scholarly journals 1059. Staphylococcus aureus Bacteremia Treatment: Results From Pilot Surveillance in Four US States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S316-S317
Author(s):  
Sarah Kabbani ◽  
Kelly Jackson ◽  
Lauren Epstein ◽  
Anita Gellert ◽  
Carmen Bernu ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Management Practices ◽  
Treatment Guidelines ◽  
Descriptive Analysis ◽  
Quality Measures ◽  
Population Based ◽  
Emerging Infections ◽  
Staphylococcus Aureus Bacteremia ◽  
Duration Of Hospitalization ◽  
Initial Culture

Abstract Background Staphylococcus aureus treatment guidelines are being revised to include proposed quality measures for evaluation of patients with S. aureus bacteremia (SAB) (e.g., infectious disease [ID] consultation, echocardiogram, and documenting clearance of bacteremia). We describe current management practices of SAB to identify opportunities for quality improvement. Methods We conducted a pilot assessment of SAB cases reported to CDC’s Emerging Infections Program active, laboratory- and population-based surveillance from 24 hospitals in four states during 1–2 months in 2017 or 2018. An SAB case was the isolation of S. aureus from a blood culture among adults (≥18 years) in the catchment area. We collected clinical and demographic information and performed a descriptive analysis of management of SAB cases. Results Among 109 SAB cases identified, 50 (46%) were methicillin-resistant S. aureus (MRSA). While hospitalized, 87 (80%) patients were evaluated by ID consultation, 90 (83%) underwent an echocardiogram (26 were transesophageal), and 92 (84%) had documented clearance of bacteremia. During the hospitalization, 15 (14%) died and 12 (11%) left against medical advice (AMA). Of those who survived and did not leave AMA, median duration of hospitalization after initial culture was 10.5 days (interquartile range 7–18). In total, 10 survivors (9% of cases) completed at least 2 weeks of antibiotics while hospitalized, and 65 (60% of cases) were discharged on antibiotic therapy. Among the 25 MRSA patients discharged on antibiotics, common treatments were vancomycin (64%), daptomycin (8%), ceftaroline (8%), and linezolid (4%). Among the 40 methicillin-susceptible SAB patients discharged on antibiotics, cefazolin (56%), ceftriaxone (13%), cefepime (5%), linezolid (5%), nafcillin (3%), and vancomycin (3%) were most common. The remainder of outpatient treatments included oral β-lactams, clindamycin, doxycycline, levofloxacin, and erythromycin. Conclusion Overall, the majority of patients with SAB underwent evaluation according to the proposed quality measures and received therapy with targeted anti-staphylococcal agents, although opportunities to optimize treatment remain. Hospitalized patients who leave AMA represent a particular challenge for effective SAB therapy. Disclosures All authors: No reported disclosures.

scholarly journals Influence of Acetylsalicylic Acid Use on Risk and Outcome of Community-Acquired Staphylococcus aureus Bacteremia: A Population-Based Study

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Jesper Smit ◽  
Michael Dalager-Pedersen ◽  
Kasper Adelborg ◽  
Achim J Kaasch ◽  
Reimar W Thomsen ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acetylsalicylic Acid ◽  
Population Based ◽  
Socioeconomic Indicators ◽  
Medical Databases ◽  
Staphylococcus Aureus Bacteremia ◽  
Increased Risk ◽  
First Time ◽  
Population Controls

Abstract Objective To investigate the influence of acetylsalicylic acid (ASA) use on risk and outcome of community-acquired Staphylococcus aureus bacteremia (CA-SAB). Method We used population-based medical databases to identify all patients diagnosed in northern Denmark with first-time CA-SAB and matched population controls from 2000–2011. Categories for ASA users included current users (new or long-term users), former users, and nonusers. The analyses were adjusted for comorbidities, comedication use, and socioeconomic indicators. Results We identified 2638 patients with first-time CA-SAB and 26 379 matched population controls. Compared with nonusers, the adjusted odds ratio (aOR) for CA-SAB was 1.00 (95% confidence interval [CI], 0.88–1.13) for current users, 1.00 (95% CI, 0.86–1.16) for former users, 2.04 (95% CI, 1.42–2.94) for new users, and 0.95 (95% CI, 0.84–1.09) for long-term users. Thirty-day cumulative mortality was 28.0% among current users compared with 21.6% among nonusers, yielding an adjusted hazard rate ratio (aHRR) of 1.02 (95% CI, 0.84–1.25). Compared with nonusers, the aHRR was 1.10 (95% CI, 0.87–1.40) for former users, 0.60 (95% CI, 0.29–1.21) for new users, and 1.06 (95% CI, 0.87–1.31) for long-term users. We observed no difference in the risk or outcome of CA-SAB with increasing ASA dose or by presence of diseases commonly treated with ASA. Conclusions Use of ASA did not seem to influence the risk or outcome of CA-SAB. The apparent increased risk among new users may relate to residual confounding from the circumstances underlying ASA treatment initiation. Our finding of no association remained robust with increasing ASA dose and across multiple patient subsets.

