scholarly journals Epidemiology of Hospital Onset Staphylococcus aureus Bloodstream Infections (HO-SA-BSI) in the Era of MRSA LabID Reporting

2020 ◽  
Vol 41 (S1) ◽  
pp. s216-s217
Author(s):  
Cassandra Salgado ◽  
Stephanie O’Driscoll ◽  
Shruti Puri ◽  
Adrienne Lorek ◽  
Scott Curry
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Previous History ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Attributable Mortality ◽  
Continuous Variables ◽  
The Mean ◽  
Few Data ◽  
Over Time

Background: Acute-care hospitals began reporting methicillin-resistant Staphylococcus aureus (MRSA) LabID facility-wide inpatient events to the NHSN in 2013. Few data are available regarding the epidemiology of these patients. Methods: We conducted a retrospective cohort study of patients who developed hospital onset Staphylococcus aureus bloodstream infections (HO-SA-BSIs) to describe the epidemiology (characteristics and outcomes) from January 2014 through June 2019 and to compare MRSA LabID BSIs to HO-MSSA BSIs. Proportions were compared using 2 and continuous variables using the Kruskal-Wallis test (EpiInfo). Results: Overall, 264 HO-SA BSIs occurred over the study period (2.21 per 10,000 patient days), 160 HO-MSSA BSIs (1.34 per 10,000 patient days), and 104 MRSA LabID BSIs (0.869 per 10,000 patient days). These rates have not significantly changed over time (Fig. 1). Most of these patients were men (64%); 42.4% were African-American; mean age was 43.5 years; mean Charlson comorbidity index was 3.2; 67.8% were admitted for medical care (vs surgical); and 13.3% had a previous history of S. aureus infection. Of all HO-SA-BSIs, 49.2% were acquired in the ICU, 53.8% were primary BSIs, and 37.9% were catheter associated. Patients were hospitalized a mean of 19.9 days prior to HO-SA BSI, and the mean overall length of stay was 48.5 days. Compared to HO-MSSA BSIs, there were no significant differences in these characteristics among MRSA LabID BSIs except that a significantly greater proportion were catheter associated (46.2% vs 32.5%; OR, 1.78; 95% CI, 1.07–2.96; P = .04). Overall, 101 patients (38.3%) died: 41 with MRSA LabID BSI (39.4%) and 60 with HO-MSSA BSI (37.5%). Mortality rates have not changed significantly over time. The mean number of days to death was 154.2, and 59 patients (22.3%) died during incident hospitalization: 26.9% of MRSA patients and 19.4% of MSSA BSI patients. Moreover, 28.3% of patients were readmitted within 30 days of discharge from incident hospitalization, and compared to HO-MSSA BSI, this rate was significantly higher among MRSA LabID BSI patients (34.2% vs 24.8%; OR, 2.07; 95% CI, 1.09–3.93; P = .03). Among those who died, 58.4% died during hospitalization, 52.5% died within 30 days, 66.3% died within 60 days, and 74.3% had died within 90 days. Also, 47.5% died as a result of their HO-SA BSI, and compared to HO-MSSA BSI, this rate was significantly higher among those with MRSA LabID-BSI (63.4% vs 36.7%; OR, 2.99; 95% CI, 1.31–6.83; P = .02). Conclusions: Among patients with HO-SA BSI, methicillin-resistance continues to be associated with higher attributable mortality, and in our study, higher rates of 30-day readmission. There has been no significant change in HO-SA BSI rates (MSSA or MRSA) since reporting for MRSA LabID events began. Furthermore, mortality rates have not changed and remain high for both MRSA BSI and MSSA BSI patients. Given these findings, MSSA LabID event reporting should be considered.Funding: NoneDisclosures: None

Activity of Oritavancin Against Gram-positive Pathogens Causing Bloodstream Infections in the United States Over 10 Years: Focus on Drug-Resistant Enterococcal Subsets (2010-2019)

2021 ◽  
Author(s):  
Cecilia G. Carvalhaes ◽  
Helio S. Sader ◽  
Jennifer M. Streit ◽  
Mariana Castanheira ◽  
Rodrigo E. Mendes
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Enterococcus Faecium ◽  
Bloodstream Infections ◽  
The United States ◽  
Drug Resistant ◽  
Gram Positive ◽  
Methicillin Resistant ◽  
Vancomycin Resistant ◽  
Over Time

Oritavancin displayed potent and stable activity (MIC 90 range, 0.06-0.5 mg/L) over time (2010-2019) against Gram-positive pathogens causing bloodstream infections, including methicillin-resistant Staphylococcus aureus and resistant subsets of Enterococcus spp. Daptomycin and linezolid were also active against methicillin-resistant S. aureus and vancomycin-resistant Enterococcus . Only oritavancin and linezolid remained active against Enterococcus faecium isolates displaying an elevated daptomycin MIC (i.e., 2-4 mg/L). Proportions of methicillin-resistant S. aureus and vancomycin-resistant Enterococcus within the respective S. aureus and enterococcal populations decreased over this period.

