P346 The changing epidemiology of infective endocarditis in a tertiary center

Abstract Background Despite the adequate antibiotic prophylaxis, the incidence and mortality rate of infective endocarditis (IE) is still high. In the past few decades, several studies have noted an increase in the proportion of IE caused by staphylococcal species. Aims The aim of our retrospective study was to assess the clinical and microbiological characteristics, trends, and the 1, 6 and 12-month cardiovascular (CV) mortality rate of patients administered for IE in our tertiary hospital between January 1, 2006 and December 31, 2016. Results We identified 465 cases (311 men, 154 women) of 448 patients, mean age was 56,1 ± 16,4 years (14-92). Native left-sided IE (NLIE) was assessed in 286 cases (61,5%, mitral in 117, aorta in 116, combined in 53 cases), prosthetic valve IE (PVIE) was in 111 cases (24%, early in 44, late in 67), right-sided IE (RIE) in 12 cases (2,5%), cardiac device related IE (CDRIE) in 50 cases (11%), other in 6 cases (1%). The underlying infection was caused by streptococci in 124 cases (27%), Staphylococcus aureus (SA) in 112 cases (24%, out of them 23 had MRSA), coagulase negative Staphylococcus (CoNS) in 39 cases (8%), enterococci in 75 cases (16%). Blood culture negative cases found in 61 patients (13%), in 38 cases (8%) other, diversified germs and in 16 cases (4%) there were no data on the pathogen agent. The mortality rates of the total population were one-month was 12.8%, six-month was 26.4%, one-year was 29.7%, and five-year was 40%. There was a significant difference in the mortality rate regarding both of the type of IE and in terms of the underlying microorganism (log-rank p = 0.03 and p = 0.04 resp). The worst survival rate was detected among patients with PVIE, and patients with staphylococcal infection, especially with MRSA. Cox regression found that age (HR: 1.4; CI:1.3-1.6; p <0.001), ejection fraction (HR: 1.4; CI:1.2-1.5; p <0.001), hemoglobin and creatinin levels (HR: 0.9; CI:0.8-0.97 p = 0.01; HR: 1.3; CI: 1.1-1.5; p = 0.001 resp.), MRSA compared to streptococcal infection (HR: 2.5; CI:1.4-4.5; p <0.001), stroke as complication (HR: 1.98; CI:1.4-2.8; p <0.001) were independent risk factors of mortality. In terms of temporal trends the rate of combined NLIE decreased over time (14.5% to 5.1%, p = 0.03), while the rate of other types of IE did not changed. Regarding the type of underlying microorganism the rate of SA infection increased (17% to 41%, p = 0.002) and the rate of CoNS decreased (16.1% - 1.3% p < 0.001) over time. The 1-year mortality rate did not change through the years. Conclusions During the observed 11 years 465 cases were administered with IE to our tertiary hospital, out of which two-third were NLIE. One-quarter of the underlying microorganism were streptococci, and the rate of Staphylococcus aureus infection was increased over time, which was associated with a worse prognosis. In addition IE had a high mortality, which unfortunately did not improve through the years.

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Temporal Trends of Infective Endocarditis in Olmsted County, Minnesota between 1970-2018: A Population-Based Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab038 ◽

2021 ◽

Author(s):

Daniel C DeSimone ◽

Brian D Lahr ◽

Nandan S Anavekar ◽

Muhammad R Sohail ◽

Imad M Tleyjeh ◽

...

