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Kessel K, Forsblom E, Ruotsalainen E, Järvinen A. Staphylococcus aureus bacteremia in alcoholics. PLoS One 2024; 19:e0298612. [PMID: 38771740 PMCID: PMC11108141 DOI: 10.1371/journal.pone.0298612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/27/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Alcoholism associates with increased Staphylococcus aureus bacteremia incidence and mortality. The objective was to compare disease progression, treatment and prognosis of Staphylococcus aureus bacteremia in alcoholics versus non-alcoholics. METHODS The study design was a multicenter retrospective analysis of methicillin-sensitive Staphylococcus aureus bacteremia with 90-day follow-up. Patients were stratified as alcoholics or non-alcoholics based on electronic health record data. Altogether 617 Staphylococcus aureus bacteremia patients were included of which 83 (13%) were alcoholics. RESULTS Alcoholics, versus non-alcoholics, were younger, typically male and more commonly had community-acquired Staphylococcus aureus bacteremia. No differences in McCabe´s classification of underlying conditions was observed. Higher illness severity at blood culture sampling, including severe sepsis (25% vs. 7%) and intensive care unit admission (39% vs. 17%), was seen in alcoholics versus non-alcoholics. Clinical management, including infectious disease specialist (IDS) consultations and radiology, were provided equally. Alcoholics, versus non-alcoholics, had more pneumonia (49% vs. 35%) and fewer cases of endocarditis (7% vs. 16%). Mortality in alcoholics versus non-alcoholics was significantly higher at 14, 28 and 90 days (14% vs. 7%, 24% vs. 11% and 31% vs. 17%), respectively. Considering all prognostic parameters, male sex (OR 0.19, p = 0.021) and formal IDS consultation (OR 0.19, p = 0.029) were independent predictors of reduced mortality, whereas ultimately or rapidly fatal comorbidity in McCabe´s classification (OR 12.34, p < 0.001) was an independent predictor of mortality in alcoholics. CONCLUSIONS Alcoholism deteriorates Staphylococcus aureus bacteremia prognosis, and our results suggests that this is predominantly through illness severity at bacteremia onset. Three quarters of Staphylococcus aureus bacteremia patients we studied had identified deep infection foci, and of them alcoholics had significantly less endocarditis but nearly half of them had pneumonia.
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Affiliation(s)
- Klaus Kessel
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:347-357. [PMID: 36729318 PMCID: PMC9892677 DOI: 10.1007/s10096-023-04557-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
S. aureus bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with S. aureus bacteremia and evaluate the role of early source control. This retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of S. aureus bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of S. aureus bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (P < 0.001), nosocomial bacteremia (P 0.019), time to blood culture positivity ≤ 13 h (P 0.004), persistent bacteremia for ≥ 48 h (P 0.004), sepsis (P < 0.001), bacteremia of unknown origin (P 0.036) and lower respiratory tract infection (P < 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (P < 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (P < 0.001) was associated with better survival. Mortality among patients with S. aureus bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality.
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Matrix metalloproteinase MMP-8, TIMP-1 and MMP-8/TIMP-1 ratio in plasma in methicillin-sensitive Staphylococcus aureus bacteremia. PLoS One 2021; 16:e0252046. [PMID: 34043679 PMCID: PMC8158883 DOI: 10.1371/journal.pone.0252046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Matrix metalloproteinase-8 (MMP-8) and tissue inhibitor of metalloproteinases-1 (TIMP-1) have been shown to predict prognosis in sepsis. However, MMP-8 and TIMP-1 in Staphylococcus aureus bacteremia (SAB) lacks evaluation and their role in the pathogenesis of SAB is unclear. Methods MMP-8 and TIMP-1 and MMP-8/TIMP-1 molar ratio were determined at days 3, 5 and 28 from positive blood cultures in patients with methicillin-sensitive SAB and the connection to disease severity and early mortality was determined. Results Altogether 395 SAB patients were included. Patients with severe sepsis or infection focus presented higher MMP-8 levels at day 3 and 5 (p<0.01). Higher day 3 and 5 MMP-8 levels were associated to mortality at day 14 and 28 (p<0.01) and day 90 (p<0.05). Day 3 MMP-8 cut-off value of 203 ng/ml predicted death within 14 days with an area under the curve (AUC) of 0.70 (95% CI 0.57–0.82) (p<0.01). Day 5 MMP-8 cut-off value of 239 ng/ml predicted death within 14 days with an AUC of 0.76 (95% CI 0.65–0.87) (p<0.001). The results for MMP-8/TIMP-1 resembled that of MMP-8. TIMP-1 had no prognostic impact. In Cox regression analysis day 3 or 5 MMP-8 or day 3 MMP-8/TIMP-1 had no prognostic impact whereas day 5 MMP-8/TIMP-1 predicted mortality within 14 days (HR, 4.71; CI, 95% 1.67–13.3; p<0.01). Conclusion MMP-8 and MMP-8/TIMP-1 ratio were high 3–5 days after MS-SAB diagnosis in patients with an infection focus, severe sepsis or mortality within 14 days suggesting that matrix metalloproteinase activation might play a role in severe SAB.
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Eby JC, Richey MM, Platts-Mills JA, Mathers AJ, Novicoff WM, Cox HL. A Healthcare Improvement Intervention Combining Nucleic Acid Microarray Testing With Direct Physician Response for Management of Staphylococcus aureus Bacteremia. Clin Infect Dis 2019; 66:64-71. [PMID: 29020181 DOI: 10.1093/cid/cix727] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/11/2017] [Indexed: 12/26/2022] Open
Abstract
Background Nucleic acid microarray (NAM) testing for detection of Staphylococcus aureus bacteremia (SAB) and S. aureus resistance gene determinants can reduce time to targeted antibiotic administration. Evidence-based management of SAB includes bedside infectious diseases (ID) consultation. As a healthcare improvement initiative at our institution, with the goal of improving management and outcomes for subjects with SAB, we implemented NAM with a process for responding to positive NAM results by directly triggered, mandatory ID consultation. Methods Preintervention, SAB was identified by traditional culture and results passively directed to antibiotic stewardship program (ASP) pharmacists. Postintervention, SAB in adult inpatients was identified by Verigene Gram-Positive Blood Culture test, results paged directly to ID fellow physicians, and consultation initiated immediately. In the new process, ASP assisted with management after the initial consultation. A single-center, retrospective, pre-/postintervention analysis was performed. Results One hundred six preintervention and 120 postintervention subjects were assessed. Time to ID consultation after notification of a positive blood culture decreased 26.0 hours (95% confidence interval [CI], 45.1 to 7.1 hours, P < .001) postintervention compared with preintervention. Time to initiation of targeted antibiotic decreased by a mean of 21.2 hours (95% CI, 31.4 to 11.0 hours, P < .001) and time to targeted antibiotics for methicillin-sensitive S. aureus decreased by a mean of 40.7 hours (95% CI, 58.0 to 23.5 hours, P < .001). The intervention was associated with lower in-hospital (13.2% to 5.8%, P = .047) and 30-day (17.9% to 8.3%, P = .025) mortality. Conclusions Compared with an ASP-directed response to traditionally detected SAB, an efficient physician response to NAM was associated with improved care and outcomes for SAB.
