1
|
Fujikura Y, Ohno T, Seki M, Mitsutake K. Is administration of anti-MRSA drugs recommended for patients with pneumonia when MRSA is isolated from respiratory specimens? A systematic review and meta-analysis. J Infect Chemother 2024; 30:88-91. [PMID: 37678748 DOI: 10.1016/j.jiac.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
It is unclear whether anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs should be uniformly administered to patients with pneumonia when MRSA is isolated from respiratory specimens. A systematic review was conducted to evaluate the efficacy of the uniform administration of anti-MRSA drugs. Two researchers independently searched the literature as of December 2022, extracted relevant papers, and performed a meta-analysis. The outcomes were mortality and adverse events. No applicable randomized controlled trials were found during the study period, but four observational studies were extracted. The relative risk of mortality in the anti-MRSA group was 1.67 [95% confidence interval 0.65-4.30], which did not differ significantly from the non-administered group. Further investigation into the background of patients demonstrated that anti-MRSA drugs were administered to groups in which only MRSA was cultured. However, the pneumonia severity index did not differ from that in the non-treated group. No studies of adverse events were found. Our review did not find a beneficial contribution to mortality from uniform anti-MRSA medication to patients with pneumonia when MRSA was isolated from respiratory specimens. Factors determining risk-based individualized treatment should be validated as the future question.
Collapse
Affiliation(s)
- Yuji Fujikura
- Department of Medical Risk Management and Infection Control, National Defense Medical College Hospital, Japan; Division of Infectious Disease and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan.
| | - Tomohiro Ohno
- Division of Infectious Disease and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Masafumi Seki
- Department of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University School of Medicine, Japan
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, International Medical Center, Saitama Medical University School of Medicine, Japan
| |
Collapse
|
2
|
Bonesso MF, Fortaleza CMCB, Cavalcante RDS, Sobrinho MT, Ronchi CF, Abraão LM, Joo HS, Otto M, Ribeiro de Souza da Cunha MDL. A Study on the Epidemiological-Molecular Role of Staphylococcus aureus Strains in the Development of Ventilator-Associated Pneumonia in a Tertiary Hospital in Brazil. Antibiotics (Basel) 2023; 12:1336. [PMID: 37627756 PMCID: PMC10451267 DOI: 10.3390/antibiotics12081336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
This study aimed to explore the molecular epidemiology of Staphylococcus aureus isolated from patients on mechanical ventilation and the participation of virulence factors in the development of ventilator-associated pneumonia (VAP). A prospective cohort study was conducted on patients under mechanical ventilation, with periodic visits for the collection of tracheal aspirates and clinical data. The S. aureus isolates were analyzed regarding resistance profile, virulence, expression of protein A and alpha-toxin using Western blot, clonal profile using PFGE, sequence type using MLST, and characterization and quantification of phenol-soluble modulins. Among the 270 patients in the study, 51 S. aureus strains were isolated from 47 patients. The incidence density of S. aureus and MRSA VAP was 2.35/1000 and 1.96/1000 ventilator days, respectively; of these, 45% (n = 5) were resistant to oxacillin, with 100% (n = 5) harboring SCCmec types II and IV. The most frequent among the tested virulence factors were icaA, hla, and hld. The clonal profile showed a predominance of sequence types originating from the community. Risk factors for VAP were the presence of solid tumors and the sea gene. In conclusion, patient-related risk factors, together with microbiological factors, are involved in the development of S. aureus VAP, which is caused by the patient's own strains.
Collapse
Affiliation(s)
- Mariana Fávero Bonesso
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP—Universidade Estadual Paulista, Botucatu 18618-691, Brazil
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Carlos Magno Castelo Branco Fortaleza
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
| | - Ricardo de Souza Cavalcante
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
| | - Moises Teixeira Sobrinho
- Hospital das Clínicas, Botucatu Medical School, University of Sao Paulo State, Botucatu 18618-687, Brazil; (M.T.S.); (C.F.R.)
| | - Carlos Fernando Ronchi
- Hospital das Clínicas, Botucatu Medical School, University of Sao Paulo State, Botucatu 18618-687, Brazil; (M.T.S.); (C.F.R.)
| | - Lígia Maria Abraão
- Nursing Research and Care Practices, Hospital Samaritano Higienópolis, São Paulo 01232-010, Brazil;
| | - Hwang-Soo Joo
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD 20814, USA; (H.-S.J.); (M.O.)
| | - Maria de Lourdes Ribeiro de Souza da Cunha
- Department of Infectology, Dermatology, Diagnostic Imaging and Radiotherapy, Medical School (FMB) of Sao Paulo State University (UNESP), Botucatu 18618-970, Brazil; (C.M.C.B.F.); (R.d.S.C.)
- Department of Chemical and Biological Sciences, Biosciences Institute, UNESP—Universidade Estadual Paulista, Botucatu 18618-691, Brazil
| |
Collapse
|
3
|
Kreitmann L, Jermoumi S, Vasseur M, Chabani M, Nourry E, Richard JC, Wallet F, Garçon P, Kachmar S, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Duhamel A, Labreuche J, Nseir S. Relationship between COVID-19 and ICU-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter before-after study. Intensive Care Med 2023; 49:796-807. [PMID: 37326645 DOI: 10.1007/s00134-023-07109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Patients presenting the most severe form of coronavirus disease 2019 (COVID-19) pneumonia, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have a prolonged intensive care unit (ICU) stay and are exposed to broad-spectrum antibiotics, but the impact of COVID-19 on antimicrobial resistance is unknown. METHODS Observational prospective before-after study in 7 ICUs in France. All consecutive patients with an ICU stay > 48 h and a confirmed SARS-CoV-2 infection were included prospectively and followed for 28 days. Patients underwent systematic screening for colonization with multidrug-resistant (MDR) bacteria upon admission and every week subsequently. COVID-19 patients were compared to a recent prospective cohort of control patients from the same ICUs. The primary objective was to investigate the association of COVID-19 with the cumulative incidence of a composite outcome including ICU-acquired colonization and/or infection related to MDR bacteria (ICU-MDR-col and ICU-MDR-inf, respectively). RESULTS From February 27th, 2020 to June 2nd, 2021, 367 COVID-19 patients were included, and compared to 680 controls. After adjustment for prespecified baseline confounders, the cumulative incidence of ICU-MDR-col and/or ICU-MDR-inf was not significantly different between groups (adjusted sub-hazard ratio [sHR] 1.39, 95% confidence interval [CI] 0.91-2.09). When considering both outcomes separately, COVID-19 patients had a higher incidence of ICU-MDR-inf than controls (adjusted sHR 2.50, 95% CI 1.90-3.28), but the incidence of ICU-MDR-col was not significantly different between groups (adjusted sHR 1.27, 95% CI 0.85-1.88). CONCLUSION COVID-19 patients had an increased incidence of ICU-MDR-inf compared to controls, but the difference was not significant when considering a composite outcome including ICU-MDR-col and/or ICU-MDR-inf.
Collapse
Affiliation(s)
- Louis Kreitmann
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Sonia Jermoumi
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Margot Vasseur
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France
| | - Myriam Chabani
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Emilie Nourry
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Jean-Christophe Richard
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, 69004, Lyon, France
| | - Florent Wallet
- Service de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, 69637, Pierre Bénite, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Université Claude Bernard Lyon, Lyon, France
| | - Pierre Garçon
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-la-Vallée, Jossigny, France
| | - Safaâ Kachmar
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-la-Vallée, Jossigny, France
| | - Yoann Zerbib
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | | | - Alain Duhamel
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive Réanimation, Hôpital R. Salengro, CHU de Lille, Rue E. Laine, 59037, Lille Cedex, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
| |
Collapse
|
4
|
Patel H, Rawat S. A genetic regulatory see-saw of biofilm and virulence in MRSA pathogenesis. Front Microbiol 2023; 14:1204428. [PMID: 37434702 PMCID: PMC10332168 DOI: 10.3389/fmicb.2023.1204428] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Staphylococcus aureus is one of the most common opportunistic human pathogens causing several infectious diseases. Ever since the emergence of the first methicillin-resistant Staphylococcus aureus (MRSA) strain decades back, the organism has been a major cause of hospital-acquired infections (HA-MRSA). The spread of this pathogen across the community led to the emergence of a more virulent subtype of the strain, i.e., Community acquired Methicillin resistant Staphylococcus aureus (CA-MRSA). Hence, WHO has declared Staphylococcus aureus as a high-priority pathogen. MRSA pathogenesis is remarkable because of the ability of this "superbug" to form robust biofilm both in vivo and in vitro by the formation of polysaccharide intercellular adhesin (PIA), extracellular DNA (eDNA), wall teichoic acids (WTAs), and capsule (CP), which are major components that impart stability to a biofilm. On the other hand, secretion of a diverse array of virulence factors such as hemolysins, leukotoxins, enterotoxins, and Protein A regulated by agr and sae two-component systems (TCS) aids in combating host immune response. The up- and downregulation of adhesion genes involved in biofilm formation and genes responsible for synthesizing virulence factors during different stages of infection act as a genetic regulatory see-saw in the pathogenesis of MRSA. This review provides insight into the evolution and pathogenesis of MRSA infections with a focus on genetic regulation of biofilm formation and virulence factors secretion.
