scholarly journals Defining the Breakpoint Duration of Staphylococcus aureus Bacteremia Predictive of Poor Outcomes

2019 ◽  
Vol 70 (4) ◽  
pp. 566-573 ◽  
Author(s):  
Emi Minejima ◽  
Nikki Mai ◽  
Nancy Bui ◽  
Melissa Mert ◽  
Wendy J Mack ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Primary Objective ◽  
Source Control ◽  
Control Procedure ◽  
Characteristic Analysis ◽  
Risk Of Death ◽  
Staphylococcus Aureus Bacteremia ◽  
Pertinent Data ◽  
Multicenter Prospective Observational Study ◽  
Poor Outcomes

Abstract Background Persistent Staphylococcus aureus bacteremia (SAB) is defined based on varying duration in literature. The primary objective was to determine the risk of poor outcomes in relation to bacteremia duration. Methods Multicenter, prospective, observational study of adult hospitalized patients with SAB. Medical records were reviewed for pertinent data. Patients were grouped by bacteremia duration: short (1–2 days), intermediate (3–6 days), and prolonged (≥7 days) and compared for risk factors and outcomes. Results Of 884 patients, 63% had short, 28% intermediate, and 9% prolonged bacteremia. Overall mean age was 57 years, and 70% were male. The prolonged group had the highest proportion of methicillin-resistant SAB (P < .0001). Choice of antibiotic therapy did not significantly affect bacteremia duration; however, time to source-control procedure was delayed in the prolonged and intermediate groups compared with the short group (3.5 vs 3 vs 1 day, P < .0001). Metastatic complications, length of stay, and 30-day mortality were progressively worse as bacteremia duration increased (P < .0001). Every continued day of bacteremia was associated with a relative risk of death of 1.16 (95% confidence interval, 1.10–1.22; P < .0001), with a significant increase in risk starting at 3 days as determined by receiver operating characteristic analysis. Conclusions Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of antistaphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes.

scholarly journals 209. What’s So Complicated About Complicated Staphylococcus aureus Bacteremia: Does Day 5 Matter?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S123-S124
Author(s):  
Cami Hilsendager ◽  
Luke Strnad
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Source Control ◽  
Control Procedure ◽  
Complication Rates ◽  
Ventricular Assist ◽  
Staphylococcus Aureus Bacteremia ◽  
Institutional Review ◽  
Culture Positive ◽  
Intracranial Infections

Abstract Background Prolonged Staphylococcus aureus bacteremia (SAB) poses challenges in clinical practice, particularly when a source is not readily identified. While SAB greater than 3 days has been identified as a risk factor for complications, little is known about risk for specific complications with each successive day of bacteremia. We sought to determine the risk for specific complications with the duration of bacteremia. Methods We retrospectively reviewed all cases of SAB between 1 January 2017 and 31 December 2017 at a 500-bed academic hospital. Adult patients (≥18 years) with at least one blood culture positive for S. aureus were identified. Patients were excluded if withdrawal of care or death occurred within 48 hours of blood culture results or if the infection was associated with a ventricular assist device. Medical records were reviewed for the duration of bacteremia, complications, treatment decisions and clinical outcomes. This study was approved by the Institutional Review Board. Results One hundred forty-two discrete episodes of SAB were identified with a median age of 54 years (IQR 40–63). Most cases were community-acquired (83.8%) and 33.8% were MRSA. Active injection drug use was present in 22.5% (33.3% MRSA, 17% MSSA). The median duration of bacteremia was 2.6 days (IQR 1.8–4.6) and 3.9 days (IQR 2.2–7.5) for MSSA and MRSA, respectively. The median time to first source control procedure was twice as long with bacteremia over 5 days than with a shorter duration of bacteremia (2.6 vs. 1.3 days). Complication rates increased with bacteremia duration and bacteremia longer than 5 days was associated with significantly higher rates of endocarditis (46.2%, P < 0.001), epidural abscesses (35.9%, P = 0.001), intracranial infections (12.8%, P = 0.02), and presence of at least one endovascular nidus (76.9%, P < 0.001) compared with bacteremia less than 5 days (28.4%), but 30 day mortality rates were similar (7.7% and 9.8%, respectively). Conclusion Complication rates increase significantly with SAB greater than 5 days duration. Early source control and investigation to identify metastatic and especially endovascular foci of infection are paramount in patients with prolonged bacteremia even if complications are not discovered on initial evaluation. Disclosures All authors: No reported disclosures.

scholarly journals Adjunctive ceftaroline in combination with daptomycin or vancomycin for complicated methicillin-resistant Staphylococcus aureus bacteremia after monotherapy failure