Real-world evidence in patient-related outcomes (PROs) of metastatic castrate-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate plus prednisone (AA+P).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 196-196 ◽  
Author(s):  
Geoffrey Gotto ◽  
Vincent Fradet ◽  
Darrel Drachenberg ◽  
Robert Sabbagh ◽  
Ricardo A. Rendon ◽  
...  
Keyword(s):  
Real World ◽  
Metastatic Cancer ◽  
Abiraterone Acetate ◽  
Cognitive Status ◽  
Continuous Variables ◽  
Absolute Change ◽  
The Mean ◽  
Clinically Significant ◽  
Moca Score ◽  
Over Time

196 Background: Oral androgen biosynthesis inhibitor, abiraterone acetate plus prednisone (AA+P), has shown to improve survival and patient-related outcomes (PROs) in clinical trials. The COSMiC study (Canadian Observational Study in Metastatic Cancer of the Prostate; ClinicalTrials.gov: NCT02364531) set out to prospectively amass real-world data on mCRPC patients (pts) managed with AA+P in communities within Canada. Here, we report the interim analysis of their PROs. Methods: At planned data cutoff in Sept 2017 after a median follow-up of 33.8 months, 264 pts were enrolled in 39 sites across Canada. Their FACT-P (Functional Assessment of Cancer Therapy – Prostate) and MoCA (Montreal Cognitive Assessment) were evaluated at baseline as well as at weeks 12, 24, 48 and 72 after AA+P initiation. A 10-point decrease denotes clinically significant degradation in FACT-P and a total MoCA score of > = 26 is considered normal. Descriptive analysis was utilized with continuous variables. Changes from baseline were summarized using mean (SD). Results: At a median age of 77 among 264 pts, 230, 185, 110 and 63 pts were available for analysis at their week 12, 24, 48, and 72 assessments respectively. The mean baseline FACT-P total score was 111.2 (19.44) with a < 3-point absolute change from baseline at subsequent assessments, denoting no clinically significant change in functional status over time. The mean baseline MoCA score was 25.2 (4.50), yet all subsequent assessments scored above 26 and a mean absolute change from baseline of < 1, showing an absence of cognitive decline over time. PSA value was available for 221 pts, 64.3% (142/221) and 34.4% (76/221) achieved a PSA decline of > 50% and 90% respectively. All-grade treatment-related adverse events were reported in 63 pts, with 11% who have had AA+P discontinuation or interruption. Conclusions: COSMiC represents the largest Canadian mCRPC cohort treated with AA+P with real world prospective evaluation of PROs. This data demonstrated the maintenance in quality of life and cognitive status over the course of the study, and underscores the importance of PRO utilization in this complex patient population. Clinical trial information: NCT02364531.

scholarly journals A retrospective analysis of pathogen profile, antimicrobial resistance and mortality in neonatal hospital-acquired bloodstream infections from 2009–2018 at Tygerberg Hospital, South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245089 ◽  
Author(s):  
Kessendri Reddy ◽  
Adrie Bekker ◽  
Andrew C. Whitelaw ◽  
Tonya M. Esterhuizen ◽  
Angela Dramowski
Keyword(s):  
South Africa ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Methicillin Resistance ◽  
Neonatal Unit ◽  
Attributable Mortality ◽  
Published Data ◽  
Period 2 ◽  
Empiric Antibiotic ◽  
Hospital Acquired

