedès, Vilafranca del Penedès, Barcelona, Spain
| | | | - Ana Coloma Conde
- Department of Internal Medicine, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | - Magdalena Muelas-Fernandez
- Department of Internal Medicine, Hospital de Viladecans-Institut Català de la Salut (Àrea Metropolitana Sud), Viladecans, Barcelona, Spain
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu, Sant Boi, Barcelona, Spain
| | - Sara Gertrudis Horna Quintana
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isabel Oriol
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Damaris Berbel
- Department of Microbiology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Càmara
- Department of Microbiology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Sara Grillo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Miquel Pujol
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Casalini G, Pagani C, Giacomelli A, Galimberti L, Milazzo L, Coen M, Reato S, Caloni B, Caronni S, Pagano S, Lazzarin S, Ridolfo AL, Rimoldi SG, Gori A, Antinori S. Impact of a Bundle of Interventions on Quality-of-Care Indicators for Staphylococcus aureus Bacteraemia: A Single-Centre, Quasi-Experimental, Before-After Study. Antibiotics (Basel) 2024; 13:646. [PMID: 39061328 PMCID: PMC11273465 DOI: 10.3390/antibiotics13070646] [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: 05/31/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Staphylococcus aureus bacteraemia (SAB) is a life-threatening bloodstream infection. Improved adherence to quality-of-care indicators (QCIs) can significantly enhance patient outcomes. This quasi-experimental study evaluated the impact of a bundle of interventions on QCI adherence in adult patients with SAB. Additionally, a molecular rapid diagnostic test (mRDT) for S. aureus and methicillin resistance was introduced during weekdays. We compared pre-intervention (January-December 2022) and post-intervention (May 2023-April 2024) data on QCI adherence and time to appropriate treatment. A total of 56 and 40 SAB episodes were included in the pre- and post-intervention periods, respectively. Full QCI adherence significantly increased from 28.6% to 67.5% in the post-intervention period (p < 0.001). The mRDT diagnosed SAB in eight cases (26.6%), but the time to achieve appropriate target therapy did not improve in the post-intervention period (54 h (IQR 30-74) vs. 72 h (IQR 51-83), p = 0.131). The thirty-day mortality rate was comparable between the two periods (17.9% vs. 12.5%, p = 0.476). This study demonstrates that a bundle of interventions can substantially improve adherence to SAB management QCIs.
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Affiliation(s)
- Giacomo Casalini
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
| | - Cristina Pagani
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Laura Galimberti
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Laura Milazzo
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Massimo Coen
- I Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
| | - Serena Reato
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Beatrice Caloni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Stefania Caronni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Simone Pagano
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Samuel Lazzarin
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
| | - Sara Giordana Rimoldi
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Andrea Gori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20122 Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
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Telles JP, Morales R, Yamada CH, Marins TA, D'Amaro Juodinis V, Sztajnbok J, Silva M, Bassetti BR, Albiero J, Tuon FF. Optimization of Antimicrobial Stewardship Programs Using Therapeutic Drug Monitoring and Pharmacokinetics-Pharmacodynamics Protocols: A Cost-Benefit Review. Ther Drug Monit 2023; 45:200-208. [PMID: 36622029 DOI: 10.1097/ftd.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Antimicrobial stewardship programs are important for reducing antimicrobial resistance because they can readjust antibiotic prescriptions to local guidelines, switch intravenous to oral administration, and reduce hospitalization times. Pharmacokinetics-pharmacodynamics (PK-PD) empirically based prescriptions and therapeutic drug monitoring (TDM) programs are essential for antimicrobial stewardship, but there is a need to fit protocols according to cost benefits. The cost benefits can be demonstrated by reducing toxicity and hospital stay, decreasing the amount of drug used per day, and preventing relapses in infection. Our aim was to review the data available on whether PK-PD empirically based prescriptions and TDM could improve the cost benefits of an antimicrobial stewardship program to decrease global hospital expenditures. METHODS A narrative review based on PubMed search with the relevant studies of vancomycin, aminoglycosides, beta-lactams, and voriconazole. RESULTS TDM protocols demonstrated important cost benefit for patients treated with vancomycin, aminoglycosides, and voriconazole mainly due to reduce toxicities and decreasing the hospital length of stay. In addition, PK-PD strategies that used infusion modifications to meropenem, piperacillin-tazobactam, ceftazidime, and cefepime, such as extended or continuous infusion, demonstrated important cost benefits, mainly due to reducing daily drug needs and lengths of hospital stays. CONCLUSIONS TDM protocols and PK-PD empirically based prescriptions improve the cost-benefits and decrease the global hospital expenditures.