2019 ◽  
Vol 6 ◽  
pp. 204993611988650 ◽  
Author(s):  
Joseph Patrik Hornak ◽  
Seher Anjum ◽  
David Reynoso
Keyword(s):  
Staphylococcus Aureus ◽  
Combination Therapy ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Treatment Options ◽  
Source Control ◽  
Optimal Timing ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Persistent Bacteremia

Background: Methicillin-resistant Staphylococcus aureus bacteremia (MRSA-B) may fail to improve with standard monotherapy, particularly in patients with multifocal infection, incomplete source control, or persistent bacteremia. Synergy observed in vitro between ceftaroline (CPT) and daptomycin (DAP) or vancomycin (VAN) may translate into clinical benefit. Here, we describe our experience with DAP/CPT and VAN/CPT for complicated MRSA-B after monotherapy failure. Methods: Single-center, retrospective review of consecutive patients treated with DAP/CPT or VAN/CPT for MRSA-B after monotherapy failure from 1 January 2016 to 30 November 2018. Results: We identified 11 instances of combination therapy in 10 patients (DAP/CPT = 6, VAN/CPT = 5) with 1 patient receiving VAN/CPT followed by DAP/CPT. Rates of multifocal infection, incomplete source control, persistent bacteremia, and infective endocarditis were high (100%, 80%, 60%, and 60%, respectively). Combination therapy was initiated most commonly for persistent bacteremia (60%). When patients were persistently bacteremic, median preceding duration was 13 days and median time to clearance was 3 days. Total microbiologic cure rate was 100%. There were zero instances of bacteremia relapse at 30 days (30D) or 60 days (60D). All-cause 30D and 60D mortality rates were 11.1% and 33.3%, respectively. Conclusions: Combination therapy demonstrated success in diverse cases of refractory MRSA-B, including instances of persistent bacteremia paired with incomplete source control. Optimal timing and therapeutic cadence for combination therapy remain unclear. Our findings suggest that DAP/CPT and VAN/CPT can be considered for complicated MRSA bacteremia when other treatment options fail or are unavailable. We propose persistent bacteremia with incomplete source control to be a clinical niche particularly worthy of further investigation.

Impact of Infectious Diseases Consultation on Management and Outcome of Staphylococcus aureus Bacteremia in Children

2020 ◽  
Author(s):  
Robert C Duguid ◽  
Mohammed Al Reesi ◽  
Adam W Bartlett ◽  
Pamela Palasanthiran ◽  
Brendan J McMullan
Keyword(s):  
Staphylococcus Aureus ◽  
Regression Analysis ◽  
Infectious Diseases ◽  
Multivariate Regression ◽  
Complete Response ◽  
Multivariate Regression Analysis ◽  
Source Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract Background To examine the impact of infectious diseases consultation (IDC) on the management and outcome of Staphylococcus aureus bacteremia (SAB) in children. Methods A retrospective cohort study of children with SAB at a teritary pediatric hospital (January 2009-June 2015) identified by medical record review as to whether they received an IDC for SAB at the discretion of the admitting physician or surgeon was conducted. Differences in management and outcomes for those with and without IDC were evaluated, and multivariate regression analysis was used to determine factors associated with cure. Results There were 100 patients included in the analysis. Fifty-five patients received IDC and 45 had no IDC (NIDC). Appropriate directed therapy within 24 hours (54/55 = 98.2% vs 34/45 = 75.6%, P &lt; .01), choice (54/55 = 98.2% vs 37/45 = 82.2%, P &lt; .01), dose (54/55 = 98.2% vs 36/45 = 80%, P &lt; .01), and duration (52/55 = 94.5% vs 24/45 = 53.3%, P &lt; .01) of directed antibiotic therapy were appropriate in more IDC group patients. Achievement of source control in indicated cases was also more common in the IDC group (28/32 = 87.5% vs 5/26 = 19.1%, P &lt; .01). Appropriate investigation with repeat blood cultures and echocardiograms was not significantly different. All 55 patients in the IDC group had a complete response (cure) compared with 40 of the 45 (88.9%) patients in the NIDC group: 2 patients died and 3 patients had a relapse of infection with subsequent cure. In multivariate regression analysis, methicillin-susceptible SAB and IDC were factors independently associated with cure. Conclusions Children who received IDC for SAB in a tertiary pediatric setting were more likely to have appropriate investigations and management and had improved outcomes.

scholarly journals Phase II, Randomized, Double-Blind, Multicenter Study Comparing the Safety and Pharmacokinetics of Tefibazumab to Placebo for Treatment of Staphylococcus aureus Bacteremia