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Affiliation(s)
- Joshua C Eby
- Division of Infectious Diseases and International Health, University of Virginia Health System
| | - Morgan M Richey
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia Health System
| | - Amy J Mathers
- Division of Infectious Diseases and International Health, University of Virginia Health System.,Clinical Microbiology, Department of Pathology, Charlottesville
| | - Wendy M Novicoff
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Heather L Cox
- Division of Infectious Diseases and International Health, University of Virginia Health System.,Department of Pharmacy Services, University of Virginia Health System, Charlottesville
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High prevalence of spa type t571 among methicillin-susceptible Staphylococcus aureus from bacteremic patients in a French University Hospital. PLoS One 2018; 13:e0204977. [PMID: 30300375 PMCID: PMC6177137 DOI: 10.1371/journal.pone.0204977] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 09/04/2018] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus bacteremia is one of the most frequent severe bacterial infections worldwide, with an associated mortality of about 20–40% in developed countries. In 2013, we noted an increase in this infection in the teaching hospital in Grenoble, France, compared to 2012. The mean incidence of S. aureus bacteremia was 0.28 per 1,000 patient-days in 2012 and 0.35 per 1,000 patient-days in 2013. This trend was confirmed in 2014 (0.35 per 1,000 patient-days). In the present work we aimed to study the population of patients presenting with S. aureus bacteremia in 2013 and to genotype the corresponding S. aureus strains in order to identify a successful and/or virulent genotype to design a specific infection control program. One hundred ninety-one S. aureus isolates (including 9 methicillin-resistant) out of 199 corresponding cases of bacteremia were characterized with the spa typing method. Among 108 spa types, t571, t002, t008 and t084 were the most prevalent. Although not widely prevalent, t571 was the most frequently identified clone (8.4% of all isolates). Spa type t571 has been described in previous studies as belonging to the clonal complex CC398, which is consistent with the recent emergence of methicillin-susceptible S. aureus CC398 reported in blood cultures in Europe.
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Steinhaus N, Al-Talib M, Ive P, Boyles T, Bamford C, Davies MA, Mendelson M, Wasserman S. The management and outcomes of Staphylococcus aureus bacteraemia at a South African referral hospital: A prospective observational study. Int J Infect Dis 2018; 73:78-84. [PMID: 29908251 DOI: 10.1016/j.ijid.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Data on the management and outcomes of Staphylococcus aureus bacteraemia (SAB) in resource-limited settings are limited. The aim of this study was to describe a cohort of South African patients with SAB, and explore the factors associated with complicated infection and death. METHODS This was a prospective observational study of patients over the age of 13 years admitted to a South African referral hospital with SAB. RESULTS One hundred SAB infection episodes occurring in 98 patients were included. SAB was healthcare-associated in 68.4%; 24.0% of all cases were caused by methicillin-resistant S. aureus (MRSA). Ninety-day mortality was 47.0%, with 83.3% of deaths attributable to SAB. There was a trend towards increased 90-day mortality with MRSA infection (odds ratio (OR) 1.28, 95% confidence interval (CI) 1.0-15.1) and the presence of comorbidities (OR 4.1, 95% CI 1.0-21.6). The risk of complicated infection was higher with non-optimal definitive antibiotic therapy (OR 8.5, 95% CI 1.8-52.4), female sex (OR 3.8, 95% CI 1.1-16.3), and community-acquired infection (OR 7.4, 95% CI 2.0-33.1). Definitive antibiotic therapy was non-optimal in 22.6% of all cases. CONCLUSIONS SAB-related mortality was high. A large proportion of cases may be preventable, and there is a need for improved antibiotic management.
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Affiliation(s)
- Nicola Steinhaus
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | | | - Prudence Ive
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tom Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Colleen Bamford
- National Health Laboratory Service, Groote Schuur, Cape Town, South Africa; Division of Microbiology, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Holmes NE, Robinson JO, van Hal SJ, Munckhof WJ, Athan E, Korman TM, Cheng AC, Turnidge JD, Johnson PDR, Howden BP. Morbidity from in-hospital complications is greater than treatment failure in patients with Staphylococcus aureus bacteraemia. BMC Infect Dis 2018; 18:107. [PMID: 29506483 PMCID: PMC5838938 DOI: 10.1186/s12879-018-3011-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Various studies have identified numerous factors associated with poor clinical outcomes in patients with Staphylococcus aureus bacteraemia (SAB). A new study was created to provide deeper insight into in-hospital complications and risk factors for treatment failure. METHODS Adult patients hospitalised with Staphylococcus aureus bacteraemia (SAB) were recruited prospectively into a multi-centre cohort. The primary outcome was treatment failure at 30 days (composite of all-cause mortality, persistent bacteraemia, or recurrent bacteraemia), and secondary measures included in-hospital complications and mortality at 6- and 12-months. Data were available for 222 patients recruited from February 2011 to December 2012. RESULTS Treatment failure at 30-days was recorded in 14.4% of patients (30-day mortality 9.5%). Multivariable analysis predictors of treatment failure included age > 70 years, Pitt bacteraemia score ≥ 2, CRP at onset of SAB > 250 mg/L, and persistent fevers after SAB onset; serum albumin at onset of SAB, receipt of appropriate empiric treatment, recent healthcare attendance, and performing echocardiography were protective. 6-month and 12-month mortality were 19.1% and 24.2% respectively. 45% experienced at least one in-hospital complication, including nephrotoxicity in 19.5%. CONCLUSIONS This study demonstrates significant improvements in 30-day outcomes in SAB in Australia. However, we have identified important areas to improve outcomes from SAB, particularly reducing renal dysfunction and in-hospital treatment-related complications.
