scholarly journals 1065. Evaluation of a Staphylococcus aureus Bacteremia Treatment Checklist

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S318-S319
Author(s):  
Hailey Soukup ◽  
Jessica Holt
Keyword(s):  
Staphylococcus Aureus ◽  
Primary Outcome ◽  
Blood Cultures ◽  
High Morbidity ◽  
Drug Selection ◽  
Evidence Based Treatment ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Improved Outcomes ◽  
Antibiotic Duration

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality. Appropriate management involves repeat blood cultures, echocardiography, drug selection/route, and duration of therapy. Multiple studies have demonstrated improved outcomes in patients who are managed by infectious disease (ID) physicians compared with non-ID physicians; however, not all sites have access to an ID provider. To improve management of SAB, a checklist was developed and approved for use in a large healthcare system in August 2015. Methods A retrospective review was conducted on 400 randomly selected patients with SAB, 200 pre- and 200 post-implementation of a four-part management checklist. The primary outcome was overall adherence to the checklist, which included: repeat blood cultures, echocardiography, correct antibiotic/route selection, and appropriate antibiotic duration. Secondary outcomes included adherence when an ID physician was not consulted, adherence to the four components individually, and appropriate imaging. Results Adherence to the four part bundle remained stable from 2015 to 2017, with overall adherence rates of 80% and 79%, respectively. From 2015 to 2017, patients without repeat blood cultures (7% vs. 2%, respectively) and inappropriate inpatient antibiotic selection (6% vs. 3%, respectively) improved. Outpatient prescribing (11% vs. 11%), lack of imaging (11% vs. 9%), and antibiotic duration (15% vs. 15%) were consistent from 2015 to 2017, respectively. In 2017, 13 patients were discharged on oral antibiotics and were deemed inappropriate per the study criteria, although 12 of these patients were on appropriate antibiotics while inpatient. Infectious diseases providers were consulted on 96% of cases in 2017, an increase from 90% in 2015. Conclusion Adherence to an evidence based treatment bundle remains consistent with a previous analysis, despite an increase in cases with an ID provider consulted. Repeating blood cultures and inpatient prescribing improved over the interval. Focus areas for improvement include imaging, outpatient prescribing, and duration of therapy. Disclosures All authors: No reported disclosures.

scholarly journals 291. Impact of Surveillance and Offered Infectious Diseases Consults for Staphylococcus aureus Bacteremia on Quality of Care Indicators

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Khushali Jhaveri ◽  
Sheena Ramdeen
Keyword(s):  
Staphylococcus Aureus ◽  
Quality Of Care ◽  
Infectious Diseases ◽  
Blood Cultures ◽  
Lower Mortality ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Source Of Infection

Abstract Background Staphylococcus aureus bacteremia (SAB) remains the leading cause of bloodstream infections and is associated with 20–40% mortality. Past studies demonstrated that Infectious Diseases (ID) consultation is associated with better adherence to quality of care indicators (QCIs), including follow-up blood cultures, echocardiography, early source control, and appropriate choice and duration of antibiotics. A 2014 quality improvement project at Medstar Washington Hospital Center (MWHC) by Narsana et al. showed significantly better adherence to SAB QCIs among patients with ID consults and a non-significant trend towards lower mortality. In 2015, MWHC instituted a policy advocating ID consultation for all SAB patients, and active surveillance was performed by the ID Section to offer prompt consults prospectively. Our study aimed to assess the impact of this policy and the proactively offered ID consults on adherence to SAB QCIs and mortality rates amongst patients with SAB with and without ID consults. Methods We retrospectively reviewed 557 patients diagnosed with SAB between July 1st, 2015 - June 30th, 2018. Data included follow-up blood cultures, echocardiography, presence of a focal source of infection, use of appropriate antibiotics, measurement of vancomycin levels, duration of therapy, death during hospitalization, and presence of an ID consultation. Chi-Square and Fisher exact tests, and t-test and Wilcoxon rank sum test were used to analyze categorical and continuous variables, respectively. Results A total of 513 patients were included in the analysis, 88% (n=453) of whom had ID consultations. Patients with ID consultations were more likely to have a focal source of infection (84% vs. 50%, p < 0.0001), echocardiography (97% vs. 56%, p < 0.0001), use of a beta-lactam antibiotic for methicillin-susceptible S. aureus (90% vs 65%, p < 0.0001), and a longer duration of therapy (33 vs 9 days, p< 0.0001). Mortality was lower among patients with ID consults (16% vs. 23%, p=0.1495), but the difference was not statistically significant. Table 1 Conclusion Our study demonstrates that ID consultation is associated with better adherence to SAB QCIs, with a trend towards lower mortality. Hospital systems should support mandatory ID consultation for patients with Staphylococcus aureus bacteremia. Disclosures All Authors: No reported disclosures

