scholarly journals Methicillin-Resistant Staphylococcus aureus Peritonitis due to Hematogenous Dissemination from Central Venous Catheter in a Maintenance Dialysis Patient

2021 ◽  
pp. 281-285
Author(s):  
Gaetano Alfano ◽  
Monica Frisina ◽  
Niccolò Morisi ◽  
Elisabetta Ascione ◽  
Francesco Fontana ◽  
...  

<i>Staphylococcus aureus</i> is a Gram-positive bacterium commonly associated with severe infections in hospitalized patients. <i>S. aureus</i> produces many virulence factors leading to local and distant pathological processes. Invasiveness of <i>S. aureus</i> generally induces metastatic infections such as bacteremia, infective endocarditis, osteomyelitis, arthritis, and endophthalmitis. Peritoneal localization from extra-abdominal infection can be a potential consequence of <i>S. aureus</i> infection. Two cases of metastatic peritonitis have been described in patients on peritoneal dialysis with concomitant peripheral vascular catheter-related bloodstream infection. We reported a case of peritoneal metastatic infection caused by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) in a patient on maintenance hemodialysis. A 37-year-old man was admitted with fever and chill due to jugular central vascular catheter (CVC)-related bloodstream infection caused by MRSA<i>.</i> CVC was placed after switching the patient from peritoneal dialysis to hemodialysis for scarce adherence to fluid restriction. Detection of MRSA on the peritoneal effluent combined with a total white blood cell count of 554 cells/mm<sup>3</sup> prompted the diagnosis of satellite MRSA peritonitis. Antibiotic treatment with daptomycin and simultaneous CVC and peritoneal catheter removal resolved the infectious process. No further metastatic localizations were detected elsewhere. In conclusion, <i>S. aureus</i> can induce metastatic infections far from the site of primary infection. As reported in this case, peritonitis can be secondary to the hematogenous dissemination of <i>S. aureus</i> especially in hospitalized patients having a central line.

2020 ◽  
Vol 77 (21) ◽  
pp. 1746-1750
Author(s):  
Qassim Abid ◽  
Basim Asmar ◽  
Edward Kim ◽  
Leah Molloy ◽  
Melissa Gregory ◽  
...  

Abstract Purpose We report the case of a 2-year-old girl with end-stage renal disease managed by peritoneal dialysis (PD) who developed methicillin-resistant staphylococcal osteomyelitis of the left shoulder and was successfully treated with intraperitoneal (IP) administration of vancomycin for 2 weeks followed by oral clindamycin therapy. Summary The patient was hospitalized with tactile fever and a 3-day history of worsening fussiness. Radiography of the left shoulder showed findings indicative of osteomyelitis. Vancomycin was administered via central venous line for 3 days, during which time the patient underwent PD 24 hours a day. After magnetic resonance imaging revealed proximal humeral osteomyelitis, septic arthritis of the shoulder joint, and osteomyelitis of the scapula, the patient underwent incision and drainage of the left shoulder joint. Both blood and joint drainage cultures grew methicillin-resistant Staphylococcus aureus that was sensitive to vancomycin. The patient’s central venous catheter was removed on hospital day 4; due to difficulties with peripheral i.v. access and a desire to avoid placing a peripherally inserted central venous catheter, vancomycin administration was changed to the IP route, with vancomycin added to the PD fluid. During IP treatment, serum vancomycin levels were maintained at 13.5 to 18.5 mg/L, and the calculated ratio of vancomycin area under the curve to minimum inhibitory concentration was maintained above 400. After completing a 14-day course of IP vancomycin therapy, the patient was switched to oral clindamycin, with subsequent complete resolution of osteomyelitis. Conclusion IP vancomycin was effective for treatment of invasive S. aureus infection in this case. This approach should be considered in patients undergoing PD for whom peripheral i.v. access options are limited and/or not preferred.


2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Supavit Chesdachai ◽  
Susan Kline ◽  
Derrek Helmin ◽  
Radha Rajasingham

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.