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Affiliation(s)
- Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia. .,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.
| | - J Owen Robinson
- Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine-WA, Royal Perth Hospital, 197 Wellington Street, Perth, WA, 6000, Australia.,Australian Collaborating Centre for Enterococcus and Staphylococcus Species (ACCESS) Typing and Research, School of Biomedical Sciences, Curtin University, Perth, WA, Australia
| | - Sebastiaan J van Hal
- Department of Microbiology and Infectious Diseases, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.,Department of Medicine, University of Western Sydney, Sydney, NSW, Australia
| | - Wendy J Munckhof
- Infection Management Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,Department of Medicine, University of Queensland, St Lucia, QLD, Australia
| | - Eugene Athan
- Department of Infectious Diseases, University Hospital Geelong, Barwon Health, Bellerine Street, Geelong, VIC, 3220, Australia.,Department of Medicine, Deakin University, Geelong, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Tony M Korman
- Department of Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.,Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Hospital, 55 Commercial Road, Prahran, VIC, 3181, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - John D Turnidge
- Australian Commission on Safety and Quality in Health Care, Level 5, 255 Elizabeth Street, Sydney, NSW, 2000, Australia.,Department of Paediatrics, University of Adelaide, Adelaide, SA, Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia
| | - Benjamin P Howden
- Department of Infectious Diseases, Austin Health, Austin Centre for Infection Research, PO Box 5555, Heidelberg, VIC, 3084, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, VIC, Australia.,Department of Microbiology, Monash University, Clayton, VIC, Australia.,Microbiological Diagnostic Unit, Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia
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Perez MG, Martiren S, Escarra F, Reijtman V, Mastroianni A, Varela-Baino A, Cedillo C, Garcia ME, Taicz M, Bologna R. Risk factors for the appearance of secondary foci of infection in children with community-acquired Staphylococcus aureus bacteraemia. Cohort study 2010-2016. Enferm Infecc Microbiol Clin 2017; 36:493-497. [PMID: 29217093 DOI: 10.1016/j.eimc.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/04/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Community-acquired Staphylococcus aureus (SA) bacteraemia is a common cause of hospitalisation in children. The occurrence of secondary foci (SF) of SA infection is associated with higher morbidity and mortality. OBJECTIVES To identify risk factors for SF of infection in children with community-acquired SA bacteraemia. MATERIAL AND METHODS Prospective cohort. All children aged from 30 days to 16 years admitted to a paediatric referral hospital between January 2010 and December 2016 for community-acquired infections, with SA isolated in blood cultures, were included. Microbiological, demographic and clinical characteristics were compared, with or without SF infection after 72hours of hospitalisation. RESULTS A total of 283 patients were included, 65% male (n=184), with a median age of 60 months (IQR: 30-132). Seventeen per cent (n=48) had at least one underlying disease and 97% (n=275) had some clinical focus of infection, the most common being: osteoarticular 55% (n=156) and soft tissue abscesses 27% (n=79). A total of 65% (n=185) were resistant to methicillin. A SF of infection was found in 16% of patients (n=44). The SF identified were pneumonia 73% (n=32), osteoarticular 11% (n=5), soft tissue 11% (n=5) and central nervous system 5% (n=2). In the multivariate analysis, the persistence of positive blood cultures after the fifth day (OR: 2.40, 95%CI: 1.07-5.37, P<0.001) and sepsis (OR: 17.23, 95%CI 5.21-56.9, P<0.001) were predictors of SF. There was no association with methicillin sensitivity. CONCLUSIONS In this cohort, methicillin-resistant SA infections predominated. The occurrence of SF of infection was associated with the persistence of bacteraemia after the fifth day and sepsis on admission.
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Affiliation(s)
- M Guadalupe Perez
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina.
| | - Soledad Martiren
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Florencia Escarra
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Vanesa Reijtman
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Alejandra Mastroianni
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Varela-Baino
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carola Cedillo
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - M Eva Garcia
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Moira Taicz
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosa Bologna
- Servicio de Control epidemiológico e Infectología, Hospital de pediatría Prof. Dr. Juan P. Garrahan, Ciudad Autónoma de Buenos Aires, Argentina
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Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond) 2017; 50:175-192. [PMID: 29105519 DOI: 10.1080/23744235.2017.1392039] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome. Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures. S. aureus is now the leading causes of infective endocarditis (IE) in many regions of the world. It accounts for 15-40% of all IE cases, and the majority of cases in people who inject drugs (PWID). Recently, the incidence of SAE in PWID in Stockholm, Sweden, was found to be 2.5/1000 person-years, with an in-hospital mortality of 2.5% in PWID as compared to 15% in non-drug users. The 30-day mortality associated with SAB amounts to 15-25% among adults in Western countries, but is lower in children (0-9%). Mortality associated with SAE is high (generally 20-30% in-hospital mortality), and symptomatic cerebral embolizations are common (12-35%). The 1-year mortality reported after SAB and SAE is 19-62% and reflects deaths from underlying diseases and complications caused by the infection. In a subset of SAE cases, valvular heart surgery is needed (15-45%), but active intravenous drug use seems to be a reason to refrain from surgery. Despite its importance, there are insufficient data on the optimal management of SAB and SAE, especially on the required duration of antibiotic therapy. Conclusions: The epidemiology of SAB and SAE has been changing in the past decades. They still carry a substantial morbidity and mortality. Intensified studies on treatment are warranted for improving patient outcome.
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Affiliation(s)
- Hilmir Asgeirsson
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Anders Thalme
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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10
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Vergis N, Khamri W, Beale K, Sadiq F, Aletrari MO, Moore C, Atkinson SR, Bernsmeier C, Possamai LA, Petts G, Ryan JM, Abeles RD, James S, Foxton M, Hogan B, Foster GR, O'Brien AJ, Ma Y, Shawcross DL, Wendon JA, Antoniades CG, Thursz MR. Defective monocyte oxidative burst predicts infection in alcoholic hepatitis and is associated with reduced expression of NADPH oxidase. Gut 2017; 66:519-529. [PMID: 26860769 PMCID: PMC5534772 DOI: 10.1136/gutjnl-2015-310378] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/07/2015] [Accepted: 10/25/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In order to explain the increased susceptibility to serious infection in alcoholic hepatitis, we evaluated monocyte phagocytosis, aberrations of associated signalling pathways and their reversibility, and whether phagocytic defects could predict subsequent infection. DESIGN Monocytes were identified from blood samples of 42 patients with severe alcoholic hepatitis using monoclonal antibody to CD14. Phagocytosis and monocyte oxidative burst (MOB) were measured ex vivo using flow cytometry, luminometry and bacterial killing assays. Defects were related to the subsequent development of infection. Intracellular signalling pathways were investigated using western blotting and PCR. Interferon-γ (IFN-γ) was evaluated for its therapeutic potential in reversing phagocytic defects. Paired longitudinal samples were used to evaluate the effect of in vivo prednisolone therapy. RESULTS MOB, production of superoxide and bacterial killing in response to Escherichia coli were markedly impaired in patients with alcoholic hepatitis. Pretreatment MOB predicted development of infection within two weeks with sensitivity and specificity that were superior to available clinical markers. Accordingly, defective MOB was associated with death at 28 and 90 days. Expression of the gp91 phox subunit of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase was reduced in patients with alcoholic hepatitis demonstrating defective MOB. Monocytes were refractory to IFN-γ stimulation and showed high levels of a negative regulator of cytokine signalling, suppressor of cytokine signalling-1. MOB was unaffected by 7 days in vivo prednisolone therapy. CONCLUSIONS Monocyte oxidative burst and bacterial killing is impaired in alcoholic hepatitis while bacterial uptake by phagocytosis is preserved. Defective MOB is associated with reduced expression of NADPH oxidase in these patients and predicts the development of infection and death.