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Affiliation(s)
- João Paulo Telles
- - AC Camargo Cancer Center, Infectious Diseases Department, São Paulo
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
| | - Ronaldo Morales
- - Clinical Pharmacokinetics Center, School of Pharmaceutical Sciences, University of São Paulo
- - Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Sírio-Libanês. São Paulo
| | - Carolina Hikari Yamada
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
- - Hospital Universitário Evangélico Mackenzie, Department of Infectious Diseases, Curitiba
| | - Tatiana A Marins
- - Hospital Israelita Albert Einstein, Department of Clinical Pharmacy, São Paulo
| | | | - Jaques Sztajnbok
- - Instituto de Infectologia Emílio Ribas, São Paulo
- - Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP)
| | - Moacyr Silva
- - Hospital Israelita Albert Einstein, Department of Infection Prevention and Control, São Paulo
| | - Bil Randerson Bassetti
- - Hospital Santa Rita de Cássia, Department of Infectious Disease and Infection Control, Vitória ; and
| | - James Albiero
- - Universidade Estadual de Maringá, Pharmacy Department, Programa de Pós-Graduação em Assistência Farmacêutica, Maringá, Brazil
| | - Felipe Francisco Tuon
- - Laboratory of Emerging Infectious Diseases, Pontifical Catholic University of Paraná, Curitiba
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Selitsky L, Racha S, Rastegar D, Olsen Y. Infective endocarditis in people who inject drugs: A scoping review of clinical guidelines. J Hosp Med 2023; 18:169-176. [PMID: 36349984 DOI: 10.1002/jhm.12996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The incidence of infective endocarditis (IE) among people who inject drugs (PWID) is rising worldwide. Multiple clinical guidelines differ on the management of this condition, and few guidelines comment on treatment for primary substance use disorder (SUD). A comprehensive comparison of these guidelines is lacking. OBJECTIVES To perform a critical review identifying key differences in clinical guideline recommendations for treating IE among PWID, focusing on the inclusion of recommendations for SUD treatment and the presence of stigmatizing language. ELIGIBILITY CRITERIA Recently published, English-language, society-developed clinical guidelines for the treatment of IE among PWID. SOURCES OF EVIDENCE PubMed, Google Scholar, and CINAHL Plus databases. CHARTING METHODS In line with Arksey and O'Malley's framework, a scoping review was adapted using Joanna Briggs Institute and PRISMA-ScR guidelines. Two reviewers independently performed database searches for clinical guidelines published between 2007 and 2020 that commented on the management of IE among PWID. RESULTS Ten clinical guidelines were included in the final analysis. Treatment recommendations varied with some societies proposing nonstandard care due to concern for return to drug use. Three guidelines include reference to addiction treatment. Only one guideline specifies the use of opioid agonist therapy for treating opioid use disorder and identifies the benefits of an addiction specialist consultation. Acute withdrawal management is not mentioned in any guideline. All guidelines utilized stigmatizing language to describe PWID. CONCLUSIONS Most guidelines do not address SUD treatment, despite its effectiveness in reducing adverse health outcomes. Future guidelines should address SUD treatment using patient-first language.
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Affiliation(s)
- Lea Selitsky
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Savitha Racha
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Darius Rastegar
- Department of Medicine, Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yngvild Olsen
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, Maryland, USA
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Calderón-Parra J, Diego-Yagüe I, Santamarina-Alcantud B, Mingo-Santos S, Mora-Vargas A, Vázquez-Comendador JM, Fernández-Cruz A, Muñez-Rubio E, Gutiérrez-Villanueva A, Sánchez-Romero I, Ramos-Martínez A. Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in Staphylococcus aureus Bacteremia. J Clin Med 2022; 11:jcm11061502. [PMID: 35329827 PMCID: PMC8955153 DOI: 10.3390/jcm11061502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE, and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. METHODS We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. RESULTS Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1-6.9%), 4.9% (95% CI 2.2-7.7%), and 2.2% (95% CI 0.2-4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0-2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10-0.54, p = 0.001). CONCLUSION PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
- Correspondence:
| | - Itziar Diego-Yagüe
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | | | - Susana Mingo-Santos
- Cardiology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Alberto Mora-Vargas
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - José Manuel Vázquez-Comendador
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
| | - Elena Muñez-Rubio
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
| | - Andrea Gutiérrez-Villanueva
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - Isabel Sánchez-Romero
- Microbiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (B.S.-A.); (I.S.-R.)
| | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
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Barry M, Bari SA, Akhtar MY, Al Nahdi F, Erlandez R, Al Khushail A, Al Hebaishi Y. Clinical and Microbiological Characteristics of Infective Endocarditis at a Cardiac Center in Saudi Arabia. J Epidemiol Glob Health 2021; 11:435-443. [PMID: 34735715 PMCID: PMC8664328 DOI: 10.1007/s44197-021-00013-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease with complex pathology and significant mortality. Little information is known regarding clinical and microbiological characteristics in Saudi Arabia. This study surveyed these characteristics at a Cardiac Center in Riyadh, Saudi Arabia over a period of 5 years. METHODS This retrospective study was done on all infective endocarditis (IE) patients admitted to Prince Sultan Cardiac Center between January 1, 2015, and December 31, 2019. Clinical characteristics, microbiological results, management, and outcomes were assessed. RESULT A total of 340 cases of infective endocarditis were identified over the study period. Most patients (64%) were 50 years old or above, and 67% were males. Fever was the most common clinical presentation, and a murmur was audible in a fifth of patients. Blood cultures were positive in 177 (52%) cases. The most common organisms were Staphylococcus aureus, coagulase negative Staphylococcus and viridans group Streptococcus. Most common microbiological organisms causing native valve endocarditis were viridans group Streptococcus (32%) followed by methicillin-susceptible Staphylococcus aureus (21%), and for prosthetic valve endocarditis they were coagulase negative Staphylococcus (32%) followed by methicillin-susceptible Staphylococcus aureus (23%), the most common causes of culture negative endocarditis were Q-fever and brucellosis. Predisposing cardiac conditions were present in 127 (37%) patients, most commonly rheumatic heart disease and congenital heart disease. Surgical intervention was done in 26% of cases, with an overall in-hospital mortality rate of 6.76%. CONCLUSION We demonstrate the epidemiological, clinical, and microbiological profile of infective endocarditis in a tertiary care cardiac center in Saudi Arabia. It gives information concerning the prevalence of responsible organisms. This information will be helpful in assessing patients with suspected IE and in planning management of cases knowing the relative frequency of types of microorganisms encountered.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.
