1
|
Rödenbeck M, Ayobami O, Eckmanns T, Pletz MW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill 2023; 28:2200672. [PMID: 37199987 PMCID: PMC10197495 DOI: 10.2807/1560-7917.es.2023.28.20.2200672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 05/19/2023] Open
Abstract
BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide.AimWe aimed to summarise the German AMR situation for clinicians and microbiologists.MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016-2021) and the case fatality rates (2010-2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively.ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886-0.891; p < 0.0001), while vancomycin resistance in Enterococcus faecium (VRE) bloodstream infections increased (OR = 1.18; (95% CI: 1.16-1.21); p < 0.0001) with a pooled proportion of 34.9%. Case fatality rates for MRSA and VRE were higher than for their susceptible strains (OR = 2.29; 95% CI: 1.91-2.75 and 1.69; 95% CI: 1.22-2.33, respectively). Carbapenem resistance in Gram-negative pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter spp. and Escherichia coli) was low to moderate (< 9%), but resistance against third-generation cephalosporins and fluoroquinolones was moderate to high (5-25%). Pseudomonas aeruginosa exhibited high resistance against carbapenems (17.0%; 95% CI: 11.9-22.8), third-generation cephalosporins (10.1%; 95% CI: 6.6-14.2) and fluoroquinolones (24.9%; 95% CI: 19.3-30.9). Statistical heterogeneity was high (I2 > 70%) across studies reporting resistance proportions.ConclusionContinuous efforts in AMR surveillance and infection prevention and control as well as antibiotic stewardship are needed to limit the spread of AMR in Germany.
Collapse
Affiliation(s)
- Maria Rödenbeck
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Olaniyi Ayobami
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Robby Markwart
- InfectoGnostics Research Campus Jena, Jena, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| |
Collapse
|
2
|
Zheng JY, Zhang H, He JD, Tian BH, Han CB, Cui Z, Yan H. Bimetallic oxide Cu 2O@MnO 2 with exposed phase interfaces for dual-effect purification of indoor formaldehyde and pathogenic bacteria. NANOSCALE ADVANCES 2023; 5:2027-2037. [PMID: 36998659 PMCID: PMC10044645 DOI: 10.1039/d2na00922f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 06/19/2023]
Abstract
The combination of materials with different functions is an optimal strategy for synchronously removing various indoor pollutants. For multiphase composites, exposing all components and their phase interfaces fully to the reaction atmosphere is a critical problem that needs to be solved urgently. Here, a bimetallic oxide Cu2O@MnO2 with exposed phase interfaces was prepared by a surfactant-assisted two-step electrochemical method, which shows a composite structure of non-continuously dispersed Cu2O particles anchored on flower-like MnO2. Compared with the pure catalyst MnO2 and bacteriostatic agent Cu2O, Cu2O@MnO2 respectively shows superior dynamic formaldehyde (HCHO) removal efficiency (97.2% with a weight hourly space velocity of 120 000 mL g-1 h-1) and pathogen inactivation ability (the minimum inhibitory concentration for 104 CFU mL-1 Staphylococcus aureus is 10 μg mL-1). According to material characterization and theoretical calculation, its excellent catalytic-oxidative activity is attributable to the electron-rich region at the phase interface which is fully exposed to the reaction atmosphere, inducing the capture and activation of O2 on the material surface, and then promoting the generation of reactive oxygen species that can be used for the oxidative-removal of HCHO and bacteria. Additionally, as a photocatalytic semiconductor, Cu2O further enhances the catalytic ability of Cu2O@MnO2 under the assistance of visible light. This work will provide efficient theoretical guidance and a practical basis for the ingenious construction of multiphase coexisting composites in the field of multi-functional indoor pollutant purification strategies.
