scholarly journals 1069. Predictive Factors for Metastatic Infection in Patients With Bacteremia Caused by Staphylococcus aureus

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S320-S320
Author(s):  
Akihiro Shimizu ◽  
Tetsuya Horino ◽  
Yumiko Hosaka ◽  
Tokio Hoshina ◽  
Kazuhiko Nakaharai ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Predictive Factors ◽  
Positive Blood Culture ◽  
Psoas Abscess ◽  
Laboratory Data ◽  
Venous Catheter ◽  
Primary Site ◽  
Persistent Fever ◽  
Metastatic Infection

Abstract Background Metastatic infections, such as infective endocarditis and pyogenic spondylitis, are very serious complications of Staphylococcus aureus bacteremia (SAB), because failure to identify metastatic infections may cause poor prognosis. The aim of the present study is to determine the predictive factors for metastatic infections of SAB. Methods This retrospective cohort study was conducted among patients with bacteremia due to S. aureus (including both methicillin-sensitive S. aureus and methicillin-resistant S. aureus: MSSA and MRSA) in The Jikei University Kashiwa Hospital. The study population comprised 125 adult patients with SAB between January 2014 and December 2017. Patients, that died or transferred within 3 months after the initial positive blood culture, were excluded, because metastatic infection was defined as deep-seated infection detected within 3 months after the initial positive blood culture. We analyzed several factors, including demographics, comorbidities, community acquisition, primary site of infection, persistent fever and laboratory data such as c-reactive protein (CRP) levels after treatment. Results Seventy-four patients met inclusion criteria of this study. The most common primary site of bacteremia was catheter-related [24 (32.4%) of 74]. Metastatic infection occurred in 22 (29.7%) of 74 patients, and spondylitis was most common, following psoas abscess. Of these, 11 infections (50% of 22) were community acquired. We did not find any significant differences in demographics and comorbidities, except central venous catheter-associated bloodstream infection, which was associated with low rate of metastatic infection. By multivariate analysis, the predictive factors associated with the development of metastatic infection were community onset of infection (OR 11.6; 95% CI 2.98–45.1; P < 0.001), persistent fever over 72 hours (OR 6.7; 95% CI 2.12–21.8; P = 0.001), and higher CRP levels (>3 mg/dL) lasting 2 weeks after the administration of appropriate antibiotics (OR 7.47; 95% CI 2.39–23.3; P < 0.001). Conclusion This study demonstrated that additional diagnostic tests to identify metastatic infection should be performed, especially in the patients with community-acquired SAB, persistent fever or persistently high CRP levels after the administration of appropriate antibiotics. Disclosures All authors: No reported disclosures.

scholarly journals 2559. Incidence and Clinical Impact of Discordant Genotypic and Phenotypic Categorization of Methicillin Susceptibility in Staphylococcus aureus Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S70-S70
Author(s):  
Jessica Gulliver ◽  
Brittney Jung-Hynes ◽  
Derrick Chen
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Rapid Identification ◽  
Clinical Impact ◽  
Staphylococcus Aureus Bacteremia ◽  
Oxacillin Resistance ◽  
Initial Hospitalization

Abstract Background Methicillin-susceptible/methicillin-resistant Staphylococcus aureus (MSSA/MRSA) can be directly identified from positive blood culture bottles using molecular methods. This provides faster results than traditional phenotypic testing, but discrepancies between the two are occasionally found. We sought to determine the incidence and clinical impact of such discrepancies. Methods Positive blood culture bottles are routinely tested in the hospital clinical laboratory for mecA via Xpert MRSA/SA BC (PCR), and antimicrobial susceptibility testing (AST) via MicroScan PC33 is performed on recovered S. aureus isolates; discrepancies between PCR and AST are resolved by repeat and supplemental (Kirby-Bauer) testing. A retrospective review of medical and laboratory data from January 2015 to December 2017 was performed on all patients that had discordant PCR and AST results. Results Approximately 1,200 PCR assays were performed from January 2015 to December 2017, and there were 5 (0.4%) cases with discordant AST Results. Four cases were classified as MSSA by PCR but MRSA by AST, and 1 case was classified as MRSA by PCR but MSSA by AST. For the former group, antimicrobial therapy was changed in 2 patients to cover MRSA and 1 patient was readmitted, while the remaining 2 patients were already being treated for MRSA; for the latter case, this patient was treated for MRSA during the initial hospitalization, but was readmitted with disseminated MSSA and subsequently deceased. Based on genetic targets identified by PCR and cefoxitin and oxacillin AST, discrepancies were likely due to borderline oxacillin resistance (BORSA) (n = 1), presence of an SCCmec variant not detected by PCR (n = 1), or undetermined (n = 3). Conclusion Rapid identification of MRSA bacteremia via PCR provides actionable information to direct empiric treatment. While highly accurate, PCR results are infrequently not corroborated by AST. This rare possibility should be considered when modifying therapy based on initial PCR results, and there should be close communication between the clinical team and laboratory for these challenging cases. Disclosures All authors: No reported disclosures.