| | - Syed Abdul Bari
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | | | - Faizah Al Nahdi
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Richilda Erlandez
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Al Khushail
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Yahya Al Hebaishi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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8
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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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9
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Garnica O, Gómez D, Ramos V, Hidalgo JI, Ruiz-Giardín JM. Diagnosing hospital bacteraemia in the framework of predictive, preventive and personalised medicine using electronic health records and machine learning classifiers. EPMA J 2021; 12:365-381. [PMID: 34484472 PMCID: PMC8405861 DOI: 10.1007/s13167-021-00252-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
Background The bacteraemia prediction is relevant because sepsis is one of the most important causes of morbidity and mortality. Bacteraemia prognosis primarily depends on a rapid diagnosis. The bacteraemia prediction would shorten up to 6 days the diagnosis, and, in conjunction with individual patient variables, should be considered to start the early administration of personalised antibiotic treatment and medical services, the election of specific diagnostic techniques and the determination of additional treatments, such as surgery, that would prevent subsequent complications. Machine learning techniques could help physicians make these informed decisions by predicting bacteraemia using the data already available in electronic hospital records. Objective This study presents the application of machine learning techniques to these records to predict the blood culture's outcome, which would reduce the lag in starting a personalised antibiotic treatment and the medical costs associated with erroneous treatments due to conservative assumptions about blood culture outcomes. Methods Six supervised classifiers were created using three machine learning techniques, Support Vector Machine, Random Forest and K-Nearest Neighbours, on the electronic health records of hospital patients. The best approach to handle missing data was chosen and, for each machine learning technique, two classification models were created: the first uses the features known at the time of blood extraction, whereas the second uses four extra features revealed during the blood culture. Results The six classifiers were trained and tested using a dataset of 4357 patients with 117 features per patient. The models obtain predictions that, for the best case, are up to a state-of-the-art accuracy of 85.9%, a sensitivity of 87.4% and an AUC of 0.93. Conclusions Our results provide cutting-edge metrics of interest in predictive medical models with values that exceed the medical practice threshold and previous results in the literature using classical modelling techniques in specific types of bacteraemia. Additionally, the consistency of results is reasserted because the three classifiers' importance ranking shows similar features that coincide with those that physicians use in their manual heuristics. Therefore, the efficacy of these machine learning techniques confirms their viability to assist in the aims of predictive and personalised medicine once the disease presents bacteraemia-compatible symptoms and to assist in improving the healthcare economy.
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Affiliation(s)
- Oscar Garnica
- Departamento de Arquitectura de Computadores, Universidad Complutense de Madrid, Madrid, Spain
| | - Diego Gómez
- Universidad Complutense de Madrid, Madrid, Spain
| | - Víctor Ramos
- Universidad Complutense de Madrid, Madrid, Spain
| | - J. Ignacio Hidalgo
- Departamento de Arquitectura de Computadores, Universidad Complutense de Madrid, Madrid, Spain
| | - José M. Ruiz-Giardín
- Departamento de Medicina Interna, Hospital Universitario de Fuenlabrada, Madrid, Spain
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10
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Avedissian SN, Rhodes NJ, Shaffer CL, Tran L, Bradley JS, Le J. Antimicrobial prescribing for treatment of serious infections caused by Staphylococcus aureus and methicillin-resistant Staphylococcus aureus in pediatrics: an expert review. Expert Rev Anti Infect Ther 2021; 19:1107-1116. [PMID: 33554692 DOI: 10.1080/14787210.2021.1886923] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), remains a significant pathogen in children. Despite evidence of decreasing prevalence, MRSA bacteremia has been closely associated with complications, including certain infections (i.e. musculoskeletal and endovascular) linked to increased treatment failures.Areas covered: This expert review summarized recent published literature on the role of treatment, dosing and administration of antibiotics used to combat serious S. aureus infections in children. The pertinent antibiotics presented were vancomycin, oxazolidinones, semi-synthetic glycopeptides, daptomycin, tigecycline, novel cephalosporins, fosfomycin and lefamulin. Vancomycin has been the most commonly used antibiotic in empiric therapy for serious MRSA infection, with new key recommendations emphasizing a different approach to dosing and therapeutic monitoring. For other antibiotics, data remain limited or clinical trials are underway.Expert opinion: MRSA remains a significant pathogen in the pediatric population. As numerous therapeutic agents are available, many agents have limited data on usage in pediatric patients. Future studies require pharmacokinetic, safety and efficacy studies in pediatric patients to ensure appropriate therapeutic treatment and outcomes. Phage therapy has been used to treat deep-seated MRSA infections and is an emerging investigational treatment option.
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Affiliation(s)
- Sean N Avedissian
- Antiviral Pharmacology Laboratory, University of Nebraska Medical Center (UNMC) Center for Drug Discovery, UNMC, Omaha, NE, USA.,University of Nebraska Medical Center, College of Pharmacy, Omaha, NE, USA
| | - Nathanial J Rhodes
- Midwestern University College of Pharmacy, Downers Grove Campus, Downers Grove, IL, USA.,Midwestern University College of Pharmacy, Downers Grove Campus, Pharmacometrics Center of Excellence, Downers Grove, IL USA
| | | | - Lan Tran
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego School of Medicine and Rady Children's Hospital San Diego
| | - Jennifer Le
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA
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11
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Validation of VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) Scores to Determine the Priority of Echocardiography in Patients With Staphylococcus aureus Bacteremia. Clin Infect Dis 2021; 73:e1151-e1157. [DOI: 10.1093/cid/ciaa1844] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography.