scholarly journals Staphylococcus aureus bacteremia and cardiac implantable electronic devices in a county hospital setting: a population-based retrospective cohort study

2021 ◽  
Vol 126 (1) ◽  
Author(s):  
Sara Pichtchoulin ◽  
Ingrid Selmeryd ◽  
Elisabeth Freyhult ◽  
Pär Hedberg ◽  
Jonas Selmeryd
Keyword(s):  
Staphylococcus Aureus ◽  
Electronic Device ◽  
Hospital Setting ◽  
Population Based ◽  
County Hospital ◽  
Individual Risk ◽  
Hospital Death ◽  
Device Removal ◽  
Staphylococcus Aureus Bacteremia ◽  
Cardiac Implantable Electronic Devices

Background: Due to a high incidence of cardiac implantable electronic device-associated infective endocarditis (CIED-IE) in cases of Staphylococcus aureus bacteremia (SAB) and high mortality with conservative management, guidelines advocate device removal in all subjects with SAB. We aimed to investigate the clinical course of SAB in patients with a CIED (SAB+CIED) in a Swedish county hospital setting and relate it to guideline recommendations. Methods: All CIED carriers with SAB, excluding clinical pocket infections, in the County of Västmanland during 2010–2017 were reviewed retrospectively. Results: There were 61 cases of SAB+CIED during the study period, and CIED-IE was diagnosed in 13/61 (21%) cases. In-hospital death occurred in 19/61 (31%) cases, 34/61 (56%) cases were discharged with CIED device retained, and 8/61 (13%) cases were discharged after device removal. Subjects dying during hospitalization were elderly and diseased. No events was seen if the CIED was removed. Among four discharged cases with conservatively managed CIED-IE one relapse occured. Among 30 cases discharged with retained CIED and no evidence of IE, 22/30 (73%) cases had an uneventful follow-up, whereas adverse events secondary to overlooked CIED-IE were likely in 1/30 (3%) cases and could not be definitely excluded in additionally 4/30 (13%) cases. Conclusions: During the study period, management became more active and prognosis improved. The heterogeneity within the population of SAB+CIED suggests that a management strategy based on an individual risk/benefit analysis could be an alternative to mandatory device removal.

scholarly journals Clinical Practice Variation Among Adult Infectious Disease Physicians in the Management of Staphylococcus aureus Bacteremia

2019 ◽  
Vol 69 (3) ◽  
pp. 530-533 ◽  
Author(s):  
Catherine Liu ◽  
Luke Strnad ◽  
Susan E Beekmann ◽  
Philip M Polgreen ◽  
Henry F Chambers
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Clinical Practice ◽  
Disease Management ◽  
Best Practices ◽  
Practice Variation ◽  
Adult Patients ◽  
Diagnostic Evaluation ◽  
Emerging Infections ◽  
Staphylococcus Aureus Bacteremia

Abstract Infectious disease management of Staphylococcus aureus bacteremia (SAB) was surveyed through the Emerging Infections Network. Although there were areas of consensus, we found substantial practice variation in diagnostic evaluation and management of adult patients with SAB. These findings highlight opportunities for further research and guidance to define best practices.

scholarly journals Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019

2020 ◽  
pp. 1-8
Author(s):  
Casey Morgan Luc ◽  
Danyel Olson ◽  
David B. Banach ◽  
Paula Clogher ◽  
James Hadler
Keyword(s):  
Treatment Guidelines ◽  
Severe Disease ◽  
Recurrence Risk ◽  
Population Based ◽  
New Haven ◽  
Emerging Infections ◽  
Medical Providers ◽  
First Line ◽  
Clostridioides Difficile ◽  
Increased Risk