Collapse
Affiliation(s)
- Jia Yu Zheng
- The Key Laboratory of Advanced Functional Materials, Ministry of Education of China, Faculty of Materials and Manufacturing, Beijing University of Technology Beijing 100124 People's Republic of China
| | - Hao Zhang
- The Key Laboratory of Advanced Functional Materials, Ministry of Education of China, Faculty of Materials and Manufacturing, Beijing University of Technology Beijing 100124 People's Republic of China
| | - Jun Da He
- Key Laboratory of Beijing on Regional Air Pollution Control, Beijing University of Technology Beijing 100124 People's Republic of China
| | - Bo Hai Tian
- The Key Laboratory of Advanced Functional Materials, Ministry of Education of China, Faculty of Materials and Manufacturing, Beijing University of Technology Beijing 100124 People's Republic of China
| | - Chang Bao Han
- The Key Laboratory of Advanced Functional Materials, Ministry of Education of China, Faculty of Materials and Manufacturing, Beijing University of Technology Beijing 100124 People's Republic of China
| | - Zhixiang Cui
- College of Materials Science and Engineering, Fujian University of Technology Fuzhou Fujian 350118 People's Republic of China
| | - Hui Yan
- The Key Laboratory of Advanced Functional Materials, Ministry of Education of China, Faculty of Materials and Manufacturing, Beijing University of Technology Beijing 100124 People's Republic of China
| |
Collapse
|
3
|
Zhu J, Li Q, Li X, Wu X, Yuan T, Yang Y. Simulated Enzyme Activity and Efficient Antibacterial Activity of Copper-Doped Single-Atom Nanozymes. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2022; 38:6860-6870. [PMID: 35617453 DOI: 10.1021/acs.langmuir.2c00155] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nanozymes with good biocompatibility are novel antibacterial agents because they mimic the structure and properties of enzymes and destroy bacterial structures by generating reactive oxygen species in large quantities. Herein, we synthesized a Cu single-atom nanozyme (Cu-N-C) with intrinsic peroxidase- and oxidase-like activities. Cu-N-C can generate ·OH and O2·- during oxidase-catalyzed reactions, which have good antibacterial effects. Meanwhile, the antimicrobial performance can be further enhanced by light emitting diode light incubation due to photocatalysis. Lethal disruption of the membrane structure was confirmed by biofilm staining and scanning electron microscopy analysis. Notably, the antibacterial effect of Cu-N-C (MIC = 16 μg/mL) was significantly better than that of vancomycin (MIC = 1500 μg/mL), a commonly used drug for methicillin-resistant Staphylococcus aureus, and Cu-N-C outperformed the positive control cephalexin and gentamicin in terms of resistance development (27.3% less production of drug-resistant bacteria). Good biocompatibility was also verified using the MTT method, hemolysis analysis, and routine blood measurements in mice. The results of this work suggest that Cu-N-C has great potential for clinical applications as an efficient metal antimicrobial agent.
Collapse
Affiliation(s)
- Junrun Zhu
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan Province 650500, China
| | - Qiulan Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan Province 650500, China
| | - Xiao Li
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan Province 650500, China
- Department of Gynecology, The First People's Hospital of Yunnan Province, Kunming, Yunnan Province 650032, China
| | - Xiaomei Wu
- Department of Gynecology, The First People's Hospital of Yunnan Province, Kunming, Yunnan Province 650032, China
| | - Tao Yuan
- Department of Gynecology, The First People's Hospital of Yunnan Province, Kunming, Yunnan Province 650032, China
| | - Yaling Yang
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan Province 650500, China
| |
Collapse
|
4
|
Rose DT, Moskhos A, Wibisono A, Reveles KR. Automated Susceptibility Testing With Vitek 2 Compared to MicroScan Reduces Vancomycin Alternative Therapy For Methicillin-Resistant Staphylococcus Aureus Bacteremia. Int J Infect Dis 2022; 117:179-186. [PMID: 35134560 DOI: 10.1016/j.ijid.2022.02.002] [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: 09/22/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Variability in minimum inhibitory concentration (MIC) with automated susceptibility testing instruments may influence methicillin-resistant Staphylococcus aureus (MRSA) treatment. The purpose of this study was to evaluate the difference in vancomycin MIC values and the impact on vancomycin alternative therapy for MRSA bacteremia using the MicroScan and VITEK 2 automated systems. METHODS This was a retrospective multicenter cohort study of adult patients with MRSA bacteremia. Patients were stratified by susceptibility testing with MicroScan (May 2013-December 2016) or VITEK 2 (June 2017-February 2020). The primary outcome was vancomycin alternative therapy use. Secondary endpoints included MRSA MIC, 30-day mortality, 30- and 90-day readmission, and hospital length of stay (LOS). RESULTS A total of 193 patients were included for analysis: 89 in the MicroScan group and 104 in the VITEK 2 group. Vancomycin alternative therapy use was higher in the MicroScan group than the VITEK 2 group (56.2% vs 20.2%; p <0.001). Median MIC value was 2 mg/L and 1 mg/L for MicroScan and VITEK 2, respectively (p <0.001). Median hospital LOS was shorter in the VITEK 2 period (16 vs 12 days; p = 0.02). Thirty-day mortality (10.1% vs 7.7%; p = 0.555) and 90-day readmission (34.8% vs 29.8%; p = 0.457) did not significantly differ between MicroScan and VITEK 2 groups. CONCLUSIONS VITEK 2 use was associated with lower reported vancomycin MICs and less use of vancomycin alternative therapy.
