scholarly journals Infektiologische Konsile bei Patienten mit Staphylococcus-aureus-Bakteriämie – eine retrospektive Beobachtungsstudie am Universitätsklinikum Jena

2018 ◽  
Vol 143 (21) ◽  
pp. e179-e187
Author(s):  
Aurelia Kimmig ◽  
Sebastian Weis ◽  
Stefan Hagel ◽  
Christina Forstner ◽  
Miriam Kesselmeier ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Odds Ratio ◽  
Retrospektive Studien

Zusammenfassung Einleitung Staphylococcus-aureus-Bakteriämien sind schwere Infektionserkrankungen mit oftmals langwierigen klinischen Verläufen und hoher Sterblichkeit. Retrospektive Studien zeigen, dass infektiologische Konsile die Adhärenz an Therapiestandards erhöhen und das Überleben von Staphylococcus-aureus-Bakteriämie-Patienten verbessern können. Methoden In dieser retrospektiven, monozentrischen Beobachtungsstudie wurde der Einfluss von infektiologischen Konsilen auf das Überleben von Patienten mit Staphylococcus-aureus-Bakteriämie am Universitätsklinikum Jena mittels logistischer Regressions- und Überlebenszeitanalyse untersucht. Der primäre Endpunkt der Studie war die Krankenhaussterblichkeit. Ergebnisse Insgesamt wurden Daten von 297 Patienten (≥ 18 Jahre) mit Staphylococcus-aureus-Bakteriämie im Zeitraum zwischen Dezember 2012 und August 2015 analysiert. Bei 159 dieser Patienten wurde ein infektiologisches Konsil durchgeführt. Die Durchführung eines Konsils war mit einer geringeren Krankenhaussterblichkeit assoziiert (23 % ohne Konsil, 11 % mit Konsil; multiple Regressionsanalyse: Odds-Ratio = 0,27 [95 %-Konfidenzintervall: 0,12 – 0,64]; p = 0,003). Ferner gab es Unterschiede bei der Erfüllung definierter Qualitätsindikatoren der Behandlung einer Staphylococcus-aureus-Bakteriämie. Dabei war die komplette Umsetzung aller im Konsil empfohlenen Maßnahmen mit der niedrigsten Krankenhaussterblichkeit verbunden. Diskussion Die Mitbehandlung von Patienten mit Staphylococcus-aureus-Bakteriämie durch klinische Infektiologen war mit einer geringeren Krankenhaussterblichkeit assoziiert.

Staphylococcus aureus Carriage in Hidradenitis Suppurativa: Impact on Response to Adalimumab

Dermatology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Dimitra Stergianou ◽  
Vassiliki Tzanetakou ◽  
Maria Argyropoulou ◽  
Theodora Kanni ◽  
Pantelis G. Bagos ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Response ◽  
Odds Ratio ◽  
Hidradenitis Suppurativa ◽  
Positive Culture ◽  
Nasal Carriage ◽  
Loss Of Response ◽  
Response Score ◽  
Stimulation Of

<b><i>Background:</i></b> Several patients with hidradenitis suppurativa (HS) present flare-ups during treatment with adalimumab (ADA), the cause of which is not clear. ADA is the only FDA-approved biologic for the therapy of moderate-to-severe HS. A previous study of our group has shown that <i>Staphylococcus aureus</i> stimulation of whole blood affects the production of human β-defensin 2 and modulates HS severity. It is, therefore, hypothesized, that carriage of <i>S. aureus</i> may drive HS flare-ups. <b><i>Objective:</i></b> To explore the association between carriage of <i>S. aureus</i> and loss of response to ADA. <b><i>Patients and Methods:</i></b> Among patients with moderate-to-severe HS without carriage of <i>S. aureus</i> at start of treatment with ADA, we investigated for carriage of <i>S. aureus</i> from the nares when flare-ups occurred. Flare-ups were pre-defined as at least 25% increase of inflammatory lesions (sum of inflammatory nodules and abscesses) from baseline. Samplings were also done after completion of 12 weeks of ADA treatment from all patients who did not present flare-ups. Clinical response to ADA was assessed by the HS Clinical Response score (HiSCR). <b><i>Results:</i></b> Thirty-nine patients were studied; 24 with Hurley II stage HS and 15 with Hurley III stage HS. Twenty-nine patients achieved HiSCR after 12 weeks of treatment without any flare-ups; 10 patients had flare-ups and failed HiSCR. Three (10.3%) and 5 (50%) patients, respectively, had nasal carriage of <i>S. aureus</i> (odds ratio 8.67; 95% CI 1.54–48.49; <i>p</i> = 0.014). Among 32 patients reaching follow-up week 48, 20 patients achieved HiSCR and 12 had flare-ups leading to ADA failure; 2 (10%) and 5 (41.7%) patients, respectively, had positive culture for <i>S. aureus</i> (odds ratio 6.42; 95% CI 1.00–41.20; <i>p</i> = 0.05). <b><i>Conclusion:</i></b> Nasal carriage of <i>S. aureus</i> may be associated with loss of response to ADA. Findings need confirmation in larger series of patients.