Collapse
Affiliation(s)
| | - Seema Rawat
- Microbiology Laboratory, School of Life Sciences, Central University of Gujarat, Gandhinagar, Gujarat, India
| |
Collapse
|
5
|
Kreitmann L, Vasseur M, Jermoumi S, Perche J, Richard JC, Wallet F, Chabani M, Nourry E, Garçon P, Zerbib Y, Van Grunderbeeck N, Vinsonneau C, Preda C, Labreuche J, Nseir S. Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study. Intensive Care Med 2023; 49:154-165. [PMID: 36592202 DOI: 10.1007/s00134-022-06954-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/05/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The impact of immunosuppression on intensive care unit (ICU)-acquired colonization and infection related to multidrug-resistant (MDR) bacteria (ICU-MDR-col and ICU-MDR-inf, respectively) is unknown. METHODS We carried out an observational prospective cohort study in 8 ICUs in France (all with single-bed rooms and similar organizational characteristics). All consecutive patients with an ICU stay > 48 h were included, regardless of immune status, and followed for 28 days. Patients underwent systematic screening for colonization with MDR bacteria upon admission and every week subsequently. Immunosuppression was defined as active cancer or hematologic malignancy, neutropenia, solid-organ transplant, use of steroids or immunosuppressive drugs, human immunodeficiency virus infection and genetic. The primary endpoint was the incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. RESULTS 750 patients (65.9% males, median age 65 years) were included, among whom 264 (35.2%) were immunocompromised. Reasons for ICU admission, severity scores and exposure to invasive devices and antibiotics during ICU stay were comparable between groups. After adjustment for center and pre-specified baseline confounders, immunocompromised patients had a lower incidence rate of ICU-MDR-col and/or ICU-MDR-inf (adjusted incidence ratio 0.68, 95% CI 0.52-0.91). When considered separately, the difference was significant for ICU-MDR-col, but not for ICU-MDR-inf. The distribution of MDR bacteria was comparable between groups, with a majority of Enterobacteriacae resistant to third-generation cephalosporins (~ 74%). CONCLUSION Immunocompromised patients had a significantly lower incidence rate of a composite outcome including ICU-MDR-col and/or ICU-MDR-inf. This finding points to the role of contact precautions and isolation measures, and could have important implications on antibiotic stewardship in this population.
Collapse
Affiliation(s)
- Louis Kreitmann
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France.,Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Margot Vasseur
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France
| | - Sonia Jermoumi
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France
| | | | - Jean-Christophe Richard
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital de la Croix Rousse, 69004, Lyon, France
| | - Florent Wallet
- Service de Réanimation, Hospices Civils de Lyon, Groupement Hospitalier Sud, 69637, Pierre Bénite, France.,Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Claude Bernard Lyon University, Villeurbanne, France
| | - Myriam Chabani
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Emilie Nourry
- Médecine Intensive Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437, Lyon Cedex 03, France
| | - Pierre Garçon
- Réanimation, Grand Hôpital de l'Est Francilien, Site de Marne-La-Vallée, Jossigny, France
| | - Yoann Zerbib
- Médecine Intensive Réanimation, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | | | - Cristian Preda
- Department of Medical Research, Biostatistics, Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.,Laboratoire Paul Painlevé, Université de Lille, CNRS UMR 8524, 59000, Lille, France
| | | | - Saad Nseir
- Médecine Intensive Réanimation, CHU de Lille, 59000, Lille, France. .,Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
| |
Collapse
|
6
|
Moglad EH, Altayb HN. Antibiogram, prevalence of methicillin-resistant and multi-drug resistant Staphylococcus spp. in different clinical samples. Saudi J Biol Sci 2022; 29:103432. [PMID: 36117784 PMCID: PMC9478920 DOI: 10.1016/j.sjbs.2022.103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 07/07/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus spp. (MRSS) are causing numerous forms of illness in humans ranging from mild to fatal infections. We need to investigate the resistant pattern for different clinical isolates to control the resistance phenomena. This study was designed to provide the resistance pattern of isolated Staphylococcus spp. from various clinical samples in Khartoum State and to elucidate the frequencies of Multidrug-resistant (MDR), Extensively drug-resistant (XDR) and pan-drug resistant (PDR). Two hundred and ten bacterial isolates were from different sources (catheter tip, sputum, vaginal swab, urine, tracheal aspirate, blood, pus, nasal swab, stool, throat swab, pleural fluid, and ear swab). Isolates were identified based on their morphological characters and biochemical reaction. Antibiotics susceptibility screening was performed using twenty-three antibiotics from eighteen classes against all isolated Staphylococcus spp. following the Clinical and Laboratory Standards Institute (CLSI) guideline. The result revealed that out of 63 Gram-positive isolated bacteria, 52 (82.5%) were Staphylococcus spp. with a high incidence of S. aureus 37(71.2%). Out of all Staphylococcus spp., 38 (73.1%) were Methicillin-resistant (MR). The prevalence of MDR was higher in S. aureus (89.2%) than in S. epidermidis (75%). All Staphylococcus spp. displayed resistance to ampicillin and penicillin, while all S. aureus were sensitive to daptomycin and fosfomycin. One isolate was XDR possible PDR, while no PDR was reported in all isolated bacteria. This study provided evidence for the antimicrobial-resistant (AMR) burden in Sudan and highlighted the need for a practical and functional stewardship program to reduce the unreasonable costs of antibiotics.
Collapse
Affiliation(s)
- Ehssan H. Moglad
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, P.O.Box 173, Alkharj 11942, Saudi Arabia
- Department of Microbiology, Medicinal and Aromatic Plants and Traditional Medicine Research Institute (MAPTMRI), P.O. Box 2404, National Center for Research, Khartoum, Sudan
- Corresponding author at: Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, PO Box 173, Alkharj 11942, Saudi Arabia.
| | - Hisham N. Altayb
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Building A 90, Jeddah 21589, Saudi Arabia
| |
Collapse
|
7
|
Pickens CI, Wunderink RG. Methicillin-Resistant Staphylococcus aureus Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia. Semin Respir Crit Care Med 2022; 43:304-309. [PMID: 35170002 PMCID: PMC10623688 DOI: 10.1055/s-0041-1740583] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). MRSA pneumonia is associated with significant morbidity and mortality. Several virulence factors allow S. aureus to become an effective pathogen. The polysaccharide intracellular adhesin allows for the production of biofilms, some strains can produce capsular polysaccharides that protect against phagocytosis, microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) allow for colonization of epithelial surfaces, and S. aureus secretes several exotoxins that aid in tissue destruction. The α-hemolysin exotoxin secreted by S. aureus is one of the most important virulence factors for the bacteria. The diagnosis of MRSA pneumonia can be challenging; the infection may present as a mild respiratory infection or severe respiratory failure and septic shock. Many individuals are colonized with MRSA and thus a positive nasopharyngeal swab does not confirm infection in the lower respiratory tract. The management of MRSA pneumonia has evolved. Historically, vancomycin has been the primary antibiotic used to treat MRSA pneumonia. Over the past decade, prospective studies have shown that linezolid leads to higher rates of clinical cure. Monoclonal antibodies are being studied as potential therapeutic options. MRSA is an important cause of HAP/VAP; novel diagnostics may facilitate rapid diagnosis of this infection and the available literature should be used to make informed decisions on management.
Collapse
Affiliation(s)
- Chiagozie I. Pickens
- Division of Critical Care, Department of Medicine, Pulmonary, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Wunderink
- Division of Critical Care, Department of Medicine, Pulmonary, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
8
|
Sakamoto Y, Yamauchi Y, Jo T, Michihata N, Hasegawa W, Takeshima H, Matsui H, Fushimi K, Yasunaga H, Nagase T. In-hospital mortality associated with community-acquired pneumonia due to methicillin-resistant Staphylococcus aureus: a matched-pair cohort study. BMC Pulm Med 2021; 21:345. [PMID: 34732194 PMCID: PMC8564271 DOI: 10.1186/s12890-021-01713-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It remains unclear whether methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is associated with higher mortality compared with non-MRSA pneumonia. This study's objective was to compare outcomes including in-hospital mortality and healthcare costs during hospitalisation between patients with MRSA pneumonia and those with non-MRSA pneumonia. METHODS Using a national inpatient database in Japan, we conducted a 1:4 matched-pair cohort study of inpatients with community-acquired pneumonia from 1 April 2012 to 31 March 2014. In-hospital outcomes (mortality, length of stay and healthcare costs during hospitalisation) were compared between patients with and without MRSA infection. We performed multiple imputation using chained equations followed by multivariable regression analyses fitted with generalised estimating equations to account for clustering within matched pairs. All-cause in-hospital mortality and healthcare costs during hospitalisation were compared for pneumonia patients with and without MRSA infection. RESULTS Of 450,317 inpatients with community-acquired pneumonia, 3102 patients with MRSA pneumonia were matched with 12,320 patients with non-MRSA pneumonia. The MRSA pneumonia patients had higher mortality, longer hospital stays and higher costs. Multivariable logistic regression analysis revealed that MRSA pneumonia was significantly associated with higher in-hospital mortality compared with non-MRSA pneumonia (adjusted odds ratio = 1.94; 95% confidence interval: 1.72-2.18; p < 0.001). Healthcare costs during hospitalisation were significantly higher for patients with MRSA pneumonia than for those with non-MRSA pneumonia (difference = USD 8502; 95% confidence interval: USD 7959-9045; p < 0.001). CONCLUSIONS MRSA infection was associated with higher in-hospital mortality and higher healthcare costs during hospitalisation, suggesting that preventing MRSA pneumonia is essential.
