Faculty Opinions recommendation of Empiric antibiotic therapy for Staphylococcus aureus bacteremia may not reduce in-hospital mortality: a retrospective cohort study.

2010 ◽  
Author(s):  
Raul Raz
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Empiric Antibiotic Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Empiric Antibiotic

scholarly journals Local audit of empiric antibiotic therapy in bacteremia: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248817
Author(s):  
Anthony D. Bai ◽  
Neal Irfan ◽  
Cheryl Main ◽  
Philippe El-Helou ◽  
Dominik Mertz
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Blood Culture ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Clinical Pathway ◽  
Retrospective Cohort ◽  
Negative Likelihood Ratio ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic

Background It is unclear if a local audit would be useful in providing guidance on how to improve local practice of empiric antibiotic therapy. We performed an audit of antibiotic therapy in bacteremia to evaluate the proportion and risk factors for inadequate empiric antibiotic coverage. Methods This retrospective cohort study included patients with positive blood cultures across 3 hospitals in Hamilton, Ontario, Canada during October of 2019. Antibiotic therapy was considered empiric if it was administered within 24 hours after blood culture collection. Adequate coverage was defined as when the isolate from blood culture was tested to be susceptible to the empiric antibiotic. A multivariable logistic regression model was used to predict inadequate empiric coverage. Diagnostic accuracy of a clinical pathway based on patient risk factors was compared to clinician’s decision in predicting which bacteria to empirically cover. Results Of 201 bacteremia cases, empiric coverage was inadequate in 56 (27.9%) cases. Risk factors for inadequate empiric coverage included unknown source at initiation of antibiotic therapy (adjusted odds ratio (aOR) of 2.76 95% CI 1.27–6.01, P = 0.010) and prior antibiotic therapy within 90 days (aOR of 2.46 95% CI 1.30–4.74, P = 0.006). A clinical pathway that considered community-associated infection as low risk for Pseudomonas was better at ruling out Pseudomonas bacteremia with a negative likelihood ratio of 0.17 (95% CI 0.03–1.10) compared to clinician’s decision with negative likelihood ratio of 0.34 (95% CI 0.10–1.22). Conclusions An audit of antibiotic therapy in bacteremia is feasible and may provide useful feedback on how to locally improve empiric antibiotic therapy.

scholarly journals Discontinuation of Glycopeptides in Patients with Culture Negative Severe Sepsis or Septic Shock: A Propensity-Matched Retrospective Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 250
Author(s):  
Yong Chan Kim ◽  
Jung Ho Kim ◽  
Jin Young Ahn ◽  
Su Jin Jeong ◽  
Nam Su Ku ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Cohort Study ◽  
Antibiotic Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Empiric Antibiotic Therapy ◽  
Empiric Antibiotic ◽  
The Impact ◽  
Culture Negative

Implementation of antibiotic stewardship is difficult in patients with sepsis because of severity of disease. We evaluated the impact of glycopeptide discontinuation (GD) in patients with culture negative severe sepsis or septic shock who received glycopeptides as initial empiric antibiotic therapy at admission. We conducted a single center retrospective cohort study between January 2010 and March 2018. GD was defined as discontinuation of initial empiric glycopeptides on availability of culture results, revealing the absence of identified pathogens. In 92 included patients, the leading causes of sepsis were pneumonia (34.8%) and intra-abdominal infection (23.9%); 28-day mortality and overall mortality were 14% and 21%, respectively. Glycopeptides were discontinued in 42/92 patients. After propensity score matching, baseline characteristics were not significantly different between the GD and non-GD (GND) groups. GND was associated with development of acute kidney injury (OR 5.54, 95% CI 1.49–20.6, P = 0.011). GD did not increase the 7-day, 14-day, and 28-day mortality compared with GND. The length of hospital stay was shorter in the GD group than in GND group (16.33 ± 17.11 vs. 25.05 ± 14.37, P = 0.082), though not statistically significant. GD may be safe and reduce adverse events of prolonged antibiotic use in patients with culture negative severe sepsis or septic shock receiving glycopeptides as initial empiric antibiotic therapy.

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 Risk factors for mortality among patients with Staphylococcus aureus bacteremia: a single-centre retrospective cohort study

CMAJ Open ◽  
2014 ◽  
Vol 2 (4) ◽  
pp. E352-E359 ◽  
Author(s):  
R. V. Anantha ◽  
J. Jegatheswaran ◽  
D. L. Pepe ◽  
F. Priestap ◽  
J. Delport ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Single Centre ◽  
Staphylococcus Aureus Bacteremia

scholarly journals Staphylococcus Aureus Bacteriuria as a Predictor of In-Hospital Mortality in Patients with Staphylococcus Aureus Bacteremia. Results of a Retrospective Cohort Study

2020 ◽  
Vol 9 (2) ◽  
pp. 508 ◽  
Author(s):  
Tobias Siegfried Kramer ◽  
Beate Schlosser ◽  
Désirée Gruhl ◽  
Michael Behnke ◽  
Frank Schwab ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
University Hospital ◽  
Hospital Death ◽  
Cox Regression Analysis

Staphylococcus aureus bloodstream infection (SA-BSI) is an infection with increasing morbidity and mortality. Concomitant Staphylococcus aureus bacteriuria (SABU) frequently occurs in patients with SA-BSI. It is considered as either a sign of exacerbation of SA-BSI or a primary source in terms of urosepsis. The clinical implications are still under investigation. In this study, we investigated the role of SABU in patients with SA-BSI and its effect on the patients’ mortality. We performed a retrospective cohort study that included all patients in our university hospital (Charité Universitätsmedizin Berlin) between 1 January 2014 and 31 March 2017. We included all patients with positive blood cultures for Staphylococcus aureus who had a urine culture 48 h before or after the first positive blood culture. We identified cases while using the microbiology database and collected additional demographic and clinical parameters, retrospectively, from patient files and charts. We conducted univariate analyses and multivariable Cox regression analysis to evaluate the risk factors for in-hospital mortality. 202 patients met the eligibility criteria. Overall, 55 patients (27.5%) died during their hospital stay. Cox regression showed SABU (OR 2.3), Pitt Bacteremia Score (OR 1.2), as well as moderate to severe liver disease (OR 2.1) to be independent risk factors for in-hospital mortality. Our data indicates that SABU in patients with concurrent SA-BSI is a prognostic marker for in-hospital death. Further studies are needed for evaluating implications for therapeutic optimization.

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