Keyword(s):

Infective Endocarditis ◽

Temporal Trends ◽

Population Based ◽

Olmsted County ◽

Calendar Time ◽

Coagulase Negative Staphylococci ◽

Significant Difference ◽

Before And After ◽

Prevention Guidelines ◽

Over Time

Abstract Background A population-based study of infective endocarditis (IE) in Olmsted County, Minnesota provides a unique opportunity to define temporal and seasonal variations in IE incidence over an extended time period. Methods Population-based review of all adults (≥18 years) residing in Olmsted County, Minnesota, with definite or possible IE using the Rochester Epidemiology Project from January 1, 1970 through December 31, 2018. Poisson regression was used to characterize the trends in IE incidence; models were fitted with age, sex, calendar time and season, allowing for non-linearity and non-additivity of their effects. Results Overall, 269 cases of IE were identified over a 49-year study period. Median age of IE cases was 67.2 years and 33.8% were females. The overall age- and sex-adjusted incidence of IE was 7.9 cases per 100,000 person-years (95% confidence interval [CI], 7.0 – 8.9), with corresponding rates of 2.4, 2.4, 0.9 and 0.7 per 100,000 person-years for Staphylococcus aureus, viridans group streptococci (VGS), Enterococcus species, and coagulase-negative staphylococci (CoNS) IE, respectively. Temporal trends varied by age, sex and season but on average IE incidence increased over time (P=0.021). Enterococcal IE increased the most (P=0.018), while S. aureus IE appeared to increase but mostly in the winter months (P=0.018). Between 1996 and 2018, the incidence of VGS IE was relatively stable, with no statistically significant difference in the trends before and after the 2007 AHA IE prevention guidelines. Conclusion Overall, IE incidence, and specifically enterococcal IE, increased over time, while S. aureus IE was seasonally dependent. There was no statistically significant difference in VGS IE incidence in the periods before and after publication of the 2007 AHA IE prevention guidelines.

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Infective endocarditis caused by HACEK group bacteria—a registry-based comparative study

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-021-04240-3 ◽

2021 ◽

Author(s):

Anna Bläckberg ◽

Christian Morenius ◽

Lars Olaison ◽

Andreas Berge ◽

Magnus Rasmussen

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Mortality Rate ◽

Haemophilus Influenzae ◽

Comparative Study ◽

Clinical Characteristics ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Common Cause ◽

Prosthetic Valves

AbstractInfective endocarditis (IE) caused by bacteria within Haemophilus (excluding Haemophilus influenzae), Aggregatibacter, Cardiobacterium, Eikenella and Kingella (HACEK) is rare. This study aimed to describe clinical features of IE caused by HACEK genera in comparison with IE due to other pathogens. Cases of IE due to HACEK were identified through the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of IE cases caused by HACEK were compared with cases of IE due to other pathogens reported to the same registry. Ninety-six patients with IE caused by HACEK were identified, and this corresponds to 1.8% of all IE cases. Eighty-three cases were definite endocarditis, and the mortality rate was 2%. The median age was 63 years, which was lower compared to patients with IE caused by other pathogens (66, 70 and 73 years respectively, p ≤ 0.01). Patients with IE caused by Haemophilus were younger compared to patients with IE due to Aggregatibacter (47 vs 67 years, p ≤ 0.001). Patients with IE due to HACEK exhibited longer duration from onset of symptoms to hospitalization and had more prosthetic valve endocarditis compared to patients with IE due to Staphylococcus aureus (10 vs 2 days, p ≤ 0.001, and 35 vs 14%, p ≤ 0.001). This is, to date, the largest study on IE due to HACEK. Aggregatibacter was the most common cause of IE within the group. The condition has a subacute onset and often strikes in patients with prosthetic valves, and the mortality rate is relatively low.

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Temporal Trends in the Severity and Mortality of Neonatal Hypoxic-Ischemic Encephalopathy in the Era of Hypothermia

Neonatology ◽

10.1159/000518654 ◽

2021 ◽

pp. 1-8

Author(s):

Cristina Vega-Del-Val ◽

Juan Arnaez ◽

Sonia Caserío ◽

Elena Pilar Gutiérrez ◽

Marta Benito ◽

...