Collapse
Affiliation(s)
- Dusten T Rose
- Ascension Seton, Dell Seton Medical Center at The University of Texas, Department of Pharmacy, Austin, TX, USA; College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
| | - Alexander Moskhos
- Ascension Seton, Dell Seton Medical Center at The University of Texas, Department of Pharmacy, Austin, TX, USA; College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Arya Wibisono
- Ascension Seton, Dell Seton Medical Center at The University of Texas, Department of Pharmacy, Austin, TX, USA; College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA; Pharmacotherapy Education & Research Center, University of Texas Health San Antonio, San Antonio, TX, USA
| |
Collapse
|
5
|
Genotyping of methicillin-resistant Staphylococcus aureus isolates causing invasive infections using spa typing and their correlation with antibiotic susceptibility. Int J Antimicrob Agents 2022; 59:106525. [PMID: 35041940 DOI: 10.1016/j.ijantimicag.2022.106525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 11/20/2022]
Abstract
The antibiotic susceptibility patterns were correlated with particular spa types, and this correlation would help physicians select appropriate antibiotics for treatment of invasive MRSA infections. The aim of this research was to investigate invasive methicillin-resistant Staphylococcus aureus (MRSA) through delineatingthe molecular typing results and correlating them with antibiotic susceptibility. Totally 670 non-duplicate mecA+MRSA isolates from patients with invasive infections were collected from a 5-year nationwide antimicrobial surveillance program (TIST), and 58 spa types were identified among 639 (95.4%) isolates by determining the allelic profile of the spa gene with PCR and nucleotide sequencing. Six major types, including spa t002 (103, 15.3%) and t037 (253, 37.8%), were classified as healthcare-associated MRSA (HA-MRSA, 53.1%); while t437 (151, 22.5%), t441 (13, 1.9%), t1081 (19, 2.8%), and t3525 (14, 2.1%) were classified as community-associated MRSA (CA-MRSA, 29.4%). Antimicrobial susceptibility was performed with agar or microbroth dilutions for various antibiotics and the Etest was used for both daptomycin and vancomycin. The declining trend in the vancomycin MIC was in parallel with an increasing frequency of CA-MRSA. The antibiotic susceptibility patterns were correlated with particular spa types, and this correlation would help physicians select appropriate antibiotics for treatment of invasive MRSA infections.
Collapse
|
6
|
Association between high vancomycin minimum inhibitory concentration and clinical outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: a meta-analysis. Infection 2021; 49:803-811. [PMID: 33394368 DOI: 10.1007/s15010-020-01568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the relationship between high vancomycin minimum inhibitory concentrations (MIC), in patients with methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), and both mortality and complicated bacteremia. METHODS Embase, Medline, EBM, Scopus and Web of Science were searched for studies published from January 1st 2014 to February 29th 2020. "High" vancomycin MIC cut off was defined as ≥ 1.5 mg/L. Three referees independently reviewed studies that compared outcomes in patients with MRSAB stratified by vancomycin MIC. Subgroup analyses were performed for rates of mortality and complicated bacteremia. RESULTS A total of 13 studies with 2089 patients were included. Overall, mortality was 27.7% and 23.3% in the high and low vancomycin MIC group, respectively. No significant difference was found between vancomycin MIC groups for overall mortality, in-hospital mortality, late mortality, persistent bacteremia, severe sepsis or septic shock, acute renal failure, septic emboli or endocarditis, and osteomyelitis or septic arthritis. Early mortality was significantly associated with low vancomycin MIC. Mortality in studies using broth microdilution method (BMD) and need for mechanical ventilation were significantly associated with high vancomycin MIC. CONCLUSION Overall mortality and complicated bacteremia were not significantly associated with high vancomycin MICs in a patient with MRSAB. Randomized controlled trials to assess the utility of vancomycin MIC values in predicting mortality and other adverse clinical outcomes are warranted.