Collapse
Affiliation(s)
- Yukiyo Sakamoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taisuke Jo
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Wakae Hasegawa
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideyuki Takeshima
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Respiratory Medicine, NTT Medical Center Tokyo, 5-9-22, Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| |
Collapse
|
9
|
Decavèle M, Gault N, Moyer JD, Gennequin M, Allain PA, Foucrier A. Prediction models of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia relapse in trauma and brain injury patients: A retrospective analysis. J Crit Care 2021; 66:20-25. [PMID: 34399115 DOI: 10.1016/j.jcrc.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the incidence and risk factors of methicillin sensitive Staphylococcus aureus ventilator associated pneumonia (MSSA-VAP) relapse in trauma and non-traumatic brain injury patients. MATERIALS AND METHODS Retrospective observational monocentric cohort study of consecutive ICU patients who developed a first episode of MSSA-VAP after trauma and non-traumatic brain injury. MSSA-VAP relapse encompass MSSA-VAP treatment failure (persistence or recurrence of MSSA) or other pathogen - VAP. RESULTS A total of 165 patients (71% of trauma and 29% of non-traumatic brain injury) with MSSA-VAP were included. MSSA-VAP relapse occurred in 54 (33%) patients, including 28 (17%) MSSA-VAP treatment failure and 46 (28%) other pathogen-VAP. Empirical first-line antibiotic therapy was appropriate in 96% of cases. In multivariate analysis, the presence of Streptococcus species (Odds ratio [OR] 7.37) and oropharyngeal flora (OR 3.64) as initial MSSA co-pathogen, suggested aspiration at the time of admission and independently predicted MSSA-VAP treatment failure. Initial Glasgow coma scale (OR 0.89), need for emergent surgery (OR 5.71) and the presence of an acute respiratory distress syndrome at the time of the first MSSA-VAP (3.99), independently predicted the onset of other pathogen - VAP. CONCLUSION Early and simple factors may help to identify patients with high-risk of MSSA-VAP relapse.
Collapse
Affiliation(s)
- Maxens Decavèle
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France; Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France.
| | - Nathalie Gault
- APHP, Département Epidémiologie Biostatistiques et Recherche Clinique, Hôpital Beaujon, 92110 Clichy, France; INSERM, CIC-EC 1425, Hôpital Bichat, 75018 Paris, France
| | - Jean Denis Moyer
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Maël Gennequin
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Pierre-Antoine Allain
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| | - Arnaud Foucrier
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 92110 Clichy, France
| |
Collapse
|
10
|
Lakbar I, Medam S, Ronflé R, Cassir N, Delamarre L, Hammad E, Lopez A, Lepape A, Machut A, Boucekine M, Zieleskiewicz L, Baumstarck K, Savey A, Leone M. Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia. Sci Rep 2021; 11:16497. [PMID: 34389761 PMCID: PMC8363636 DOI: 10.1038/s41598-021-95852-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs ("REA-Raisin") database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii. The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii, 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45-1.70], P < 0.001). This association was confirmed in the matched sample (3006 HAMR and 5640 non-HAMR, OR 95%, CI 1.39 [1.27-1.52], P < 0.001) and after adjusting for confounding factors (OR ranged from 1.34 to 1.39, all P < 0.001). Our findings suggest that ICU-acquired pneumonia due to HAMR bacteria is associated with an increased ICU mortality rate, ICU length of stay, and mechanical ventilation duration.
Collapse
Affiliation(s)
- Ines Lakbar
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France.,Department of Anesthesiology and Intensive Care Unit, University hospital of Toulouse, Toulouse, France
| | - Sophie Medam
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Romain Ronflé
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Nadim Cassir
- MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Louis Delamarre
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France.,Department of Anesthesiology and Intensive Care Unit, University hospital of Toulouse, Toulouse, France
| | - Emmanuelle Hammad
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Alexandre Lopez
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France.,MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France
| | - Alain Lepape
- Intensive Care Unit, Centre Hospitalier Lyon Sud, Pierre Bénite, Hospices Civils de Lyon, France.,Rea-Raisin study group (National network for Healthcare-Associated Infection surveillance in ICU, Marseille, France.,PHE3ID, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS Unité Mixte de Recherche 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Saint Genis Laval, France
| | - Anaïs Machut
- Rea-Raisin study group (National network for Healthcare-Associated Infection surveillance in ICU, Marseille, France.,Infection Control & Prevention, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France
| | - Mohamed Boucekine
- APHM, EA 3279 CEReSS, School of Medicine, La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France
| | - Karine Baumstarck
- APHM, EA 3279 CEReSS, School of Medicine, La Timone Medical Campus, Health Service Research and Quality of Life Center, Aix Marseille Université, Marseille, France
| | - Anne Savey
- Rea-Raisin study group (National network for Healthcare-Associated Infection surveillance in ICU, Marseille, France.,Infection Control & Prevention, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Saint Genis Laval, France.,PHE3ID, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS Unité Mixte de Recherche 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Saint Genis Laval, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France. .,MEPHI, IHU Méditerranée Infection, Aix Marseille Université, Marseille, France. .,Service d'anesthésie et de réanimation, Chemin des Bourrely, Hôpital Nord, 13015, Marseille, France.
| | | |
Collapse
|
11
|
Mo Y, West TE, MacLaren G, Booraphun S, Li AY, Kayastha G, Lau YH, Chew YT, Chetchotisakd P, Tambyah PA, Limmathurotsakul D, Cooper B. Reducing antibiotic treatment duration for ventilator-associated pneumonia (REGARD-VAP): a trial protocol for a randomised clinical trial. BMJ Open 2021; 11:e050105. [PMID: 33986070 PMCID: PMC8126270 DOI: 10.1136/bmjopen-2021-050105] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs). Using short-course antibiotics to treat VAP caused by Gram-negative non-fermenting bacteria has been reported to be associated with excess pneumonia recurrences. The "REducinG Antibiotic tReatment Duration for Ventilator-Associated Pneumonia" (REGARD-VAP) trial aims to provide evidence for using a set of reproducible clinical criteria to shorten antibiotic duration for individualised treatment duration of VAP. METHODS AND ANALYSIS This is a randomised controlled hierarchical non-inferiority-superiority trial being conducted in ICUs across Nepal, Thailand and Singapore. The primary outcome is a composite endpoint of death and pneumonia recurrence at day 60. Secondary outcomes include ventilator-associated events, multidrug-resistant organism infection or colonisation, total duration of antibiotic exposure, mechanical ventilation and hospitalisation. Adult patients who satisfy the US Centers for Disease Control and Prevention National Healthcare Safety Network VAP diagnostic criteria are enrolled. Participants are assessed daily until fever subsides for >48 hours and have stable blood pressure, then randomised to a short duration treatment strategy or a standard-of-care duration arm. Antibiotics may be stopped as early as day 3 if respiratory cultures are negative, and day 5 if respiratory cultures are positive in the short-course arm. Participants receiving standard-of-care will receive antibiotics for at least 8 days. Study participants are followed for 60 days after enrolment. An estimated 460 patients will be required to achieve 80% power to determine non-inferiority with a margin of 12%. All outcomes are compared by absolute risk differences. The conclusion of non-inferiority, and subsequently superiority, will be based on unadjusted and adjusted analyses in both the intention-to-treat and per-protocol populations. ETHICS AND DISSEMINATION The study has received approvals from the Oxford Tropical Research Ethics Committee and the respective study sites. Results will be disseminated to patients, their caregivers, physicians, the funders, the critical care societies and other researchers. TRIAL REGISTRATION NUMBER NCT03382548.