scholarly journals Amoxicillin-Clavulanate Therapy Increases Childhood Nasal Colonization by Methicillin-Susceptible Staphylococcus aureus Strains Producing High Levels of Penicillinase

2004 ◽  
Vol 48 (12) ◽  
pp. 4618-4623 ◽  
Author(s):  
Didier Guillemot ◽  
Stephane Bonacorsi ◽  
John S. Blanchard ◽  
Philippe Weber ◽  
Sylvie Simon ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Drug Use ◽  
Odds Ratio ◽  
Selection Process ◽  
Nasal Carriage ◽  
Penicillin G ◽  
Nasal Colonization ◽  
Factors Associated ◽  
Amoxicillin Clavulanate ◽  
Resistant Strains

ABSTRACT We examined factors associated with penicillinase production by nasal carriage Staphylococcus aureus strains in 648 children aged 3 to 6 years attending 20 randomly sampled playschools. The children were prospectively monitored for drug use and medical events for 6 months and were then screened for S. aureus carriage. Isolates were tested for their susceptibility to penicillin G and methicillin, and penicillinase production by methicillin-susceptible, penicillin-resistant strains was quantified. S. aureus was isolated from 166 children (25.6%). Exposure to amoxicillin-clavulanate during the previous 3 months was associated with higher penicillinase production by penicillin-resistant, methicillin-susceptible strains (odds ratio, 3.6; P = 0.03). These results suggest that use of the amoxicillin-clavulanate combination could induce a herd selection process of S. aureus strains producing higher levels of penicillinase.

scholarly journals Pharmacokinetic-Pharmacodynamic Relationships Describing the Efficacy of Oritavancin in Patients with Staphylococcus aureus Bacteremia

2006 ◽  
Vol 50 (3) ◽  
pp. 994-1000 ◽  
Author(s):  
Sujata M. Bhavnani ◽  
Julie A. Passarell ◽  
Joel S. Owen ◽  
Jeffrey S. Loutit ◽  
Steven B. Porter ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Odds Ratio ◽  
Regression Tree ◽  
Bloodstream Infections ◽  
Free Drug ◽  
Classification And Regression Tree ◽  
Population Pharmacokinetic ◽  
Dose Selection ◽  
Staphylococcus Aureus Bacteremia ◽  
Drug Concentrations

ABSTRACT Bloodstream infections due to antimicrobial-resistant Staphylococcus aureus occur with increasing frequency and represent an important cause of morbidity and mortality. To date, the evaluation of pharmacokinetic-pharmacodynamic relationships for efficacy among patients with bacteremia has been limited. The objectives of these analyses were to evaluate relationships between microbiological and clinical responses for patients with S. aureus bacteremia and exposures for oritavancin, a novel bactericidal glycopeptide in development. Bayesian oritavancin exposure predictions, following treatment with 5, 6.5, 8, or 10 mg/kg of body weight/day, were derived using a validated population pharmacokinetic model for 55 patients with S. aureus bacteremia. Using classification and regression tree analysis, a breakpoint of the percentage of the dosing interval duration for which free-drug concentrations were above the MIC (free-drug % time > MIC) of 22% was identified for microbiological response; the probabilities of success greater than or equal to and less than this value were 93% and 76%, respectively. Using logistic regression, a relationship was found between microbiological response and free-drug % time > MIC (odds ratio = 4.42, P = 0.09, and odds ratio = 8.84, P = 0.05, when one patient, a medical outlier, was excluded). A similar relationship was found for clinical response. These results will be valuable in supporting dose selection of oritavancin for patients with S. aureus bacteremia.

scholarly journals Predicting High Prevalence of Community Methicillin-Resistant Staphylococcus aureus Strains in Nursing Homes

2013 ◽  
Vol 34 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Courtney R. Murphy ◽  
Lyndsey O. Hudson ◽  
Brian G. Spratt ◽  
Victor Quan ◽  
Diane Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Homes ◽  
Odds Ratio ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multivariate Models ◽  
Methicillin Resistant ◽  
Hispanic Ethnicity ◽  
High Prevalence