Methods
Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated.
Results
The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT.
Conclusions
In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
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12
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Xie P, Zhuang X, Liu M, Zhang S, Liu J, Liu D, Liao X. An appraisal of clinical practice guidelines for the appropriate use of echocardiography for adult infective endocarditis-the timing and mode of assessment (TTE or TEE). BMC Infect Dis 2021; 21:92. [PMID: 33478412 PMCID: PMC7819184 DOI: 10.1186/s12879-021-05785-6] [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: 07/31/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Echocardiography (echo) is the primary imaging modality for infective endocarditis (IE). However, the recommendations on timing and mode selection for transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) vary across guidelines, which can be confusing for clinical decision makers. In this case, we aim to appraise the quality of recommendations by appraising the quality of various guidelines. Methods A search of guidelines containing recommendations for the appropriate use of echo in adult IE patients published in English between 2007 and 2019 was conducted. The APPRAISAL OF GUIDELINES FOR RESEARCH & EVALUATION II (AGREE II) instrument was applied independently by two reviewers to assess the integrated quality of the identified guidelines. The recommendations of concern are extracted from related chapters. Results A total of 9 guidelines met the criteria, with AGREE II scores ranging from 36 to 79%, and the domain of “stakeholder involvement” received the lowest score. The most contentious issue is whether a follow-up TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Conflicting recommendations are presented with a low evidence level based on little evidence. Conclusions In general, the recommendations proposed in the 9 identified guidelines on the appropriate use of echo are satisfying. The guideline quality score can be taken into account by the clinicians when evaluating the recommendations for clinical decisions. Additional studies with high evidence level should be conducted on the most controversial issues of whether a subsequent TEE is mandatory in uncomplicated native valve IE with an initial positive TTE. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05785-6.
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Affiliation(s)
- Peihan Xie
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China.,Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiaodong Zhuang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), 58 Zhongshan 2nd Rd, Guangzhou, 510080, People's Republic of China
| | - Shaozhao Zhang
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jia Liu
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Donghong Liu
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Xinxue Liao
- Department of Ultrasonography, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.
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13
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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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14
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Pérez-Rodríguez MT, Sousa A, López-Cortés LE, Martínez-Lamas L, Val N, Baroja A, Nodar A, Vasallo F, Álvarez-Fernández M, Crespo M, Rodríguez-Baño J. Moving beyond unsolicited consultation: additional impact of a structured intervention on mortality in Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2020; 74:1101-1107. [PMID: 30689894 DOI: 10.1093/jac/dky556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Some evidence-based bundles have tried to standardize the management of Staphylococcus aureus bacteraemia (SAB) to improve the outcome. The aim of our study was to analyse the additional impact on mortality of a structured intervention in patients with SAB. METHODS Compliance with the bundle was evaluated in an ambispective cohort of patients with SAB, which included a retrospective cohort [including patients treated before and after the implementation of a bacteraemia programme (no-BP and BP, respectively)] and a prospective cohort (i-BP), in which an additional specific intervention for bundle application was implemented. Multivariate logistic regression was used to measure the influence of the independent variables including compliance with the bundle on 14 and 30 day crude mortality. RESULTS A total of 271 adult patients with SAB were included. Mortality was significantly different among the three groups (no-BP, BP and i-BP): mortality at 14 days was 18% versus 7% versus 2%, respectively, P = 0.002; and mortality at 30 days was 20% versus 12% versus 5%, respectively, P = 0.011. The factors associated with 14 and 30 day mortality in multivariable analysis were heart failure (OR = 7.63 and OR = 2.27, respectively), MRSA infection (OR = 4.02 and OR = 4.37, respectively) and persistent bacteraemia (OR = 11.01 and OR = 7.83, respectively); protective factors were catheter-related bacteraemia (OR = 0.16 and OR = 0.19, respectively) and >75% bundle compliance (OR = 0.15 and OR = 0.199, respectively). Time required to perform the intervention and the follow-up was 50 min (IQR 40-55 min) per patient. CONCLUSIONS High-level compliance with a standardized bundle of intervention for management of SAB that requires little time was associated with lower mortality at 14 and 30 days.
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Affiliation(s)
- María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Adrián Sousa
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lucía Martínez-Lamas
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Nuria Val
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Aida Baroja
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Francisco Vasallo
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Maximiliano Álvarez-Fernández
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Manuel Crespo
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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15
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Nakatani S, Ohara T, Ashihara K, Izumi C, Iwanaga S, Eishi K, Okita Y, Daimon M, Kimura T, Toyoda K, Nakase H, Nakano K, Higashi M, Mitsutake K, Murakami T, Yasukochi S, Okazaki S, Sakamoto H, Tanaka H, Nakagawa I, Nomura R, Fujiu K, Miura T, Morizane T. JCS 2017 Guideline on Prevention and Treatment of Infective Endocarditis. Circ J 2019; 83:1767-1809. [PMID: 31281136 DOI: 10.1253/circj.cj-19-0549] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, the University of Tokyo
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Kazuhiko Nakano
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization, Osaka National Hospital
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center
| | | | | | - Shuhei Okazaki
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Haruo Sakamoto
- Department of Oral and Maxicillofacial Surgery, Tokai University Hachioji Hospital
| | - Hiroshi Tanaka
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University
| | | | - Ryota Nomura
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, the University of Tokyo
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
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16
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Baquero-Artigao F, Rabes TDR. Fosfomycin in the pediatric setting: Evidence and potential indications. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32 Suppl 1:55-61. [PMID: 31131593 PMCID: PMC6555161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To date, there has been little experience in using fosfomycin in children. However, its broad spectrum of action and excellent safety profile have renewed interest in this antibiotic, especially for treating infections by multidrug-resistant bacteria. The main indication for fosfomycin in pediatrics is currently community-acquired lower urinary tract infection. Given its good activity against bacteria, fosfomycin can also be useful in urinary infections caused by extended-spectrum beta-lactamase-producing enterobacteria. Fosfomycin presents very good dissemination to tissues including bone and is therefore an option in the combined therapy of osteomyelitis, especially in cases produced by methicillin-resistant Staphylococcus aureus (MRSA) or in cases with beta-lactam allergies. Fosfomycin can also be employed in combination for multidrug-resistant Gram-negative bacteremia (especially carbapenemase-producing enterobacteria), S. aureus (if there is a high suspicion of MRSA or complicated infections) and vancomycin-resistant Enterococcus spp. Other infections in which fosfomycin could be part of a combined therapy include staphylococcal endocarditis (in case of beta-lactam allergy or MRSA), central nervous system infections (mainly by MRSA, S. epidermidis, Listeria and resistant pneumococcus), nosocomial pneumonia and infections associated with mechanical ventilation.
