scholarly journals DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Carmen Hidalgo-Tenorio ◽  
David Vinuesa ◽  
Antonio Plata ◽  
Pilar Martin Dávila ◽  
Simona Iftimie ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Bloodstream Infection ◽  
Consolidation Therapy ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Hospitalised Patients ◽  
Pharmacodynamic Profile ◽  
Cost Effective Treatment ◽  
Gram Positive Cocci

Abstract Objectives To analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact. Methods A multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year. Results Eighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20€) and 557 days for IE (283,187.45€). Conclusions DBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.

scholarly journals Nosocomial blood stream infections in Imam Khomeini Hospital, Urmia, Islamic Republic of Iran, 1999-2001

2005 ◽  
Vol 11 (3) ◽  
pp. 478-484
Author(s):  
M. Rahbar
Keyword(s):  
Blood Stream ◽  
Blood Cultures ◽  
Microbiology Laboratory ◽  
Islamic Republic ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Blood Stream Infections ◽  
Skin Contamination ◽  
Islamic Republic Of Iran ◽  
Gram Positive Cocci

Ina 2-year retrospective study, the database of the microbiology laboratory of the Imam Khomeini Hospital was reviewed to identify patients who had nosocomial bacteraemia between 1 May 1999 and 31 May 2001 and identify the pathogen responsible and its resisitance to antibiotics. Of 6492 patients in various wards, 593 [9.1%] had positive blood cultures; 85 of those [14.3%] had signs of potential skin contamination. Gram-positive cocci, including coagulase-negative staphylococci, Staphylococcus aureus, Streptococcus pneumoniae and other Gram-positive cocci, accounted for 42.3% of isolates. Gram-negative bacilli were responsible for another 42.3% of isolates; Pseudomonas aeruginosa was the predominant isolate. Patterns of drug resistance varied according to species of bacteria but were generally quite high

scholarly journals Comparative Analysis of Dalbavancin versus Other Antimicrobial Options for Gram-Positive cocci Infections: Effectiveness, Hospital Stay and Mortality

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1296
Author(s):  
Mar de Pablo-Miró ◽  
Sergi Pujol-Ruiz ◽  
Simona Iftimie ◽  
María del Mar Arenas-Miras ◽  
Inmaculada López-Montesinos ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Multidrug Resistant ◽  
Ambulatory Setting ◽  
Bivariate Analysis ◽  
Gram Positive ◽  
Healthcare Associated ◽  
Remarkable Reduction ◽  
Gram Positive Cocci ◽  
Control Study

Dalbavancin is a new antibiotic that is effective against Gram-positive microorganisms, including methicillin-resistant Staphylococci, and offers the possibility of administering intravenous therapy once weekly in an ambulatory setting. We conducted a multicenter observational case-control study, comparing all patients who received dalbavancin (cases) with hospitalized patients who were treated instead with daptomycin, linezolid or vancomycin (controls), based on clinical diagnosis, main microorganism involved, and age. The primary outcome was the length of hospital stay after starting the study antimicrobial. Secondary outcomes were 7-day and 30-day efficacy, 30-day mortality, 90-day recurrence, 90-day and 6-month hospitalization, presence of adverse events and healthcare-associated infections; 161 patients (44 cases and 117 controls) were included. Bivariate analysis showed that dalbavancin reduced the total length of hospital stay (p < 0.001), with fewer 90-day recurrences (p = 0.005), 6-month hospitalizations related to the same infection (p = 0.004) and non-related hospitalizations (p = 0.035). Multivariate analyses showed that length of hospital stay was significantly shorter in patients treated with dalbavancin (−12.05 days 95% CI [−17.00, −7.11], p < 0.001), and 30-day efficacy was higher in the dalbavancin group (OR 2.62 95% CI [1.07, 6.37], p = 0.034). Although sample size of the study may be a limitation, we can conclude that Dalbavancin is a useful antimicrobial drug against Gram-positive infections, including multidrug-resistant pathogens, and allows for a remarkable reduction in length of hospital stay with greater 30-day efficacy.