Collapse
Affiliation(s)
- Yin Mo
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, National University of Singapore, Singapore
| | - Timothy Eoin West
- International Respiratory and Severe Illness Center, University of Washington, Seattle, Washington, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Graeme MacLaren
- National University Heart Centre, National University Hospital, Singapore
| | - Suchart Booraphun
- Medical Department, Sunpasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Andrew Yunkai Li
- University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, National University of Singapore, Singapore
| | - Gyan Kayastha
- Patan Hospital, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Yie Hui Lau
- Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Yin Tze Chew
- Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
| | - Ploenchan Chetchotisakd
- Department of Medicine,Srinagarind Hospital, Faculty of Medicine and Research and Diagnostic Center for Emerging Infectious Diseases (RCEID), Khon Kaen University, Khon Kaen, Thailand
| | - Paul Anantharajah Tambyah
- University Medicine Cluster, National University Hospital, Singapore
- Department of Medicine, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ben Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
12
|
Prevalence of Methicillin-Resistant Staphylococcus aureus and Associated Risk Factors among Patients with Wound Infection at Referral Hospital, Northeast Ethiopia. J Pathog 2020; 2020:3168325. [PMID: 32566311 PMCID: PMC7271240 DOI: 10.1155/2020/3168325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background The spectrums of infections due to methicillin-resistant Staphylococcus aureus are manifold and are associated with worse outcomes. A study on the prevalence of these pathogens and their sensitivity patterns will give updated information which is very helpful for health personnel responsible in the management of patients and timely monitoring of the emergence of resistant bacteria. Hence, the study aimed at assessing the prevalence of methicillin-resistant Staphylococcus aureus and associated factors among patients with wound infection at Dessie Referral Hospital. Method A cross-sectional study was conducted among 266 patients at Dessie Referral Hospital from February to May 2016. Wound swab samples were collected aseptically using Levine's technique and transported to Dessie Regional Laboratory by using brain-heart infusion transport media. Isolation of Staphylococcus aureus was done based on cultural and biochemical profiles. Drug susceptibility test was performed using the disc diffusion technique as per the standard and interpreted based on the Clinical and Laboratory Standards Institute guidelines. The data were entered and analyzed by using SPSS version 20. Result Staphylococcus isolates from 266 processed wound swabs were 92 (34.58%). Of these, 26 (28.3%) were identified as methicillin-resistant S. aureus and 66 (71.7%) were methicillin-sensitive S. aureus. The overall prevalence of methicillin-resistant S. aureus among the study population was 9.8%. The isolated methicillin-resistant S. aureus showed full resistance to penicillin (100%) followed by erythromycin and ciprofloxacin (16, 61.5%) and cotrimoxazole and gentamicin (14, 53.8%). From the total S. aureus isolates, 20 (21.7%) of them showed multidrug resistance. Of these methicillin-resistant S. aureus, 18 (69.8%) showed high multidrug resistance. Patients who are farmers in occupation (AOR = 6.1, 95% CI (1.086–33.724)), admitted in the hospital (AOR = 3.56, 95% CI (1.429–8.857)), and have low BMI (<18.5) (AOR = 13.89, 95% CI (4.919–39.192)) were among the risk factors significantly associated with wound infection due to methicillin-resistant S. aureus. Conclusion All methicillin-resistant S. aureus isolates were 100% resistant to penicillin and showed high multidrug resistance. Therefore, antibiotic susceptibility test should be performed prior to treatment.
Collapse
|
13
|
Hagiwara E, Baba T, Shinohara T, Kitamura H, Sekine A, Komatsu S, Ogura T. Ten-Year Trends and Clinical Relevance of the Antimicrobial Resistance Genotype in Respiratory Isolates of Streptococcus pneumoniae. Chemotherapy 2017; 62:256-261. [DOI: 10.1159/000470828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
Abstract
Background: Antimicrobial resistance of Streptococcus pneumoniae, especially against β-lactam antibiotics, is a global concern. We aimed to analyze a 10-year trend in the antimicrobial resistance genotype of respiratory isolates of S. pneumoniae and to clarify whether resistance genotypes were correlated with phenotypic drug susceptibility, pathogenicity, and host clinical background. Methods: Respiratory isolates of S. pneumoniae from 2003 to 2012 were analyzed with polymerase chain reaction for the presence of β-lactam resistance gene mutations on pbp1a, pbp2x, and pbp2b. Sixty-eight strains isolated from different patients in 2012 were particularly analyzed for the association between genotypes and clinical data. Results: The 10-year trend analysis showed a recent increase in gPRSP (genotypic penicillin-resistant S. pneumoniae) with all 3 β-lactam resistance genes (from 21.7 to 35.3% in 3 years) and a steady level of gPSSP (genotypic penicillin-susceptible S. pneumoniae) without any β-lactam resistance genes (13.2% in 2012). This resistance trend in genotypes was more prominent than resistance phenotypes determined with a drug susceptibility test. The probability of being a causative pathogen did not differ in gPSSP (55.6%), gPISP (genotypic penicillin-intermediate resistant S. pneumoniae; 54.3%), and gPRSP (54.2%). There was no significant difference in the ratio of patients who presented with respiratory failure in respiratory infection caused by gPSSP, gPISP, or gPRSP. Host clinical characteristics including age and gender were not different among resistance genotypes. Conclusions: There was no difference in pathogenicity or clinical background between gPSSP, gPISP, and gPRSP. Antimicrobial resistance in respiratory isolates of S. pneumoniae was more prevalent in genotypes than in phenotypes.
Collapse
|
14
|
White BP, Barber KE, Stover KR. Ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Am J Health Syst Pharm 2017; 74:201-208. [PMID: 28179245 DOI: 10.2146/ajhp160006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The utility of ceftaroline for the treatment of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is reviewed. SUMMARY Ceftaroline was originally approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin structure infections (ABSSSIs) but recently received an additional approval for the treatment of S. aureus bacteremia (SAB) associated with ABSSSIs. Ceftaroline has demonstrated efficacy for the treatment of MRSAB, including isolates with elevated minimum inhibitory concentrations to conventional therapy when used alone or in combination with other agents. In multiple studies, ceftaroline has displayed rapid bloodstream eradication, even in the setting of refractory MRSAB or infective endocarditis. The clinical resolution of MRSAB or SAB in patients who received ceftaroline ranged from 31.0% to 83.3%; studies used varying definitions for clinical resolution and included differing proportions of patients with endocarditis. The use of ceftaroline in treatment-refractory patients and assorted populations makes absolute effectiveness difficult to determine. Ceftaroline has been shown to be effective in patients who have not responded to other agents for MRSAB, making it an attractive option for such patients. Although the approved dosing regimen for ceftaroline fosamil is 600 mg every 12 hours for patients with normal renal function for the treatment of ABSSSIs and CABP, there is some debate about whether more frequent doses (i.e., every 8 hours) are needed for MRSAB. CONCLUSION Ceftaroline has been used to successfully treat SAB, including endocarditis. Therapy with ceftaroline may be considered when antibiotic resistance or previous treatment failure precludes the use of first-line agents.
Collapse
Affiliation(s)
| | - Katie E Barber
- University of Mississippi School of Pharmacy, Jackson, MS
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, MS
| |
Collapse
|
15
|
Maclayton DO, Hall RG. Infectious Diseases: Pharmacologic Treatment Options for Nosocomial Pneumonia Involving Methicillin-Resistant Staphylococcus aureus. Ann Pharmacother 2016; 41:235-44. [PMID: 17299012 DOI: 10.1345/aph.1h414] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To discuss current and potential treatment options for nosocomial pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA). Data Sources: A MEDLINE search (1966–January 2007) was conducted to identify English-language literature on pharmacotherapy of nosocomial pneumonia and the bibliographies of pertinent articles. Programs and abstracts from infectious disease meetings were also searched. Search terms included MRSA, nosocomial pneumonia, pulmonary infections, vancomycin, quinupristin/dalfopristin, linezolid, daptomycin, tigecycline, dalbavancin, oritavancin, and ceftobiprole. Data Selection and Data Extraction: All articles were critically evaluated and all pertinent information was included in this review. Data Synthesis: Vancomycin has been the drug of choice for MRSA infections for many years. Recent data suggest that linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia. However, there are limitations to the available data. Therefore, prospective, randomized studies are needed before linezolid is recommended as the preferred first-line therapy. Other approved agents for nosocomial MRSA infections, such as quinupristin/dalfopristin and daptomycin, should not be used in the treatment of MRSA pneumonia, as they were inferior in clinical trials. Tigecycline has excellent activity against MRSA in vitro, but should not be routinely used for the treatment of MRSA pneumonia, as clinical data are lacking. In a Phase III clinical trial, an anti-MRSA cephalosporin, ceftobiprole, is being evaluated for effectiveness against nosocomial pneumonia. Investigational glycopeptides may eventually have a role in the treatment of nosocomial pneumonia, but data are currently lacking. Conclusions: Vancomycin is still the drug of choice for treatment of MRSA pneumonia, and linezolid should be used as an alternative agent. Linezolid should carry strong consideration for patients with vancomycin-induced nephrotoxicity or a documented lack of response to vancomycin. Tigecycline and investigational agents with activity against MRSA may be future options for nosocomial pneumonia due to MRSA.
Collapse
Affiliation(s)
- Darego O Maclayton
- Texas Southern University College of Pharmacy & Health Sciences, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX 77004, USA.
| | | |
Collapse
|
16
|
Rapid diagnostic test and use of antibiotic against methicillin-resistant Staphylococcus aureus in adult intensive care unit. Eur J Clin Microbiol Infect Dis 2016; 36:267-272. [DOI: 10.1007/s10096-016-2795-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/16/2016] [Indexed: 10/20/2022]
|
17
|
Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2673] [Impact Index Per Article: 297.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
Collapse
Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
18
|
Pasquale TR, Tan MJ, Trienski TL, File TM. Methicillin-resistant Staphylococcus aureus nosocomial pneumonia patients treated with ceftaroline: retrospective case series of 10 patients. J Chemother 2015; 27:29-34. [PMID: 24621164 DOI: 10.1179/1973947813y.0000000156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a common nosocomial pneumonia (NP) pathogen in US ICUs. Ceftaroline fosamil is a novel cephalosporin with activity against MRSA. METHODS We retrospectively reviewed patients (pts) who received ceftaroline therapy for MRSA NP. RESULTS A total of 10 pts received ceftaroline from September 2011 to September 2012 for MRSA NP. Nine pts received prior anti-MRSA therapy before initiation of ceftaroline. Ceftaroline duration of therapy ranged from 4 to 28 days. Three pts pursued palliative care prior to completion of therapy and expired off antibiotics. Of the remaining seven pts, six pts were considered to have clinical cure or improvement either at the end of therapy with ceftaroline or total antibiotic treatment. One pt had a relapse 1 week after ceftaroline treatment. CONCLUSIONS This case series suggests the potential of ceftaroline as an alternative agent for the treatment of MRSA NP and warrants further investigation.
