scholarly journals 1208. Impact of Admission to an Inpatient Infectious Disease Unit on Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S366-S366
Author(s):  
Zainab Farooqui Mirza ◽  
Ana C Bardossy ◽  
Helina Misikir ◽  
Hind Hadid ◽  
Nathalie Baratz ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Blood Stream Infection ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infection (BSI) remains a condition with high mortality. Despite the introduction of new antibiotics, the mortality in the past 10 years at our institution remains unchanged. To evaluate measures that improve outcomes in these patients (patients), we studied the impact of admission to an inpatient infectious disease (ID) unit. Methods We identified a retrospective cohort of patients with MRSA BSI at an 800-bed hospital in urban Detroit from January 2013 to February 2017. Patients were assigned to one of the three groups: group 1 was admission to inpatient ID unit where the ID doctors were the attending physicians, group 2 was ID consultation (without admission to ID unit), and group 3 was no ID consultation. Demographics, clinical information, and 30 day mortality from index blood culture were collected. Source of BSI was classified into four categories: primary (endovascular infection); secondary (respiratory, skin, osteomyelitis, abdominal and genitourinary infections); central line associated; unknown. Unpaired t-test and Fisher’s exact test were used to compare groups. Results A total of 477 patients were identified with MRSA BSI during the study period. 89 (18.7%) were in group 1, 299 (62%) in group 2 and 89 (18.7%) in group 3. Pt clinical characteristics and outcomes are shown in Table 1. Overall 30-day mortality was 21.4%. Comparison of mortality between groups are shown in Table 2. Conclusion While it is well established that ID consultation has improved outcomes in MRSA BSI, this is the first study that shows that admission to an inpatient ID unit decreases mortality even further. Disclosures All authors: No reported disclosures.

scholarly journals Methicillin-resistant staphylococcus aureus carriage and comorbidity in patients with chronic kidney disease V D stage: a 3-year prospective study

2020 ◽  
pp. 24-31
Author(s):  
I. Shifris
Keyword(s):  
Staphylococcus Aureus ◽  
Pathogenic Bacteria ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Chronic Obstructive ◽  
Nasal Colonization ◽  
Comorbid Conditions ◽  
Methicillin Resistant ◽  
Group 2 ◽  
Esrd Patients ◽  
Group 1

Asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a confirmed factor that affects the frequency of comorbid bacterial infections and mortality in patients with end-stage renal disease (ESRD). The aim was to study the frequency of comorbid conditions and their dynamics in ESRD patients depending on their MRSA status. Methods. To prospective cohort study included 265 ESRD patients, 204 of whom were treated by hemodialysis (HD) and 61 by peritoneal dialysis (PD). All recorded comorbidities, their frequency and the dynamics of change, polymorbidity indices, were analyzed depending on whom had MRSA nasal colonization (group 1, n = 92) and without it (group 2, n= 173). The most common cause of ESRD was glomerulonephritis - 161 patients (60.75%). The groups were representative according to gender, age, type of kidney injury and modality of renal replacement therapy (RRT). Results. According to the results of a 3-year study investigation, the patients with MRSA carriage had a statistically significant higher level of comorbid conditions frequencies compared to the patients who had opportunistic pathogenic bacteria carriage, namely: prevalence of coronary artery disease (55.4% vs 30.1%, р=0.0001), heart failure (44.6% vs 25.4%, р=0.0015), secondary hyperparathyroidism (61.9% vs 45.1%, р=0,009), chronic obstructive pulmonary disease (31.5% vs 17.3%, р=0.0082), peripheral vascular disease (39.15 vs 17.9%, р=0.0001). The increase in the modified polymorphism index in patients of Group 1 and Group 2 during the observation period, was 30 % and 5% respectively. One hundred thirty three hospitalization cases were detected during follow-up period: among patients from Group 1- 66 (71.34%) cases, Group 2 - 67 (38.73%); χ² = 26.180, р < 0.0001; RR – 1.8524, 95% ДІ: 1.4760 – 2.3247. Conclusions. Asymptomatic MRSA nasal colonization is a factor that can increase the incidence of coexisting diseases as well as the total number of comorbid conditions in dialysis patients.

scholarly journals The Effect of Infectious Diseases Consultation on Mortality in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus, Candida, and Pseudomonas Bloodstream Infections

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Supavit Chesdachai ◽  
Susan Kline ◽  
Derrek Helmin ◽  
Radha Rajasingham
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Bloodstream Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Hospitalized Patients ◽  
Methicillin Resistant ◽  
Infectious Disease Consultation ◽  
Infectious Diseases Consultation