Keyword(s):

Temporal Trends ◽

Cross Sectional Study ◽

Annual Incidence ◽

Hypoxic Ischemic Encephalopathy ◽

Cross Sectional ◽

Incidence And Mortality ◽

Changes Over Time ◽

Ischemic Encephalopathy ◽

Annual Decline ◽

Over Time

Introduction: There is a paucity of studies examining temporal trends in the incidence and mortality of moderate-to-severe hypoxic-ischemic encephalopathy (HIE) during the last decade of therapeutic hypothermia (TH). Methods: Multicenter cross-sectional study of all infants ≥35 weeks gestational age diagnosed with moderate-to-severe HIE within 6 h of birth in an extensive region of Spain between 2011 and 2019, in order to detect trend changes over time in the (1) annual incidence, (2) severity of neurological and systemic organ involvement, and (3) neonatal death from HIE. Results: Annual incidence rate of moderate-to-severe HIE was 0.84 (95% confidence interval [CI] 0.7–0.97) per 1,000 births, without trend changes over time (p = 0.8), although the proportion of severe HIE infants showed an average annual decline of 0.86 points (95% CI 0.75–0.98). There were 102 (70%) infants diagnosed with moderate HIE and 44 (30%) with severe HIE. TH was offered to 139/146 (95%) infants. Infants with clinical and/or electrical seizures showed a decreasing trend from 56 to 28% (p = 0.006). Mortality showed a nonstatistically significant decline (p = 0.4), and the severity of systemic damage showed no changes (p = 0.3). Obstetric characteristics remained unchanged, while higher perinatal pH values (p = 0.03) and Apgar scores (p = 0.05), and less need for resuscitation (p = 0.07), were found over time. Conclusion: The annual incidence of moderate-to-severe HIE has stabilized at around 1 per 1,000 births, with a temporal trend toward a decrease in severe HIE infants and a slight decline of mortality. No association was found between temporal trends and changes in perinatal/obstetric characteristics over time.

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Temporal trends in tolvaptan use after revision of national heart failure guidelines in Japan

Scientific Reports ◽

10.1038/s41598-021-98173-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yusuke Yamazaki ◽

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Yuji Nagatomo ◽

Keiichi Fukuda ◽

...

Keyword(s):

Heart Failure ◽

Clinical Practice ◽

Mortality Rate ◽

Risk Score ◽

Temporal Trends ◽

National Guidelines ◽

Hospital Outcomes ◽

Trends Over Time ◽

Multicenter Registry ◽

Over Time

AbstractWithin no definite diuretic protocol for acute heart failure (AHF) patients and its variation in regional clinical guidelines, the latest national guidelines in Japan commends use of tolvaptan in diuretic-resistant patients. This study aimed to examine trends in tolvaptan usage and associated outcomes of AHF patients requiring hospitalization. Between April, 2018 and October, 2019, 1343 consecutive AHF patients (median 78 [69–85] year-old) were enrolled in a prospective, multicenter registry in Japan. Trends over time in tolvaptan usage, along with the severity of heart failure status based on the Get With The Guideline-Heart Failure [GWTG-HF] risk score, and in-hospital outcomes were investigated. During the study period, tolvaptan usage has increased from 13.0 to 28.7% over time (p for trend = 0.07), and 49.4% started tolvaptan within 3 days after admission. The GWTG-HF risk score in the tolvaptan group has significantly decreased over time, while that in the non-tolvaptan group has unchanged. There were no differences in the in-hospital mortality rate between the patients with and without tolvaptan (6.7% vs. 5.8%). After revision of the Japanese clinical practice guidelines for AHF in March 2018, tolvaptan usage for AHF patients has steadily increased. However, in-hospital outcomes including mortality do not seem to be affected.

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Temporal trend and survival impact of infection source among patients with sepsis: a nationwide study

Critical Care and Resuscitation ◽

10.51893/2020.2.oa2 ◽

2020 ◽

Vol 22 (2) ◽

pp. 126-132

Author(s):

Yueh-Sheng Chen ◽

◽

Tin-Yun Liao ◽

Tzu-Chun Hsu ◽

Wan-Ting Hsu ◽

...