Collapse
|
19
|
Lee MK, Kim SH, Yong SJ, Shin KC, Park HC, Choi J, Choi YS, Seong JH, Jung YR, Lee WY. Clinical and microbiological features of patients admitted to the intensive care unit with nursing and healthcare-associated pneumonia. J Int Med Res 2015; 43:236-49. [PMID: 25563575 DOI: 10.1177/0300060514551188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate clinical and microbiological features in patients with nursing and healthcare-associated pneumonia (NHCAP), admitted to the intensive care unit (ICU). METHODS Demographic, clinical and microbiological data were retrospectively reviewed from patients with NHCAP admitted to a respiratory ICU. Patients were categorized into one of four NHCAP groups: (A) residence in a long-term nursing-home setting or healthcare home; (B) hospital discharge in the preceding 90 days; (C) elderly or physically disabled patients who stay at home but require healthcare; (D) continuously receiving outpatient endovascular therapy including chronic dialysis, anticancer drugs, and immunosuppressants. Pneumonia severity index (PSI), CURB-65, duration of ICU stay and 30-day mortality were evaluated. RESULTS Out of 428 patients reviewed (male, 67.1%; mean age, 71.2 ± 11.9 years), 30-day mortality was 25.5%, and duration of ICU stay was 13.8 ± 13.3 days. Mortality rate was not significantly different between the four NHCAP groups; duration of ICU stay was significantly longer in groups C and D. PSI score, serum HCO3(-) level, duration of ICU stay, extended spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and multidrug resistant (MDR) Acinetobacter baumannii were significantly associated with 30-day mortality. CONCLUSION ESBL-producing K. pneumoniae, MDR A. baumannii and PSI score should be considered in ICU patients with NHCAP.
Collapse
Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Suk Joong Yong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Kye Chul Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hyeon Cheol Park
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jiwon Choi
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yeun Seoung Choi
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Ho Seong
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ye-Ryung Jung
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| |
Collapse
|
20
|
Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2015; 28:249-60. [PMID: 17326014 DOI: 10.1086/512261] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
Collapse
Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Shurland S, Zhan M, Bradham DD, Roghmann MC. Comparison of Mortality Risk Associated With Bacteremia Due to Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2015; 28:273-9. [PMID: 17326017 DOI: 10.1086/512627] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 02/27/2006] [Indexed: 01/28/2023]
Abstract
Objective.To quantify the clinical impact of methicillin-resistance in Staphylococcus aureus causing infection complicated by bacteremia in adult patients, while controlling for the severity of patients' underlying illnesses.Design.Retrospective cohort study from October 1, 1995, through December 31, 2003.Patients and Setting.A total of 438 patients with S. aureus infection complicated by bacteremia from a single Veterans Affairs healthcare system.Results.We found that 193 (44%) of the 438 patients had methicillin-resistant S. aureus (MRSA) infection and 114 (26%) died of causes attributable to S. aureus infection within 90 days after the infection was identified. Patients with MRSA infection had a higher mortality risk, compared with patients with methicillin-susceptible S. aureus (MSSA) infections (relative risk, 1.7 [95% confidence interval, 1.3-2.4]; P < .01), except for patients with pneumonia (relative risk, 0.7 [95% confidence interval, 0.4-1.3]). Patients with MRSA infections were significantly older (P < .01), had more underlying diseases (P = .02), and were more likely to have severe sepsis in response to their infection (P < .01) compared with patients with MSSA bacteremia. Patients who died within 90 days after S. aureus infection was identified were significantly older (P < .01) and more likely to have severe sepsis (P < .01) and pneumonia (P = .01), compared with patients who survived. After adjusting for age as a confounder, comorbidities, and pneumonia as an effect modifier, S. aureus infection-related mortality remained significantly higher in patients with MRSA infection than in those with MSSA infection, among those without pneumonia (hazard ratio, 1.8 [95% confidence interval, 1.2-3.0]); P < .01.Conclusions.The results of this study suggest that patients with MRSA infections other than pneumonia have a higher mortality risk than patients with MSSA infections other than pneumonia, independent of the severity of patients' underlying illnesses.
Collapse
Affiliation(s)
- Simone Shurland
- Department of Epidemiology and Preventive Medicine, Division of Health Outcomes Research, University of Maryland, School of Medicine, Baltimore, MD 21201, USA.
| | | | | | | |
Collapse
|
22
|
Nelson RE, Stevens VW, Jones M, Samore MH, Rubin MA. Health care-associated methicillin-resistant Staphylococcus aureus infections increases the risk of postdischarge mortality. Am J Infect Control 2015; 43:38-43. [PMID: 25564122 DOI: 10.1016/j.ajic.2014.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although many studies have estimated the impact of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) infections on mortality during initial hospitalization, little is known about the long-term risk of death in these patients. The purpose of this study was to quantify the effect of MRSA health care-acquired infections (HAIs) on mortality after hospital discharge. METHODS Our study cohort consisted of patients with inpatient admission within the U.S. Department of Veterans Affairs system between October 1, 2007, and September 30, 2010. Of these patients, we identified those with a positive MRSA culture from electronic microbiology reports. We constructed multivariable Cox proportional hazards regressions to assess the impact of a positive culture on postdischarge mortality in the 365 days following discharge using both the full cohort and a propensity score-matched subsample. RESULTS In our analysis cohort of 369,743 inpatients, positive MRSA cultures were recorded in 3,599 (1.0%) patients. We found that positive cultures resulted in an increased risk of postdischarge mortality both in the full cohort (hazard ratio = 1.42, P < .001) and in the subset of propensity score-matched patients (hazard ratio = 1.37, P < .0001). CONCLUSION We found that MRSA HAIs significantly elevate the long-term risk of mortality. These results underscore the importance of infection prevention efforts in the hospital.
Collapse
Affiliation(s)
- Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Health System, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
| | - Vanessa W Stevens
- IDEAS Center, Veterans Affairs Salt Lake City Health System, Salt Lake City, UT; Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT
| | - Makoto Jones
- IDEAS Center, Veterans Affairs Salt Lake City Health System, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew H Samore
- IDEAS Center, Veterans Affairs Salt Lake City Health System, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Michael A Rubin
- IDEAS Center, Veterans Affairs Salt Lake City Health System, Salt Lake City, UT; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
23
|
Affiliation(s)
- Younghee Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
24
|
Stryjewski ME, Corey GR. Methicillin-resistant Staphylococcus aureus: an evolving pathogen. Clin Infect Dis 2014; 58 Suppl 1:S10-9. [PMID: 24343827 DOI: 10.1093/cid/cit613] [Citation(s) in RCA: 223] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The horizontal transmission of methicillin resistance to Staphylococcus aureus (MRSA) in hospital and community settings, and growing prevalence of these strains, presents a significant clinical challenge to the management of serious infections worldwide. While infection control initiatives have stemmed the rising prevalence, MRSA remains a significant pathogen. More recently, evidence that MRSA is becoming resistant to glycopeptides and newer therapies raises concern about the use of these therapies in clinical practice. Vancomycin resistance has become evident in select clinical settings through rising MICs, growing awareness of heteroresistance, and emergence of intermediate-resistant and fully resistant strains. While resistance to linezolid and daptomycin remains low overall, point mutations leading to resistance have been described for linezolid, and horizontal transmission of cfr-mediated resistance to linezolid has been reported in clinical isolates. These resistance trends for newer therapies highlight the ongoing need for new and more potent antimicrobial therapies.
Collapse
Affiliation(s)
- Martin E Stryjewski
- Department of Medicine and Division of Infectious Diseases, Centro de Educación Médica e Investigaciones Clínicas "Norberto Quirno" (CEMIC), Buenos Aires, Argentina
| | | |
Collapse
|
25
|
Seligman R, Ramos-Lima LF, Oliveira VDA, Sanvicente C, Sartori J, Pacheco EF. Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia. J Bras Pneumol 2014; 39:339-48. [PMID: 23857697 PMCID: PMC4075848 DOI: 10.1590/s1806-37132013000300011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 03/14/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.
Collapse
Affiliation(s)
- Renato Seligman
- Federal University of Rio Grande do Sul, School of Medicine, Department of Internal Medicine, Porto Alegre, Brazil.
| | | | | | | | | | | |
Collapse
|
26
|
Casapao AM, Davis SL, Barr VO, Klinker KP, Goff DA, Barber KE, Kaye KS, Mynatt RP, Molloy LM, Pogue JM, Rybak MJ. Large retrospective evaluation of the effectiveness and safety of ceftaroline fosamil therapy. Antimicrob Agents Chemother 2014; 58:2541-6. [PMID: 24550331 PMCID: PMC3993242 DOI: 10.1128/aac.02371-13] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/07/2014] [Indexed: 01/12/2023] Open
Abstract
Ceftaroline has been approved for acute bacterial skin infections and community-acquired bacterial pneumonia. Limited clinical experience exists for use outside these indications. The objective of this study was to describe the outcomes of patients treated with ceftaroline for various infections. Retrospective analyses of patients receiving ceftaroline ≥72 h from 2011 to 2013 were included. Clinical and microbiological outcomes were analyzed. Clinical success was defined as resolution of all signs and symptoms of infection with no further need for escalation while on ceftaroline treatment during hospitalization. A total of 527 patients received ceftaroline, and 67% were treated for off-label indications. Twenty-eight percent (148/527) of patients had bacteremia. Most patients (80%) were initiated on ceftaroline after receipt of another antimicrobial, with 48% citing disease progression as a reason for switching. The median duration of ceftaroline treatment was 6 days, with an interquartile range of 4 to 9 days. A total of 327 (62%) patients were culture positive, and the most prevalent pathogen was Staphylococcus aureus, with a frequency of 83% (271/327). Of these patients, 88.9% (241/271) were infected with methicillin-resistant S. aureus (MRSA). Clinically, 88% (426/484) achieved clinical success and hospital mortality was seen in 8% (40/527). While on ceftaroline, adverse events were experienced in 8% (41/527) of the patients and 9% (28/307) were readmitted within 30 days after discharge for the same infection. Patients treated with ceftaroline for both FDA-approved and off-label infections had favorable outcomes. Further research is necessary to further describe the role of ceftaroline in a variety of infections and its impact on patient outcomes.