Collapse
|
7
|
Kuo CF, Lio CF, Chen HT, Wang YTT, Ma KSK, Chou YT, Chang FC, Tsai SY. Discordance of vancomycin minimum inhibitory concentration for methicillin-resistant Staphylococcus aureus at 2 μg/mL between Vitek II, E-test, and Broth Microdilution. PeerJ 2020; 8:e8963. [PMID: 32435531 PMCID: PMC7224226 DOI: 10.7717/peerj.8963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
Background Vancomycin, the first line antibiotic for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, is often administered inappropriately when MIC is greater than 2 µg/mL, including ‘susceptible’ strains. This study assessed the discordance of vancomycin minimum inhibitory concentration (MIC) for methicillin-resistant Staphylococcus aureus (MRSA). Methods In total, 229 MRSA isolates from blood cultures collected between 2009 and 2015 at a tertiary hospital in Taiwan were examined. The MICs of vancomycin were measured using Vitek 2, E-test, and standard broth microdilution at the level of 2 µg/mL. Results The geometric mean of the MICs of hospital-acquired MRSA was higher than that of community-acquired MRSA (P < 0.001), with the exact agreement rates (with broth microdilution) at 2 µg/mL being 53.6% in Vitek 2 and 86.7% in E-test. Overall, E-test (98.1%) had more categorical accordance than did Vitek 2 (94.0%; P = 0.026). Vitek 2 had a tendency to overestimate MRSA in high-MIC isolates, whereas E-test inclined underestimation in low-MIC isolates. Surprisingly, the discordance rates of MRSA vancomycin MICs were higher in hospital-acquired isolates (13.3%–17.0%) than in community-acquired isolates (6.2%–7.0%). Conclusion The Infectious Diseases Society of America recommends the use of alternative antimicrobial agents when vancomycin MIC is ≥ 2 µg/mL; in this study, only 53.6% of the isolates tested using Vitek 2 showed a high MIC in the broth microdilution method. Accurate identification of the resistance profile is a key component of antimicrobial stewardship programs. Therefore, to reduce inappropriate antibiotic use and mitigate the emergence of resistant strains, we recommend using complementary tests such as E-test or Broth microdilution to verify the MIC before administering second-line antibiotics. Strengths (1) We compared the categorical agreement between different methods measuring MRSA MICs level. (2) Physicians should incorporate this information and consider a complementary test to verify the appropriateness of the decision of shifting vancomycin to second-line antibiotic treatment to improve patients’ prognosis. (3) MRSA-vancomycin MICs at a cutoff of 2 µg/mL obtained using Vitek II exhibited a higher sensitivity level and negative predictive value than those obtained using E-test in the prediction of categorical agreement with standard broth microdilution. Limitation (1) Our research was based on a single hospital-based study. (2) The MRSA strains in this study were stored for more than 12 months after isolation. (3) We did not collect information on clinical prognosis.
Collapse
Affiliation(s)
- Chien-Feng Kuo
- Division of Infectious Disease, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chon Fu Lio
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsiang-Ting Chen
- Division of Infectious Disease, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Yu-Ting Tina Wang
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Pathology, School of Dental Medicine, University of Pennsylvania, Philadelphia, USA
| | - Yi Ting Chou
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fu-Chieh Chang
- Infection control center, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shin-Yi Tsai
- Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, Taipei, Taiwan.,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, U.S.,Graduate Institute of Long-Term Care, Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan
| |
Collapse
|
8
|
Fabri FV, Lolis MA, Gimenes M, Tognim MCB, Caparroz-Assef SM. Different formulations of vancomycin: In vitro antimicrobial activity against clinical isolates of methicillin-resistant Staphylococcus aureus. Diagn Microbiol Infect Dis 2018; 92:332-337. [PMID: 30033164 DOI: 10.1016/j.diagmicrobio.2018.06.020] [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: 02/22/2017] [Revised: 02/18/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022]
Abstract
We compared in vitro antimicrobial activity of four vancomycin formulations used clinically against clinical isolates of Staphylococcus aureus, including methicillin-resistant and -susceptible (MRSA and MSSA, respectively), using different susceptibility assays. The minimal inhibitory concentrations (MICs) against MRSA clinical isolates were significantly different for some vancomycin formulations by the broth microdilution and agar dilution methods. However, these variations would not compromise their clinical use, since the MICs were within the range recommended by the Clinical and Laboratory Standards Institute. Furthermore, 26.9% of MRSA clinical isolates showed a vancomycin MIC ≥1.5 μg/mL according to the Etest® method but none by broth microdilution. Regarding quality, all formulations were in accordance with United States Pharmacopeia criteria. Our results showed that all vancomycin formulations tested showed similar in vitro antimicrobial activity, making them suitable for clinical use, and that the evaluation method chosen to determine sensitivity to this antimicrobial should be carefully performed, particularly for MRSA.