Abstract We evaluated the association between infectious disease consultation and bloodstream infection outcomes, including methicillin-resistant Staphylococcus aureus, Candida, and Pseudomonas. No infectious diseases consultation was associated with over 4-fold increased hazard of death at 3 months and 6-fold increased hazard of death in hospital.

scholarly journals The Impact of Concomitant Empiric Cefepime on Patient Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections Treated With Vancomycin

2019 ◽  
Vol 6 (4) ◽  
Author(s):  
Evan J Zasowski ◽  
Trang D Trinh ◽  
Safana M Atwan ◽  
Marina Merzlyakova ◽  
Abdalhamid M Langf ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Patient Outcomes ◽  
Primary Outcome ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Hazard Models ◽  
Binary Outcomes ◽  
Subdistribution Hazard ◽  
Methicillin Resistant ◽  
The Impact

Abstract Background Data suggest that vancomycin + β-lactam combinations improve clearance of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs). However, it is unclear which specific β-lactams confer benefit. This analysis evaluates the impact of concomitant empiric cefepime on outcomes of MRSA BSIs treated with vancomycin. Methods Retrospective cohort study of adults with MRSA BSI from 2006 to 2017. Vancomycin + cefepime therapy was defined as ≥24 hours of cefepime during the first 72 hours of vancomycin. The primary outcome was microbiologic failure, defined as BSI duration ≥7 days and/or 60-day recurrence. Multivariable logistic regression was used to evaluate the association between vancomycin + cefepime therapy and binary outcomes. Cause-specific and subdistribution hazard models were used to evaluate the association between vancomycin + cefepime and BSI clearance. Results Three hundred fifty-eight patients were included, 129 vancomycin and 229 vancomycin + cefepime. Vancomycin + cefepime therapy was independently associated with reduced microbiologic failure (adjusted odds ratio [aOR], 0.488; 95% confidence interval [CI], 0.271–0.741). This was driven by a reduction in the incidence of BSI durations ≥7 days (vancomycin + cefepime aOR, 0.354; 95% CI, 0.202–0.621). Vancomycin + cefepime had no association with 30-day mortality (aOR, 0.952; 95% CI, 0.435–2.425). Vancomycin + cefepime was associated with faster BSI clearance in both cause-specific (HR, 1.408; 95% CI, 1.125–1.762) and subdistribution hazard models (HR, 1.264; 95% CI, 1.040–1.536). Conclusions Concomitant empiric cefepime improved MRSA BSI clearance and may be useful as the β-lactam component of synergistic vancomycin + β-lactam regimens when empiric or directed gram-negative coverage is desired.

scholarly journals QOL-49. THE IMPACT OF OTOTOXICITY AND VISUAL IMPAIRMENT ON EDUCATION IN CHILDREN TREATED FOR CNS TUMOURS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii440-iii440
Author(s):  
Harriet Dulson ◽  
Rachel McAndrew ◽  
Mark Brougham
Keyword(s):  
Visual Impairment ◽  
Impaired Hearing ◽  
Cranial Radiotherapy ◽  
Radiotherapy Group ◽  
Platinum Based Chemotherapy ◽  
Cns Tumours ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract INTRODUCTION Children treated for CNS tumours experience a very high burden of adverse effects. Platinum-based chemotherapy and cranial radiotherapy can cause ototoxicity, which may be particularly problematic in patients who have impaired vision and cognition as a result of their tumour and associated treatment. This study assessed the prevalence of impaired hearing and vision and how this may impact upon education. METHODS 53 patients diagnosed with solid tumours in Edinburgh, UK between August 2013–2018 were included in the study. Patients were split into three groups according to treatment received: Group 1 – cisplatin-based chemotherapy and cranial radiotherapy; Group 2 - platinum-based chemotherapy, no cranial radiotherapy; Group 3 – benign brain tumours treated with surgery only. Data was collected retrospectively from patient notes. RESULTS Overall 69.5% of those treated with platinum-based chemotherapy experienced ototoxicity as assessed by Brock grading and 5.9% of patients had reduced visual acuity. Patients in Group 1 had the highest prevalence of both. 44.4% of patients in Group 1 needed increased educational support following treatment, either with extra support in the classroom or being unable to continue in mainstream school. 12.5% of Group 2 patients required such support and 31.3% in Group 3. CONCLUSIONS Children with CNS tumours frequently require support for future education but those treated with both platinum-based chemotherapy and cranial radiotherapy are at particular risk, which may be compounded by co-existent ototoxicity and visual impairment. It is essential to provide appropriate support for this patient cohort in order to maximise their educational potential.