Collapse
Affiliation(s)
- Anthony M. Casapao
- Anti-Infective Research Laboratory, Pharmacy Practice Department, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Susan L. Davis
- Anti-Infective Research Laboratory, Pharmacy Practice Department, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan, USA
| | - Viktorija O. Barr
- Department of Pharmacy Services, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Kenneth P. Klinker
- Department of Pharmacy Services, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Debra A. Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
- Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, Ohio, USA
| | - Katie E. Barber
- Anti-Infective Research Laboratory, Pharmacy Practice Department, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Keith S. Kaye
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Infection Prevention, Hospital Epidemiology and Antimicrobial Stewardship, Detroit Medical Center, Detroit, Michigan, USA
| | - Ryan P. Mynatt
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Leah M. Molloy
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Jason M. Pogue
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Michael J. Rybak
- Anti-Infective Research Laboratory, Pharmacy Practice Department, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan, USA
| |
Collapse
|
27
|
Ohlsen K. Novel antibiotics for the treatment ofStaphylococcus aureus. Expert Rev Clin Pharmacol 2014; 2:661-72. [DOI: 10.1586/ecp.09.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
28
|
M R, D'Souza M, Kotigadde S, Saralaya K V, Kotian M S. Prevalence of Methicillin Resistant Staphylococcus aureus Carriage amongst Health Care Workers of Critical Care Units in Kasturba Medical College Hospital, Mangalore, India. J Clin Diagn Res 2013; 7:2697-700. [PMID: 24551616 DOI: 10.7860/jcdr/2013/5160.3735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 10/18/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Outbreaks and prevalence of Methicillin resistant Staphylococcus aureus (MRSA) Nosocomial Infection (NI) among various populations have been well reported in literature, particularly those from developed countries. There is a paucity of information on carriage of MRSA in developing nations, including the carriage by critical healthcare givers who are potential transmitters. AIM AND OBJECTIVES Present study was aimed at establishing the carriage rate of MRSA among healthcare workers in the critical care units of Kasturba Medical College Hospital, Mangalore, India and at formulating an MRSA control policy, based on the outcomes. MATERIAL AND METHODS We screened 200 healthcare workers in the critical care units of the Kasturba Medical College Hospital, Mangalore, India, for MRSA and vancomycin susceptibility of the isolates. Swabs taken from both anterior nares were transported, inoculated onto mannitol salt agar (MSA) and incubated aerobically at 37°C for 18-24 hours. Gram positive cocci in clusters, with positive catalase, coagulase and DNAse tests, were identified as S.aureus. Further categorization of S.aureus into MRSA was done by using cefoxitin disc diffusion method. Sensitivity to vancomycin was tested by vancomycin disc diffusion and vancomycin agar screen plating. RESULTS The number of strains of S. aureus which was isolated from our 200 participants was 35, with a rate of 17.5% of the 35 isolates of S. aureus, 5 (14.3%) were MRSA. None of the S. aureus strains were vancomycin resistant. CONCLUSION MRSA carriage among healthcare workers who were involved in the management of critically ill patients at Kasturba Medical College hospital, Mangalore, India was 2.5%, which is comfortably low. The existing infection control policy in our hospital seems to be effective and the same should be maintained.
Collapse
Affiliation(s)
- Radhakrishna M
- Associate Professor, Department of Microbiology, KMC , Mangalore, India
| | - Monalisa D'Souza
- Final Year MBBS Student, Department of Microbiology, KMC Mangalore, India
| | | | | | - Shashidar Kotian M
- Assistant Professor, Department of Community Medicine, KMC , Mangalore, India
| |
Collapse
|
29
|
Exploring extra-cellular proteins in methicillin susceptible and methicillin resistant Staphylococcus aureus by liquid chromatography-tandem mass spectrometry. World J Microbiol Biotechnol 2013; 30:1269-83. [PMID: 24214678 DOI: 10.1007/s11274-013-1550-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/30/2013] [Indexed: 01/06/2023]
Abstract
Staphylococcus aureus (S. aureus) strains cause several diseases in humans from minor skin infections to severe lethal infections. To explore the virulence determinants of this important microorganism, two clinical isolates of methicillin susceptible S. aureus (MSSA) and methicillin resistant S. aureus (MRSA) were subjected to proteomic analysis of their extracellular products using liquid chromatography-tandem mass spectrometry. The numbers of proteins identified in MSSA and MRSA extracellular products were 168 and 261; respectively, from them 117 were shared, while 144 proteins were unique to MRSA. The shared proteins, having a higher protein score with increased number of peptide matches in MRSA over MSSA, reflect the relatively active secretory state of MRSA rather than biased analytical variances. Characteristic determinants for MRSA were identified; mostly found to play a role in the virulence. We conclude that MRSA produces distinct proteins considered as its virulence determinants and we found that the shared extracellular products are more abundant in MRSA than MSSA that supporting the high invasiveness of MRSA over MSSA in pathogenesis.
Collapse
|
30
|
Baraboutis IG, Tsagalou EP, Papakonstantinou I, Marangos MN, Gogos C, Skoutelis AT, Bassaris H, Johnson S. Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study. Braz J Infect Dis 2012; 15:426-35. [PMID: 22230848 DOI: 10.1016/s1413-8670(11)70223-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/16/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Both total antimicrobial use and specific antimicrobials have been implicated as risk factors for healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA) infection. The aims of this study were: (I) to explore predictors of a new HCA-MRSA infection in comparison with a new healthcare-associated methicillin-sensitive Staphylococcus aureus (HCA-MSSA); (II) to thoroughly assess the role of recent antibiotic use qualitatively and quantitatively. METHODS The time-period for our study was from October 1997 through September 2001. Through applying strict criteria, we identified two groups of inpatients, one with a new HCA-MRSA infection and one with a new HCA-MSSA infection. We recorded demographic, clinical and antibiotic use-related data up to 30 days before the positive culture date. RESULTS We identified 127 and 70 patients for each group, respectively. Two logistic regression models were carried out to assess the role of antimicrobial use (qualitatively and quantitatively). In model I, duration of hospital stay, presence of chronic wounds, aminoglycoside and fluoroquinolone use retained statistical significance. In model II, duration of hospital stay and history of intubation during the last month stood out as the only significant predictors of a subsequent HCA-MRSA infection. No significant differences in outcome were noted. CONCLUSIONS The length of exposure to the hospital environment may be the best predictor of a new HCA-MRSA infection. Use of aminoglycosides and fluoroquinolones may also stand independently along with presence of chronic ulcers and surgical procedures. No independent association between quantitative antibiotic use and subsequent HCA-MRSA infection was documented.
Collapse
Affiliation(s)
- Ioannis G Baraboutis
- Infectious Diseases and HIV Division, Evangelismos General Hospital, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Staphylococcus aureus résistant à la méticilline en réanimation. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0497-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Bouza E, Giannella M, Bunsow E, Torres MV, Granda MJP, Martín-Rabadán P, Muñoz P. Ventilator-associated pneumonia due to meticillin-resistant Staphylococcus aureus: risk factors and outcome in a large general hospital. J Hosp Infect 2012; 80:150-5. [PMID: 22226126 DOI: 10.1016/j.jhin.2011.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 11/08/2011] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data about risk factors and impact on outcome of methicillin-resistant S. aureus (MRSA) in unselected patients with ventilator-associated pneumonia (VAP) are limited. AIM To assess predisposing factors and outcome of VAP due to MRSA in a large teaching institution. METHODS Prospective study carried out over four years in the three adult ICUs of our hospital. Patients with MRSA-VAP were compared with those with bacterial VAP due to other microorganisms. FINDINGS Overall, 474 episodes of bacterial VAP were collected. Significant differences between MRSA-VAP (111) and VAP due to other microorganisms (363) were found for median age (68 vs. 62 years), median APACHE II score (12 vs. 11), neurosurgery (5.4% vs. 13.8%), abdominal surgery (35% vs. 19%), prior treatment with any antibiotic (82.9% vs. 64.5%) and with imipenem (24% vs. 11%) at present admission before VAP, and pleural effusion (12% vs. 5%). Multivariate analysis adjusted for confounding factors showed that higher APACHE II score, prior treatment with any antibiotic and pleural effusion were independent risk factors for MRSA. As for treatment and outcome, the differences between MRSA-VAP and other VAP were inadequate empiric treatment (70% vs. 53%), median cost of antibiotics per episode (€974 vs. €726), and in-hospital mortality (60% vs. 47%). At multivariate analysis, however, MRSA was not found to be an independent risk factor for mortality. CONCLUSION MRSA is a common cause of VAP. Underlying conditions predispose to its high mortality.