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Affiliation(s)
- Fernando Baquero-Artigao
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical. Hospital Universitario La Paz, Madrid,Red Española de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Teresa del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Patología Tropical. Hospital Universitario La Paz, Madrid,Red Española de Investigación Traslacional en Infectología Pediátrica (RITIP)
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17
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Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva 2019; 42:5-36. [PMID: 29406956 DOI: 10.1016/j.medin.2017.09.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (the Spanish Society of Infectious Diseases and Clinical Microbiology and [SEIMC] and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units [SEMICYUC]). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Staphylococcus aureus, Enterococcus spp., Gram-negative bacilli, and Candida spp.), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Tsai CY, Lee CH, Chen IL. Daptomycin versus teicoplanin for bloodstream infection due to methicillin-resistant Staphylococcus aureus with a high teicoplanin minimal inhibitory concentration ≥1.5 mg/L: a propensity score-based analysis. Infect Drug Resist 2018; 11:2011-2020. [PMID: 30464543 PMCID: PMC6208792 DOI: 10.2147/idr.s184411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Recent reports have described decreased effectiveness of teicoplanin in the treatment of bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) with teicoplanin minimal inhibitory concentration (MIC) ≥1.5 mg/L. Consensus guidelines recommend considering use of alternative agents for MRSA infections involving a higher teicoplanin MIC, despite of limited data to support this recommendation. Patients and methods To compare the clinical outcome among patients with bacteremia due to MRSA with teicoplanin MIC ≥1.5 mg/L, we included patients who received high-dose daptomycin (≥8 mg/kg/day) and those who received standard-dose (6 mg/kg/day) or high-dose (6 mg/kg/12 hours) maintenance teicoplanin. The primary endpoint was a favorable outcome, defined as the resolution of clinical signs and symptoms and a negative culture report at the end of therapy. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Results Of 142 patients eligible for inclusion, 28 (19.7%) were treated with high-dose daptomycin, 27 (19.0%) with high-dose teicoplanin, and 87 (61.3%) with standard-dose teicoplanin. In multivariate regression analysis, Pittsburgh bacteremia score ≥4 (OR, 5.3; 95%CI, 1.9-14.5) was independently associated with an unfavorable outcome. After propensity-score matching with age and Pittsburgh bacteremia score ≥4, patients on high-dose daptomycin were more likely to have favorable outcomes than those on standard-dose teicoplanin (74.1% vs 42.6%; P=0.02). However, there was no significant difference in terms of favorable outcomes (P=0.12) between patients receiving high-dose daptomycin and those receiving high-dose teicoplanin after the same propensity-score matching. Conclusion Treatment with high-dose daptomycin resulted in significantly better outcomes than with standard-dose teicoplanin in the treatment of MRSA bacteremia with teicoplanin MIC ≥1.5 mg/L. However, the clinical outcome of the patients receiving high-dose teicoplanin was similar to that of the patients receiving high-dose daptomycin.
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Affiliation(s)
- Ching-Yen Tsai
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, .,College of Medicine, Chang Gung University College of Medicine, Kaohsiung, Taiwan,
| | - I-Ling Chen
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Morales-Cartagena A, Fernández-Ruiz M, Lalueza A, Lora-Tamayo J, San Juan R, López-Medrano F, Origüen J, Chaves F, Aguado JM. Impact on mortality of adherence to evidence-based interventions in patients with catheter-related bloodstream infection due to methicillin-sensitive Staphylococcus aureus. Infect Dis (Lond) 2018; 50:837-846. [PMID: 30325676 DOI: 10.1080/23744235.2018.1501513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated improved survival when the management of Staphylococcus aureus bloodstream infection (BSI) is compliant with evidence-based therapeutic interventions. Whether this effect extends to low-risk sources, such as catheter-related BSI, remains unclear. METHODS We retrospectively included 225 episodes of methicillin-sensitive S. aureus catheter-related BSI diagnosed in our centre during two non-consecutive periods: 2002-2004 (first period (101 episodes)) and 2009-2013 (second period (124 episodes)). We evaluated the adherence (percentage of compliance = (no. of interventions performed/no. of interventions recommended) × 100) to the following bundle: early catheter removal (≤72 hours), early initiation of appropriate antibiotic therapy, adequate sampling of follow-up blood cultures, transthoracic echocardiography (TTE) during hospitalization and adequate duration of therapy. RESULTS Patients in the second period had a higher burden of comorbidities and more severe underlying conditions. All-cause 30-day mortality was 9.3%, with a significant difference between the first and second periods (13.9% versus 5.6%; p value = .035). Bundle adherence was significantly higher in the second period, particularly for follow-up blood cultures (26.7% versus 48.4%; p value = .001), performance of TTE (45.5% versus 84.7%; p value < .001) and appropriate duration of therapy (34.7% versus 50.0%; p value = .022). Bundle adherence ≥ 55% was associated with lower 30-day mortality (hazard ratio: 0.31; 95% confidence interval: 0.13-0.76). This effect remained significant across propensity score-based models adjusted for septic shock, study period and underlying conditions. CONCLUSIONS There was a survival benefit in adhering to a bundle of evidence-based interventions in the specific setting of catheter-related BSI due to methicillin-sensitive S. aureus.