Background Analysis of hospital-acquired bloodstream infection (HA-BSI) trends is important to monitor emerging antimicrobial resistance (AMR) threats and guide empiric antibiotic choices. Methods A retrospective 10-year review of neonatal HA-BSI was performed at Tygerberg Hospital’s neonatal unit in Cape Town, South Africa. Neonatal clinical and laboratory data from 2014 to 2018 (Period 2) was compared with published data from 2009 to 2013 (Period 1). Results The neonatal unit’s HA-BSI rate declined between periods from 3.9/1000 inpatient-days in Period 1 to 3.3/1000 inpatient-days in Period 2 (p = 0.002). Pathogen yield and blood culture contamination rate were unchanged (11.0% to 10.4%, p = 0.233; 5.1% to 5.3%, p = 0.636 respectively). Gram-negative pathogens predominated (1047/1636; 64.0%); Klebsiella species, Staphylococcus aureus, Serratia marcescens, Enterococcus species and Acinetobacter baumannii were the most frequent pathogens. Extended spectrum beta-lactamase production was observed in 319/432 (73.8%) of Klebsiella species, methicillin resistance in 171/246 (69.5%) of Staphylococcus aureus and extensive drug resistance in 115/137 (83.9%) of Acinetobacter species (2009–2018). The crude mortality rate of neonatal HA-BSI episodes increased from Period 1 to Period 2 from 139/717 (19.4%) to 179/718 (24.9%) (p = 0.014), but HA-BSI attributable mortality remained unchanged (97/139 [69.8%] vs 118/179 [65.9%], p = 0.542). The in-vitro activity of piperacillin-tazobactam and amikacin declined during Period 2 (74.6% to 61.4%; p<0.001). Conclusion Although HA-BSI rates declined in the neonatal unit, antimicrobial resistance rates in BSI pathogens remained high. Continuous BSI surveillance is a valuable tool to detect changes in pathogen and AMR profiles and inform empiric antibiotic recommendations for neonatal units in resource-limited settings.

scholarly journals Epidemiology of Methicillin-Resistant Staphylococcus Aureus Bloodstream Infections from 2013-2017 at Chiang Mai University: What Changes Occurred from 2007-2011?

2020 ◽  
Author(s):  
Kawisara Krasaewes ◽  
Saowaluck Yasri ◽  
Phadungkiat Khamnoi ◽  
Romanee Chaiwarith
Keyword(s):  
Staphylococcus Aureus ◽  
Mortality Rate ◽  
Methicillin Resistance ◽  
Bloodstream Infections ◽  
Arterial Graft ◽  
Chiang Mai ◽  
Methicillin Resistant ◽  
Vancomycin Mics ◽  
Significant Difference ◽  
Tract Infections

Abstract Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an established pathogen that causes hospital- acquired infections worldwide. Bloodstream infection is associated with significant morbidity and mortality. We conducted a study aimed at describing the epidemiology of MRSA bloodstream infections, to determine the minimal inhibitory concentration (MIC) of the antibiotic vancomycin among MRSA isolates, and to determine the rate and risk factors of mortality.Methods: A retrospective study was conducted among patients aged ≥ 18 years whose blood culture grew MRSA at Chiang Mai University from January 2013 to December 2017Results: The annual prevalence of MRSA in S.aureus bloodstream infections from 2013 to 2017 were 32.8, 23.1, 26.8, 19.2 and 15.4%, respectively. This prevalence showed a non-significant decrease (p = 0.086). Eighty-four patients with 84 episodes of MRSA bloodstream infections were enrolled. Fifty-three patients (63.1%) were male, and the median age was 68.5 years (IQR 56, 79). Fifty-eight patients (69%) had bloodstream infections with other sites of infection: pneumonia (28 episodes, 43.1%), skin and soft tissue infections (16 episodes, 24.6%), osteomyelitis (7 episodes, 10.8%), infective endocarditis (4 episodes, 6.2%), septic arthritis (4 episodes, 6.2%), arterial graft infections (4 episodes, 6.2%), and urinary tract infections (2 episodes, 3.1%). Percentage of patients with vancomycin MICs ≥ 1.5 mg/L were 68.2%, 62.5%, 47.4%, 26.7%, and 75% from 2013 to 2017, respectively. (p = 0.325). The mortality rate was 64.3%. There was no significant difference in mortality rate between those infected with MRSA with a MIC of vancomycin < 1.5 and ≥ 1.5 mg/L (p = 0.172). Factors associated with mortality included age ≥ 40 years old (OR 11.35; 95% CI: 1.35–95.78, p = 0.026), presence of alteration of consciousness (OR 11.19; 95% CI: 2.83–44.18, p = 0.001) and concurrent pneumonia (OR 4.44; 95% CI: 1.09–18.14, p = 0.038).Conclusions: Methicillin-resistance among Staphylococcus aureus bloodstream infections showed a non-significant decrease of 50%, from 32.88% and 15.4%, between 2013 and 2017. Concurrent infection with pneumonia increased mortality. Although the vancomycin MIC was unchanged from 2013 to 2017, the mean MICs were > 1.0 mg/L. Careful monitoring of vancomycin MIC creep is crucial for the selection of the appropriate antibiotic dosage to prevent treatment failure.