Collapse
Affiliation(s)
- E Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
33
|
Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med 2011; 39:1886-95. [PMID: 21516036 DOI: 10.1097/ccm.0b013e31821b827c] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES We evaluated the respective influence of the causative pathogen and infection site on hospital mortality from severe sepsis related to community-, hospital-, and intensive care unit-acquired infections. DESIGN We used a prospective observational cohort 10-yr database. We built a subdistribution hazards model with corrections for competing risks and adjustment for potential confounders including early appropriate antimicrobial therapy. SETTING Twelve intensive care units. PATIENTS We included 4,006 first episodes of acquisition-site-specific severe sepsis in 3,588 patients. INTEVENTIONS: None. MEASUREMENTS AND MAIN RESULTS We included 1562 community-acquired, 1432 hospital-acquired, and 1012 intensive care unit-acquired episodes of severe sepsis. After adjustment, we found no independent associations of the causative organism, multidrug resistance of the causative organism, infection site, or presence of bacteremia with mortality. Early appropriate antimicrobial therapy was consistently associated with better survival in the community-acquired (0.64 [0.51-0.8], p = .0001), hospital-acquired (0.72 [0.58-0.88], p = .0011), and intensive care unit-acquired (0.79 [0.64-0.97], p = .0272) groups. CONCLUSION The infectious process may not exert as strong a prognostic effect when severity, organ dysfunction and, above all, appropriateness of early antimicrobials are taken into account. Our findings emphasize the importance of developing valid recommendations for early antimicrobial therapy.
Collapse
|
34
|
Are we doing enough to prevent methicillin-resistant Staphylococcus aureus outbreaks? Pediatr Crit Care Med 2011; 12:479-80. [PMID: 21799315 DOI: 10.1097/pcc.0b013e3181fe2a76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
35
|
Kaminski C, Timsit JF, Dubois Y, Zahar JR, Garrouste-Orgeas M, Vesin A, Azoulay E, Feger C, Dumenil AS, Adrie C, Cohen Y, Allaouchiche B. Impact of ureido/carboxypenicillin resistance on the prognosis of ventilator-associated pneumonia due to Pseudomonas aeruginosa. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R112. [PMID: 21481266 PMCID: PMC3219393 DOI: 10.1186/cc10136] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 03/18/2011] [Accepted: 04/11/2011] [Indexed: 01/07/2023]
Abstract
Introduction Although Pseudomonas aeruginosa is a leading pathogen responsible for ventilator-associated pneumonia (VAP), the excess in mortality associated with multi-resistance in patients with P. aeruginosa VAP (PA-VAP), taking into account confounders such as treatment adequacy and prior length of stay in the ICU, has not yet been adequately estimated. Methods A total of 223 episodes of PA-VAP recorded into the Outcomerea database were evaluated. Patients with ureido/carboxy-resistant P. aeruginosa (PRPA) were compared with those with ureido/carboxy-sensitive P. aeruginosa (PSPA) after matching on duration of ICU stay at VAP onset and adjustment for confounders. Results Factors associated with onset of PRPA-VAP were as follows: admission to the ICU with septic shock, broad-spectrum antimicrobials at admission, prior use of ureido/carboxypenicillin, and colonization with PRPA before infection. Adequate antimicrobial therapy was more often delayed in the PRPA group. The crude ICU mortality rate and the hospital mortality rate were not different between the PRPA and the PSPA groups. In multivariate analysis, after controlling for time in the ICU before VAP diagnosis, neither ICU death (odds ratio (OR) = 0.73; 95% confidence interval (CI): 0.32 to 1.69; P = 0.46) nor hospital death (OR = 0.87; 95% CI: 0.38 to 1.99; P = 0.74) were increased in the presence of PRPA infection. This result remained unchanged in the subgroup of 87 patients who received adequate antimicrobial treatment on the day of VAP diagnosis. Conclusions After adjustment, and despite the more frequent delay in the initiation of an adequate antimicrobial therapy in these patients, resistance to ureido/carboxypenicillin was not associated with ICU or hospital death in patients with PA-VAP.
Collapse
Affiliation(s)
- Catherine Kaminski
- Surgical ICU, Hôpital Edouard Herriot, 5 place d'Arsonval, Lyon 69437, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Textoris J, Wiramus S, Martin C, Leone M. Overview of antimicrobial therapy in intensive care units. Expert Rev Anti Infect Ther 2011; 9:97-109. [PMID: 21171881 DOI: 10.1586/eri.10.147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the management of a patient with severe sepsis, it is important to suspect the infection early, to collect samples immediately after diagnosis and to promptly initiate a broad-spectrum antibiotic treatment. The choice of this empirical antimicrobial therapy should be based on host characteristics, site of infection, local ecology and pharmacokinetics/pharmacodynamics of antibiotics. In severe infection, guidelines recommend the use of a combination of antibiotics. After results of cultures are obtained, treatment should be re-evaluated to either de-escalate or escalate the antibiotic prescription. This is associated with optimal costs, decreased incidence of superinfection and minimal development of antimicrobial resistance. All these steps should rely on written protocols, and the compliance to these protocols should be continuously monitored in order to detect violations and implement corrective procedures.
Collapse
Affiliation(s)
- Julien Textoris
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France
| | | | | | | |
Collapse
|
37
|
Meyer E, Schwab F, Gastmeier P. Nosocomial methicillin resistant Staphylococcus aureus pneumonia - epidemiology and trends based on data of a network of 586 German ICUs (2005-2009). Eur J Med Res 2011; 15:514-24. [PMID: 21163726 PMCID: PMC3352100 DOI: 10.1186/2047-783x-15-12-514] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The epidemiology of MRSA pneumonia varies across countries. One of the most import risk factors for the development of nosocomial MRSA pneumonia is mechanical ventilation. Methicillin resistance in S. aureus ventilator associated pneumonia (VAP) ranged between 37% in German, 54% in the US American and 78% in Asian and Latin American ICUs. In 2009, the incidence density of nosocomial VAP caused by MRSA was 0.28 per 1000 ventilation days in a network of 586 German ICUs. Incidences peaked in neurological and neurosurgical ICUs. Crude hospital mortality in studies performed after 2005 lay between 27% and 59% and attributable MRSA pneumonia mortality at 40%. Since 2005, US American and German data indicate decreasing trends for MRSA pneumonia. Measures to reduce MRSA pneumonia or to control the spread of MRSA include hand hygiene, standard and contact precautions, oral contamination with chlor hexidine, skin decontamination with antiseptics, screening, and (possibly) patient isolation in a single room.
Collapse
Affiliation(s)
- Elisabeth Meyer
- Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
| | | | | |
Collapse
|
38
|
Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, J Rybak M, Talan DA, Chambers HF. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011; 52:e18-55. [PMID: 21208910 DOI: 10.1093/cid/ciq146] [Citation(s) in RCA: 1870] [Impact Index Per Article: 143.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
Collapse
Affiliation(s)
- Catherine Liu
- Department of Medicine, Division of Infectious Diseases, University of California-San Francisco, San Francisco, California94102, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Lambert ML, Suetens C, Savey A, Palomar M, Hiesmayr M, Morales I, Agodi A, Frank U, Mertens K, Schumacher M, Wolkewitz M. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. THE LANCET. INFECTIOUS DISEASES 2010; 11:30-8. [PMID: 21126917 DOI: 10.1016/s1473-3099(10)70258-9] [Citation(s) in RCA: 252] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensive-care units from bloodstream infections and pneumonia. METHODS We analysed data collected prospectively from intensive-care units that reported according to the European standard protocol for surveillance of health-care-associated infections. We focused on the most frequent causative microorganisms. Resistance was defined as resistance to ceftazidime (Acinetobacter baumannii or Pseudomonas aeruginosa), third-generation cephalosporins (Escherichia coli), and oxacillin (Staphylococcus aureus). We defined 20 different exposures according to infection site, microorganism, and resistance status. For every exposure, we compared outcomes between patients exposed and unexposed by use of time-dependent regression modelling. We adjusted results for patients' characteristics and time-dependency of the exposure. FINDINGS We obtained data for 119 699 patients who were admitted for more than 2 days to 537 intensive-care units in ten countries between Jan 1, 2005, and Dec 31, 2008. Excess risk of death (hazard ratio) for pneumonia in the fully adjusted model ranged from 1·7 (95% CI 1·4-1·9) for drug-sensitive S aureus to 3·5 (2·9-4·2) for drug-resistant P aeruginosa. For bloodstream infections, the excess risk ranged from 2·1 (1·6-2·6) for drug-sensitive S aureus to 4·0 (2·7-5·8) for drug-resistant P aeruginosa. Risk of death associated with antimicrobial resistance (ie, additional risk of death to that of the infection) was 1·2 (1·1-1·4) for pneumonia and 1·2 (0·9-1·5) for bloodstream infections for a combination of all four microorganisms, and was highest for S aureus (pneumonia 1·3 [1·0-1·6], bloodstream infections 1·6 [1·1-2·3]). Antimicrobial resistance did not significantly increase length of stay; the hazard ratio for discharge, dead or alive, for sensitive microorganisms compared with resistant microorganisms (all four combined) was 1·05 (0·97-1·13) for pneumonia and 1·02 (0·98-1·17) for bloodstream infections. P aeruginosa had the highest burden of health-care-acquired infections because of its high prevalence and pathogenicity of both its drug-sensitive and drug-resistant strains. INTERPRETATION Health-care-associated bloodstream infections and pneumonia greatly increase mortality and pneumonia increase length of stay in intensive-care units; the additional effect of the most common antimicrobial resistance patterns is comparatively low. FUNDING European Commission (DG Sanco).