2006 ◽  
Vol 50 (8) ◽  
pp. 2751-2755 ◽  
Author(s):  
J. John Weems ◽  
James P. Steinberg ◽  
Scott Filler ◽  
John W. Baddley ◽  
G. Ralph Corey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Primary Objective ◽  
Related Complication ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Adhesion Protein ◽  
Treatment Groups ◽  
Staphylococcus Aureus Bacteremia ◽  
Humanized Monoclonal Antibody ◽  
Healthcare Associated

ABSTRACT Tefibazumab (Aurexis), a humanized monoclonal antibody that binds to the surface-expressed adhesion protein clumping factor A, is under development as adjunctive therapy for serious Staphylococcus aureus infections. Sixty patients with documented S. aureus bacteremia (SAB) were randomized and received either tefibazumab at 20 mg/kg of body weight as a single infusion or a placebo in addition to an antibiotic(s). The primary objective of the study was determining safety and pharmacokinetics. An additional objective was to assess activity by a composite clinical end point (CCE). Baseline characteristics were evenly matched between groups. Seventy percent of infections were healthcare associated, and 57% had an SAB-related complication at baseline. There were no differences between the treatment groups in overall adverse clinical events or alterations in laboratory values. Two patients developed serious adverse events that were at least possibly related to tefibazumab; one hypersensitivity reaction was considered definitely related. The tefibazumab plasma half-life was 18 days. Mean plasma levels were <100 μg/ml by day 14. A CCE occurred in six patients (four placebo and two tefibazumab patients) and included five deaths (four placebo and one tefibazumab patient). Progression in the severity of sepsis occurred in four placebo and no tefibazumab patients. Tefibazumab was well tolerated, with a safety profile similar to those of other monoclonal antibodies. Additional trials are warranted to address the dosing range and efficacy of tefibazumab.

scholarly journals 292. Impact of the BACT/ALERT VIRTUO blood culture system in the management of Staphylococcus aureus bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S146
Author(s):  
Miguel A Chavez ◽  
Satish Munigala ◽  
Carey-Ann Burnham ◽  
David K Warren
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Median Time ◽  
Culture System ◽  
Source Control ◽  
Similar Proportion ◽  
Blood Culture System ◽  
Staphylococcus Aureus Bacteremia ◽  
Time To Positivity ◽  
Implementation Period

Abstract Background Staphylococcus aureus bacteremia (SAB) is a major cause of mortality. Recovery of SA may be enhanced with new blood culture systems resulting in a longer observed duration of bacteremia. Methods We performed a 24-month retrospective study of adults hospitalized with SAB at a 1250-bed academic hospital. Between 1/2018-12/2018 the VersaTREK system was used and 1/2019-12/2019 the BACT/ALERT VIRTUO (VIRTUO) system was used. We excluded patients without an Infectious Diseases (ID) consult. We defined SAB duration as short (1–2 days), intermediate (3–6 days), or prolonged (&gt;7 days). We compared SAB detection and management pre- and post-implementation of VIRTUO. Results 456 patients had SAB during study period; 420 (92%) had ID consultation: 178 (42%) pre- and 242 (58%) post-implementation. Similar proportion of methicillin-resistant SAB was seen (44.9% pre- vs. 36.8% post-implementation, p=0.09). Post-implementation, patients were more likely to have intermediate (22.4% pre- vs. 40.1% post-implementation; p&lt; 0.001) and prolonged SAB duration (3.9% pre- vs. 13.6% post-implementation; p&lt; 0.001). Median time to positivity for the index blood culture was shorter (19.9 pre- vs. 15.0 hours post-implementation, p&lt; 0.001). Dual anti-staphylococcal therapy was used more frequently in the post-implementation period (6.2% pre- vs. 15.7% post-implementation, p=0.003). No difference was noted in frequency of diagnostic studies (transesophageal echocardiography, magnetic resonance imaging, and computed tomography). Source control was similar (46.1% pre- vs. 45.0% post-implementation; p=0.84) but the median time to source-control was shorter post-implementation (4 pre- vs. 2 days post-implementation; p=0.02). Median planned duration of intravenous antibiotics did not vary between pre- and post-implementation periods (6 vs. 6 weeks, p=0.31). There was no difference in 90-day readmissions (38.2% pre- vs. 34.3% post-implementation; p=0.41). Conclusion VIRTUO blood culture system decreased time to positivity and increased frequency of prolonged SAB compared to the VersaTREK system. This resulted in increased use of dual anti-staphylococcal therapy and shorter time to source-control, but no difference in interventions, planned duration of antibiotics, or readmissions. Disclosures All Authors: No reported disclosures

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 Impact of Mandatory Infectious Diseases Consultation and Real-time Antimicrobial Stewardship Pharmacist Intervention on Staphylococcus aureus Bacteremia Bundle Adherence