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Affiliation(s)
- Nikhil Vergis
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Wafa Khamri
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Kylie Beale
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Fouzia Sadiq
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Mina O Aletrari
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Celia Moore
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Stephen R Atkinson
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Christine Bernsmeier
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | - Lucia A Possamai
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Gemma Petts
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
| | - Jennifer M Ryan
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | - Robin D Abeles
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | - Sarah James
- Department of Hepatology, University College, London, UK
| | | | - Brian Hogan
- Department of Hepatology, Royal Free Hospital, London, UK
| | - Graham R Foster
- Department of Gastroenterology, Royal London Hospital, London, UK
| | | | - Yun Ma
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | - Debbie L Shawcross
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | - Julia A Wendon
- Department of Hepatology, King's College Hospital, Institute of Liver Studies, London, UK
| | | | - Mark R Thursz
- Department of Hepatology and Gastroenterology, Imperial College, London, UK
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11
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Jokinen E, Laine J, Huttunen R, Rahikka P, Huhtala H, Vuento R, Vuopio J, Syrjänen J. Comparison of outcome and clinical characteristics of bacteremia caused by methicillin-resistant, penicillin-resistant and penicillin-susceptible Staphylococcus aureus strains. Infect Dis (Lond) 2017; 49:493-500. [PMID: 28276799 DOI: 10.1080/23744235.2017.1292046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the association of methicillin resistance and penicillinase production with clinical characteristics and outcome of Staphylococcus aureus bacteremia. METHODS For 126 patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, 378 age- and gender-matched controls with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia were selected. Of controls, 126 had bacteremia caused by penicillin-susceptible strains (PSSA) and 252 by penicillinase-producing strains (PRSA). Underlying diseases, clinical course and mortality were retrospectively assessed. RESULTS Patients with MRSA bacteremia were more often smokers than patients with MSSA bacteremia (OR 2.34, 95% CI 1.27-4.32). MRSA bacteremia was more often healthcare-associated (OR 4.23, 95% CI 2.47-7.24), associated with central venous catheters (OR 2.09, 95% CI 1.27-3.47), glucocorticoid therapy (OR 1.82, 95% CI 1.12-2.93) and prior surgery (OR 2.32, 95% CI 1.43-3.76). Patients with MRSA bacteremia received appropriate empiric antibiotic (31%) less often than controls (98%). Mortality within 28 days was higher in MRSA bacteremia (26.8%) than in MSSA bacteremia (15.5%) (OR 2.00, 95% CI 1.20-3.34), PRSA bacteremia (17.0%) (OR 1.79 95% CI 1.04-3.09) or PSSA bacteremia (12.5%) (OR 2.56 95% CI 1.27-5.15). The difference remained after adjusting for underlying diseases and foci. There was no significant difference in clinical course between PRSA and PSSA bacteremias. CONCLUSIONS MRSA bacteremia was associated with poorer outcome than either PRSA or PSSA bacteremia. We corroborated several risk factors found in previous studies.
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Affiliation(s)
- Elina Jokinen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Janne Laine
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Reetta Huttunen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland
| | - Pekka Rahikka
- b The Health Centre of Heinola , Doctagon OY , Heinola , Finland
| | - Heini Huhtala
- c Faculty of Social Sciences , University of Tampere , Tampere , Finland
| | - Risto Vuento
- d Department of Clinical Microbiology , Fimlab Laboratories , Tampere , Finland
| | - Jaana Vuopio
- e Department of Infectious Diseases , National Institute for Health and Welfare , Helsinki , Finland.,f Department of Medical Microbiology and Immunology , University of Turku , Turku , Finland
| | - Jaana Syrjänen
- a Department of Internal Medicine , Infectious Disease Unit, Tampere University Hospital , Tampere , Finland.,g School of Medicine , University of Tampere , Tampere , Finland
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12
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Thrombocytopaenia during methicillin-sensitive Staphylococcus aureus bacteraemia. Eur J Clin Microbiol Infect Dis 2016; 36:887-896. [PMID: 28012099 DOI: 10.1007/s10096-016-2877-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
The prognostic impact of thrombocytopaenia in Staphylococcus aureus bacteraemia (SAB) has previously been determined at bacteraemia onset only and relevant pre-bacteraemic thrombocytopaenia predisposing parameters have not been accounted for. We evaluated the prognostic impact of low thrombocyte count in SAB excluding pre-bacteraemic factors potentially causing thrombocytopaenia. This was a multicentre retrospective analysis of methicillin-sensitive SAB (MS-SAB) patients. Thrombocyte count was determined at blood culture collection and at days 3 and 7. Thrombocytopaenia was defined as a thrombocyte count less than 150 ×109/L. Patients with chronic alcoholism, liver diseases and haematologic malignancies were excluded. Altogether, 495 patients were identified. Thrombocytopaenia at blood culture and at day 3 associated to endocarditis (p < 0.05 and p < 0.01) and defervescence (p < 0.001 and p < 0.01). Mortality at 90 days was higher for patients with thrombocytopaenia at blood culture collection (26 vs. 16%, p < 0.05), at day 3 (32 vs. 13%, p < 0.01) and at day 7 (50 vs. 14%, p < 0.001). In receiver operating characteristic analyses, thrombocytopaenia predicted a poor outcome at blood culture collection (p < 0.05), at day 3 (p < 0.001) and at day 7 (p < 0.001). When accounting for all prognostic parameters, thrombocytopaenia at day 3 [hazard ratio (HR), 1.83; p = 0.05] demonstrated a trend towards poor outcome, whereas thrombocytopaenia at day 7 (HR, 3.64; p < 0.001) associated to poor outcome. Thrombocytopaenia at blood culture collection was not a prognostic parameter when all prognostic factors were taken into account. However, thrombocytopaenia at day 3 indicated a poor outcome and thrombocytopaenia at day 7 was a significant independent negative prognostic marker that has not been previously reported in SAB.
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13
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Forsblom E, Ruotsalainen E, Järvinen A. Comparable Effectiveness of First Week Treatment with Anti-Staphylococcal Penicillin versus Cephalosporin in Methicillin-Sensitive Staphylococcus aureus Bacteremia: A Propensity-Score Adjusted Retrospective Study. PLoS One 2016; 11:e0167112. [PMID: 27898714 PMCID: PMC5127580 DOI: 10.1371/journal.pone.0167112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022] Open
Abstract
The objective was to compare the prognostic impact of first week treatment with anti-staphylococcal penicillin (ASP) versus cephalosporin in methicillin-sensitive Staphylococcus aureus bacteremia (MS-SAB). Altogether 580 patients were retrospectively followed and categorized according to first week treatment; 84% (488) received ASP (cloxacillin) and 16% (92) cephalosporin (cefuroxime or ceftriaxone). SAB management was optimized with formal bedside infectious disease specialist consultation in 88%, deep infection foci diagnosed in 77% and adjunctive rifampicin therapy given to 61% of patients. The total case fatality in 580 patients was 12% at 28 days and 18% at 90 days. When comparing effectiveness of first week ASP versus cephalosporin treatment there were no significant differences in 28-days (11% vs. 12%, OR; 1.05, 95% CI, 0.53-2.09) or 90-days (17% vs. 21% OR; 1.25, 95% CI, 0.72-2.19) outcome. In univariate analysis no prognostic impact of either first week ASP or cephalosporin treatment was observed for 28-days (OR; 0.96, 95% CI, 0.48-1.90 and OR; 1.05, 95% CI, 0.53-2.09) or 90-days (OR; 0.80, 95% CI, 0.46-1.39 and OR; 1.25, 95% CI, 0.72-2.19) outcome. Propensity-score adjusted Cox proportional regression analysis for first week treatment with cephalosporin demonstrated no significant prognostic impact at 28-days (HR 1.54, 95% CI 0.72-3.23) or 90-days (HR 1.56, 95% CI 0.88-2.86). IN CONCLUSION There is a comparable effectiveness with respect to 28- and 90-days outcome for first week treatment with ASP versus cephalosporin in MS-SAB. The results indicate that the difference in prognostic impact between first week ASP and cephalosporin may be non-significant in patient cohorts with SAB management optimized by infectious disease specialist consultation.