Keyword(s):

Mortality Rate ◽

Tract Infection ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Temporal Trends ◽

Administrative Database ◽

Common Source ◽

Sepsis Management ◽

Incidence And Mortality ◽

Different Sources

BACKGROUND: To determine the temporal trends of incidence and outcome based on different sources of sepsis using a nationwide administrative database. METHODS: From 2002 to 2012, the entire Taiwan's health insurance claims data of emergency-treated and hospital-treated sepsis were analysed for incidence and mortality trends. The information about patients with sepsis and sources of sepsis was identified using a set of validated International Classification of Diseases, ninth revision, clinical modification (ICD-9-CM) codes. The 30-day all-cause mortality was verified by linked death certificate database. RESULTS: A total of 1 259 578 episodes of sepsis were identified during the 11-year study period. Lower respiratory tract infection is the most common source of sepsis in patients, with the highest mortality rate. The incidence of genitourinary tract infection has the fastest growing rate. The sepsis mortality was declining at different rates for each source of sepsis. Co-infections in patients with sepsis are associated with higher mortality rate. CONCLUSION: The temporal trends of sepsis incidence and mortality varied among different sources of sepsis, with lower respiratory tract being the highest burden among patients with sepsis. Furthermore, sources of sepsis and the presence of co-infection are independent predictors of mortality. Our results support source-specific preventive and treatment strategies for future sepsis management.

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472 Epidemiology and temporal trends of cardiac device related infective endocarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.251 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Denes ◽

A Bence ◽

T Ferenci ◽

S Borbas ◽

Z Som ◽

...

Keyword(s):

Infective Endocarditis ◽

Temporal Trends ◽

Mortality Rates ◽

Coagulase Negative Staphylococcus ◽

Cardiac Device ◽

Native Valve ◽

Tertiary Referral Center ◽

Device Implantation ◽

Epidemiological Characteristics ◽

Over Time

Abstract Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p < 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p < 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.

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146. Infective Endocarditis in South Korea: a 12-year Single-Center Experience of 419 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.221 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S100-S101

Author(s):

Jung Ho Kim ◽

Hi Jae Lee ◽

Woon Ji Lee ◽

Hye Seong ◽

Jin young Ahn ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Logistic Regression ◽

Regression Analysis ◽

Infective Endocarditis ◽

Mortality Rate ◽

South Korea ◽

Hospital Mortality ◽

Incidence Rate ◽

Logistic Regression Analysis

Abstract Background Infective endocarditis (IE) is a potentially lethal disease that has undergone constant changes in epidemiology and pathogen. Treatment of IE has become more complex with today’s myriad healthcare-associated factors as well as regional differences in causative organisms. Therefore, it is necessary to investigate the overall trends, microbiological features, clinical characteristics and outcomes of IE in South Korea. Methods We performed a retrospective cohort study of patients with the diagnosis of probable or definite IE according to the modified Duke Criteria admitted to a tertiary care center in South Korea between November 2005 and August 2017. Poisson log-linear regression was used to estimate time trends of IE incidence rate and mortality rate. Risk factors for in-hospital mortality were evaluated by multivariate logistic regression analysis including an interaction term. Results There were 419 IE patients (275 male vs. 144 female) during the study period. The median age of the patients was 56 years. The annual incidence rate of IE of our institution was significantly increased. (RR 1.05; 95% CI, 1.02–1.08; P = 0.006) The mortality rate showed trends toward down, but not statistically significant (P = 0.875). IE was related to a prosthetic valve in 15.0% and 21.7% patients developed IE during hospitalization. The mitral valve was the most commonly affected valve (61.3%). Causative microorganisms were identified in 309 patients (73.7%) and included streptococci (34.6%), followed by Staphylococcus aureus (15.8%) and enterococci (7.9%). The in-hospital mortality rate was 14.6%. Logistic regression analysis found aortic valve endocarditis (OR 3.18; P = 0.001), IE caused by staphylococcus aureus (OR 2.32; P = 0.026), a presence of central nervous system embolic complication (OR 1.98; P = 0.031), a high SOFA score (OR 1.22; P = 0.023) and a high Charlson’s comorbidity index (OR 1.11; P = 0.019) as predictors of in-hospital mortality. On the other hand, surgical intervention for IE was found to be a protective factor against mortality. (OR 0.25, P < 0.001) Conclusion Although IE has been increasing, the mortality rate has not yet reduced significantly. Studies on causative organisms of IE and risk factors for mortality are warranted in improving prognosis. Disclosures All authors: No reported disclosures.