We assessed characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among residents of 22 nursing homes. Of MRSA-positive swabs, 25% (208/824) were positive for CA-MRSA. Median facility CA-MRSA percentage was 22% (range, 0%–44%). In multivariate models, carriage was associated with age less than 65 years (odds ratio, 1.2; P < .001) and Hispanic ethnicity (odds ratio, 1.2; P = .006). Interventions are needed to target CA-MRSA.

scholarly journals Prolonged Colonization with the Methicillin-Resistant Staphylococcus aureus Strain USA300 among Residents of Extended Care Facilities

2010 ◽  
Vol 31 (8) ◽  
pp. 838-841 ◽  
Author(s):  
Simone M. Shurland ◽  
O. Colin Stine ◽  
Richard A. Venezia ◽  
Jennifer K. Johnson ◽  
Min Zhan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Adjusted Odds Ratio ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Aureus Strain ◽  
Methicillin Resistant ◽  
Extended Care ◽  
Care Facilities ◽  
Mrsa Strains

We performed a retrospective cohort study (n = 129) to assess whether residents of extended care facilities who were initially colonized or infected with the methicillin-resistant Staphylococcus aureus (MRSA) strain USA300 were less likely to have prolonged colonization than were residents colonized or infected with other MRSA strains. We found no difference in prolonged colonization (adjusted odds ratio, 1.1 [95% confidence interval, 0.5–2.4]).

Development and Validation of a Simple and Easy-to-Employ Electronic Algorithm for Identifying Clinical Methicillin-Resistant Staphylococcus aureus Infection

2014 ◽  
Vol 35 (6) ◽  
pp. 692-698 ◽  
Author(s):  
Westyn Branch-Elliman ◽  
Judith Strymish ◽  
Kalpana Gupta
Keyword(s):  
Staphylococcus Aureus ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Multivariable Analysis ◽  
Simple Algorithm ◽  
Electronic System ◽  
Surveillance Systems ◽  
Methicillin Resistant ◽  
Sterile Site ◽  
Mrsa Infection

Background.With growing demands to track and publicly report and compare infection rates, efforts to utilize automated surveillance systems are increasing. We developed and validated a simple algorithm for identifying patients with clinical methicillin-resistant Staphylococcus aureus (MRSA) infection using microbiologic and antimicrobial variables. We also estimated resource savings.Methods.Patients who had a culture positive for MRSA at any of 5 acute care Veterans Affairs hospitals were eligible. Clinical infection was defined on the basis of manual chart review. The electronic algorithm defined clinical MRSA infection as a positive non-sterile-site culture with receipt of MRSA-active antibiotics during the 5 days prior to or after the culture.Results.In total, 246 unique non-sterile-site cultures were included, of which 168 represented infection. The sensitivity (43.4%–95.8%) and specificity (34.6%–84.6%) of the electronic algorithm varied depending on the combination of antimicrobials included. On multivariable analysis, predictors of algorithm failure were outpatient status (odds ratio, 0.23 [95% confidence interval, 0.10–0.56]) and respiratory culture (odds ratio, 0.29 [95% confidence interval, 0.13–0.65]). The median cost was $2.43 per chart given 4.6 minutes of review time per chart.Conclusions.Our simple electronic algorithm for detecting clinical MRSA infections has excellent sensitivity and good specificity. Implementation of this electronic system may streamline and standardize surveillance and reporting efforts.Infect Control Hosp Epidemiol 2014;35(6):692–698

Epidemiology of Methicillin-Resistant Staphylococcus aureus in a University Medical Center Day Care Facility

2009 ◽  
Vol 30 (10) ◽  
pp. 985-992 ◽  
Author(s):  
Angela L. Hewlett ◽  
Pamela S. Falk ◽  
Katrina S. Hughes ◽  
C. Glen Mayhall
Keyword(s):  
Staphylococcus Aureus ◽  
Child Care ◽  
Molecular Typing ◽  
Odds Ratio ◽  
Environmental Samples ◽  
Medical Center ◽  
Care Center ◽  
Child Care Center ◽  
Macrolide Antibiotics ◽  
Mrsa Colonization