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Affiliation(s)
- Erik Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Finland and University of Helsinki, City of Helsinki, Finland
- * E-mail:
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Finland and University of Helsinki, City of Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Finland and University of Helsinki, City of Helsinki, Finland
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14
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Braquet P, Alla F, Cornu C, Goehringer F, Piroth L, Chirouze C, Revest M, Lechiche C, Duval X, Le Moing V. Factors associated with 12 week case-fatality in Staphylococcus aureus bacteraemia: a prospective cohort study. Clin Microbiol Infect 2016; 22:948.e1-948.e7. [PMID: 27515395 DOI: 10.1016/j.cmi.2016.07.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/24/2016] [Accepted: 07/31/2016] [Indexed: 12/21/2022]
Abstract
Staphylococcus aureus bacteraemia (SAB) is a frequent and deadly disease. Given the lack of a randomized trial, optimal first-line antibiotic treatment is still debated. Our aim was to identify prognostic factors in SAB patients and to analyse the impact of first-line antibiotics. The VIRSTA prospective cohort study was conducted in eight tertiary care centres in France. Consecutive incident adults in whom a blood culture drawn in participating centres grew S. aureus between April 2009 and October 2011 were prospectively followed for 12 weeks. Factors associated with 12-week case-fatality were identified by multivariate logistic regression. We enrolled 2091 patients and analysed survival in 1972 (median age 67.8 years, interquartile range 55.5-78.9; females 692/1972, 35.1%). SAB was nosocomial or healthcare-related in 1372/1972 (69.6%) of cases and the primary focus was unknown in 414/1972 (21.0%) of cases. Week 12 case-fatality rate was 671/1972 (34.0%). The main independent prognostic factors on multivariate analysis were age (adjusted OR by 10-year increment 1.56; 95% CI 1.44-1.69), septic shock (OR 5.11; 95% CI 3.84-6.80), metastatic cancer (OR 4.28; 95% CI 2.88-6.38), and unknown primary focus (OR 2.62; 95% CI 2.02-3.41). In the 1538 patients with methicillin-sensitive S. aureus (MSSA) bacteraemia, first-line empiric antistaphylococcal penicillins (OR 0.40; 95% CI 0.17-0.95) and vancomycin (OR 0.37; 95% CI 0.17-0.83), alone or combined with an aminoglycoside, were associated with better outcome compared with other antibiotics. There are few modifiable prognostic factors for SAB. Initiating empiric antibiotics with antistaphylococcal penicillins or vancomycin may be associated with better outcome in MSSA bacteraemia.
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Affiliation(s)
- P Braquet
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
| | - F Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA 4360, Nancy, France; INSERM, CIC-EC, CIE6, Nancy, France; CHU Nancy, Nancy, France
| | - C Cornu
- INSERM, CIC1407, Lyon, France; CHU Lyon, Service de Pharmacologie Clinique, Lyon, France; Université Lyon, UMR 5558, Lyon, France
| | - F Goehringer
- Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nancy, France
| | - L Piroth
- CHU de Dijon, UMR 1347-MERS, Université de Bourgogne, Dijon, France
| | - C Chirouze
- UMR CNRS 6249 Chrono-environnement, Université de Bourgogne Franche-Comté, CHU de Besançon, Besançon, France
| | - M Revest
- Infectious Diseases and Intensive Care Unit, Centre Hospitalier Universitaire de Rennes, France
| | - C Lechiche
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - X Duval
- Université Paris Diderot Sorbonne, Paris, France; IAME, INSERM, UMR 1137, CIC 1425, Paris, France; AP-HP, Hôpital Bichat Claude Bernard, Paris, France
| | - V Le Moing
- Department for Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de Montpellier, Montpellier, France; UMI 233 TransVIHMI, Université de Montpellier, Institut de Recherche sur le Développement, Montpellier, France.
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15
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Predictive Value of C-Reactive Protein (CRP) in Identifying Fatal Outcome and Deep Infections in Staphylococcus aureus Bacteremia. PLoS One 2016; 11:e0155644. [PMID: 27182730 PMCID: PMC4868312 DOI: 10.1371/journal.pone.0155644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/02/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Clear cut-off levels could aid clinicians in identifying patients with a risk of fatal outcomes or complications such as deep infection foci in Staphylococcus aureus bacteremia (SAB). Cut-off levels for widely used clinical follow-up parameters including serum C-reactive protein (CRP) levels and white blood cell counts (WBC) have not been previously studied. Methods 430 adult SAB patients in Finland took part in prospective multicentre study in which their CRP levels and WBC counts were measured on the day of the positive blood culture, every other day during the first week, twice a week during hospitalization and at 30 days. Receiver operating characteristic (ROC) analysis was used to evaluate the prognostic value of CRP and WBC on the day of the positive blood culture and at days 4, 7, and 14 in predicting mortality and the presence of deep infections at 30 days. Adjusted hazard ratios (HR) for CRP level and WBC count cut-off values for mortality were calculated by the Cox regression analysis and adjusted odds ratios (OR) for cut-off values to predict the presence of deep infection by the binary logistic regression analysis. Results The succumbing patients could be distinguished from the survivors, starting on day 4 after the positive blood culture, by higher CRP levels. Cut-off values of CRP for day 30 mortality in adjusted analysis, that significantly predicted fatal outcome were at day 4 CRP >103 mg/L with sensitivity of 77%, specificity of 55%, and HR of 3.5 (95% CI, 1.2–10.3; p = 0.024), at day 14 CRP >61 mg/L with a sensitivity of 82%, specificity of 80% and HR of 3.6 (95% CI, 1.1–10.3; p<0.039) and cut-off value of WBC at day 14 >8.6 x109/L was prognostic with sensitivity of 77%, specificity of 78% and HR of 8.2 (95% CI, 2.9–23.1; p<0.0001). Cut-off values for deep infection in adjusted analysis were on the day of the positive blood culture CRP >108 mg/L with sensitivity of 77%, specificity of 60%, and HR of 2.6 (95% CI, 1.3–4.9; p = 0.005) and at day 14 CRP >22 mg/L with sensitivity of 59%, specificity of 68%, and HR of 3.9 (95% CI, 1.6–9.5; p = 0.003). The lack of decline of CRP in 14 days or during the second week were neither prognostic nor markers of deep infection focus. Conclusions CRP levels have potential for the early identification of SAB patients with a greater risk for death and deep infections.