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kellie Arensman ◽  
Jennifer Dela-Pena ◽  
Jessica L Miller ◽  
Erik LaChance ◽  
Maya Beganovic ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Real Time ◽  
Antimicrobial Stewardship ◽  
Source Control ◽  
Staphylococcus Aureus Bacteremia ◽  
Period 2 ◽  
Review Period ◽  
Infectious Diseases Consultation ◽  
The Impact

Abstract Background The purpose of this study was to evaluate the impact of infectious diseases consultation (IDC) and a real-time antimicrobial stewardship (AMS) review on the management of Staphylococcus aureus bacteremia (SAB). Methods This retrospective study included adult inpatients with SAB from January 2016 to December 2018 at 7 hospitals. Outcomes were compared between 3 time periods: before mandatory IDC and AMS review (period 1), after mandatory IDC and before AMS review (period 2), and after mandatory IDC and AMS review (period 3). The primary outcome was bundle adherence, defined as appropriate intravenous antimicrobial therapy, appropriate duration of therapy, appropriate surveillance cultures, echocardiography, and removal of indwelling intravenous catheters, if applicable. Secondary end points included individual bundle components, source control, length of stay (LOS), 30-day bacteremia-related readmission, and in-hospital all-cause mortality. Results A total of 579 patients met inclusion criteria for analysis. Complete bundle adherence was 65% in period 1 (n = 241/371), 54% in period 2 (n = 47/87), and 76% in period 3 (n = 92/121). Relative to period 3, bundle adherence was significantly lower in period 1 (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.37–0.93; P = .02) and period 2 (OR, 0.37; 95% CI, 0.20–0.67; P = .0009). No difference in bundle adherence was noted between periods 1 and 2. Significant differences were seen in obtaining echocardiography (91% vs 83% vs 100%; P &lt; .001), source control (34% vs 45% vs 45%; P = .04), and hospital LOS (10.5 vs 8.9 vs 12.0 days; P = .01). No differences were noted for readmission or mortality. Conclusions The addition of AMS pharmacist review to mandatory IDC was associated with significantly improved quality care bundle adherence.

scholarly journals 1041. Staphylococcus aureus Bacteremia Bundle Adherence Pre- and Post-Implementation of Mandatory Infectious Diseases Consultation and Antimicrobial Stewardship Pharmacist Intervention

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S366-S367
Author(s):  
Kellie Arensman ◽  
Jennifer Dela-Pena ◽  
Jessica Miller ◽  
Erik LaChance ◽  
Maya Beganovic ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Source Control ◽  
Care Bundle ◽  
Review Group ◽  
Staphylococcus Aureus Bacteremia ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Infectious diseases consult (IDC) and antimicrobial stewardship (AMS) intervention independently demonstrate improved management of Staphylococcus aureus bacteremia (SAB). However, data supporting utilizing both strategies is limited. The objective of the current study is to assess evidence-based bundle adherence for SAB in the presence and absence of mandatory IDC and AMS pharmacist review in a multi-site health system. Methods This retrospective study included adult inpatients with SAB from January 2016 to December 2018 at seven hospitals. Outcomes were compared between three groups: pre-mandatory IDC and AMS review (group 1), post-mandatory IDC and pre-AMS review (group 2), and post-mandatory IDC and AMS review (group 3). The primary outcome was bundle adherence defined as: appropriate intravenous antimicrobial therapy, appropriate duration of therapy, 24–48-hour surveillance cultures until documented clearance, echocardiography, and removal of indwelling intravenous catheters, if applicable. Secondary endpoints included individual bundle components, source control, length of stay (LOS), 30-day bacteremia-related readmission, and in-hospital all-cause mortality. Results A total of 579 patients met the final inclusion criteria for analysis. Complete bundle adherence was achieved in 65% of patients for group 1 (n = 371), 54% for group 2 (n = 87), and 76% for group 3 (n = 121). Adherence to bundle elements was significantly higher in group 3 when compared with group 1 (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37–0.93), and group 2 (OR 0.37, 95% CI 0.20 – 0.67). No difference in bundle adherence was noted between groups 1 and 2. When comparing groups 1, 2 and 3, significant differences were seen in obtaining echocardiography (91% vs. 83% vs. 100%; P = 0.0378), and hospital LOS (10.5 vs. 8.85 vs. 12.0 days; P = 0.0149), respectively. Increased hospital LOS in group 3 may be due to nonsignificant higher rates of complicated bacteremia compared with groups 2 and 1 (32% vs. 44% vs. 43%, P = 0.09), respectively. No differences were noted for readmission or mortality. Conclusion The addition of AMS pharmacist review to mandatory IDC significantly improved quality care bundle adherence. Disclosures All authors: No reported disclosures.

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