scholarly journals 9. The Skip Phenomenon in Staphylococcus aureus Bacteremia: Clinical Associations

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S7-S8
Author(s):  
John Raymond U Go ◽  
Larry M Baddour ◽  
Brian Lahr ◽  
Muhammad R Sohail ◽  
Raj Palraj
Keyword(s):  
Staphylococcus Aureus ◽  
Statistical Significance ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Clinical Microbiology Laboratory ◽  
Staphylococcus Aureus Bacteremia ◽  
Increased Risk ◽  
Antibiotic Duration ◽  
Using Data

Abstract Background Serial blood cultures are integral in managing Staphylococcus aureus bacteremia (SAB) as clinicians rely on the results to determine infectious complication risks and antibiotic duration. Current IDSA guidelines suggest a single set of negative blood cultures is adequate evidence of SAB clearance. Several studies, however, have identified the skip phenomenon (SP), which is the occurrence of intermittent negative blood cultures, and have recommended obtaining additional blood cultures to document bacterial clearance (Table 1). We therefore examined patients who manifested the SP to determine its clinical significance and to study this, associations were tested for SP in relation to various baseline factors as well as clinical outcomes. Methods We performed a retrospective, multicenter study of all patients with a positive blood culture for S. aureus from January 2019 to December 2019 using data collected from electronic health records and the clinical microbiology laboratory. Results A total of 602 patients with SAB were identified and 495 patients were included in the investigation (Figure 1). Overall, 25 (5.1%) patients had the SP. Significant differences between those who did and did not manifest the SP included higher rates of injection drug use, automatic implantable cardioverter defibrillator, and community onset of infection in the SP cohort (Table 2). Moreover, the median duration of SAB was longer (3.2 [2.3-5.4] vs 1.90 [1.2-2.9] days, p=0.002), and high-grade SAB, (88.0% vs 58.7%, p=0.004), complicated bacteremia (92.0% vs 67.9%, p=0.011) and IE diagnosis (28.0% vs 11.3%, p=0.013) were all more common in the SP group. In unadjusted outcome analyses, association of SP with hospital length of stay was not significant, although a higher risk of in-hospital mortality among SP patients approached statistical significance (p=0.055). Analysis of 435 hospital survivors revealed no significant differences in rates of 1-year mortality or 90-day relapse between the two groups (Table 3). Conclusion Findings of the current investigation demonstrates an increased risk of SAB complications in patients with the SP and support the notion that serial negative blood cultures are needed to document clearance of SAB. Disclosures Larry M. Baddour, MD, Boston Scientific (Individual(s) Involved: Self): Consultant; Botanix Pharmaceuticals (Individual(s) Involved: Self): Consultant; Roivant Sciences (Individual(s) Involved: Self): Consultant Muhammad R. Sohail, MD, Medtronic (Consultant)Philips (Consultant)

scholarly journals Top Questions in Uncomplicated, Non–Staphylococcus aureus Bacteremia

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Jesse D Sutton ◽  
Sena Sayood ◽  
Emily S Spivak
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Blood Cultures ◽  
Oral Antibiotics ◽  
Beta Lactams ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia

Abstract The Infectious Diseases Society of America infection-specific guidelines provide limited guidance on the management of focal infections complicated by secondary bacteremias. We address the following 3 commonly encountered questions and management considerations regarding uncomplicated bacteremia not due to Staphylococcus aureus: the role and choice of oral antibiotics focusing on oral beta-lactams, the shortest effective duration of therapy, and the role of repeat blood cultures.

scholarly journals Successful Clearance of Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia with Daptomycin, Linezolid, and Meropenem Salvage Therapy