scholarly journals Antibiotic Resistance, spa Typing and Clonal Analysis of Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Blood of Patients Hospitalized in the Czech Republic

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 395
Author(s):  
Katarina Pomorska ◽  
Vladislav Jakubu ◽  
Lucia Malisova ◽  
Marta Fridrichova ◽  
Martin Musilek ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Czech Republic ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Spa Typing ◽  
The Czech Republic ◽  
Methicillin Resistant ◽  
Mrsa Strains ◽  
Spa Types ◽  
Repeat Pattern

Staphylococcus aureus is one of the major causes of bloodstream infections. The aim of our study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates from blood of patients hospitalized in the Czech Republic between 2016 and 2018. All MRSA strains were tested for antibiotic susceptibility, analyzed by spa typing and clustered using a Based Upon Repeat Pattern (BURP) algorithm. The representative isolates of the four most common spa types and representative isolates of all spa clonal complexes were further typed by multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing. The majority of MRSA strains were resistant to ciprofloxacin (94%), erythromycin (95.5%) and clindamycin (95.6%). Among the 618 strains analyzed, 52 different spa types were detected. BURP analysis divided them into six different clusters. The most common spa types were t003, t586, t014 and t002, all belonging to the CC5 (clonal complex). CC5 was the most abundant MLST CC of our study, comprising of 91.7% (n = 565) of spa-typeable isolates. Other CCs present in our study were CC398, CC22, CC8, CC45 and CC97. To our knowledge, this is the biggest nationwide study aimed at typing MRSA blood isolates from the Czech Republic.

scholarly journals 286. Exploratory Cost-Effectiveness Analysis for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections: Are Daptomycin and Linezolid Favored over Vancomycin and Other Antibiotics?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S144
Author(s):  
Michelle Vu ◽  
Kenneth Smith ◽  
Sherrie L Aspinall ◽  
Cornelius J Clancy ◽  
Deanna Buehrle
Keyword(s):  
Staphylococcus Aureus ◽  
Cost Effectiveness ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Sensitivity Analyses ◽  
Drug Event ◽  
Base Case ◽  
Health Administration ◽  
Research Support ◽  
Methicillin Resistant

Abstract Background Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSAB) cause significant mortality and often require extended antibiotic therapy. Vancomycin, the most common initial MRSAB treatment, carries significant monitoring burden and nephrotoxicity risks. We compared cost-effectiveness of vancomycin and other antibiotic regimens as MRSAB treatment. Methods We estimated cost-effectiveness of intravenous antibiotics (vancomycin, daptomycin, linezolid, ceftaroline/daptomycin, dalbavancin) for Veterans Health Administration (VA) patients with MRSAB using an exploratory decision-tree model. Primary effectiveness outcome was composite of microbiological failure and adverse drug event (ADE)-related discontinuation at 7-days. Results In base-case analyses, linezolid and daptomycin were less expensive and had fewer treatment failures than other regimens at 4 and 6-weeks. Compared to linezolid, daptomycin incremental cost-effectiveness ratios were ~$45,000 (4-weeks) and ~$61,000 (6-weeks) per composite failure avoided, respectively. In one-way sensitivity analyses, daptomycin (4-weeks) was favored over linezolid if linezolid microbiological failure or ADE-related discontinuation rates were &gt;14.8% (base case: 14.0%) or &gt;14.3% (base case: 14.0%), respectively, assuming a willingness to pay (WTP) threshold of $40,000/ composite treatment failure avoided. Vancomycin was favored if its microbiological failure risk was &lt; 16.4% (base case: 27.2%). In two-way sensitivity analyses, daptomycin was favored if linezolid microbiological failure and ADE-related discontinuation rates were &gt;19% and &gt; 16%, respectively. Linezolid, daptomycin and vancomycin were favored in 47%, 39%, and 11% of 4-week probabilistic iterations, respectively, at $40,000 WTP. Conclusion Daptomycin or linezolid are likely less expensive and more effective than vancomycin or other initial regimens for MRSAB. More data are needed to support safety of linezolid in MRSAB patients. Disclosures Cornelius J. Clancy, MD, Astellas (Consultant, Grant/Research Support)Cidara (Consultant, Research Grant or Support)Melinta (Grant/Research Support)Merck (Consultant, Grant/Research Support)Needham Associates (Consultant)Qpex (Consultant)Scynexis (Consultant)Shionogi (Consultant)

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