Objective.Few data are available on methicillin-resistant Staphylococcus aureus (MRSA) colonization in day care. We performed a study in a medical university child care center to study the epidemiology of MRSA in this population.Design.Survey.Setting.A child care center on the campus of a university medical center.Methods.One hundred four children who attended the child care center and 32 employees gave samples that were cultured for MRSA. Seventeen household members of the children and employee found to be colonized with MRSA also gave samples that were cultured. Parents and employees completed questionnaires about demographic characteristics, medical conditions and treatments, and possible exposure risks outside the child care center. In addition, 195 environmental samples were taken from sites at the childcare center. Isolates were analyzed for relatedness by use of molecular typing, and statistical analysis was performed.Results.The prevalence of MRSA in the children was 6.7%. One employee (3.1%) was colonized with MRSA. Cultures of samples given by 6 of 17 (35.3%) family members of these children and the employee yielded MRSA. MRSA was recovered from 4 of 195 environmental samples. Molecular typing revealed that many of the MRSA isolates were indistinguishable, and 18 of the 21 isolates were community-associated MRSA. Multivariable analysis revealed that receipt of macrolide antibiotics (P = .002; odds ratio, 39.6 [95% confidence interval, 3.4—651.4]) and receipt of asthma medications (P = .024; odds ratio, 26.9 [95% confidence interval, 1.5-500.7]) were related to MRSA colonization.Conclusions.There was a low prevalence of MRSA colonization in children and employees in the child care center but a higher prevalence of colonization in their families. Molecular typing showed that transmission of MRSA likely occurred in the child care center. The use of macrolide antibiotics and asthma medications may increase the risk of MRSA colonization in this population.

scholarly journals Faktor Risiko terhadap Total Bakteri, Staphylococcus aureus, Koliform, dan E. coli pada Susu Kambing

2018 ◽  
Vol 38 (1) ◽  
pp. 39
Author(s):  
Widodo Suwito ◽  
Erna Winarti ◽  
Felisitas Kristiyanti ◽  
Ari Widyastuti ◽  
Andriani Andriani
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Relative Risk ◽  
Odds Ratio ◽  
Goat Milk ◽  
Plate Count ◽  
Dairy Goat ◽  
Chi Square ◽  
E Coli ◽  
Total Bacteria

The objective of this research is to determine the risk factors that affect the total bacteria, S. aureus, coliform, and E. coli in goat milk against SNI No 01-6366-2000 requirements. A total of 16 samples of goat milk from Sleman district were analyzed for total bacteria, S. aureus, coliform using dilution plate count, whereas E. coli count was based on biochemical reaction. Management of each dairy goat farm was recorded using questionnaires. The risk factors of total bacteria, S. aureus, coliform, and E. coli in goat milk were determined based on chi square ( χ2) bivariate analysis, odds ratio (OR), and relative risk (RR). The risk factors that affected total bacteria, S. aureus, coliform, and E. coli in goat milk are cleanliness of stall, milk containers, personal knowledge of dairy hygiene, washing of the udder before milking, the time and the amount of milking. ABSTRAKPenelitian ini bertujuan untuk menentukan faktor risiko yang mempengaruhi total bakteri, Staphylococcus aureus (S. Aureus), koliform, dan Escherichia coli (E. coli) pada susu kambing dari Kabupaten Sleman agar memenuhi persyaratan SNI No 01-6366-2000. Sebanyak 16 susu kambing dari Kabupaten Sleman digunakan dalam penelitian ini. Susu kambing diperiksa terhadap total bakteri, S. aureus, koliform, dengan hitungan cawan sedangkan E. coli berdasarkan reaksi biokimia. Manajemen pemerahan dari masing-masing peternakan ditulis dalam lembar kuesioner. Analisis bivariate chi square (χ2), odds ratio (OR), dan relative risk (RR) digunakan untuk menentukan faktor risiko yang mempengaruhi total bakteri, S. aureus, koliform, dan E. coli pada susu kambing. Faktor risiko yang mempengaruhi total bakteri, S. aureus, koliform, dan E. coli dalam susu kambing adalah kebersihan kandang, tempat penampung susu, pengetahuan personal hygiene pemerah susu, mencuci ambing sebelum diperah, waktu dan banyaknya pemerahan.

scholarly journals Fatores de risco da sepse em pacientes queimados

2005 ◽  
Vol 32 (4) ◽  
pp. 173-177 ◽  
Author(s):  
Jefferson Lessa S. de Macedo ◽  
Simone Corrêa Rosa ◽  
Kátia Cilene Soares de Macedo ◽  
Cleudson Castro
Keyword(s):  
Staphylococcus Aureus ◽  
Acinetobacter Baumannii ◽  
Odds Ratio ◽  
Enterobacter Cloacae

