Impact of immunosuppressive agents on clinical manifestations and outcome of Staphylococcus aureus bloodstream infection – A propensity score matched analysis in two large, prospectively evaluated cohorts

2021 ◽  
Author(s):  
Johannes Camp ◽  
Lina Glaubitz ◽  
Tim Filla ◽  
Achim J Kaasch ◽  
Frieder Fuchs ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Propensity Score ◽  
Bloodstream Infection ◽  
Cox Regression ◽  
Immunosuppressive Agents ◽  
Late Complications ◽  
Competing Risk ◽  
Immunosuppressed Patients ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
Baseline Characteristics

Abstract Background Staphylococcus aureus bloodstream infection (SAB) is a common, life-threatening infection. The impact of immunosuppressive agents on the outcome of patients with SAB is incompletely understood. Methods Data from two large prospective, international, multicenter cohort studies (INSTINCT and ISAC) between 2006 and 2015 were analyzed. Patients receiving immunosuppressive agents were identified and a 1:1 propensity score (PS) matched analysis was performed to adjust for baseline characteristics of patients. Overall survival and time to SAB-related late complications (SAB relapse, infective endocarditis, osteomyelitis, or other deep-seated manifestations) were analyzed by Cox regression and competing risk analyses, respectively. This approach was then repeated for specific immunosuppressive agents (corticosteroids [CSMT] and immunosuppressive agents other than steroids [IMOTS]). Results Of 3,188 analyzed patients, 309 were receiving immunosuppressive treatment according to our definitions and were matched to 309 non-immunosuppressed patients. After PS matching, baseline characteristics were well balanced. In the Cox regression analysis, we observed no significant difference in survival between the two groups (death during follow-up: 105/309 (33.9 %) immunosuppressed patients vs. 94/309 (30.4 %) non-immunosuppressed, hazard ratio 1.20 (95% CI 0.84–1.71). Competing risk analysis showed a cause-specific hazard ratio (CSHR) of 1.81 (95% CI 0.85–3.87) for SAB-related late-complications in patients receiving immunosuppressive agents. CSHR was higher in patients taking IMOTS (3.69; 95% CI 1.41–9.68). Conclusions Immunosuppressive agents were not associated with an overall higher mortality. The risk for SAB-related late complications in patients receiving specific immunosuppressive agents such as IMOTs warrants further investigations.

scholarly journals 1124. Impact of a Best Practice Advisory for Pediatric Patients with Staphylococcus aureus Bloodstream Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S399-S400
Author(s):  
Elizabeth C Lloyd ◽  
Emily T Martin ◽  
Nicholas Dillman ◽  
Jerod Nagel ◽  
Tejal N Gandhi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Bloodstream Infection ◽  
Best Practice ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Post Intervention ◽  
Optimal Therapy ◽  
Practice Advisory ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
Over Time

Abstract Background Infectious diseases (ID) consultation and use of optimal antibiotic therapy have been shown to improve outcomes of patients with Staphylococcus aureus bloodstream infection (SA-BSI). We investigated the ability of an electronic medical record (EMR)-based best practice advisory (BPA) to enhance adherence to these practices for pediatric patients with SA-BSI. Methods An EMR-based BPA for SA-BSI (Figure 1) was implemented on 8/1/2017, recommending ID consultation and optimal therapy based on mecA gene rapid testing (vancomycin if mecA-positive; cefazolin or nafcillin if mecA-negative). We conducted a quasi-experimental pre/post study to evaluate impact of the BPA. Patients <21 years old admitted to C.S. Mott Children’s Hospital with SA-BSI during the pre- (1/2015 – 7/2017) and post-intervention (8/2017 – December 2018) periods were included. Demographic and clinical data were collected via chart review. Receipt of ID consult and optimal therapy before and after intervention were compared using interrupted time series (ITS) analysis with segmented regression. Time to optimal therapy was compared with segmented Cox regression. Results We included 99 SA-BSI episodes (70.7% pre-intervention and 29.3% post-intervention). Pre-intervention, 68.6% of patients received an ID consult compared with 93.1% post-intervention, but this was not significant with ITS analysis (Figure 2). The proportion of patients receiving optimal therapy did not significantly increase following the intervention, but time to optimal therapy significantly decreased (Figure 3). The median time to optimal therapy decreased from 26.1 hours to 5.5 hours. Cox regression showed both an immediate decrease in time to optimal therapy (HR 3.9, P = 0.009), followed by a continued decrease over time. Conclusion Following implementation of a novel EMR-based intervention, ID consultation for SA-BSI increased, although this was not statistically significant due to a pre-existing trend of increasing ID consults over time. Implementation of the BPA was associated with a significant decrease in time to optimal therapy, likely due to a combination of increasing ID consultation and antibiotic guidance provided by the BPA. Disclosures All authors: No reported disclosures

Combination therapy with rifampicin or fosfomycin in patients with Staphylococcus aureus bloodstream infection at high risk for complications or relapse: results of a large prospective observational cohort

