The Modified APACHE II Score Outperforms Curb65 Pneumonia Severity Score as a Predictor of 30-Day Mortality in Patients With Methicillin-Resistant Staphylococcus aureus Pneumonia

Abstract Background Combination β-lactam and vancomycin (VAN) prevent the emergence of resistance and result in synergistic antimicrobial activity against methicillin-resistant Staphylococcus aureus (MRSA) in vitro. We sought to provide clinical translation to these data and determine if patients with MRSA bloodstream infection (BSI) treated with VAN + cefazolin (VAN/CFZ) via our MRSA BSI clinical pathway had improved clinical outcomes compared VAN alone. Methods Multicenter, retrospective, comparative cohort study from 2006 to 2019 in adults with MRSA BSI treated with VAN for ≥ 72 hours. VAN/CFZ was defined as VAN + CFZ within ≤ 72 hours of index culture for ≥ 24 hours. Other β-lactams were allowed for < 48 h in the VAN/CFZ group. The VAN alone group could not have other β-lactams within 7 days of treatment initiation. The primary outcome was clinical failure defined as a composite of 30-d all-cause mortality, 60-day recurrence, and persistent BSI (≥ 7 days). The independent effect of VAN/CFZ on clinical failure was evaluated with multivariable logistic regression. The primary safety endpoint was nephrotoxicity within 7 days of treatment initiation. Results A total of 237 patients were included (104 VAN/CFZ, 133 VAN). The most common BSI sources were skin/soft tissue (29.1%), IV catheter (21.9%), osteoarticular (20.3%) and infective endocarditis (16.0%). Demographic and clinical characteristics were similar between groups except VAN/CFZ had a higher median APACHE II score (18 vs. 13, P = 0.011). VAN/CFZ patients were also more likely to have received an infectious disease consult (100% vs. 81.2%, P < 0.001). Median (IQR) duration of CFZ was 115 (87–164) hours. After controlling for age, APACHE II score, ID consult and infection source, VAN/CFZ was associated with reduced odds of clinical failure (aOR 0.425, 95% CI 0.228, 0.792). Bivariate outcomes are shown in the table: Conclusion Patients with MRSA BSI treated with VAN/CFZ vs. VAN experienced fewer clinical failures, supporting additional studies evaluating the role of adjuvant CFZ for MRSA BSI. Disclosures All authors: No reported disclosures.

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Prediction of Failure in Vancomycin-Treated Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: a Clinically Useful Risk Stratification Tool

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00115-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4581-4588 ◽

Cited By ~ 23

Author(s):

Carol L. Moore ◽

Mei Lu ◽

Faiqa Cheema ◽

Paola Osaki-Kiyan ◽

Mary Beth Perri ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Risk Stratification ◽

Bloodstream Infection ◽

Apache Ii ◽

Risk Level ◽

Apache Ii Score ◽

City Hospital ◽

Clinical Failure ◽

Methicillin Resistant ◽

Risk Stratification Tool

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.

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Role of interleukin-17 in a murine community-associated methicillin-resistant Staphylococcus aureus pneumonia model

Microbes and Infection ◽

10.1016/j.micinf.2018.06.006 ◽

2019 ◽

Vol 21 (1) ◽

pp. 33-39 ◽

Cited By ~ 3

Author(s):

Yasushi Shibue ◽

Soichiro Kimura ◽

Chiaki Kajiwara ◽

Yoichiro Iwakura ◽

Keizo Yamaguchi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Interleukin 17 ◽

Methicillin Resistant ◽

Staphylococcus Aureus Pneumonia

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MiR-155 regulates Th9 differentiation in children with methicillin-resistant Staphylococcus aureus pneumonia by targeting SIRT1

Human Immunology ◽

10.1016/j.humimm.2021.07.002 ◽

2021 ◽

Author(s):

Keyin Tian ◽

Weihua Xu

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Staphylococcus Aureus Pneumonia

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Ceftaroline Desensitization Procedure in a Pregnant Patient With Multiple Drug Allergies

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv027 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 3

Author(s):

James L. Kuhlen ◽

Kimberly G. Blumenthal ◽

Caroline L. Sokol ◽

Diana S. Balekian ◽

Ana A. Weil ◽

...

Keyword(s):

Cystic Fibrosis ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Skin Testing ◽

Pregnant Patient ◽

Cross Reactivity ◽

Multiple Drug ◽

Methicillin Resistant ◽

The Cross ◽

Staphylococcus Aureus Pneumonia

Abstract Validated skin testing is lacking for many drugs, including ceftaroline. The cross-reactivity between ceftaroline and other β-lactam antibiotics is unknown. We report a case of a pregnant patient with cystic fibrosis and multiple drug allergies who required ceftaroline for methicillin-resistant Staphylococcus aureus pneumonia and underwent an uncomplicated empiric desensitization procedure.

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