Acute kidney injury in Staphylococcus aureus bacteremia

2022 ◽  
Author(s):  
Annette C. Westgeest ◽  
Emile F. Schippers ◽  
Nathalie M. Delfos ◽  
Leo G. Visser ◽  
Johan W. de Fijter ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Superantigens Are Critical for Staphylococcus aureus Infective Endocarditis, Sepsis, and Acute Kidney Injury

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Wilmara Salgado-Pabón ◽  
Laura Breshears ◽  
Adam R. Spaulding ◽  
Joseph A. Merriman ◽  
Christopher S. Stach ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Kidney Injury ◽  
The United States ◽  
Content Type ◽  
Lethal Sepsis ◽  
Control And Prevention ◽  
Bacterial Accumulation ◽  
High Level

ABSTRACTInfective endocarditis and kidney infections are serious complications ofStaphylococcus aureussepsis. We investigated the role of superantigens (SAgs) in the development of lethal sepsis, infective endocarditis, and kidney infections. SAgs cause toxic shock syndrome, but it is unclear if SAgs contribute to infective endocarditis and kidney infections secondary to sepsis. We show in the methicillin-resistantS. aureusstrain MW2 that lethal sepsis, infective endocarditis, and kidney infections in rabbits are critically dependent on high-level SAgs. In contrast, the isogenic strain lacking staphylococcal enterotoxin C (SEC), the major SAg in this strain, is attenuated in virulence, while complementation restores disease production. SAgs’ role in infective endocarditis appears to be both superantigenicity and direct endothelial cell stimulation. Maintenance of elevated blood pressure by fluid therapy significantly protects from infective endocarditis, possibly through preventing bacterial accumulation on valves and increased SAg elimination. These data should facilitate better methods to manage these serious illnesses.IMPORTANCEThe Centers for Disease Control and Prevention reported in 2007 thatStaphylococcus aureusis the most significant cause of serious infectious diseases in the United States (R. M. Klevens, M. A. Morrison, J. Nadle, S. Petit, K. Gershman, et al., JAMA 298:1763–1771, 2007). Among these infections are sepsis, infective endocarditis, and acute kidney injury. Infective endocarditis occurs in 30 to 60% of patients withS. aureusbacteremia and carries a mortality rate of 40 to 50%. Over the past decades, infective endocarditis outcomes have not improved, and infection rates are steadily increasing (D. H. Bor, S. Woolhandler, R. Nardin, J. Brusch, D. U. Himmelstein, PLoS One 8:e60033, 2013). There is little understanding of theS. aureusvirulence factors that are key for infective endocarditis development and kidney abscess formation. We demonstrate that superantigens are critical in the causation of all three infections. We show that their association results from both superantigenicity and direct toxic effects on endothelial cells, the latter likely contributing to delayed endothelium healing. Our studies contribute significantly to understanding the development of these illnesses and are expected to lead to development of important therapies to treat such illnesses.

scholarly journals Incidence and Risk Factors for Acute Kidney Injury during the Treatment of Methicillin-Sensitive Staphylococcus aureus Infections with Cloxacillin Based Antibiotic Regimens: A French Retrospective Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2603
Author(s):  
Romain Crochette ◽  
Camille Ravaiau ◽  
Lucia Perez ◽  
Jean-Philippe Coindre ◽  
Giorgina Barbara Piccoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Kidney Injury ◽  
Loop Diuretics ◽  
Inclusion Criteria ◽  
Medical Department ◽  
Factors Associated ◽  
Aureus Infection