Collapse
Affiliation(s)
- Franciele Viana Fabri
- Post Graduate Program in Biociências e Fisiopatologia, Universidade Estadual de Maringá, Maringá, PR, Brazil.
| | | | | | | | | |
Collapse
|
9
|
Holmes NE, Robinson JO, van Hal SJ, Munckhof WJ, Athan E, Korman TM, Cheng AC, Turnidge JD, Johnson PDR, Howden BP. Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. BMC Infect Dis 2018; 18:107. [PMID: 29506483 PMCID: PMC5838938 DOI: 10.1186/s12879-018-3011-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. METHODS Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. RESULTS Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. CONCLUSIONS This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.
Collapse
Affiliation(s)
- Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia. .,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
| | - J Owen Robinson
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Royal Perth Hospital, 197 Wellington Street, Perth, WA, 6000, Australia.,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.,Department of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Wendy J Munckhof
- Infection Management Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,Department of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Eugene Athan
- Department of Infectious Diseases, University Hospital Geelong, Barwon Health, Bellerine Street, Geelong, VIC, 3220, Australia.,Department of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Tony M Korman
- Department of Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Hospital, 55 Commercial Road, Prahran, VIC, 3181, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - John D Turnidge
- Australian Commission on Safety and Quality in Health Care, Level 5, 255 Elizabeth Street, Sydney, NSW, 2000, Australia.,Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Benjamin P Howden
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia.,Microbiological Diagnostic Unit, Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
| | | |
Collapse
|
10
|
Reproducible measurement of vancomycin MICs within the susceptible range in Staphylococcus aureus by a broth microdilution method with a "quasi-continuum" gradient of antibiotic concentrations. Eur J Clin Microbiol Infect Dis 2017; 36:2355-2360. [PMID: 28741096 DOI: 10.1007/s10096-017-3067-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
The availability of reproducible broth microdilution (BMD) methods including inter log2 antibiotic dilutions for measuring Staphylococcus aureus (SA) vancomycin minimum inhibitory concentrations (MICs) within the susceptible range is needed to elucidate the impact of vancomycin MICs on clinical outcomes of invasive SA infections. Here, we report on the development of a very precise BMD method that incorporates the following incremental antibiotic concentrations: 0.50, 0.62, 0.75, 0.87, 1.0, 1.25, 1.40, 1.50, 1.60, 1.75, and 2.0 μg/mL. The intra- and inter-assay coefficients of variation of this method were around 20%. The mean of the differences in MIC values for all isolates obtained across two independent runs performed at one center was 0.04 μg/mL [95% confidence interval (CI), 0.011-0.07 μg/mL] and that for ten isolates measured at two different centers was 0.04 μg/mL (95% CI, 0-13 μg/mL). Vancomycin MIC values differed by less than 0.1 μg/mL between runs for most isolates. Storage of isolates at -20 °C for up to 3 months had no impact on the vancomycin MIC values. The mean vancomycin MIC values obtained by the Etest using a standard inoculum (0.5 McFarland) were significantly higher (p ≤ 0.001) than those measured by BMD and the MIC values measured by the two methods correlated poorly (Rho, 0.319; p = 0.148). Nevertheless, the mean MIC values measured by the Etest using lower inocula (107 or 106 CFU/mL) and those measured by BMD were comparable and correlated significantly (p = 0.004 for 107 CFU/mL and p = 0.029 for 106 CFU/mL).
Collapse
|