2011 ◽  
Vol 55 (10) ◽  
pp. 4581-4588 ◽  
Author(s):  
Carol L. Moore ◽  
Mei Lu ◽  
Faiqa Cheema ◽  
Paola Osaki-Kiyan ◽  
Mary Beth Perri ◽  
...  

ABSTRACTMethicillin-resistantStaphylococcus aureus(MRSA) is a common cause of bloodstream infection (BSI) and is often associated with invasive infections and high rates of mortality. Vancomycin has remained the mainstay of therapy for serious Gram-positive infections, particularly MRSA BSI; however, therapeutic failures with vancomycin have been increasingly reported. We conducted a comprehensive evaluation of the factors (patient, strain, infection, and treatment) involved in the etiology and management of MRSA BSI to create a risk stratification tool for clinicians. This study included consecutive patients with MRSA BSI treated with vancomycin over 2 years in an inner-city hospital in Detroit, MI. Classification and regression tree analysis (CART) was used to develop a risk prediction model that characterized vancomycin-treated patients at high risk of clinical failure. Of all factors, the Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, with a cutoff point of 14, was found to be the strongest predictor of failure and was used to split the population into two groups. Forty-seven percent of the population had an APACHE-II score < 14, a value that was associated with low rates of clinical failure (11%) and mortality (4%). Fifty-four percent of the population had an APACHE-II score ≥ 14, which was associated with high rates of clinical failure (35%) and mortality (23%). The risk stratification model identified the interplay of three other predictors of failure, including the vancomycin MIC as determined by Vitek 2 analysis, the risk level of the source of BSI, and the USA300 strain type. This model can be a useful tool for clinicians to predict the likelihood of success or failure in vancomycin-treated patients with MRSA bloodstream infection.


2017 ◽  
Vol Volume 10 ◽  
pp. 49-55 ◽  
Author(s):  
Abdulhakeem O Althaqafi ◽  
Madonna J Matar ◽  
Rima Moghnieh ◽  
Adel F Alothman ◽  
Thamer H Alenazi ◽  
...  

2012 ◽  
Vol 45 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Karinne Spirandelli Carvalho Naves ◽  
Natália Vaz da Trindade ◽  
Paulo Pinto Gontijo Filho

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is spread out in hospitals across different regions of the world and is regarded as the major agent of nosocomial infections, causing infections such as skin and soft tissue pneumonia and sepsis. The aim of this study was to identify risk factors for methicillin-resistance in Staphylococcus aureus bloodstream infection (BSI) and the predictive factors for death. METHODS: A retrospective cohort of fifty-one patients presenting bacteraemia due to S. aureus between September 2006 and September 2008 was analysed. Staphylococcu aureus samples were obtained from blood cultures performed by clinical hospital microbiology laboratory from the Uberlândia Federal University. Methicillinresistance was determined by growth on oxacillin screen agar and antimicrobial susceptibility by means of the disk diffusion method. RESULTS: We found similar numbers of MRSA (56.8%) and methicillin-susceptible Staphylococcus aureus (MSSA) (43.2%) infections, and the overall hospital mortality ratio was 47%, predominantly in MRSA group (70.8% vs. 29.2%) (p=0.05). Age (p=0.02) was significantly higher in MRSA patients as also was the use of central venous catheter (p=0.02). The use of two or more antimicrobial agents (p=0.03) and the length of hospital stay prior to bacteraemia superior to seven days (p=0.006) were associated with mortality. High odds ratio value was observed in cardiopathy as comorbidity. CONCLUSIONS: Despite several risk factors associated with MRSA and MSSA infection, the use of two or more antimicrobial agents was the unique independent variable associated with mortality.