Background: Cloxacillin has been associated with the occurrence of acute kidney injury (AKI). The incidence of this complication in the literature is low (2.5–3.5%) and probably underestimated, since most studies were done by selecting the presence of AKI in discharge codes. Objectives: The primary goal was to define the incidence of AKI in patients with a methicillin-sensitive Staphylococcus aureus infection treated with cloxacillin based antibiotic regimens. The secondary goals were to identify the risk factors associated with this complication and to describe the characteristics of AKI. Patients and methods: We carried out a retrospective study. The inclusion criteria were adult patients hospitalized in a medical department at the Le Mans Hospital between 1 July 2012 and 1 July 2019 with a diagnosis of methicillin-sensitive Staphylococcus aureus infection treated with cloxacillin. Results: One hundred twenty-three patients were included in the study. Forty-two patients (34.2%) developed AKI. In the multivariate analysis, age, the use of diuretics and the presence of endocarditis were independently associated with AKI. Age was associated with an OR of 4.38 (p = 0.002) for patients older than 75, being treated with diuretics was associated with an OR of 2.94 (p = 0.036) for loop diuretics and an OR of 3.05 (p = 0.027) for non-loop diuretics; type of infection was associated with an OR of 3.42 (p = 0.012) for endocarditis. Conclusions: The occurrence of AKI is frequent during cloxacillin based antibiotic regimens for methicillin-sensitive Staphylococcus aureus infections. Being older than 75, being treated with diuretics and the presence of endocarditis were the main risk factors for AKI in our population.

A 62-year-old man with a purpuric rash and acute kidney injury

2021 ◽  
Author(s):  
Marta Lorente-Ros ◽  
◽  
Shabari Mangalore Shenoy ◽  
Joseph P Matthew ◽  
◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Joint Pain ◽  
Kidney Injury ◽  
Type Ii Diabetes Mellitus ◽  
Source Control ◽  
Acute Glomerulonephritis ◽  
Diagnostic Challenge ◽  
Staphylococcus Aureus Bacteremia ◽  
The Right ◽  
Purpuric Rash

Staphylococcus aureus bacteremia can infrequently present as vasculitis or Acute Glomerulonephritis (AGN). The association between Staphylococcus aureus bacteremia and these immune-mediated responses is rare and remains a diagnostic challenge. We present a case of a 62-year-old man with hypertension, hyperlipidemia, and type II diabetes mellitus who presented with joint pain, hematuria and a purpuric rash in his legs and oral cavity after he dropped a bag of heavy metal on his right foot. He was found to have acute glomerulonephritis with rapidly progressing renal failure requiring emergent hemodialysis. At first, the presentation seemed to be of a rheumatologic origin and he was initially managed with methylprednisolone. However, further work-up revealed methicillin-sensitive Staphylococcus aureus bacteremia. The right toe was amputated for source control and the patient was treated with antibiotics. This case is, to our knowledge, the first reported clinical presentation of Staphylococcus aureus bacteremia manifesting as purpuric rash, glomerulonephritis, and joint pain. It highlights the importance of making an initial differential diagnosis between a rheumatologic and an infectious disorder, as initial suspicion would change initial management and prognosis.

scholarly journals Is Early Monitoring Better? Impact of Early Vancomycin Exposure on Treatment Outcomes and Nephrotoxicity in Patients with Methicillin-Resistant Staphylococcus aureus Infections

Antibiotics ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. 672 ◽  
Author(s):  
Thanawat Chattaweelarp ◽  
Dhitiwat Changpradub ◽  
Baralee Punyawudho ◽  
Sudaluck Thunyaharn ◽  
Wichai Santimaleeworagun
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Clinical Outcomes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Kidney Injury ◽  
Methicillin Resistant ◽  
Increased Risk ◽  
Broth Microdilution Method

Optimal early vancomycin target exposure remains controversial. To clarify the therapeutic exposure range, we investigated the association between vancomycin exposure and treatment outcomes or nephrotoxicity in patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. This retrospective study reviewed clinical data obtained from 131 patients with MRSA infections between January 2017 and September 2019. Clinical outcomes included treatment failure, 30-day mortality, microbiological failure, and acute kidney injury. We measured serum vancomycin levels after the first dose to 48 h and estimated vancomycin exposure using the Bayesian theorem. The minimum inhibitory concentration (MIC) of antimicrobial agents was determined using the broth microdilution method. Classification and Regression Tree analyses identified day 1 and 2 exposure thresholds associated with an increased risk of failure and nephrotoxicity. Treatment failure (27.9% vs. 33.3%) and 30-day mortality (26.6% vs. 31.74%) were numerically but not significantly reduced in patients with the area under the curve (AUC)24–48h/MICBMD ≥ 698. Patients with AUCss/MICBMD ≥ 679 exhibited a significantly increased risk of acute kidney injury (27.9% vs. 10.9%, p = 0.041). These findings indicate that AUCss/MICBMD ratios > 600 may cause nephrotoxicity. AUC/MICBMD at days 1 and 2 do not appear to be significantly associated with particular clinical outcomes, but further studies are needed.

