scholarly journals Uncomplicated Staphylococcus aureus Bacteremia Treatment Duration and Outcomes at an Academic Medical Center

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Daniel Taupin ◽  
Adolf W Karchmer ◽  
Roger B Davis ◽  
Mary T LaSalvia
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Duration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vein Thrombosis ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Academic Medical ◽  
Intravenous Antibiotics ◽  
Deep Vein

Abstract We compared outcomes and clinical characteristics of uncomplicated Staphylococcus aureus bacteremia planned for a 14-day or >14-day course of intravenous antibiotics. Treatment failure was infrequent in both groups (0% and 5%, respectively). Catheter-associated deep vein thrombosis, immunosuppression, and valvular dysfunction were associated with a longer planned duration of therapy.

scholarly journals 301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Mohammed Aldhaeefi ◽  
Jeffrey Pearson ◽  
Sanjat Kanjilal ◽  
Brandon Dionne
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Similar Distribution ◽  
Clinical Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy >72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

scholarly journals Reduced Mortality of Staphylococcus aureus Bacteremia in a Retrospective Cohort Study of 2139 Patients: 2007–2015

2019 ◽  
Vol 70 (8) ◽  
pp. 1666-1674 ◽  
Author(s):  
Eloise D Austin ◽  
Sean S Sullivan ◽  
Nenad Macesic ◽  
Monica Mehta ◽  
Benjamin A Miko ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rapid Diagnostics ◽  
Staphylococcus Aureus Bacteremia ◽  
Group 3 ◽  
Group 2 ◽  
Mssa Infection ◽  
Group 1

Abstract Background Understanding the changing epidemiology of Staphylococcus aureus bacteremia, as well as the variables associated with poor outcomes, can yield insight into potential interventions. Methods This study was a retrospective, observational cohort study of adult patients at an academic medical center in New York City who had S. aureus bloodstream infections between 1 January 2007 and 31 December 2015. Participants were divided into 3 periods: group 1 (2007–2009), group 2 (2010–2012), and group 3 (2013–2015) for trend analysis. All clinical strains were genotyped (spa.). The main outcome was 30-day all-cause mortality. Results There were 1264 episodes of methicillin-susceptible S. aureus (MSSA) and 875 episodes of methicillin-resistant S. aureus (MRSA) bacteremia, with a rising proportion due to MSSA (55% group 1; 59% group 2; 63% group 3; P = .03.) There were no significant changes in average age, gender, Charlson score, and distribution of strain genotypes. Mortality in MRSA infection was unchanged (25% group 1; 25% group 2; 26% group 3), while mortality in MSSA infection significantly declined (18% group 1; 18% group 2; 13% group 3). The average time to antistaphylococcal therapy (AST) in MSSA infection declined during the study (3.7 days group 1; 3.5 group 2; 2.2 group 3). In multivariate analysis, AST within 7 days of initial positive MSSA culture was associated with survival. Conclusions Mortality in MSSA bloodstream infection is declining, associated with a decrease in time to targeted therapy. These results emphasize the potential for rapid diagnostics and early optimization of treatment to impact outcomes in MSSA bacteremia.

Effectiveness and Safety of Twice- Versus Thrice-Daily Subcutaneous Heparin for Venous Thromboembolism Prophylaxis at a Large Academic Medical Center

2021 ◽  
pp. 106002802110413
Author(s):  
Eryne E. Wiethorn ◽  
Sarah Harrison ◽  
Erin R. Weeda ◽  
Carolyn Magee Bell
Keyword(s):  
Venous Thromboembolism ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Secondary Outcome ◽  
Bleeding Events ◽  
Thromboembolism Prophylaxis ◽  
Vein Thrombosis ◽  
Venous Thromboembolism Prophylaxis ◽  
Deep Vein

Background Dosing variation of subcutaneous unfractionated heparin (UFH) exist for venous thromboembolism prophylaxis (VTEP). Objective The purpose of this study was to compare the safety and effectiveness of thrice-daily (TID) versus twice-daily (BID) administration of UFH during a heparin shortage for VTEP. Methods A single-center retrospective analysis was conducted in patients with orders for BID subcutaneous UFH during a heparin shortage from September 1, 2019, to February 4, 2020. These patients were matched to patients with TID subcutaneous UFH orders from January 1, 2019, to May 31, 2019. The primary outcome was the incidence of deep-vein thrombosis or pulmonary embolism confirmed by imaging during hospitalization. The secondary outcome was the incidence of major or clinically relevant nonmajor bleeding events as defined by International Society on Thrombosis and Haemostasis (ISTH) definitions. Results A total of 277 patients with orders for BID UFH and meeting inclusion criteria were evaluated and matched to patients who received TID UFH. After the exclusion criteria were implemented, 510 patients remained in the TID group. The primary outcome occurred in 4% of patients in the BID group and 3% in the TID group ( P = 0.645). Major bleeding or clinically relevant nonmajor bleeding events occurred in 10% of patients in the BID group and 8% in the TID group ( P = 0.310). Conclusion and Relevance There was no difference in effectiveness or safety of TID versus BID subcutaneous UFH for VTEP. During a heparin shortage, transitioning patients to BID UFH for VTEP to conserve supply may be considered.

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