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Affiliation(s)
- Alejandra Morales-Cartagena
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Mario Fernández-Ruiz
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Antonio Lalueza
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Jaime Lora-Tamayo
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Rafael San Juan
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Francisco López-Medrano
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Julia Origüen
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - Fernando Chaves
- b Department of Microbiology, School of Medicine , Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
| | - José María Aguado
- a School of Medicine , Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense , Madrid , Spain
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Shi C, Xiao Y, Zhang Q, Li Q, Wang F, Wu J, Lin N. Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis. BMC Infect Dis 2018; 18:508. [PMID: 30305037 PMCID: PMC6180622 DOI: 10.1186/s12879-018-3418-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023] Open
Abstract
Background Antistaphylococcal penicillins (ASPs) and cefazolin have become the most frequent choices for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, the best therapeutic agent to treat MSSA bacteremia remains to be established. Methods We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these two regimens for the treatment of MSSA bacteremia. PubMed, EMBASE and the Cochrane Library from inception to February 2018 were searched. The primary outcome was mortality. The secondary outcomes included treatment failure, recurrence of bacteremia, adverse effects (AEs) and discontinuation due to AEs. Data were extracted and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results A total of ten observational studies met the inclusion criteria. The results indicate that compared to ASPs, cefazolin was associated with significant reduction in mortality (OR, 0.69; 95% CI, 0.58 to 0.82; I2 = 3.4%) and clinical failure (OR, 0.56; 95% CI, 0.37 to 0.85; I2 = 44.9%) without increasing the recurrence of bacteremia (OR, 1.12; 95% CI, 0.94 to 1.34; I2 = 0%). There were no significant differences for the risk of anaphylaxis (OR, 0.91; 95% CI, 0.36 to 2.99; I2 = 0%) or hematotoxicity (OR, 0.56; 95% CI, 0.17 to 1.88; I2 = 0%). However, nephrotoxicity (OR, 0.36; 95% CI, 0.16 to 0.81; I2 = 0%) and hepatotoxicity (OR, 0.12; 95% CI, 0.04 to 0.41; I2 = 0%) were significantly lower in the cefazolin group. Moreover, cefazolin was associated with lower probability of discontinuation due to AEs compared with the ASPs (OR, 0.24; 95% CI, 0.12 to 0.48; I2 = 18%). Conclusion The results of present study favor the application of cefazolin and should be regarded as important evidence to help make clinical decisions in choosing a treatment option for treating MSSA bacteremia. Electronic supplementary material The online version of this article (10.1186/s12879-018-3418-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Changcheng Shi
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Yubo Xiao
- Department of Pharmacometrics, Mosim Co., Ltd, Shanghai, China
| | - Qi Zhang
- Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China
| | - Qingyu Li
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fei Wang
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wu
- Department of Pharmacy, Hangzhou Obstetrics & Gynecology Hospital, Hangzhou, China
| | - Nengming Lin
- Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China. .,Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China. .,Department of Clinical Pharmacology, Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Cai JY, Li J, Hou YN, Ma K, Yao GD, Liu WW, Hayashi T, Itoh K, Tashiro SI, Onodera S, Ikejima T. Concentration-dependent dual effects of silibinin on kanamycin-induced cells death in Staphylococcus aureus. Biomed Pharmacother 2018; 102:782-791. [DOI: 10.1016/j.biopha.2018.03.133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/31/2022] Open
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Castañeda X, García-de-la-Mària C, Gasch O, Pericas JM, Armero Y, Soy D, García-González J, Falces C, Ninot S, Almela M, Ambrosioni J, Quintana E, Vidal B, Fuster D, Llopis J, Soto S, Moreno A, Marco F, Miró JM. AUC/MIC Pharmacodynamic Target Is Not a Good Predictor of Vancomycin Efficacy in Methicillin-Resistant Staphylococcus aureus Experimental Endocarditis. Antimicrob Agents Chemother 2017; 61:e02486-16. [PMID: 28373187 PMCID: PMC5444163 DOI: 10.1128/aac.02486-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/10/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of this in vivo study was to compare the efficacy of vancomycin at standard doses (VAN-SD) to that of VAN at adjusted doses (VAN-AD) in achieving a VAN area under the curve/MIC ratio (AUC/MIC) of ≥400 against three methicillin-resistant Staphylococcus aureus (MRSA) strains with different microdilution VAN MICs in an experimental endocarditis model. The valve vegetation bacterial counts after 48 h of VAN therapy were compared, and no differences were observed between the two treatment groups for any of the three strains tested. Overall, for VAN-SD and VAN-AD, the rates of sterile vegetations were 15/45 (33.3%) and 21/49 (42.8%) (P = 0.343), while the medians (interquartile ranges [IQRs]) for log10 CFU/g of vegetation were 2 (0 to 6.9) and 2 (0 to 4.5) (P = 0.384), respectively. In conclusion, this VAN AUC/MIC pharmacodynamic target was not a good predictor of vancomycin efficacy in MRSA experimental endocarditis.