scholarly journals Reduced susceptibility to daptomycin in methicillin-resistant Staphylococcus aureus isolated from catheter-related bloodstream infections

2021 ◽  
Author(s):  
Sho Ohyatsu ◽  
Tomoyuki Nariyama ◽  
Kotaro Matsumoto ◽  
Yuki Moritoki ◽  
Kentaro Kikuchi
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Drug Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
High Dose ◽  
Methicillin Resistant ◽  
Treatment Methods ◽  
History Of ◽  
The Mean

Abstract Background The appearance of reduced susceptibility to daptomycin in methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported. It is unclear how likely MRSA involved in catheter-related bloodstream infections (CRBSI) is to dampen susceptibility to daptomycin. We investigated the minimum inhibitory concentrations (MIC) of daptomycin in MRSA isolated from the blood of patients with CRBSI and examined how it was affected by previous anti-MRSA drug treatment. Methods A total of 115 patients whose blood culture samples were found to contain MRSA were enrolled in this study. The MIC of daptomycin and vancomycin and whether the subjects had a history of anti-MRSA drug treatment were investigated and compared between the CRBSI and non-CRBSI groups. Results The mean MIC of daptomycin was significantly higher for the 46 CRBSI-related MRSA isolates than for the 69 non-CRBSI-related MRSA isolates (0.78 vs. 0.33, respectively; p<0.0001). Among the CRBSI-related MRSA isolates, those collected from patients with a history of anti-MRSA drug treatment had significantly higher MIC (1.27 vs. 0.53, respectively; p <0.01). During treatment, MRSA was detected again in 10 CRBSI and 4 non-CRBSI patients, and all of the CRBSI-related MRSA isolates exhibited 1-2 log2 increases in their daptomycin MIC. Conclusions It is considered that when MRSA in catheter biofilms is exposed to anti-MRSA drugs, strains with reduced susceptibility to daptomycin are able to survive and disperse into the blood. Catheters should be removed if an MRSA-induced CRBSI is suspected. Further study of whether high-dose daptomycin treatment is effective when catheters cannot be immediately removed is needed.

scholarly journals Clinical Blood Isolates from Hemodialysis Patients: Distribution of Organisms and Antimicrobial Resistance, 2007–2014

2020 ◽  
Vol 73 (4) ◽  
Author(s):  
Courtney K Lawrence ◽  
Chris Sathianathan ◽  
Mauro Verrelli ◽  
Philippe Lagacé-Wiens ◽  
Robert Ariano ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Antimicrobial Resistance ◽  
Bloodstream Infections ◽  
Hemodialysis Patients ◽  
Gram Negative Bacteria ◽  
Blood Isolate ◽  
Gram Negative ◽  
Essential Components ◽  
Over Time