2020 ◽  
Vol 8 (A) ◽  
pp. 297-302
Author(s):  
Blerta Kika ◽  
Erjona Abazaj ◽  
Oltiana Petri ◽  
Andi Koraqi

AIM: The aim of this study was to evaluate the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in clinical specimens hospitalized to “Mother Theresa” Hospital Center for 2 years. METHODS: We isolated and identified S. aureus on 356 clinical specimens using standard tests. Furthermore, for further accurate microbial identification, we have to use the VITEK® 2 system. The samples were tested to detect the presence of MRSA by a slide latex agglutination kit for the rapid detection of PBP2. RESULTS: The overall prevalence of S. aureus in patients was 34.2%. The prevalence of MRSA was 20.5% of cases. Of the MRSA isolates identified in this study, 28% were susceptible to antibiotics, 24% demonstrated intermediate resistance, and 48% were multi-drug resistant with resistance to nineteen antibiotics involved in the examination. In addition, seven of the 25 MRSA cases showed 100% resistance to norfloxacin, imipenem, meropenem, levofloxacin, etc. CONCLUSIONS: The rate of S. aureus in hospitalized patients on this study was 34.2% and the MRSA 20.5%. These results indicated that this type of infection is a significant concern for health services and patients included. A screening of all hospitalized cases can lead to reduce the incidence of this infection in the hospital environment.


2014 ◽  
Vol 66 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Ivana Cirkovic ◽  
Slobodanka Djukic ◽  
Biljana Carevic ◽  
Natasa Mazic ◽  
Vesna Mioljevic ◽  
...  

The aim of the present study was to provide the first comprehensive analysis of methicillin-resistant Staphylococcus aureus (MRSA) carriage among patients and healthcare workers (HCWs) in the largest healthcare facility in Serbia. Specimens from anterior nares obtained from 195 hospitalized patients and 105 HCWs were inoculated after broth enrichment onto chromogenic MRSA-ID medium. In total, 21 of 300 specimens yielded MRSA. Among hospitalized patients, 7.7% were colonized with MRSA, and 5.7% HCWs were colonized with MRSA. Five out of 21 (23.8%) tested MRSA strains were classified as community-associated MRSA (CA-MRSA), and four of them were isolated from HCWs. The remaining 16 MRSA strains had characteristics of healthcare-associated MRSA (HA-MRSA), and two of them were isolated from HCWs. The HA-MRSA strains isolated from HCWs were indistinguishable from HA-MRSA of the same cluster isolated from patients. This finding reveals the circulation of HA-MRSA strains between patients and HCWs in the Clinical Center of Serbia.


2021 ◽  
Author(s):  
Erika Reategui Schwarz ◽  
Adriana van de Guchte ◽  
Amy C. Dupper ◽  
Ana Berbel Caban ◽  
Devika Nadkarni ◽  
...  

Abstract Background. Healthcare-associated infections pose a potentially fatal threat to patients worldwide and Staphylococcus aureus is one of the most common causes of healthcare-associated infections. S. aureus is a common commensal pathogen and a frequent cause of bacteremia, with studies demonstrating that nasal and blood isolates from single patients match more than 80% of the time. Here we report on a contemporary collection of colonizing isolates from those with methicillin-resistant S. aureus (MRSA) bloodstream infections to evaluate the diversity within hosts, and detail the clinical features associated with concomitant nasal colonization.Methods. Swabs of the bilateral anterior nares were obtained from patients diagnosed with MRSA bacteremia. A single colony culture from the blood and an average of 6 colonies from the nares were evaluated for MRSA growth. For the nares cultures, we typed multiple isolates for staphylococcal protein A (spa) and derived the clonal complexes. Demographic and clinical data were obtained retrospectively from the electronic medical record system and analysed using univariate and multivariable regression models.Results. Over an 11-month period, 68 patients were diagnosed with MRSA bloodstream infection, 53 were swabbed, and 37 (70%) were colonized with MRSA in the anterior nares. We performed molecular typing on 210 nasal colonies. Spa types and clonal complexes found in the blood were also detected in the nares in 95% of the cases. We also found that 11% of patients carried more than one clone of MRSA in the nares. Male sex and history of prior hospitalization within the past 90 days increased odds for MRSA colonization. Conclusion. The molecular epidemiological landscape of colonization in the setting of invasive disease is diverse and defining the interplay between colonization and invasive disease is critical to combating invasive MRSA disease.


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