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Affiliation(s)
- Ximena Castañeda
- Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Cristina García-de-la-Mària
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Oriol Gasch
- Hospital Parc Tauli de Sabadell, Autonomous University of Barcelona, Barcelona, Spain
| | - Juan M Pericas
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Yolanda Armero
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dolors Soy
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Javier García-González
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Carlos Falces
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Salvador Ninot
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Manel Almela
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Eduardo Quintana
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Barbara Vidal
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - David Fuster
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Department of Statistics, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Sara Soto
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Asuncion Moreno
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - Jose M Miró
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Méndez-Echevarria A, Coronado-Poggio M, Baquero-Artigao F, Del Rosal T, Rodado-Marina S, Calvo C, Domínguez-Gadea L. Septic pulmonary emboli detected by 18F-FDG PET/CT in children with S. aureus catheter-related bacteremia. Infection 2017; 45:691-696. [PMID: 28243995 DOI: 10.1007/s15010-017-0992-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) in the diagnosis of metastatic infectious foci in children with catheter-related blood stream infection has been hardly studied, although some authors have reported it benefit in the screening of metastatic foci in adult population. Septic pulmonary emboli are among the most difficult to identify, because many cases do not present pulmonary complaints or abnormal chest radiography. However, diagnosis of these foci has important therapeutic consequences. The purpose of this article is to describe the role of 18F-FDG PET/CT in the diagnosis of septic pulmonary embolism in children with S. aureus catheter-related bacteremia. METHODS We report 3 children with S. aureus catheter-related bacteremia and normal chest X-ray at admission, in whom 18F-FDG PET/CT led to the diagnosis of unsuspected septic pulmonary emboli, with an impact on clinical management. RESULTS All patients had hemophilia and implantable venous access ports and presented with fever and normal lung auscultation. Only 1 reported non-specific symptoms (undifferentiated left chest pain). All patients had normal chest X-ray on admission. Catheters were removed within 48 h after admission in 2 cases, and 5 days after admission in the last case, subsiding fever. In 2 children, paired blood cultures were not able to identify bacteremia. However, in all cases catheter tip and subcutaneous port cultures yielded S. aureus and PET/CT detected unsuspected pulmonary metastatic emboli. CONCLUSIONS 18F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.
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Affiliation(s)
- A Méndez-Echevarria
- General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain.
| | - M Coronado-Poggio
- Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain
| | - F Baquero-Artigao
- General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain
| | - T Del Rosal
- General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain
| | - S Rodado-Marina
- Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain
| | - C Calvo
- General Paediatrics and Infectious and Tropical Diseases Department, La Paz Universitary Hospital, 28046, Madrid, Spain
| | - L Domínguez-Gadea
- Department of Nuclear Medicine, La Paz Universitary Hospital, Madrid, Spain
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Xu X, Khadzhynov D, Peters H, Chaves RL, Hamed K, Levi M, Corti N. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy. Br J Clin Pharmacol 2016; 83:498-509. [PMID: 27628437 PMCID: PMC5306496 DOI: 10.1111/bcp.13131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/22/2016] [Accepted: 09/06/2016] [Indexed: 12/11/2022] Open
Abstract
Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno‐venous haemodialysis (CVVHD; n = 9) and continuous veno‐venous haemodiafiltration (CVVHDF; n = 8). Model‐based simulations were performed to compare the 24 h AUC, Cmax and Cmin of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg−1 every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right‐sided infective endocarditis. Results The previously developed daptomycin structural population PK model could reasonably describe data from the patients on CRRT. The clearance in patients undergoing CVVHDF and CVVHD was estimated at 0.53 and 0.94 l h−1, respectively, as compared with 0.75 l h−1 in patients with creatinine clearance (CrCl) ≥ 30 ml min−1. Daptomycin Q24 h dosing in patients undergoing CRRT resulted in optimal exposure for efficacy, with AUC comparable to that in patients with CrCl ≥ 30 ml min−1. In contrast, Q48 h dosing was associated with considerably lower AUC24–48h in all patients for doses up to 12 mg kg−1 and is therefore inappropriate. Conclusions Q24 h dosing of daptomycin up to 12 mg kg−1 provides comparable drug exposure in patients on CVVHD and in those with CrCl ≥ 30 ml min−1. Daily daptomycin use up to 8 mg kg−1 doses are appropriate for patients on CVVHDF, but higher doses may increase the risk of toxicity.