Abstract Objectives: To assess Connecticut medical providers’ concordance (2018–2019) with the 2017 Clostridioides difficile infection (CDI) treatment update by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). The effect of guideline concordance on CDI recurrence risk was also assessed. Design: Prospective, population-based study. Setting: New Haven County, Connecticut, from January 1, 2017, to December 31, 2019. Patients: CDI incident case (no positive tests in the prior 8 weeks), not limited by care setting. Methods: Using data from the Emerging Infections Program’s CDI surveillance, severity and concordance were defined. Presence of megacolon and/or ileus defined fulminant disease; absence defined nonsevere/severe disease. Using 2017 treatment as baseline, 2018–2019 concordance was defined as receiving the recommended first-line antibiotic (ie, vancomycin or fidaxomicin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. For all analyses, significance was P < .05. Results: Among 990 cases, concordance increased from 24.8% in 2018 to 37.0% in 2019. First-line antibiotic concordance increased from 61.2% in 2018 to 79.9% in 2019. Recurrence risk was significantly associated with patients aged ≥65 years and was highest for those aged 75–84 years, but this factor was not significantly associated with concordance. Conclusions: From 2018 through 2019, CDI treatment in New Haven County increasingly was concordant with the 2017 treatment update but remained low in 2019. Although concordance with treatment guidelines did not affect recurrence risk, close attention should be paid by medical providers to patients aged ≥65 years, specifically those aged 75–84 years because they are at an increased risk for recurrence.

Epidemiology and Outcome Determinants of Staphylococcus aureus Bacteremia Revisited: A Population-Based Study

Infection ◽  
2019 ◽  
Vol 47 (6) ◽  
pp. 961-971 ◽  
Author(s):  
John C. Lam ◽  
Daniel B. Gregson ◽  
Stephen Robinson ◽  
Ranjani Somayaji ◽  
John M. Conly ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Population Based ◽  
Population Based Study ◽  
Staphylococcus Aureus Bacteremia

scholarly journals 312. Unplanned Readmission after Hospitalization with Staphylococcus aureus Bacteremia in Children: a Multistate Population Based Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S152-S153
Author(s):  
Kengo Inagaki ◽  
Md Abu Yusuf Ansari ◽  
Charlotte V Hobbs
Keyword(s):  
Staphylococcus Aureus ◽  
Hematologic Malignancy ◽  
Adult Population ◽  
Multivariable Analysis ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Interquartile Range ◽  
Unplanned Readmission ◽  
Catheter Related Infection ◽  
Staphylococcus Aureus Bacteremia

Abstract Background Staphylococcus aureus bacteremia is associated with substantial mortality and morbidity. Readmission is becoming increasingly recognized as an important quality measure and can inform optimal patient care. We previously reported readmission analyses in the setting of S. aureus bacteremia in the adult population. However, readmission has not been characterized in children. Methods We performed a population-based longitudinal observational study using the State Inpatient Database from New York, Florida, and Washington states, 2009–2015. Children aged 18 years or younger hospitalized with S. aureus bacteremia were included. The outcome of unplanned readmission within 30 days and 90 days of discharge was assessed by developing Cox proportional hazards regression models. Results Of 1240 children that were included in the analysis, 18% (223 children) had unplanned readmission within 30 days after discharge, and 28.3% were readmitted within 90 days. On multivariable analysis, children with underlying conditions of hematologic malignancy (hazard ratio, HR: 1.67, 95% confidence interval, CI: 1.09–2.56) and catheter related infection (HR: 1.79, 95%CI: 1.31–2.45) had higher hazards of readmission, whereas coexisting skin and soft tissue infection (HR: 0.42, 95%CI: 0.24–0.71) was associated with a lower rate of readmission (Table, Figure). In addition to these, solid tumor malignancy and longer length of stay during the original hospitalization were associated with higher hazards of 90-day readmission. The median cost of the original hospitalization for S. aureus bacteremia was $29914 (interquartile range, IQR: $13276-$71284), and that of 30-day readmission was $10956 (interquartile range, IQR: $5765-$24753). Table Figure Conclusion Unplanned readmission is common and costly among children who survived S. aureus bacteremia, occurring in 18% and 28.3% within 30 and 90 days after discharge, respectively. Those with malignancies and catheter related infection had higher hazards of unplanned readmission. Further research is needed to identify optimal interventions to reduce readmission rates associate with S. aureus bacteremia in children. Disclosures All Authors: No reported disclosures

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