Staphylococci

2020 ◽  
pp. 991-1010
Author(s):  
Kyle J. Popovich ◽  
Robert A. Weinstein ◽  
Bala Hota
Keyword(s):  
Drug Users ◽  
Renal Dialysis ◽  
Risk Groups ◽  
Regulatory Elements ◽  
Intravenous Drug Users ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Skin Commensals ◽  
Insulin Dependent ◽  
Gram Positive Cocci

This chapter looks at staphylococci, which are Gram-positive cocci that form clusters, but can occur singly, in pairs, chains, or tetrads. They are classically distinguished from other Gram-positive cocci by presence of catalase, an enzyme that degrades hydrogen peroxide (H2O2). S. aureus is distinguished from other coagulase-negative staphylococci, which are generally less virulent, by the presence of coagulase, an enzyme that coagulates plasma. Many toxins and regulatory elements enhance virulence in staphylococci. Staphylococci are skin commensals. About 20% of adults are persistently colonized by S. aureus, 60% are intermittently colonized, and 20% are never colonized. High-risk groups for S. aureus colonization include infants, insulin-dependent diabetics, intravenous drug users, HIV-infected patients, and renal dialysis patients. Methicillin-resistant Staphylococcus aureus (MRSA) was once predominantly seen in hospitals. However, over the past twenty years the epidemiology of MRSA has significantly changed, with MRSA infections now being observed in community settings.

scholarly journals In Vitro Activities of DX-619 and Comparison Quinolones against Gram-Positive Cocci

2006 ◽  
Vol 50 (6) ◽  
pp. 2255-2257 ◽  
Author(s):  
Paul A. Wickman ◽  
Jennifer A. Black ◽  
Ellen Smith Moland ◽  
Kenneth S. Thomson
Keyword(s):  
Staphylococcus Aureus ◽  
Streptococcus Pneumoniae ◽  
Streptococcus Pyogenes ◽  
Vitro Activity ◽  
The Novel ◽  
In Vitro Activity ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Positive Cocci

ABSTRACT The in vitro activity of the novel quinolone DX-619 was compared to those of currently available quinolones against U.S. clinical isolates of Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., Streptococcus pyogenes, and Streptococcus pneumoniae. DX-619 was the most potent quinolone overall, indicating possible utility as an anti-gram-positive quinolone.

Epidemiology and Clinical Characteristics of Bloodstream Infection in Patients Under Extracorporeal Membranous Oxygenation

2020 ◽  
pp. 088506662098553
Author(s):  
Ji Hyun Yun ◽  
Sang-Bum Hong ◽  
Sung-Ho Jung ◽  
Pil Je Kang ◽  
Heungsup Sung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Clinical Characteristics ◽  
Gram Positive ◽  
Adequate Treatment ◽  
Gram Negative ◽  
Tertiary Center ◽  
Microbial Etiology ◽  
Independent Risk Factors ◽  
Gram Positive Cocci

Background: Bloodstream infection (BSI) is an important complication of extracorporeal membranous oxygenation (ECMO) and a major cause of mortality. This study evaluated the epidemiological and clinical characteristics of BSI that occur during ECMO application according to microbial etiology. Methods: Adult patients who underwent ECMO from January 2009 to December 2016 were retrospectively analyzed for BSI episodes at a 2,700-bed, tertiary center. Epidemiological and clinical characteristics and outcomes of BSI were evaluated and were compared for etiologic groups (gram-positive cocci, gram-negative rods, and fungi groups). Risk factors for 14-day mortality were analyzed. Results: A total of 1,100 patients underwent ECMO during the study period, and 65 BSI episodes occurred in 61 patients. The BSI incidence was 8.3 episodes/1,000 ECMO days, which significantly decreased over time ( P = 0.03), primarily in gram-positive cocci BSI. Gram-positive cocci, gram-negative rods, and fungi accounted for 38%, 40%, and 22% of the 73 blood isolates, respectively. Baseline characteristics were comparable between groups. Catheter-related infection (CRI) and pneumonia were the most common sources of BSI; 52% of gram-positive cocci BSIs and 79% of fungi BSIs were caused by CRI, and 75% of gram-negative BSIs by pneumonia. Patients with gram-negative rods BSI died more frequently and earlier than those with other BSIs. Independent risk factors for 14-day mortality were older age and gram-negative rods BSI. Conclusions: The decreased BSI incidence during ECMO was mainly because of the decrease of gram-positive cocci BSI. The high early mortality of gram-negative rods BSI makes prevention and adequate treatment necessary.

scholarly journals Epidemiology, resistant pathogens and main causes of early death of bloodstream infection in patients with hematological malignancies from 2012 to 2019 in a Chinese tertiary hospital