Background: Given the morbidity and mortality associated with bloodstream infections in hemodialysis patients, understanding the microbiology is essential to optimizing treatment in this high-risk population.Objectives: To conduct a retrospective surveillance study of clinical blood isolates from adult hemodialysis patients, and to predict the microbiological coverage of empiric therapies for bloodstream infections in this population.Methods: Clinical blood isolate data were collected from the 4 main outpatient hemodialysis units in Winnipeg, Manitoba, from 2007 to 2014. The distribution of organisms and antimicrobial susceptibilities were characterized. When appropriate, changes over time were tested using time series analysis. Study data were used to predict and compare the microbiological coverage of various empiric therapies for bloodstream infections in hemodialysis patients.Results: The estimated annual number of patients receiving chronic hemodialysis increased steadily over the study period (p < 0.001), whereas the number of blood isolates increased initially, then decreased significantly, from 180 in 2011 to 93 in 2014 (p = 0.04). Gram-positive bacteria represented 72.6% (743/1024) of isolates, including Staphylococcus aureus (36.9%, 378/1024) and coagulase-negative staphylococci (23.1%, 237/1024). Only 26.1% (267/1024) of the isolates were gram-negative bacteria, the majority Enterobacteriaceae. The overall rate of methicillin resistance in S. aureus was 17.5%, and although annual rates were variable, there was a significant increase over time (p = 0.04). Antibiotic resistance in gram-negative bacteria was relatively low, except in Escherichia coli, where 13.5% and 16.2% of isolates were resistant to ceftriaxone and ciprofloxacin, respectively. Empiric therapy with vancomycin plus an agent for gram-negative coverage was predicted to cover 98.8% to 99.7% of blood isolates from hemodialysis patients, whereas cefazolin plus an agent for gram-negative coverage would cover only 67.5% to 68.4%.Conclusions: In an era of increasing antimicrobial resistance, data such as these and ongoing surveillance are essential components of antimicrobial stewardship in the hemodialysis population.Keywords: hemodialysis, microbiology, surveillance, resistance, antimicrobial stewardshipRÉSUMÉ Contexte : Étant donné la morbidité et la mortalité associées aux infections du sang parmi les patients en hémodialyse, la compréhension de la microbiologie est essentielle à l’optimisation du traitement de cette population exposée à un risque élevé.Objectifs : Mener une étude de surveillance rétrospective des isolats de sang cliniques des patients adultes en hémodialyse et prédire la couverture microbiologique des thérapies empiriques contre les infections du sang dans cette population.Méthodes : Les données relatives aux isolats de sang cliniques ont été recueillies dans les quatre unités ambulatoires principales d’hémodialyse à Winnipeg (Manitoba), entre 2007 et 2014. La caractérisation a porté sur la distribution des organismes et les susceptibilités aux antimicrobiens. L’évolution dans le temps a été testée au besoin à l’aide d’une analyse chronologique. Les données de l’étude ont permis de prédire et de comparer la couverture microbiologique de diverses thérapies empiriques contre les infections du sang pour les patients en hémodialyse.Résultats : On estime que le nombre annuel de patients recevant une hémodialyse chronique a augmenté régulièrement au cours de la période de l’étude (p < 0,001); le nombre d’isolats de sang a tout d’abord augmenté, puis il a grandement diminué : de 180 en 2011, il est passé à 93 en 2014 (p = 0,04). Les bactéries à Gram positif représentaient 72,6 % (743/1024) des isolats, y compris les Staphylococcus aureus (36,9 %, 378/1024) et les staphylocoques à coagulase négative (23,1 %, 237/1024). Seulement 26,1 % (267/1024) des isolats étaient des bactéries à Gram négatif, la majorité desquelles étant des Enterobacteriaceae. Le taux général de résistance à la méticilline de S. aureus était de 17,5 %, et bien que les taux annuels étaient variables, une augmentation importante a été observée avec le temps (p = 0,04). La résistance aux antibiotiques des bactéries à Gram négatif était relativement faible, sauf Escherichia coli, où respectivement 13,5 % et 16,2 % des isolats étaient résistants à la ceftriaxone et à la ciprofloxacine. On prévoyait que la thérapie empirique à la vancomycine associée à un agent pour la couverture à Gram positif couvrirait de 98,8 % à 99,7 % des isolats de sang des patients en hémodialyse, tandis que la céfazoline associée à un agent de la couverture à Gram négatif ne couvrirait que 67,5 % à 68,4 %.Conclusions : À une époque qui se caractérise par une augmentation de la résistance aux antimicrobiens, des données comme celles-ci et celles portant sur la surveillance continue sont des composantes essentielles de la bonne gestion de l’utilisation des antimicrobiens pour les patients adultes en hémodialyse.Mots-clés : hémodialyse, microbiologie, surveillance, résistance, gestion de l’utilisation des antimicrobiens

scholarly journals DEVELOPMENT AND ANAYSIS OF A CYSTIC FIBROSIS SPECIFIC ANTIBIOGRAM

2021 ◽  
Author(s):  
E. Elson ◽  
Ellen Meier ◽  
Doug Swanson ◽  
Rangaraj Selvarangan ◽  
Megan Gripka ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Selection Methods ◽  
Antibiotic Selection ◽  
Gram Negative ◽  
Oropharyngeal Swab ◽  
Lung Infections ◽  
Over Time