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

Clinical significance of follow-up blood culture in patients with a single Staphylococcus aureus-positive blood culture

2019 ◽  
Vol 52 (3) ◽  
pp. 207-212
Author(s):  
Taeeun Kim ◽  
Seung Cheol Lee ◽  
Min Jae Kim ◽  
Jiwon Jung ◽  
Heungsup Sung ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Clinical Significance ◽  
Positive Blood Culture

Infectious Complications In 96 Matched-Related Bone Marrow Transplants Performed Without Positive Pressure Room Or Centralized Hepa Filtration In Lower Middle Income Countries

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1731-1731
Author(s):  
Mohamed El Missiry ◽  
Sadaf Khaled ◽  
Naila Yaqub ◽  
Priya Marwa ◽  
Rajpreet Soni ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Blood Culture ◽  
Infection Control ◽  
Positive Blood Culture ◽  
Broad Spectrum ◽  
Infectious Complications ◽  
Broad Spectrum Antibiotic ◽  
Middle Income ◽  
Persistent Fever ◽  
Middle Income Countries

Abstract Background There is general perception that bone marrow transplant (BMT) centers need complex and costly infection control engineering standards, even more in developing countries where a greater infection-related transplant risk is often assumed in spite of lack of scientific evidence. We aim to investigate incidence of BMT-associated infectious complications in patients admitted to BMT units with no centralized air control systems in lower middle income countries (Pakistan and India). Methods A total of 96 consecutive patients (87 cases with thalassemia major (TM), 4 fanconi and 4 severe aplastic anemia (SAA); and 1 acute lymphoblastic leukemia (ALL); median age 3.8 years (range; 0.9 - 15.3)) transplanted in 3 centers in Pakistan (86 patients) and 1 in India (10 patients), with at least 100 days follow up from BMT where included in this analysis. All patients where admitted to single rooms with split air conditioning but no central HEPA filtration. Evidence-based infection control measures such as hand washing and daily cleaning/drying and disinfection where implemented. Mebendazole, fluconazole, and acyclovir were used as anti-infection prophylaxis. Broad-spectrum antibiotic therapy was used empirically for fever and neutropenia but not as prophylaxis. Voriconazole was used empirically for persistent fever (> 3 days) on broad spectrum antibiotic coverage and/or clinical suspicion of fungal infection. Results Among the 96 transplanted patients; 8 cases suffered from infections with ECOG scoring grade over 2 (i.e. ranging from severe systemic infections up to septicemia) of which 3 had clinical sepsis (one with a positive blood culture for Pseudomonas Aeruginosa and two with negative cultures). In three cases a fungal infection was suspected: One had a positive β-D-Glucan (Fungitell Assay), one had a paranasal sinusitis responding to voriconazole and one a positive blood culture for Candida, neutropenia duration (<500 neutrophils/µL) was 18, 30 and 13 days respectively. Median neutropenic days (<500 neutrophils/µL) of all 96 patients was 16 (range; 9-30). A total of 7 patients received voriconazole empirical therapy for persistent fever not responding to broad spectrum antibiotics. CMV reactivation (PCR +ve) was observed in 18 patients; of which 10 were in subclinical form (without symptoms or signs of CMV disease). A total of 3 infection-related deaths were reported: sepsis (2; one with a positive blood culture for Pseudomonas Aeruginosaand one with negative culture) and 1 CMV intersitital pneumonia. Conclusions Incidence and type of infection in these low-risk BMTs did not seem to be higher compared to published reports from stringent air-controlled BMT units. This may have important implications to simplify and increase access to low-risk HLA-compatible BMT in limited-resources settings. Disclosures: El Missiry: Cure2Children Foundation: Employment. Khaled:Cure2Children Foundation: Employment; PIDSA: Research Funding. Cornelio:Cure2Children Foundation: Employment. Faulkner:Cure2Children Foundation: Employment.

scholarly journals Clinical Significance of Staphylococcus aureus in a Single Positive Blood Culture Bottle

2021 ◽  
Author(s):  
John Raymond Go ◽  
Douglas Challener ◽  
Cristina Corsini Campioli ◽  
M Rizwan Sohail ◽  
Raj Palraj ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Clinical Significance ◽  
Positive Blood Culture ◽  
Blood Culture Bottle ◽  
Hospital Length Of Stay ◽  
Culture Bottle ◽  
Single Positive ◽  
Clinically Significant

Abstract Clinical significance of a single positive blood culture bottle (SPBCB) with Staphylococcus aureus is unclear. We aimed to assess the significance of a SPBCB by looking at the associated outcomes. We performed a retrospective, multicenter study of patients with a SPBCB with S. aureus using data collected from both electronic health records and the clinical microbiology laboratory. Overall, 534 patients with S. aureus bacteremia were identified and 118 (22.1%) had a SPBCB. Among cases with a SPBCB, 106 (89.8%) were classified as clinically significant while 12 (10.2%) were considered contaminated or of unclear significance. A majority (92.4%) of patients received antibiotic therapy but patients with clinically significant bacteremia were treated with longer courses (25.9 vs 5.7 days, P&lt;0.001). Significant differences in both frequency of echocardiography (65.1% vs 84.6%, P&lt;0.001), and infective endocarditis diagnosis (3.8% vs 14.2%, P=0.002) were seen in those with a single positive blood culture bottle compared to those with multiple positive bottles. A longer hospital length of stay, and higher 90-day, 6-month, and 1-year mortality rates were seen in patients with multiple positive blood culture bottles. A SPBCB with S. aureus was common among our patients. While this syndrome has a more favorable prognosis as compared to those with multiple positive blood cultures, clinicians should remain concerned as it portends a risk of infective endocarditis and mortality.

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