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Affiliation(s)
- Xiaoying Xu
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Dmytro Khadzhynov
- Department of Nephrology, Charité Campus Mitte, Charité - Universitätsmedizin, Berlin, Germany
| | - Harm Peters
- Department of Nephrology, Charité Campus Mitte, Charité - Universitätsmedizin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Micha Levi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Natascia Corti
- Department of Clinical Pharmacology and Toxicology, Zurich University Hospital, Zurich, Switzerland
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Seaton RA, Menichetti F, Dalekos G, Beiras-Fernandez A, Nacinovich F, Pathan R, Hamed K. Evaluation of Effectiveness and Safety of High-Dose Daptomycin: Results from Patients Included in the European Cubicin(®) Outcomes Registry and Experience. Adv Ther 2015; 32:1192-205. [PMID: 26610384 PMCID: PMC4679787 DOI: 10.1007/s12325-015-0267-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Daptomycin, a rapid concentration-dependent bactericidal antibiotic, is approved at a dose of 4 mg/kg/day for the treatment of complicated skin and soft tissue infections (cSSTI) and at a dose of 6 mg/kg/day for the treatment of Staphylococcus aureus right-sided infective endocarditis (RIE) and bacteremia associated with cSSTI and RIE. Studies have reported the successful use of high-dose daptomycin (>6 mg/kg/day) in patients with difficult-to-treat infections. The present analysis evaluated the effectiveness and safety of high doses (>6 mg/kg/day) of daptomycin for the treatment of different Gram-positive infections. METHODS European Cubicin(®) Outcomes Registry and Experience (EU-CORE) is a non-interventional, multicenter, retrospective, patient registry designed to collect real-world data from patients treated with daptomycin between 2006 and 2012. Clinical outcomes were assessed at the end of daptomycin treatment for three dose groups: ≤6, >6 to <8, and ≥8 mg/kg/day. Safety was assessed for up to 30 days post-daptomycin treatment. RESULTS Of the 6075 patients enrolled in EU-CORE, 4892 patients received daptomycin doses ≤6 mg/kg/day, while 1097 patients received high doses (>6 mg/kg/day). The primary infections with the largest proportion of patients treated with a high dose (>6 mg/kg/day) were osteomyelitis (37.1%), foreign body/prosthetic infection (31.6%), and endocarditis (27.6%). S. aureus was identified in 42.9% of patients with positive cultures treated with either ≤6 or >6 mg/kg/day. The overall clinical success rate was 82.0% (899/1097) with high doses (>6 mg/kg/day) and 80.3% (3928/4890) with doses ≤6 mg/kg/day. Numerically higher clinical success rate was observed for endocarditis and foreign body/prosthetic infection, as well as for coagulase-negative staphylococcal and enterococcal infections, with high-dose daptomycin treatment. There were no new or unexpected safety findings at doses >6 mg/kg/day. CONCLUSION These results suggested that daptomycin at doses >6 mg/kg/day was effective and well tolerated. High-dose daptomycin is a potential therapeutic option in patients with difficult-to-treat Gram-positive infections. FUNDING This study was funded by Novartis Pharma AG.
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Affiliation(s)
| | - Francesco Menichetti
- Azienda Ospedaliera Universitaria Pisana-Ospedale Cisanello-U.O. Malattie Infettive, Pisa, Italy
| | - Georgios Dalekos
- Departments of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Andres Beiras-Fernandez
- Klinik für Herzchirurgie, Universitätsklinik Großhadern, München, Germany
- Department of Cardiothoracic Surgery, University of Frankfurt, Frankfurt, Germany
| | | | | | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
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Kern WV. Usefulness of the CPG in the management of severe S. aureus infections. Enferm Infecc Microbiol Clin 2015; 33:577-8. [DOI: 10.1016/j.eimc.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022]
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Gudiol F, Aguado JM, Almirante B, Bouza E, Cercenado E, Domínguez MÁ, Gasch O, Lora-Tamayo J, Miró JM, Palomar M, Pascual A, Pericas JM, Pujol M, Rodríguez-Baño J, Shaw E, Soriano A, Vallés J. Executive summary of the diagnosis and treatment of bacteremia and endocarditis due to Staphylococcus aureus. A clinical guideline from the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC). Enferm Infecc Microbiol Clin 2015; 33:626-32. [PMID: 25937456 DOI: 10.1016/j.eimc.2015.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
Bacteremia and infective endocarditis caused by Staphylococcus aureus are common and severe diseases. Optimization of treatment is fundamental in the prognosis of these infections. The high rates of treatment failure and the increasing interest in the influence of vancomycin susceptibility in the outcome of infections caused by both methicillin-susceptible and -resistant isolates have led to research on novel therapeutic schemes. The interest in the new antimicrobials with activity against methicillin-resistant staphylococci has been extended to susceptible strains, which still carry the most important burden of infection. New combinations of antimicrobials have been investigated in experimental and clinical studies, but their role is still being debated. Also, the appropriateness of the initial empirical therapy has acquired relevance in recent years. The aim of this guideline is to update the 2009 guidelines and to provide an ensemble of recommendations in order to improve the treatment of staphylococcal bacteremia and infective endocarditis, in accordance with the latest published evidence.
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Affiliation(s)
- Francesc Gudiol
- Servicio de Enfermedades Infecciosas, IDIBELL, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - José María Aguado
- Unidad de Enfermedades Infecciosas, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Benito Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitario Valle de Hebrón, Barcelona, Spain
| | - Emilio Bouza
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Emilia Cercenado
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - M Ángeles Domínguez
- Servicio de Microbiología, IDIBELL, Hospital Universitario de Bellvitge, Barcelona, Spain; Departamento de patología y terapéutica experimental, Universidad de Barcelona, Spain
| | - Oriol Gasch
- Servicio de Enfermedades Infecciosas, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Jaime Lora-Tamayo
- Unidad de Enfermedades Infecciosas, Instituto de Investigación i + 12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clínic - IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Mercedes Palomar
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Lleida, Spain
| | - Alvaro Pascual
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departamento de Microbiología, Universidad de Sevilla, Spain
| | - Juan M Pericas
- Servicio de Enfermedades Infecciosas, Hospital Clínic - IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Miquel Pujol
- Servicio de Enfermedades Infecciosas, IDIBELL, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Spain
| | - Evelyn Shaw
- Servicio de Enfermedades Infecciosas, IDIBELL, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic - IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Jordi Vallés
- Servicio de Cuidados Intensivos, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
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