scholarly journals Vancomycin Exposure and Acute Kidney Injury Outcome: A Snapshot From the CAMERA2 Study

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Jiajun Liu ◽  
Steven Y C Tong ◽  
Joshua S Davis ◽  
Nathaniel J Rhodes ◽  
Marc H Scheetz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Randomized Clinical Trial ◽  
Therapeutic Range ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Kidney Injury ◽  
Methicillin Resistant ◽  
Prospective Randomized Clinical Trial

Abstract Among patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia from a prospective randomized clinical trial, acute kidney injury (AKI) rates increased with increasing vancomycin exposure, even within the therapeutic range. AKI was independently more common for the (flu)cloxacillin group. Day 2 vancomycin AUC ≥470 mg·h/L was significantly associated with AKI, independent of (flu)cloxacillin receipt.

scholarly journals 438. Dalbavancin Clinical Experience at an NCI Designated Cancer Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S217-S218
Author(s):  
Patrick McDaneld ◽  
Devlin Smith ◽  
Frank Tverdek
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Clinical Success ◽  
Kidney Injury ◽  
Patient Discharge ◽  
Cancer Center ◽  
Tumor Type ◽  
Oncology Patient ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Long Acting

Abstract Background Dalbavancin (DAL) is a long-acting lipoglycopeptide, which allows for up to 2 weeks of therapy from a single dose. Outside of its FDA-approved indication for the treatment of acute bacterial skin and skin structure infections (ABSSSI), there is a growing interest in the utilization of DAL for other indications, including catheter-related bloodstream infection (CRBSI). The long-acting formulation potentially facilitates patient discharge or admission deferral without the need for daily outpatient parenteral antimicrobial therapy (OPAT). However, there is limited experience reporting DAL utilization in an oncology population. The objective of this study was to report our experience with DAL in an oncology patient population at a National Cancer Institute (NCI) Designated Cancer Center. Methods We conducted a retrospective review of all patients receiving DAL therapy in June 2016–June 2017. The primary outcome was a clinical success at 30 days (complete/partial resolution of symptoms without readmission for a same/similar infection), with secondary outcomes including readmission rate, acute kidney injury (AKI) incidence (Acute Kidney Injury Network [AKIN] criteria) and additional antimicrobial use within 30 days. Results We identified 76 unique subjects, with 77 unique infectious episodes, receiving 78 DAL doses. The majority of the subjects were male (57%), the median age was 61 years old, 55% had a solid tumor type and most were treated for ABSSSI (86%). Doses were administered inpatient 76% of the time and most patients received 1500 mg (90%). The most common pathogen isolated was Staphylococcus aureus (19%). Patients frequently received additional methicillin-resistant Staphylococcus aureus active oral antibiotics (39%). Clinical success was reported in 78% of infections. Potential DAL-related AKI was identified in 4 subjects (5%). Conclusion We reported on the use of DAL in a variety of oncology patients at a major cancer center. Clinical success was often achieved in ABSSSI with a single DAL dose and nephrotoxicity was infrequently encountered. Limitations include the frequent use of additional, potentially active antimicrobials and difficulty in assessment of clinical success and AKI in patients after discharge. Disclosures All authors: No reported disclosures.

scholarly journals Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-ResistantStaphylococcus aureusBacteremia: Does β-Lactam Class Matter?

2019 ◽  
Vol 63 (3) ◽  
Author(s):  
Thomas J. Dilworth ◽  
Anthony M. Casapao ◽  
Omar M. Ibrahim ◽  
David M. Jacobs ◽  
Dana R. Bowers ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Odds Ratio ◽  
Observational Studies ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Content Type ◽  
Pooled Data ◽  
Persistent Bacteremia ◽  
The Impact

ABSTRACTWe analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (Combo) on persistent (≥5 days) methicillin-resistantStaphylococcus aureusbacteremia versus VAN alone by using pooled data from two previously published observational studies (n = 156). Combo was inversely associated with persistent bacteremia (adjusted odds ratio, 0.460; 95% confidence interval, 0.229 to 0.923). Acute kidney injury was more common with Combo than with VAN (18.9% and 7.6%, respectively;P= 0.062).

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