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Grant Shaddix ◽  
Kalindi Patel ◽  
Matthew Simmons ◽  
Kelsie Burner
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Salvage Therapy ◽  
Blood Cultures ◽  
Empiric Antibiotic Therapy ◽  
White Female ◽  
Salvage Regimen ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Empiric Antibiotic

Staphylococcus aureus is one of the most virulent Gram-positive organisms responsible for a multitude of infections, including bacteremia. Methicillin-resistant Staphylococcus aureus (MRSA) is of special concern in patients with bacteremia. Due to its associated poor clinical outcomes, morbidity, and mortality, the superlative salvage regimen for persistent MRSA bacteremia remains uncertain. An 85-year-old white female presented with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Empiric antibiotic therapy with linezolid was initiated prior to blood culture results. Once MRSA bacteremia was confirmed, alternative antibiotic therapy with daptomycin was initiated. Blood cultures remained positive for MRSA despite three days of daptomycin therapy after which ceftaroline was added to the antibiotic regimen. Blood cultures remained positive for MRSA despite seven days of combination therapy with daptomycin and ceftaroline. Salvage therapy was then initiated with daptomycin, linezolid, and meropenem. One day following initiation of salvage therapy, blood cultures revealed no bacterial growth for the remainder of the length of stay. This report supports the effectiveness of salvage therapy consisting of daptomycin, linezolid, and meropenem in patients with persistent MRSA bacteremia.

scholarly journals 172. Risk Factors for 30-Day Mortality in Patients with Staphylococcus aureus Bacteremia at a Community Hospital: A Prospective Case–Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S109-S110
Author(s):  
Charles Hoffmann ◽  
Gordon Watkins ◽  
Patrick DeSimone ◽  
Peter Hallisey ◽  
David Hutchinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Case Control Study ◽  
Community Hospital ◽  
Univariate Analysis ◽  
Case Control ◽  
Blood Cultures ◽  
Staphylococcus Aureus Bacteremia ◽  
Initial Blood ◽  
Control Study

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with 30-day all-cause mortality rates approaching 20–30%. The purpose of this case–control study was to evaluate risk factors for 30-day mortality in patients with SAB at a community hospital. Methods As part of an antimicrobial stewardship program (ASP) initiative mandating Infectious Diseases consultation for episodes of SAB, our ASP prospectively monitored all cases of SAB at a 341-bed community hospital in Jefferson Hills, PA from April 2017–February 2019. Cases included patients with 30-day mortality from the initial positive blood culture. Only the first episode of SAB was included; patients were excluded if a treatment plan was not established (e.g., left against medical advice). Patient demographics, comorbidities, laboratory results, and clinical management of SAB were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day mortality. Results 100 patients with SAB were included; 18 (18%) experienced 30-day mortality. Cases were older (median age 76.5 vs. 64 years, P < 0.001), more likely to be located in the intensive care unit (ICU) at time of ASP review (55.6% vs. 30.5%, P = 0.043), and less likely to have initial blood cultures obtained in the emergency department (ED) (38.9% vs. 80.5%, P < 0.001). Variables associated with significantly higher odds for 30-day mortality in univariate analysis: older age, location in ICU at time of ASP review, initial blood cultures obtained at a location other than the ED, and total Charlson Comorbidity Index (CCI). Variables with P < 0.2 on univariate analysis were analyzed via multivariate logistic regression (Table 1). Conclusion Results show that bacteremia due to MRSA and total CCI were not significantly associated with 30-day mortality in SAB, whereas older age was identified as a risk factor. Patients with initial blood cultures obtained at a location other than the ED were at increased odds for 30-day mortality on univariate analysis, which may raise concern for delayed diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals Rapid Detection of Methicillin-Resistant Staphylococcus aureus Directly from Blood for the Diagnosis of Bloodstream Infections: A Mini-Review

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 830
Author(s):  
Anna Rita Buonomini ◽  
Elisabetta Riva ◽  
Giovanni Di Bonaventura ◽  
Giovanni Gherardi
Keyword(s):  
Staphylococcus Aureus ◽  
Gold Standard ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Rapid Diagnostic Tests ◽  
Blood Cultures ◽  
High Morbidity ◽  
Human Pathogen ◽  
Gold Standard Method ◽  
Methicillin Resistant