2020 ◽  
Author(s):  
Siegbert Rieg ◽  
Angela Ernst ◽  
Gabriele Peyerl-Hoffmann ◽  
Insa Joost ◽  
Johannes Camp ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Combination Therapy ◽  
Bloodstream Infection ◽  
Late Complications ◽  
Native Valve ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Staphylococcus Aureus Bloodstream Infection

Abstract Objectives To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin. Methods In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs). Results A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46–0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35–0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36–0.91). Upon agent-specific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions. Conclusions In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.

scholarly journals Eosinopenia Associated with Infection is an Independent Risk Factor for 28-day Mortality in Staphylococcus aureus Bloodstream Infection

2019 ◽  
pp. 1-9
Author(s):  
Chunxia Zhou ◽  
Jing Sun ◽  
Fengqin Xu ◽  
Shanping Jiang
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Retrospective Study ◽  
Bloodstream Infection ◽  
Independent Risk Factor ◽  
Cox Regression ◽  
Survival Curve ◽  
Cox Regression Analysis ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
The Impact

Aims: This retrospective study aimed to evaluate the impact of eosinopenia on 28-day mortality in Staphylococcus aureus bloodstream infection (SABSI).  Methods:  A retrospective study was designed to evaluate the impact of eosinopenia on 28-day mortality in SABSI. Results: Patients who were ≥16 years old with SABSI at Sun Yat-Sen Memorial Hospital between January 1st 2014 and December 31st 2018 were included. The overall 28-day mortality of all patients was 14.3% (44 out of 307). Patients with eosinopenia in the onset of SABSI had a significantly higher 28-day mortality than those without eosinopenia (22.4% vs 6.5%; P<0.01). For patients who developed SABSI after the first 48 hours in the hospital, eosinophils decreased significantly from the baseline (P<0.01). Kaplan–Meier survival curve showed that patients with eosinopenia had a lower survival rate than those without eosinopenia (P<0.01). Multivariate Cox regression analysis revealed that eosinophils in the onset of SABSI were associated independently with 28-day mortality (hazard ratio [HR], 2.84; 95% confidence interval [CI], 1.36–5.91; P<0.01). Conclusion: Eosinopenia associated with infection might be an independent risk factor for 28-day mortality in SABSI.

scholarly journals Methicillin-resistant Staphylococcus aureus bloodstream infection: risk factors and clinical outcome in non-intensive-care units

2012 ◽  
Vol 45 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Karinne Spirandelli Carvalho Naves ◽  
Natália Vaz da Trindade ◽  
Paulo Pinto Gontijo Filho
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Bloodstream Infection ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bloodstream Infection

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is spread out in hospitals across different regions of the world and is regarded as the major agent of nosocomial infections, causing infections such as skin and soft tissue pneumonia and sepsis. The aim of this study was to identify risk factors for methicillin-resistance in Staphylococcus aureus bloodstream infection (BSI) and the predictive factors for death. METHODS: A retrospective cohort of fifty-one patients presenting bacteraemia due to S. aureus between September 2006 and September 2008 was analysed. Staphylococcu aureus samples were obtained from blood cultures performed by clinical hospital microbiology laboratory from the Uberlândia Federal University. Methicillinresistance was determined by growth on oxacillin screen agar and antimicrobial susceptibility by means of the disk diffusion method. RESULTS: We found similar numbers of MRSA (56.8%) and methicillin-susceptible Staphylococcus aureus (MSSA) (43.2%) infections, and the overall hospital mortality ratio was 47%, predominantly in MRSA group (70.8% vs. 29.2%) (p=0.05). Age (p=0.02) was significantly higher in MRSA patients as also was the use of central venous catheter (p=0.02). The use of two or more antimicrobial agents (p=0.03) and the length of hospital stay prior to bacteraemia superior to seven days (p=0.006) were associated with mortality. High odds ratio value was observed in cardiopathy as comorbidity. CONCLUSIONS: Despite several risk factors associated with MRSA and MSSA infection, the use of two or more antimicrobial agents was the unique independent variable associated with mortality.

scholarly journals Peripheral Intravenous Catheter Placement Is an Underrecognized Source of Staphylococcus aureus Bloodstream Infection

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Eloise D. Austin ◽  
Sean B. Sullivan ◽  
Susan Whittier ◽  
Franklin D. Lowy ◽  
Anne-Catrin Uhlemann
Keyword(s):  
Staphylococcus Aureus ◽  
Bloodstream Infection ◽  
Catheter Placement ◽  
Intravenous Catheter ◽  
Staphylococcus Aureus Bacteremia ◽  
Peripheral Intravenous Catheter ◽  
Life Threatening ◽  
Staphylococcus Aureus Bloodstream Infection ◽  
Life Threatening Complication ◽  
Intravenous Catheters

Abstract Few studies have focused on the risks of peripheral intravenous catheters (PIVs) as sources for Staphylococcus aureus bacteremia (SAB), a life-threatening complication. We identified 34 PIV-related infections (7.6%) in a cohort of 445 patients with SAB. Peripheral intravenous catheter-related SAB was associated with significantly longer bacteremia duration and thrombophlebitis at old PIV sites rather than current PIVs.

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