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16
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Smit J, Søgaard M, Schønheyder HC, Nielsen H, Frøslev T, Thomsen RW. Diabetes and risk of community-acquired Staphylococcus aureus bacteremia: a population-based case-control study. Eur J Endocrinol 2016; 174:631-9. [PMID: 26966175 DOI: 10.1530/eje-16-0023] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/26/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Patients with diabetes may experience higher risk of Staphylococcus aureus bacteremia (SAB) than patients without diabetes due to decreased immunity or coexisting morbidities. We investigated the risk of community-acquired (CA) SAB in persons with and without diabetes. DESIGN Using population-based medical databases, we conducted a case-control study of all adults with first-time CA-SAB and matched population controls in Northern Denmark, 2000-2011. METHODS Based on conditional logistic regression, we computed odds ratios (ORs) of CA-SAB according to diabetes. We further assessed whether the risk of CA-SAB differed according to various diabetes-related characteristics (e.g. duration of diabetes, glycemic control, and presence of diabetes complications). RESULTS We identified 2638 patients with incident CA-SAB, of whom 713 (27.0%) had diabetes, and 26,379 matched population controls (2495 or 9.5% with diabetes). Individuals with diabetes had a substantially increased risk of CA-SAB compared with population controls (adjusted OR = 2.8 (95% confidence interval (CI): 2.5-3.1)). Duration of diabetes of ≥10 years and poor glycemic control conferred higher risk estimates, with an adjusted OR = 2.3 (95% CI: 1.9-2.7) for diabetes with Hba1c < 7% (< 53 mmol/mol) and an adjusted OR = 5.7 (95% CI: 4.2-7.7) for diabetes with Hba1c ≥9% (≥75 mmol/mol). The risk of CA-SAB was particularly high in patient with diabetes complications: adjusted OR = 5.5 (95% CI: 4.2-7.2) with presence of microvascular complications and OR = 7.0 (95% CI: 5.4-9.0) with combined macro- and microvascular complications. CONCLUSIONS Diabetes is associated with a substantially increased risk of CA-SAB, particularly in patients with diabetes of long duration, poor glycemic control, and diabetes complications.
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Affiliation(s)
- Jesper Smit
- Department of Clinical MicrobiologyAalborg University Hospital, Aalborg, Denmark Department of Infectious DiseasesAalborg University Hospital, Aalborg, Denmark Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark
| | - Mette Søgaard
- Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical MicrobiologyAalborg University Hospital, Aalborg, Denmark Department of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Henrik Nielsen
- Department of Infectious DiseasesAalborg University Hospital, Aalborg, Denmark Department of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Trine Frøslev
- Department of Clinical EpidemiologyAarhus University Hospital, Aalborg, Denmark
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Forsblom E, Nurmi AM, Ruotsalainen E, Järvinen A. Should all adjunctive corticosteroid therapy be avoided in the management of hemodynamically stabile Staphylococcus aureus bacteremia? Eur J Clin Microbiol Infect Dis 2016; 35:471-9. [PMID: 26768583 DOI: 10.1007/s10096-015-2563-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/16/2015] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to examine the prognostic impact of corticosteroids in hemodynamically stabile Staphylococcus aureus bacteremia (SAB). There were 361 hemodynamically stabile methicillin-sensitive SAB patients with prospective follow-up and grouping according to time-point, dose and indication for corticosteroid therapy. To enable analyses without external interfering corticosteroid therapy all patients with corticosteroid therapy equivalent to prednisone >10 mg/day for ≥1 month prior to positive blood culture results were excluded. Twenty-five percent (92) of patients received corticosteroid therapy of which 11 % (40) had therapy initiated within 1 week (early initiation) and 9 % (31) had therapy initiated 2-4 weeks after (delayed initiation) positive blood culture. Twenty-one patients (6 %) had corticosteroid initiated after 4 weeks and were not included in the analyses. A total of 55 % (51/92) received a weekly prednisone dose >100 mg. Patients with early initiated corticosteroid therapy had higher mortality compared to patients treated without corticosteroid therapy at 28 days (20 % vs. 7 %) (OR, 3.11; 95%CI, 1.27-7.65; p < 0.05) and at 90 days (30 % vs. 10 %) (OR, 4.01; 95%CI, 1.82-8.81; p < 0.001). Considering all prognostic markers, early initiated corticosteroid therapy predicted 28-day (HR, 3.75; 95%CI, 1.60-8.79; p = 0.002) and 90-day (HR, 3.10; 95%CI, 1.50-6.39; p = 0.002) mortality in Cox proportional hazards regression analysis. When including only patients receiving early initiated corticosteroid therapy with prednisone ≥100 mg/week the negative prognostic impact on 28-day mortality was accentuated (HR 4.8, p = 0.001). Corticosteroid therapy initiation after 1 week of positive blood cultures had no independent prognostic impact. Early initiation of corticosteroid therapy may be associate to increased mortality in hemodynamically stabile SAB.
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Affiliation(s)
- E Forsblom
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland. .,Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Aurora Hospital, Nordenskiöldinkatu 26, Building 3, P.O. Box 348, 00029, HUS Helsinki, Finland.
| | - A-M Nurmi
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - E Ruotsalainen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - A Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
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18
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Staphylococcus aureus Bloodstream Infection and Endocarditis--A Prospective Cohort Study. PLoS One 2015; 10:e0127385. [PMID: 26020939 PMCID: PMC4447452 DOI: 10.1371/journal.pone.0127385] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/15/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE). METHODS All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. RESULTS SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%). CONCLUSION SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.
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Forsblom E, Ruotsalainen E, Järvinen A. Improved outcome with early rifampicin combination treatment in methicillin-sensitive Staphylococcus aureus bacteraemia with a deep infection focus - a retrospective cohort study. PLoS One 2015; 10:e0122824. [PMID: 25874546 PMCID: PMC4395220 DOI: 10.1371/journal.pone.0122824] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Rifampicin has been used as adjunctive therapy in Staphylococcus aureus bacteraemia (SAB) with a deep infection focus. However, data for prognostic impact of rifampicin therapy is unestablished including the optimal initiation time point. We studied the impact of rifampicin therapy and the optimal initiation time for rifampicin treatment on prognosis in methicillin-sensitive S. aureus bacteraemia with a deep infection. METHODS Retrospective, multicentre study in Finland including 357 SAB patients with a deep infection focus. Patients with alcoholism, liver disease or patients who died within 3 days were excluded. Patients were categorised according to duration of rifampicin therapy and according to whether rifampicin was initiated early (within 7 days) or late (7 days after) after the positive blood cultures. Primary end point was 90 days mortality. RESULTS Twenty-seven percent of patients received no rifampicin therapy, 14% received rifampicin for 1-13 days whereas 59% received rifampicin ≥14 days. The 90 day mortality was; 26% for patients treated without rifampicin, 16% for rifampicin therapy of any length and 10% for early onset rifampicin therapy ≥14 days. Lack of rifampicin therapy increased (OR 1.89, p=0.026), rifampicin of any duration decreased (OR 0.53, p=0.026) and rifampicin therapy ≥14 days with early onset lowered the risk for a fatal outcome (OR 0.33, p<0.01) during 90 days follow-up. CONCLUSION Rifampicin adjunctive therapy for at least 14 days and initiated within 7 days of positive blood culture associated with improved outcome among SAB patients with a deep infection.
