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 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.

Integration of FDG-PET/CT in the Diagnostic Workup for Staphylococcus aureus Bacteremia: A Prospective Interventional Matched-cohort Study

2020 ◽  
Author(s):  
Nesrin Ghanem-Zoubi ◽  
Olga Kagna ◽  
Jawad Abu-Elhija ◽  
Mona Mustafa-Hellou ◽  
Majd Qasum ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Fdg Pet ◽  
Intervention Group ◽  
Control Group ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Staphylococcus Aureus Bacteremia ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Background Staphylococcus aureus bacteremia (SAB) is uniquely characterized by focal pyogenic complications that might not be apparent clinically. We investigated the benefit of adding fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) in the workup of patients with SAB. Methods In a matched-cohort study patients with SAB (intervention group) were prospectively recruited to undergo FDG-PET/CT 7–14 days after diagnosis. Treatment was directed by FDG-PET/CT findings. Clinical outcomes were compared with a control group of patients with SAB who had not undergone FDG-PET/CT, matched by age, Charlson score, methicillin susceptibility, and survival duration to FDG-PET/CT. The primary outcome was 90-day mortality. Residual confounding was controlled through regression analyses. Results During the study period 149 patients with 151 separate episodes of SAB underwent FDG-PET/CT and were compared with 150 matched patients with 151 SAB episodes. Patients in the intervention group acquired infections more frequently in the community and had less frequently solid malignancies and more frequently high-risk SAB. Ninety-day mortality in the intervention group was significantly lower than in the control group (21/151 [13.9%] vs 43/151 [28.5%], P = .002). The difference remained significant in a subgroup analysis of patients with community-onset infections without malignancy and among patients with low-risk SAB. Controlling for other risk factors for mortality, FDG-PET/CT performance among all patients was independently associated with lower mortality (OR, .39; 95% CI, .18–.84). Patients in the intervention group had longer duration of treatment and more focus control procedures performed compared with the control group. Conclusions FDG-PET/CT in patients with SAB seems to improve survival through guidance of treatment duration and co-interventions.

Comparable Outcomes of Short-Course and Prolonged-Course Therapy in Selected Cases of Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Pooled Cohort Study

2021 ◽  
Author(s):  
Louise Thorlacius-Ussing ◽  
Håkon Sandholdt ◽  
Jette Nissen ◽  
Jon Rasmussen ◽  
Robert Skov ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Outcomes ◽  
Treatment Duration ◽  
Cohort Analysis ◽  
Antimicrobial Treatment ◽  
Low Risk ◽  
Logistic Regression Models ◽  
Staphylococcus Aureus Bacteremia ◽  
Short Course ◽  
The Individual

Abstract Background The recommended duration of antimicrobial treatment for Staphylococcus aureus bacteremia (SAB) is a minimum of 14 days. We compared the clinical outcomes of patients receiving short-course (SC; 6–10 days), or prolonged-course (PC; 11–16 days) antibiotic therapy for low-risk methicillin-susceptible SAB (MS-SAB). Methods Adults with MS-SAB in 1995–2018 were included from 3 independent retrospective cohorts. Logistic regression models fitted with inverse probability of treatment weighting were used to assess the association between the primary outcome of 90-day mortality and treatment duration for the individual cohorts as well as a pooled cohort analysis. Results A total of 645, 219, and 141 patients with low-risk MS-SAB were included from cohorts I, II, and III. Median treatment duration in the 3 SC groups was 8 days (interquartile range [IQR], 7–10), 9 days (IQR, 8–10), and 8 days (IQR, 7–10). In the PC groups, patients received a median therapy of 14 days (IQR, 13–15), 14 days (IQR, 13–15), and 13 days (IQR, 12–15). No significant differences in 90-day mortality were observed between the SC and PC group in cohort I (odds ratio [OR], 0.85 [95% confidence interval {CI}, .49–1.41]), cohort II (OR, 1.24 [95% CI, .60–2.62]), or cohort III (OR, 1.15 [95% CI, .24–4.01]). This result was consistent in the pooled cohort analysis (OR, 1.05 [95% CI, .71–1.51]). Furthermore, duration of therapy was not associated with the risk of relapse. Conclusions In patients with low-risk MS-SAB, shorter courses of antimicrobial therapy yielded similar clinical outcomes as longer courses of therapy.

scholarly journals Administration of breast milk cell fractions to neonates with birthweight equal to or less than 1800 g: a randomized controlled trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Minoo Fallahi ◽  
Seyed Masoud Shafiei ◽  
Naeeme Taslimi Taleghani ◽  
Maryam Khoshnood Shariati ◽  
Shamsollah Noripour ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Breast Milk ◽  
Hospital Mortality ◽  
Low Birthweight ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Randomized Controlled ◽  
Cell Fractions ◽  
Breast Milk Cell