BACKGROUND: Antibiotic therapy is essential for the treatment of cystic fibrosis (CF) lung infections. CF-specific airway pathophysiology and frequent antimicrobial exposure increase the risk of resistant infections, creating challenges to antibiotic selection. Antibiotic selection is generally based on previous cultures or hospital-wide antibiograms (HWA); however, most HWA exclude CF isolates. We developed a multi-year CF antibiogram (CFA) to compare with HWA and inform antibiotic selection. METHODS: CF culture data were collected 2015 - 2019 at a single pediatric CF center. All sputum and oropharyngeal swab isolates are included in the CFA. Demographics, microorganism isolates, and susceptibility information are presented. Susceptibilities were reported for methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa (PA), Achromobacter species, Burkholderia species and Stenotrophomonas maltophilia. RESULTS: Over five years, the proportion of all SA isolates having methicillin-resistance was higher in the HWA (32%) than the CFA (28%). The most common gram-negative CF isolate was PA. Both gram-positive and gram-negative microorganisms were less susceptible in the CFA versus the HWA. CF isolates from sputum were less susceptible than oropharyngeal. MSSA and MRSA had significantly lower clindamycin susceptibility in the CFA compared to the HWA (MSSA 71% vs 79%, p<0.0001 and MRSA 39% vs 83%, p<0.0001). For every antimicrobial tested, PA isolates were less susceptible in the CFA compared to the HWA. There did not appear to be significant changes in susceptibility of CF isolates over time. CONCLUSIONS: These findings have clinical implications for empiric antimicrobial selection. A CFA will allow monitoring of resistance over time.

Candidemia in Intensive Care Units Over Nine Years at a Large Italian University Hospital 

2020 ◽  
Author(s):  
Sara Mazzanti ◽  
Lucia Brescini ◽  
Gianluca Morroni ◽  
Elena Orsetti ◽  
Antonella Pocognoli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Incidence Rate ◽  
Intensive Care Units ◽  
Antifungal Therapy ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
University Hospital ◽  
Related Factors ◽  
Icu Patients ◽  
Over Time

Abstract Purpose: Candidemia is an alarming problem in critically ill patients including those admitted in intensive care units (ICUs). We aimed to describe the clinical and microbiological characteristics of bloodstream infections (BSIs) due to Candida spp. in patients admitted to ICUs of an italian tertiary referral university hospital over nine years. Methods: A retrospective observational study of all cases of candidemia in adult patients was carried out from January 1, 2010 to December 31, 2018 at a 980-bedded University Hospital in Ancona, Italy, counting five ICUs. The incidence, demographics, clinical and microbiologic characteristics, therapeutic approaches and outcomes of ICU-patients with candidemia were collected. Early (7 days from the occurrence of the episode of Candida BSI) and late (30 days) mortality rates were calculated. Results: During the study period, 188/505 (36%) episodes of candidemia occurred in ICU patients. Incidence rate was 9.9/1000 ICU admission and it showed to be stable over time. Candida albicans accounted for 52% of the cases, followed by C. parapsilosis (24%), and C. glabrata (14%). With the exception of isolates of C. tropicalis which showed to be fluconazole resistant in 25% of the cases, resistance to antifungals was not of concern in our patients. Early and late mortality rates were 19% and 41%, respectively and did not increased significantly over time. Independent risk factors for higher mortality were septic shock, acute kidney failure, pulmonary embolism and lack of antifungal therapy. The type of antifungal therapy did not influence the outcome. Conclusion: Neither incidence rate nor crude mortality of candidemia in ICU patients increased over time at our institution. However, mortality rate remained high and significantly associated with specific host-related factors.

The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges

2005 ◽  
Vol 26 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Youlin Qi ◽  
Keith S. Kaye ◽  
Stephan Harbarth ◽  
Adolf W. Karchmer ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Bloodstream Infections ◽  
Hospital Charge ◽  
Hospital Charges ◽  
The Impact ◽  
Length Of Hospitalization

AbstractObjective:To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.Design:A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.Setting:A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.Patients:Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.Results:Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.Conclusion:Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.

scholarly journals Caspofungin Inhibits Mixed Biofilms of Candida albicans and Methicillin-Resistant Staphylococcus aureus and Displays Effectiveness in Coinfected Galleria mellonella Larvae

2021 ◽  
Author(s):  
Gaby Scheunemann ◽  
Bruna N. Fortes ◽  
Nilton Lincopan ◽  
Kelly Ishida
Keyword(s):  
Staphylococcus Aureus ◽  
Candida Albicans ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Galleria Mellonella ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Methicillin Resistant ◽  
Content Type

Infections by microorganisms resistant to antimicrobials is a major challenge that leads to high morbidity and mortality rates and increased time and cost with hospitalization. It was estimated that 27 to 56% of bloodstream infections by C. albicans are polymicrobial, with S. aureus being one of the microorganisms commonly coisolated worldwide.

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