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Affiliation(s)
- Erik Forsblom
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
- * E-mail:
| | - Eeva Ruotsalainen
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
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Parlet CP, Kavanaugh JS, Horswill AR, Schlueter AJ. Chronic ethanol feeding increases the severity of Staphylococcus aureus skin infections by altering local host defenses. J Leukoc Biol 2015; 97:769-78. [PMID: 25605871 DOI: 10.1189/jlb.4a0214-092r] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Alcoholics are at increased risk of Staphylococcus aureus skin infection and serious sequelae, such as bacteremia and death. Despite the association between alcoholism and severe S. aureus skin infection, the impact of EtOH on anti-S. aureus cutaneous immunity has not been investigated in a model of chronic EtOH exposure. To test the hypothesis that EtOH enhances the severity of S. aureus skin infection, mice were fed EtOH for ≥12 weeks via the Meadows-Cook model of alcoholism and inoculated with S. aureus following epidermal abrasion. Evidence of exacerbated staphylococcal disease in EtOH-fed mice included: skin lesions that were larger and contained more organisms, greater weight loss, and increased bacterial dissemination. Infected EtOH-fed mice demonstrated poor maintenance and induction of PMN responses in skin and draining LNs, respectively. Additionally, altered PMN dynamics in the skin of these mice corresponded with reduced production of IL-23 and IL-1β by CD11b(+) myeloid cells and IL-17 production by γδ T cells, with the latter defect occurring in the draining LNs as well. In addition, IL-17 restoration attenuated S. aureus-induced dermatopathology and improved bacterial clearance defects in EtOH-fed mice. Taken together, the findings show, in a novel model system, that the EtOH-induced increase in S. aureus-related injury/illness corresponds with defects in the IL-23/IL-17 inflammatory axis and poor PMN accumulation at the site of infection and draining LNs. These findings offer new information about the impact of EtOH on cutaneous host-defense pathways and provide a potential mechanism explaining why alcoholics are predisposed to S. aureus skin infection.
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Affiliation(s)
- Corey P Parlet
- Departments of *Pathology and Microbiology and Interdisciplinary Graduate Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jeffrey S Kavanaugh
- Departments of *Pathology and Microbiology and Interdisciplinary Graduate Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Alexander R Horswill
- Departments of *Pathology and Microbiology and Interdisciplinary Graduate Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Annette J Schlueter
- Departments of *Pathology and Microbiology and Interdisciplinary Graduate Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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The impact of bacteremia on the outcome of bone infections. Med Mal Infect 2014; 44:380-6. [PMID: 25169941 DOI: 10.1016/j.medmal.2014.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 11/21/2022]
Abstract
UNLABELLED We have used a medical database to analyze our activity since 2005. We observed a frequent association between bone and joint infection (BI) and bacteremia. Our aim was to characterize patients with BI and bacteremia, and focus on the outcome. PATIENTS AND METHOD Our database includes the prospective recording of 28 characteristics of all hospitalized patients, including diagnosis, comorbid conditions, microbiological data, therapy, and outcome. We selected patients presenting with BI in this database, from July 2005 to December 2012. Fever before blood culture was retrospectively documented from the patient's chart. Chronic BI was defined as a disease lasting more than 1 month. An unfavorable outcome was defined by the need for intensive care or death. RESULTS Six hundred and thirty-two patients presented with BI and 125 with bacteremia (19.8%). We used a stepwise logistic regression analysis and determined that bacteremia was associated with vertebral osteomyelitis, OR, 3.97, P<0.001; alcohol abuse, OR, 2.51, P=0.010; fever, OR, 2.43, P<0.001; neurological and/or psychiatric diseases, OR, 2.41, P ≤ 0.001; and Staphylococcus aureus infection, OR, 2.32, P<0.001. The outcome was unfavorable in 23 cases (3.6%), associated with bacteremia, OR, 8.00, P<0.001, age> 60 years, OR, 4.78, P=0.018, and S. aureus infection, OR, 3.96, P=0.010. No single comorbid condition was significantly associated with an unfavorable outcome. CONCLUSION Bacteremia occurred in nearly 20% of the patients presenting with BI, and was associated with identifiable comorbid conditions; it was the main risk factor for an unfavorable outcome.
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Host–pathogen interactions in epidermolysis bullosa patients colonized with Staphylococcus aureus. Int J Med Microbiol 2014; 304:195-203. [DOI: 10.1016/j.ijmm.2013.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Tom S, Galbraith JC, Valiquette L, Jacobsson G, Collignon P, Schønheyder HC, Søgaard M, Kennedy KJ, Knudsen JD, Ostergaard C, Lyytikäinen O, Laupland KB. Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2014; 20:O630-2. [PMID: 24461038 DOI: 10.1111/1469-0691.12564] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/16/2014] [Accepted: 01/18/2014] [Indexed: 11/26/2022]
Abstract
Lethal outcomes can be expressed as a case fatality ratio (CFR) or as a mortality rate per 100 000 population per year (MR). Population surveillance for community-onset methicillin-sensitive (MSSA) and methicillin-resistant (MRSA) Staphylococcus aureus bacteraemia was conducted in Canada, Australia, Sweden and Denmark to evaluate 30-day CFR and MR trends between 2000 and 2008. The CFR was 20.3% (MSSA 20.2%, MRSA 22.3%) and MR was 3.4 (MSSA 3.1, MRSA 0.3) per 100 000 per year. Although MSSA CFR was stable the MSSA MR increased; MRSA CFR decreased while its MR remained low during the study. Community-onset S. aureus bacteraemia, particularly MSSA, is associated with major disease burden. This study highlights complementary information provided by evaluating both CFR and MR.