Abstract Background Most premature and very low birthweight infants cannot tolerate breast milk feeding in the first few days of life and are deprived of its benefits. This study evaluates the clinical outcomes of administering breast milk cell fractions to neonates with a birthweight of ≤1800 g. Methods We conducted a randomized controlled trial on 156 infants in the neonatal intensive care unit of Mahdieh Maternity Hospital in Tehran, Iran, from May 2019 to April 2020. All neonates with a birthweight ≤1800 g were enrolled and divided into intervention and control groups using stratified block randomization. Neonates in the intervention group received the extracted breast milk cell fractions (BMCFs) of their own mother’s milk after being centrifuged in the first 6 to 12 h after birth. The control group received routine care, and breastfeeding was started as soon as tolerated in both groups. Study outcomes were necrotizing enterocolitis (NEC), death, and in-hospital complications. Results We divided participants into two groups: 75 neonates in the intervention group and 81 neonates in the control group. The mean birthweight of neonates was 1390.1 ± 314.4 g, and 19 (12.2%) neonates deceased during their in-hospital stay. The incidence of NEC was similar in both groups. After adjustment for possible confounders in the multivariable model, receiving BMCFs were independently associated with lower in-hospital mortality (5 [26.3%] vs. 70 (51.1%]; odds ratio (OR): 0.24; 95% confidence interval [CI] 0.07, 0.86). Also, in a subgroup analysis of neonates with birthweight less than 1500 g, in-hospital mortality was significantly lower in the intervention group (4 [9.5%] vs. 13 [30.2%]; OR: 0.24; 95% CI 0.07, 0.82). There were no differences in major complications such as bronchopulmonary dysplasia and retinopathy of prematurity between the two groups. No adverse effects occurred. Conclusions Our research demonstrated a significantly lower mortality rate in neonates (with a birthweight of ≤1800 g) who received breast milk cell fractions on the first day of life. Since this is a novel method with minimal intervention, we are looking forward to developing and evaluating this method in larger studies. Trial registration IIranian Registry of Clinical Trials. Registered 25 May 2019, IRCT20190228042868N1.

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 Traumatic brain injury with concomitant injury to the spleen: characteristics and mortality of a high-risk trauma cohort from the TraumaRegister DGU®

2020 ◽  
Author(s):  
Marius Marc-Daniel Mader ◽  
Rolf Lefering ◽  
Manfred Westphal ◽  
Marc Maegele ◽  
Patrick Czorlich
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Injury Severity ◽  
Cohort Analysis ◽  
Independent Effect ◽  
Trauma Patients ◽  
Confounding Factors ◽  
Retrospective Cohort Analysis ◽  
Effect Of Splenectomy

Abstract Purpose Based on the hypothesis that systemic inflammation contributes to secondary injury after initial traumatic brain injury (TBI), this study aims to describe the effect of splenectomy on mortality in trauma patients with TBI and splenic injury. Methods A retrospective cohort analysis of patients prospectively registered into the TraumaRegister DGU® (TR-DGU) with TBI (AISHead ≥ 3) combined with injury to the spleen (AISSpleen ≥ 1) was conducted. Multivariable logistic regression modeling was performed to adjust for confounding factors and to assess the independent effect of splenectomy on in-hospital mortality. Results The cohort consisted of 1114 patients out of which 328 (29.4%) had undergone early splenectomy. Patients with splenectomy demonstrated a higher Injury Severity Score (median: 34 vs. 44, p < 0.001) and lower Glasgow Coma Scale (median: 9 vs. 7, p = 0.014) upon admission. Splenectomized patients were more frequently hypotensive upon admission (19.8% vs. 38.0%, p < 0.001) and in need for blood transfusion (30.3% vs. 61.0%, p < 0.001). The mortality was 20.7% in the splenectomy group and 10.3% in the remaining cohort. After adjustment for confounding factors, early splenectomy was not found to exert a significant effect on in-hospital mortality (OR 1.29 (0.67–2.50), p = 0.45). Conclusion Trauma patients with TBI and spleen injury undergoing splenectomy demonstrate a more severe injury pattern, more compromised hemodynamic status and higher in-hospital mortality than patients without splenectomy. Adjustment for confounding factors reveals that the splenectomy procedure itself is not independently associated with survival.

scholarly journals Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

1998 ◽  
Vol 9 (6) ◽  
pp. 1085-1092
Author(s):  
R Sesso ◽  
D Barbosa ◽  
I L Leme ◽  
H Sader ◽  
M E Canziani ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Insertion Site ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Catheter Colonization ◽  
Central Venous ◽  
Exit Site Infection ◽  
Staphylococcus Aureus Bacteremia ◽  
Mupirocin Ointment

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

scholarly journals Real-World Effectiveness of A Digital-Based Coaching Intervention for Cancer Survivors with Job Loss

2021 ◽  
Author(s):  
Jonathon Lo ◽  
Kieran Ballurkar ◽  
Simonie Fox ◽  
kate Tynan ◽  
Nghiep Luu ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Real World ◽  
Matched Control ◽  
Cox Model ◽  
Cohort Analysis ◽  
Intervention Group ◽  
Control Group ◽  
Matched Control Group ◽  
Real World Setting

Abstract Purpose:Return-to-work (RTW) is a key unmet need for working age cancer survivors. This study sought to evaluate RTW outcomes of a multidisciplinary intervention provided as routine employee support.Method:In a retrospective cohort analysis, patients with cancer and more than 3 months absent from work were provided an intervention consisting of digital resources and calls with a health coach. A logit regression model was used to calculate a propensity score using covariates of age, gender, insurance benefit type, date of cancer diagnosis and time from diagnosis derived from insurance-claims data and captured as standard business practice. Participants were matched on a 1:1 basis using the nearest-neighbor method without replacement to create a matched control group from a further 1,856 participants who did not receive the intervention.Results:220 participants enrolled in the intervention, of which 125 met the criteria for analysis. The median follow-up from cancer diagnosis was 79 weeks (IQR 60-106). In the matched control group, 22 returned to work (17.6%) compared with 38 (30.4%) in the intervention group (P=.02). Nineteen matched controls died prior to claim closure (15.2%) compared with 13 in the intervention group (10.4%; P=.26). Cox model estimated median time for the first 15% of the cohorts to RTW was 87.1 weeks for the matched control (CI 60.0-109.1 weeks) compared with 70.6 weeks for the intervention (CI 52.6-79.6 weeks; P=.08).Conclusion:A digitally delivered coaching program in a real-world setting for patients diagnosed with cancer improves the likelihood of RTW.Implications for cancer survivors: a remotely delivered coaching program in a real-world setting for cancer survivors can improve the likelihood of RTW.

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