OBJETIVO: Os avanços no tratamento de queimados têm reduzido as taxas de mortalidade e melhorado a qualidade de vida das vítimas de queimaduras. Entretanto, a sepse continua sendo um desafio e umas das principais causas de óbito no queimado. O objetivo deste trabalho é investigar, através de um estudo caso-controle, os fatores de risco da sepse em pacientes queimados. MÉTODO: O estudo caso-controle foi conduzido durante 12 meses, compreendendo os pacientes que foram tratados em regime de internação hospitalar na Unidade de Queimados do Hospital Regional da Asa Norte (HRAN), Brasília-DF. RESULTADOS: Quarenta e nove (19,4%) pacientes tiveram sepse, de um total de 252 queimados internados na Unidade de Queimados durante o periodo do estudo. Eles tiveram um ou no maximo tres episodios de sepse durante a internacao, totalizando 62 episodios. Vinte e seis (53,1%) eram homens e a media de idade foi de 21,9 ± 18,9 anos (variacao de um a 89 anos). A superficie corporal queimada dos pacientes que tiveram sepse variou de sete a 84%, com uma media de 37,7 ± 18,4%, sendo significativamente superior aos controles. As principais bacterias causadoras de sepse foram Staphylococcus aureus (46,5%), Staphylococcus coagulase negativo (20,7%), Acinetobacter baumannii (12,1%) e Enterobacter cloacae (12,1%). Trinta (61,2%) pacientes tiveram seu primeiro episodio de sepse na primeira semana de internacao. Quanto aos fatores de risco para a ocorrencia de sepse, destacam-se os seguintes, conforme seu poder de associacao "odds ratio": o uso de tres ou mais cateteres, a presenca de duas ou mais complicacoes, a superficie corporal queimada > 30%, o agente chama aberta e o sexo feminino. No geral, a taxa de letalidade por sepse foi de 24,5%. CONCLUSÃO: Um melhor conhecimento dos fatores de risco da sepse no paciente queimado permite o tratamento precoce dessa complicação, com antibioticoterapia sistêmica adequada, contribuindo para reduzir a morbidade e a mortalidade desses pacientes.

scholarly journals Risk factors for methicillin-resistant Staphylococcus aureus bacteremia: A multicenter matched case-control study

Biomédica ◽  
2016 ◽  
Vol 36 (4) ◽  
pp. 612 ◽  
Author(s):  
Paola Mariana Arias-Ortiz ◽  
Libia Del Pilar Calderón ◽  
Juan Sebastián Castillo ◽  
José Moreno ◽  
Aura Lucía Leal ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Odds Ratio ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Factores De Riesgo ◽  
Matched Case ◽  
Matched Case Control Study ◽  
Control Study

Introducción. Staphylococcus aureus resistente a la meticilina es uno de los agentes patógenos más frecuentes en las unidades de cuidados intensivos. Su presencia prolonga las hospitalizaciones y aumenta el riesgo de mortalidad en los pacientes con bacteriemia. Sin embargo, la etiología de este marcador de resistencia no ha sido completamente estudiada.Objetivo. Determinar los factores asociados con la aparición de S. aureus resistente a la meticilina causante de bacteriemia en pacientes atendidos en unidades de cuidados intensivos en Bogotá.Materiales y métodos. Se hizo un estudio retrospectivo de casos y controles emparejados, anidado en una cohorte de pacientes con diagnóstico de bacteriemia por S. aureus atendidos en unidades de cuidados intensivos de Bogotá entre 2006 y 2008. Los casos fueron pacientes con hemocultivo positivo para resistencia a la meticilina, emparejados 1 a 1 con controles con hemocultivos sensibles a la meticilina de la misma institución y año de hospitalización. Se analizaron mediante regresión logística condicional los factores de riesgo asociados con la presencia de resistencia, con énfasis en el tratamiento previo con antibióticos.Resultados. Se incluyeron 372 pacientes con bacteriemia por S. aureus. Factores como el uso de dispositivos previos a la hospitalización: vasculares (Odds ratio, OR=1,986; IC95% 1,038-3,801) y urinarios (OR=2,559; IC95% 1,170-5,596), así como el número de antibióticos administrado previamente, se asociaron con la aparición de resistencia. Se registró un efecto de gradiente con el número de antibióticos usados previamente, especialmente carbapenémicos.Conclusiones. El uso racional de antibióticos y la vigilancia de la exposición a procedimientos quirúrgicos o al uso de dispositivos invasivos, son intervenciones que podrían disminuir la aparición de S. aureus resistente a meticilina causante de bacteriemia.

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