Collapse
Affiliation(s)
- Marie-Laurence Lambert
- Public Health and Surveillance Department, Scientific Institute for Public Health, Brussels, Belgium.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Taneja C, Haque N, Oster G, Shorr AF, Zilber S, Kyan PO, Reyes KC, Moore C, Spalding J, Kothari S, Zervos M. Clinical and economic outcomes in patients with community-acquired Staphylococcus aureus pneumonia. J Hosp Med 2010; 5:528-34. [PMID: 20734457 DOI: 10.1002/jhm.704] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 02/03/2010] [Accepted: 03/07/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND While the clinical and economic consequences of S. aureus pneumonia in healthcare settings have been well documented, much less is known about community-acquired S. aureus pneumonia (CAP). METHODS We retrospectively identified all patients admitted to a large US urban teaching hospital between January 2005 and May 2008 with pneumonia and positive blood or respiratory cultures for S. aureus within 48 hours of admission. Patients with suspected healthcare-associated pneumonia (HCAP) were excluded from the study sample, using established criteria (eg, recent hospitalization, admission from nursing home, hemodialysis). Patients were designated as having methicillin-resistant (MRSA) or methicillin-susceptible (MSSA) CAP based on initial S. aureus isolates. Initial therapy was designated "appropriate" vs. "inappropriate" based on expected susceptibility of the organism to the regimen received. RESULTS We identified a total of 128 CAP patients with S. aureus isolates; mean (standard deviation [SD]) age was 60 (17) years. A total of 55 patients (43%) had initial cultures positive for MRSA. Patients with MRSA CAP were more likely to receive inappropriate initial therapy (24 [44%] vs. 13 [18%] for MSSA; P = 0.002). Approximately 25% of all patients underwent surgery for pneumonia, 69% received mechanical ventilation, 79% were admitted to intensive care unit (ICU), and 24% died in hospital. Mean (SD) length of stay was 17.0 (15.7) days, and total hospital charges averaged $127,922 ($154,605) per patient; there were no significant differences between patients with MRSA vs. MSSA CAP. CONCLUSION Outcomes are poor, hospital stays are long, and costs of care are high in patients with S. aureus CAP, and do not differ between those with MRSA vs. MSSA.
Collapse
Affiliation(s)
- Charu Taneja
- Policy Analysis Inc., Brookline, Massachusetts 02445, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Abstract
Multidrug-resistant bacteria have emerged as an increasing threat in many areas of medicine. The most prominent multidrug-resistant pathogens are methicillin-resistant S. aureus (MRSA), vancomycin-resistant MRSA (VMRSA), vancomycin-resistant enterococci (VRE), and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL). In particular, MRSA and VRE cause infections seen in ophthalmology. The lids, lacrimal duct, and ocular surface are frequently involved.
Collapse
Affiliation(s)
- T Ness
- Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106 Freiburg.
| |
Collapse
|
42
|
Consensus document on controversial issues for the treatment of hospital-associated pneumonia. Int J Infect Dis 2010; 14 Suppl 4:S55-65. [DOI: 10.1016/j.ijid.2010.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
43
|
Ippolito G, Leone S, Lauria FN, Nicastri E, Wenzel RP. Methicillin-resistant Staphylococcus aureus: the superbug. Int J Infect Dis 2010; 14 Suppl 4:S7-11. [PMID: 20851011 DOI: 10.1016/j.ijid.2010.05.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Over the last decade, methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as serious pathogens in the nosocomial and community setting. Hospitalization costs associated with MRSA infections are substantially greater than those associated with methicillin-sensitive S. aureus (MSSA) infections, and MRSA has wider economic effects that involve indirect costs to the patient and to society. In addition, there is some evidence suggesting that MRSA infections increase morbidity and the risk of mortality. Glycopeptides are the backbone antibiotics for the treatment of MRSA infections. However, several recent reports have highlighted the limitations of vancomycin, and its role in the management of serious infections is now being reconsidered. Several new antimicrobials demonstrate in vitro activity against MRSA and other Gram-positive bacteria. Data from large surveys indicate that linezolid, daptomycin, and tigecycline are almost universally active against MRSA. This review will briefly discuss the epidemiology, costs, outcome, and therapeutic options for the management of MRSA infections.
Collapse
Affiliation(s)
- Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Via Portuense 293, 00149 Rome, Italy.
| | | | | | | | | |
Collapse
|
44
|
Patterns of Early and Late Ventilator-Associated Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Trauma Population. ACTA ACUST UNITED AC 2010; 69:519-22. [DOI: 10.1097/ta.0b013e3181c4521c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
45
|
Reed RL. Recurrent Ventilator-Associated Pneumonias: The Gift That Keeps on Giving or the Guest Who Won't Leave? Surg Infect (Larchmt) 2010; 11:319-24. [DOI: 10.1089/sur.2010.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- R. Lawrence Reed
- Department of Surgery, Indiana University, and Division of Trauma Services, Clarian Methodist Hospital Indianapolis, Indiana
| |
Collapse
|
46
|
|
47
|
Epidemiología e impacto de las infecciones nosocomiales. Med Intensiva 2010; 34:256-67. [DOI: 10.1016/j.medin.2009.11.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 11/22/2009] [Indexed: 11/22/2022]
|
48
|
Nguile-Makao M, Zahar JR, Français A, Tabah A, Garrouste-Orgeas M, Allaouchiche B, Goldgran-Toledano D, Azoulay E, Adrie C, Jamali S, Clec'h C, Souweine B, Timsit JF. Attributable mortality of ventilator-associated pneumonia: respective impact of main characteristics at ICU admission and VAP onset using conditional logistic regression and multi-state models. Intensive Care Med 2010; 36:781-9. [PMID: 20232046 DOI: 10.1007/s00134-010-1824-6] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 01/13/2010] [Indexed: 01/01/2023]
Abstract
PURPOSE Methods for estimating the excess mortality attributable to ventilator-associated pneumonia (VAP) should handle VAP as a time-dependent covariate, since the probability of experiencing VAP increases with the time on mechanical ventilation. VAP-attributable mortality (VAP-AM) varies with definitions, case-mix, causative microorganisms, and treatment adequacy. Our objectives here were to compare VAP-AM estimates obtained using a traditional cohort analysis, a multistate progressive disability model, and a matched-cohort analysis; and to compare VAP-AM estimates according to VAP characteristics. METHODS We used data from 2,873 mechanically ventilated patients in the Outcomerea database. Among these patients from 12 intensive care units, 434 (15.1%) experienced VAP; of the remaining patients, 1,969 (68.5%) were discharged alive and 470 (16.4%) died. With the multistate model, VAP-AM was 8.1% (95% confidence interval [95%CI], 3.1-13.1%) for 120 days' complete observation, compared to 10.4% (5.6-24.5%) using a matched-cohort approach (2,769 patients) with matching on mechanical ventilation duration followed by conditional logistic regression. VAP-AM was higher in surgical patients and patients with intermediate (but not high) Simplified Acute Physiologic Score II values at ICU admission. VAP-AM was significantly influenced by time to VAP but not by resistance of causative microorganisms. Higher Logistic Organ Dysfunction score at VAP onset dramatically increased VAP-AM (to 31.9% in patients with scores above 7). CONCLUSION A multistate model that appropriately handled VAP as a time-dependent event produced lower VAP-AM values than conditional logistic regression. VAP-AM varied widely with case-mix. Disease severity at VAP onset markedly influenced VAP-AM; this may contribute to the variability of previous estimates.
Collapse
|
49
|
|
50
|
Ness T, Schneider C. Endogenous endophthalmitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Retina 2009; 29:831-4. [PMID: 19516121 DOI: 10.1097/iae.0b013e3181a3b7a1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To report clinical features, diagnostic features, and outcome in three patients presenting with fulminant endogenous endophthalmitis caused by methicillin-resistant Staphylococcus aureus. METHODS Retrospective review of clinical data and microbiological findings in three cases. RESULTS All three patients had predisposing conditions for endogenous endophthalmitis (B-cell lymphoma, diabetes mellitus, steroid therapy, or gastrointestinal symptoms, such as vomiting and diarrhea). Two patients were colonized by methicillin-resistant Staphylococcus aureus in typical sites (nose, groin, throat, and conjunctiva), whereas one patient who developed phlebitis at the infusion puncture site followed by bacteremia presented no typical colonization. Despite adequate therapy, two patients lost visual function in the infected eye, one of which had to be enucleated. The other patient's eye regained adequate function. CONCLUSION Endogenous endophthalmitis by methicillin-resistant Staphylococcus aureus is a rare but serious condition. Early and specific therapy based on reliable detection of the underlying microorganism may help in preventing loss of visual function.
Collapse
|