Staphylococcus aureus represents a major human pathogen able to cause a number of infections, especially bloodstream infections (BSI). Clinical use of methicillin has led to the emergence of methicillin-resistant S. aureus (MRSA) and MRSA-BSI have been reported to be associated with high morbidity and mortality. Clinical diagnosis of BSI is based on the results from blood culture that, although considered the gold standard method, is time-consuming. For this reason, rapid diagnostic tests to identify the presence of methicillin-susceptible S. aureus (MSSA) and MRSA isolates directly in blood cultures are being used with increasing frequency to rapidly commence targeted antimicrobial therapy, also in the light of antimicrobial stewardship efforts. Here, we review and report the most common rapid non-molecular and molecular methods currently available to detect the presence of MRSA directly from blood.

scholarly journals The Impact of a Pharmacist-Driven Staphylococcus aureus Bacteremia Initiative in a Community Hospital: A Retrospective Cohort Analysis

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 191
Author(s):  
Nate Berger ◽  
Michael Wright ◽  
Jonathon Pouliot ◽  
Montgomery Green ◽  
Deborah Armstrong
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Mortality ◽  
Community Hospital ◽  
Cohort Analysis ◽  
Intervention Group ◽  
Blood Cultures ◽  
Control Group ◽  
Staphylococcus Aureus Bacteremia ◽  
Retrospective Cohort Analysis ◽  
Bundle Compliance

Purpose: Staphylococcus aureus is a leading cause of bacteremia with a 30-day mortality of 20%. This study evaluated outcomes after implementation of a pharmacist-driven Staphylococcus aureus bacteremia (SAB) initiative in a community hospital. Methods: This retrospective cohort analysis compared patients admitted with SAB between May 2015 and April 2018 (intervention group) to those admitted between May 2012 and April 2015 (historical control group). Pharmacists were notified of and responded to blood cultures positive for Staphylococcus aureus by contacting provider(s) with a bundle of recommendations. Components of the SAB bundle included prompt source control, selection of appropriate intravenous antibiotics, appropriate duration of therapy, repeat blood cultures, echocardiography, and infectious diseases consult. Demographics (age, gender, and race) were collected at baseline. Primary outcome was in-hospital mortality. Compliance with bundle components was also assessed. Results: Eighty-three patients in the control group and 110 patients in the intervention group were included in this study. Demographics were similar at baseline. In-hospital mortality was lower in the intervention group (3.6% vs. 15.7%; p = 0.0033). Bundle compliance was greater in the intervention group (69.1% vs. 39.8%; p < 0.0001). Conclusions: We observed a significant reduction in in-hospital mortality and increased treatment bundle compliance in the intervention cohort with implementation of a pharmacist-driven SAB initiative. Pharmacists’ participation in the care of SAB patients in the form of recommending adherence to treatment bundle components drastically improved clinical outcomes. Widespread adoption and implementation of similar practice models at other institutions may reduce in-hospital mortality for this relatively common and life-threatening infection.

scholarly journals The use of daptomycin for the treatment of infectious endocarditis: results of a multicenter study

2017 ◽  
Vol 95 (4) ◽  
pp. 328-332
Author(s):  
Yu. L. Shevchenko ◽  
V. P. Tyurin ◽  
L. V. Popov ◽  
V. G. Gudymovich ◽  
E. P. Pavlikova ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Surgical Treatment ◽  
Blood Cultures ◽  
Average Dose ◽  
Surgical Mortality ◽  
Cardioverter Defibrillator ◽  
Duration Of Therapy ◽  
Results Of Treatment ◽  
Serious Disease ◽  
Emergency Echocardiography

Analysis of the results of daptomycin antibiotic therapy and surgical treatment of 37 patients with infective endocarditis (IE) admitted to three Moscow hospitals during 2012 to 2016 is presented. Primary endocarditis was diagnosed in 32.4% of the cases. The secondary forms of the disease dominated by endocarditis following cardiac surgery (29.7%) including valve prosthetics and implantation of pacemaker/cardioverter-defibrillator (PM/CVD). Positive reaction in 2 or more blood cultures was observed in 73% of the patients with the prevalence of Staphylococcus aureus (27%). Vegetation at TT and emergency echocardiography was documented in 89.2% of the patients, fibrous ring or leaflet abscesses in 24.3%). All patients were treated with daptomycin at an average dose of 6,7 ± 0,7 mg/kg b w. The duration of therapy was 26,7 ± 9,8 days. Surgical treatment was given to 48.6% of the patients including PM/CVD replacement in 5.4%. Surgical mortality was absent. Hospital mortality amounted to 13.5%. The use of daptomycin in combination with surgical treatment can significantly improve the results of treatment of this serious disease.