2020 ◽  
Author(s):  
Meng Li ◽  
Mingmei Du ◽  
Honghua Li ◽  
Yunxi Liu ◽  
Daihong Liu
Keyword(s):  
Bloodstream Infection ◽  
Hematological Malignancies ◽  
Early Death ◽  
Tertiary Hospital ◽  
Klebsiella Pneumonia ◽  
Gram Negative Bacteria ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Resistance Rates

Abstract Background: To investigate epidemiology, antibiotic-susceptibility of pathogens, and risk factors for mortality of bloodstream infection (BSI) in patients with hematological malignancies (HMs).Methods: Single-centre retrospective analysis of BSI episodes in patients with HMs in a Chinese tertiary hospital from 2012 to 2019.Results: Among 17,796 analyzed admissions, 508 BSI episodes (2.85%) were identified. Of the 522 isolates, 326 (62.45%) were Gram-negative bacteria, 173 (33.14%) were Gram-positive bacteria, and 23 (4.41%) were fungi. The incidence of BSI differed significantly among the patients with different HMs (P = 0.000): severe aplastic anemia (6.67%), acute leukemia (6.15%), myelodysplastic syndrome(3.22%), multiple myeloma (1.29%), and lymphoma (1.02%). Escherichia coli (30.65%, 160/522) was the most common pathogens, followed by Coagulase-negative staphylococci (CoNS) (19.35%, 101/522) and Klebsiella pneumonia（9.96%, 52/522). The resistance rates of E. coli, K. pneumonia, P. aeruginosa, and A. baumannii to carbapenems were 6.42%, 15.00%, 27.78%, and 78.95%, respectively. All the Gram-positive pathogens were susceptible to linezolid, and 3 vancomycin-resistant Enterococcus were isolated. The overall 14-day mortality was 9.84%. The mortality of BSI caused by A. baumannii was 73.86%, while caused by other pathogens was 7.36% (p=0.000). A multivariate analysis showed that age >65 years, A. baumannii and non-remission of the malignancy were independent predictors of 14-day mortality.Conclusion: Gram-negative bacteria continued to be the most common pathogens causing BSIs in HM patients. An extensive multi-drug resistant baumanni with high mortality rate in HM patients made empirical antimicrobial choice a highly challenging issue.

scholarly journals Endophthalmitis Panorama in The Jerusalem Area

2021 ◽  
Author(s):  
Juan Martin Sanchez ◽  
Hila Elinav ◽  
Liran Tiosano ◽  
Radgonde Amer
Keyword(s):  
Bacterial Resistance ◽  
Management Strategies ◽  
Western World ◽  
Diabetic Patients ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Tertiary Referral Center ◽  
Intraocular Surgery ◽  
Microbial Spectrum

Abstract Purpose: The spectrum of microbial infections and the pattern of their susceptibility is variable among communities. Researching this data will lead to the establishment of the most appropriate national management strategies. The purpose of this study was to analyze the epidemiological, clinical, microbial spectrum and antibiotic susceptibility of endophthalmitis cases in a tertiary referral center in Jerusalem.Methods: Retrospective review of medical charts of patients presenting with endophthalmitis over a 12-year-period.Results: Included were 74 eyes of 70 patients (males 56%). Mean age±SD at presentation was 60±19.5 years. Exogenous endophthalmitis accounted for 78% of cases; of which, 62% followed an intraocular surgery, 21% occurred after intravitreal injections, 10% followed infectious keratitis and 7% were post-traumatic. Endogenous cases were predominantly observed in diabetic patients. Microbial isolates were identified in 44 samples. Of them, gram-positive bacteria were the predominant microorganisms detected in 33 samples (75%); Staphylococcus epidermidis and Enterococcus faecalis were the most commonly detected pathogens. Mean presenting±SD LogMAR visual acuity (VA) was 2.38±1.21 and it improved at last follow-up to 1.7±1.37 (p=0.004, paired t-test). Cases secondary to gram-positive microbes were associated with improved VA during the follow-up while cases secondary to gram-negative microbes was correlated with poor final VA (p=0.046, r2=0.4). There was no evidence of bacterial resistance in the antibiograms for either vancomycin, ceftazidime, ceftriaxone or amikacin.Conclusions: Intraocular surgery remains the most common event preceding endophthalmitis with coagulase-negative staphylococci being the most frequently detected microorganisms. The microbial spectrum of endophthalmitis is similar to that in the western world.

scholarly journals Activity of a New Oral Streptogramin, XRP2868, against Gram-Positive Cocci Harboring Various Mechanisms of Resistance to Streptogramins

