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Kouijzer IJE, Fowler VG, Ten Oever J. Redefining Staphylococcus aureus bacteremia: A structured approach guiding diagnostic and therapeutic management. J Infect 2023; 86:9-13. [PMID: 36370898 PMCID: PMC11105116 DOI: 10.1016/j.jinf.2022.10.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/20/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Abstract
The current duration of therapy in patients with Staphylococcus aureus bacteremia (SAB) is based on differentiating complicated from uncomplicated disease. While this approach allows clinicians and investigators to group SAB patients into broadly similar clinical categories, it fails to account for the intrinsic heterogeneity of SAB. This is due in part to the fact that risk factors for metastatic infection and confirmed metastatic infection are considered as equivalent in most scoring systems. In this viewpoint, we propose a two-step system of categorizing patients with SAB. Initially, patients with SAB would be categorized as 'high risk' or 'low risk' for metastatic infection based upon an initial set of diagnostic procedures. In the second step, patients identified as 'high-risk' would undergo additional diagnostic evaluation. The results of this stepwise diagnostic evaluation would define a 'final clinical diagnosis' to inform an individualized final treatment plan.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jaap Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands.
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Lindberg H, Löfström E, Rasmussen M. Risk stratification score screening for infective endocarditis in patients with Gram-positive bacteraemia. Infect Dis (Lond) 2022; 54:488-496. [DOI: 10.1080/23744235.2022.2049360] [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: 11/05/2022] Open
Affiliation(s)
- Helena Lindberg
- Department of Infectious Diseases, Hospital of Halland, Halmstad, Sweden
| | - Emma Löfström
- Department of Clinical Microbiology, Hospital of Halland, Halmstad, Sweden
| | - Magnus Rasmussen
- Division of Infection, Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Westgeest AC, Schippers EF, Delfos NM, Visser LG, de Fijter JW, de Boer MGJ, Lambregts MMC. Acute kidney injury in Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2022; 41:431-437. [PMID: 34993670 DOI: 10.1007/s10096-021-04391-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
Acute kidney injury (AKI) is a frequent complication in patients with Staphylococcus aureus bacteremia (SAB), with a significant impact on patient management and outcome. This study aimed to provide insight in the proportion of patients with SAB that develop AKI, the risk factors for developing AKI in this population, and its reversibility. In this retrospective, multicenter cohort study, adult patients with SAB were eligible for inclusion. Patient characteristics, clinical variables, and laboratory results were retrieved from the electronic patient files. Primary outcome was development of AKI, defined as 1.5 times baseline creatinine. Secondary outcomes were reversibility of AKI and risk factors for AKI. A total of 315 patients with SAB were included, of whom 115/315 (37%) developed acute kidney injury. In 68/115 (59%), the AKI was reversible. If kidney function recovered, this occurred within 7 days in 56/68 (82%) of patients. In multivariable logistic regression analyses, independent risk factors for AKI were as follows: complicated SAB, use of diuretics, and hemodynamic instability. Development of AKI was associated with 30-day mortality (OR 3.9; CI 2.2-6.9; p < 0.01). Acute kidney injury is a frequent complication in patients with Staphylococcus aureus bacteremia. Considering the irreversibility in a relevant proportion of patients, future research into the underlying pathophysiology and potential interventions is warranted.
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Affiliation(s)
- Annette C Westgeest
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), C5-P, P.O. box 9600, 2300 RC, Leiden, The Netherlands. .,Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands.
| | - Emile F Schippers
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), C5-P, P.O. box 9600, 2300 RC, Leiden, The Netherlands.,Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Nathalie M Delfos
- Department of Internal Medicine, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), C5-P, P.O. box 9600, 2300 RC, Leiden, The Netherlands
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mark G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), C5-P, P.O. box 9600, 2300 RC, Leiden, The Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center (LUMC), C5-P, P.O. box 9600, 2300 RC, Leiden, The Netherlands
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