scholarly journals 184. Staphylococcus aureus Bacteremia Management and Outcomes Following Infectious Disease Consult Over Time at a Tertiary Care Center in Canada

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S200-S201
Author(s):  
Mark McAllister ◽  
Justin Chen ◽  
Stephanie Smith ◽  
Arienne King ◽  
Tanis C Dingle ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Staphylococcus Aureus ◽  
Length Of Stay ◽  
Care Center ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
High Morbidity ◽  
University Of Alberta ◽  
Staphylococcus Aureus Bacteremia ◽  
Over Time

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality. Infectious disease consultation (IDC) is associated with increased adherence to guideline management and improved patient outcomes. We describe the IDC rate over time and impact of IDC on the management and outcomes of patients with SAB. Methods This retrospective chart review includes adult patients (≥ 18 years) hospitalized at the University of Alberta Hospital, Edmonton, Canada who had at least 1 blood culture growing Staphylococcus aureus during two time periods (A: Jan 2010 to Dec 2012; B: Jan to Oct 2020). Patients who died or were made palliative within 48hrs following bacteremia were excluded. Descriptive statistics were used to compare appropriateness of SAB management and outcomes in patients receiving IDC and those who did not (NIDC). Results 325 patients in period A and 129 in period B were included. Baseline demographics were similar. IDC rate increased from 63% to 88% (p&lt; 0.001) between the study periods. IDC was associated with increased odds of receiving an echocardiogram (OR=3.56, 95% CI 2.22 – 5.57; OR=20.4, 95% 4.13 – 110.6, p&lt; 0.001) and appropriate duration of antimicrobial therapy (OR=6.74, 95% 3.93 – 11.54; OR=43.2, 95% 5.72 – 529.5, p&lt; 0.001) between study periods. Mean length of stay decreased in patients receiving IDC (44.8 vs 28.1 days, p=0.005) and increased in NIDC patients (19.9 vs 28.7 days, p=0.216). IDC was associated with lower 30-day mortality in period A (OR=3.53, 95% 1.95 – 6.36), however this association was not observed in period B (OR=1.43, 95% 0.40 – 5.56). There was a trend towards decreased odds of mortality in patients receiving early IDC (≤2 days from bacteremia, n=65) compared to late IDC (≥3 days from bacteremia, n=45) (OR=2.59, 95% 0.95 – 7.10, p=0.077). Conclusion Our centre’s IDC rate for SAB increased over time without specific intervention. IDC increased the odds of appropriate SAB management and was associated with decreased length of stay in period B. IDC was associated with lower 30-day mortality in period A and trended towards lower mortality in period B. Specifically, early IDC decreased odds of 30-day mortality compared to late IDC. These results suggest that routine early IDC be part of SAB management. Disclosures All Authors: No reported disclosures

scholarly journals Clinical Reasoning of Infectious Diseases Physicians Behind the Use or Nonuse of Transesophageal Echocardiography in Staphylococcus aureus Bacteremia

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Heather Young ◽  
Bryan C. Knepper ◽  
Connie S. Price ◽  
Susan Heard ◽  
Timothy C. Jenkins
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Transesophageal Echocardiography ◽  
Clinical Reasoning ◽  
Prospective Cohort ◽  
Treatment Duration ◽  
Blood Cultures ◽  
Extended Treatment ◽  
Staphylococcus Aureus Bacteremia ◽  
Rapid Clearance

Abstract In this prospective cohort with Staphylococcus aureus bacteremia, transesophageal echocardiography (TEE) was performed in 24% of cases. Consulting Infectious Diseases physicians most frequently cited low suspicion for endocarditis due to rapid clearance of blood cultures and the presence of a secondary focus requiring an extended treatment duration as reasons for foregoing TEE.

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