2006 ◽  
Vol 50 (1) ◽  
pp. 237-242 ◽  
Author(s):  
Michel Dupuis ◽  
Roland Leclercq
Keyword(s):  
Staphylococcus Aureus ◽  
Antibacterial Activity ◽  
Bactericidal Effect ◽  
The Other ◽  
Mechanisms Of Resistance ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Strong Activity ◽  
Factor B ◽  
Gram Positive Cocci

ABSTRACT The antibacterial activity of XRP2868, a new oral streptogramin composed of a combination of RPR132552 (streptogramin A) and RPR202868 (streptogramin B), was evaluated against a collection of clinical gram-positive isolates with characterized phenotypes and genotypes of streptogramin resistance. The effects of genes for resistance to streptogramin A or B on the activity of XRP2868 and its components were also tested by cloning these genes individually or in various combinations in gram-positive recipient strains susceptible to quinupristin-dalfopristin. The species tested included Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, and other species of streptococci. XRP2868 was generally fourfold more potent than quinupristin-dalfopristin against S. aureus, E. faecium, and streptococci and had activity against E. faecalis (MICs = 0.25 to 1 μg/ml). XRP2868 appeared to be affected by the same mechanisms of resistance as those to quinupristin-dalfopristin. Nevertheless, the strong activity of factor A of the oral streptogramin enabled the combination to be very potent against streptogramin-susceptible staphylococci, streptococci, and E. faecium (MICs = 0.03 to 0.25 μg/ml) and to retain low MICs against the strains harboring a mechanism of resistance to factor A or factor B of the streptogramin. However, the combination of mechanisms of resistance to factors A and B caused an increase in the MICs of XRP2868, which reached 1 to 4 μg/ml. As with the other streptogramins, there was a reduction in the bactericidal effect of XRPR2868 when the staphylococcal strains acquired a constitutively expressed erm gene.

scholarly journals In Vitro Activity of Cephalosporin RWJ-54428 (MC-02479) against Multidrug-Resistant Gram-Positive Cocci

2002 ◽  
Vol 46 (2) ◽  
pp. 321-326 ◽  
Author(s):  
Alan P. Johnson ◽  
Marina Warner ◽  
Michael Carter ◽  
David M. Livermore
Keyword(s):  
Multidrug Resistant ◽  
Vitro Activity ◽  
In Vitro Activity ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Methicillin Resistant ◽  
Group A ◽  
Viridans Group Streptococci ◽  
Gram Positive Cocci

ABSTRACT RWJ-54428 (MC-02479) is a novel cephalosporin that binds to penicillin-binding protein (PBP) PBP 2′ (PBP 2a) of methicillin-resistant staphylococci. Its in vitro activity was assessed against 472 gram-positive cocci, largely selected as epidemiologically unrelated isolates with multidrug resistance. The MIC at which 50% of isolates are inhibited (MIC50) and MIC90 of RWJ-54428 for methicillin-resistant Staphylococcus aureus (MRSA) were 1 and 2 μg/ml, respectively, whereas they were 0.5 and 0.5 μg/ml, respectively, for methicillin-susceptible S. aureus. The MIC50 and MIC90 were 1 and 4 μg/ml, respectively, for methicillin-resistant coagulase-negative staphylococci (MRCoNS), whereas they were 0.25 and 1 μg/ml, respectively, for methicillin-susceptible isolates. The highest MICs for MRSA and MRCoNS isolates were 2 and 4 μg/ml, respectively. The MIC50 and MIC90 of RWJ-54428 for Enterococcus faecalis were 0.5 and 1 μg/ml, respectively, but they were 4 and 8 μg/ml, respectively, for Enterococcus faecium. For penicillin-susceptible, -intermediate, and -resistant pneumococci, the MIC90s of RWJ-54428 were 0.03, 0.25, and 0.5 μg/ml, respectively, with the highest MIC for a pneumococcus being 1 μg/ml, recorded for a strain for which penicillin and cefotaxime MICs were 8 and 4 μg/ml. MICs for Lancefield group A, B, C, and G streptococci were ≤0.008 μg/ml; those for viridans group streptococci, including isolates not susceptible to penicillin, were from 0.015 to 0.5 μg/ml. RWJ-54428 did not select resistant mutants of MRSA or enterococci in challenge experiments and has the potential to be useful for the treatment of infections caused by gram-positive cocci.

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