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National trends in local excision and esophagectomy for cT1N0 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.62 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 62-62 ◽

Cited By ~ 1

Author(s):

Emily C. Sturm ◽

Whitney Zahnd ◽

John D. Mellinger ◽

Sabha Ganai

Keyword(s):

Esophageal Cancer ◽

Regression Analysis ◽

Local Excision ◽

Clinical Characteristics ◽

Cox Regression ◽

Chi Square ◽

Cox Regression Analysis ◽

Significant Difference ◽

Chi Square Analysis ◽

Over Time

62 Background: Esophageal cancer management has evolved due to improvements in staging and treatment strategies. Endoscopic local excision presents an attractive option for definitive management of T1 cancers, avoiding the morbidity of esophagectomy. We hypothesized that for cT1N0 cancers, patients who underwent local excision would have lower survival compared to esophagectomy due to potential discordant staging. Methods: The National Cancer Database was queried for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC) with AJCC T1N0 clinical stage who underwent local excision (n = 1625) or esophagectomy (n = 3255) between 1998 and 2012. Chi-square analysis was used to compare demographic and clinical characteristics by procedure. Chi-square trend analysis was performed to assess trends in procedure type over time. Cox Regression analysis was performed to assess survival by procedure controlling for demographic and clinical characteristics. Results: Between 1998 and 2012, the proportion of patients who underwent local excision increased from 12% to 50% for all patients (p < 0.001); from 17% to 40% for SCC patients (p < 0.001); and from 9% to 51% for AC patients (p < 0.001). Surgical procedure varied significantly by demographic, socioeconomic status, facility, and tumor-related factors. 65% of cT1N0 cancers had concordant clinical and pathological staging after esophagectomy, with 11% having positive nodal disease; 44% were concordant after local excision. While no significant difference was seen in unadjusted survival, adjusted Cox Regression analysis indicated worse survival after esophagectomy compared to local excision for all cases (HR 1.67; 95% CI, 1.40-2.00) and for ACs with concordant staging (HR 1.54; 95% CI, 1.11-2.14). Conclusions: Local excision for cT1N0 esophageal cancer has increased over time. Staging concordance for esophagectomy is seen in two-thirds of cases. Contrary to our hypothesis, patients undergoing local excision for T1N0 cancers have better overall survival than those undergoing esophagectomy, which may reflect early differences in mortality and/or selection bias. As this study was unable to distinguish T1a from T1b, further analysis is warranted.

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Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016

10.21203/rs.2.19349/v1 ◽

2019 ◽

Author(s):

Zhenzhu Wu ◽

Yi Chen ◽

Tingting Xiao ◽

Tianshui Niu ◽

Qingyis Shi ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Hypertension ◽

Heart Disease ◽

Infective Endocarditis ◽

Mortality Rate ◽

Hospital Mortality ◽

Tertiary Hospital ◽

The Past ◽

Increasing Trend ◽

One Year

Abstract Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years. Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and streptococci (44.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.5, 95% CI 5.5-148.1) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality. Conclusions: There was no significant change in the overall incidence of IE, the clinical features of IE have changed slightly during the past ten years. Streptococci IE was still the predominant. IE patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.

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

10.21203/rs.3.rs-32103/v1 ◽

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.

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