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Affiliation(s)
- S Tom
- University of Calgary, Calgary, AB, Canada
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Parlet CP, Waldschmidt TJ, Schlueter AJ. Chronic ethanol feeding induces subset loss and hyporesponsiveness in skin T cells. Alcohol Clin Exp Res 2014; 38:1356-64. [PMID: 24512045 DOI: 10.1111/acer.12358] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/27/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Chronic alcoholism is associated with increased incidence and severity of cutaneous infection. Skin-resident T cells orchestrate numerous immunological functions that are critically involved in both tissue homeostasis and cutaneous immunity. The impact of chronic ethanol (EtOH) exposure on skin T cells has not previously been examined; given their important role in maintaining the immune barrier function of the skin further study is warranted. METHODS Mice were administered EtOH in the drinking water for 12 to 16 weeks. Flow cytometry was used to evaluate impact of EtOH feeding on skin T cell numbers, rates of proliferation, and apoptosis as well as activation marker expression and cytokine production after ex vivo stimulation. RESULTS Chronic EtOH feeding caused a baseline reduction in dendritic epidermal T cell (DETC) numbers that corresponded with reduced expression of the activation marker JAML following phorbol 12-myristate 13-acetate (PMA)/ionomycin stimulation. Chronic EtOH feeding did not alter total numbers of dermal T cells, but specific subset loss was observed in Foxp3(+) regulatory T cells (Tregs) as well as CD3hi, Vγ3(+) and CD3int, Vγ3(-) dermal γδ T cells. EtOH-induced dysfunction in the latter population, which represents prototypical interleukin-17 (IL-17)-producing dermal γδT17s, was made evident by diminished IL-17 production following anti-CD3 stimulation. Additionally, the capacity of lymph node γδ T cells to produce IL-17 following anti-CD3 and PMA/ionomycin stimulation was impaired by chronic EtOH feeding. CONCLUSIONS Chronic EtOH feeding induced defects in both numbers and function of multiple skin T cell subsets. The decreased density and poor responsiveness of DETCs and γδT17 cells in particular would be expected to compromise immune effector mechanisms necessary to maintain a protective barrier and restrict pathogen invasion. These findings demonstrate the sensitivity of skin T cells to EtOH and provide new mechanisms to help explain the propensity of alcoholics to suffer skin infection.
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Affiliation(s)
- Corey P Parlet
- Department of Pathology and Interdisciplinary Graduate Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa
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25
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Kaasch AJ, Barlow G, Edgeworth JD, Fowler VG, Hellmich M, Hopkins S, Kern WV, Llewelyn MJ, Rieg S, Rodriguez-Baño J, Scarborough M, Seifert H, Soriano A, Tilley R, Tőrők ME, Weiß V, Wilson APR, Thwaites GE. Staphylococcus aureus bloodstream infection: a pooled analysis of five prospective, observational studies. J Infect 2013; 68:242-51. [PMID: 24247070 DOI: 10.1016/j.jinf.2013.10.015] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 09/17/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome. METHODS We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States. RESULTS The median age of participants was 64 years (interquartile range 50-75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001). CONCLUSION The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
| | - Gavin Barlow
- Department of Infection and Tropical Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vance G Fowler
- Department of Medicine, Duke University, Durham, NC, USA
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Susan Hopkins
- Department of Infectious Diseases and Microbiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Winfried V Kern
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Martin J Llewelyn
- Department of Infectious Diseases and Microbiology, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Siegbert Rieg
- Center for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital of Freiburg, Germany
| | - Jesús Rodriguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena; Department of Medicine, University of Seville, Seville, Spain
| | - Matthew Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany
| | - Alex Soriano
- Service of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Robert Tilley
- Department of Microbiology, Plymouth Hospitals NHS Trust, Plymouth, United Kingdom
| | - M Estée Tőrők
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Verena Weiß
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - A Peter R Wilson
- Department of Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Guy E Thwaites
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London & Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
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Tak V, Mathur P, Lalwani S, Misra MC. Staphylococcal blood stream infections: epidemiology, resistance pattern and outcome at a level 1 Indian trauma care center. J Lab Physicians 2013; 5:46-50. [PMID: 24014969 PMCID: PMC3758705 DOI: 10.4103/0974-2727.115939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Blood stream infection (BSI)/bacteremia is a potentially life threatening infection and are associated with a high crude mortality. Coagulase negative Staphylococcus (CONS) and Staphylococcus aureus are the most commonly isolated gram positive bacteria from blood culture samples. While S. aureus is a known pathogen causing BSIs, CONS are considered to be common contaminants of blood culture. Of late many studies have challenged this traditional viewpoint. The aim of this study was to determine the epidemiology and significance of Staphylococcus aureus and CONS bacteremia, their resistance patterns and associated mortality in critically ill trauma patients admitted to a level 1 trauma center. Materials and Methods: The study was conducted from January 2009 to June 2011. All patients from whose blood samples yielded a S. aureus or CONS on culture were included in this study. A detailed history was obtained and follow-up of the patients was done. The isolates of Staphylococci were identified to species level. Antibiotic susceptibility was performed by the disc diffusion method and VITEK-2 system. Results: During this 30 month period, total of 10,509 blood samples were received from 2,938 patients. A total of 1,961 samples taken from 905 patients were positive for one or more pathogens. S. aureus/CONS were isolated from 469 samples from 374 patients. Crude mortality amongst the patients having Staphylococcal BSI was 25% (94/374). Conclusion: Staphylococcal blood stream infections are a leading cause of morbidity and mortality.
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Affiliation(s)
- Vibhor Tak
- Department of Laboratory Medicine, JPNA Trauma Centre, AIIMS, New Delhi, India
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Kullar R, Rybak MJ, Kaye KS. Comparative epidemiology of bacteremia due to methicillin-resistant Staphylococcus aureus between older and younger adults: a propensity score analysis. Infect Control Hosp Epidemiol 2013; 34:400-6. [PMID: 23466914 DOI: 10.1086/669868] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We evaluated the clinical and molecular epidemiology of bloodstream infections (BSIs) due to methicillin-resistant Staphylococcus aureus (MRSA) in older versus younger patients treated with vancomycin, determining the independent effect of increased age on outcomes. DESIGN Observational retrospective cohort study. SETTING Detroit Medical Center, level I trauma center. PATIENTS Adult older (65 years and older) and younger (younger than 65 years) patients with documented BSIs due to MRSA treated with vancomycin (2005-2010). METHODS Collected demographics, comorbidities, microbiology, treatment, outcomes. Multivariable model used to generate propensity score for each patient on the basis of the probability of being 65 years of age or older. RESULTS Three hundred twenty patients were eligible (69 patients 65 years and older; 251 patients younger than 65 years). Catheter-related infections and endocarditis were the most common sites of infection for older (20.3%) and younger (19.1%) adults, respectively. Median first total 24-hour vancomycin dose (1,000 vs 2,000 mg; [Formula: see text]) and initial trough (13.1 vs 15.0 mg/L; [Formula: see text]) was significantly lower in older versus younger patients. Vancomycin treatment failure rates were similar among older and younger patients (49.3% vs 53.4%; [Formula: see text]). In multivariable analysis of outcomes, after controlling for predictors of older age, there was no difference in clinical outcomes between older and younger adults. CONCLUSIONS After accounting for confounders associated with increased age, failure rate of patients with BSIs due to MRSA treated with vancomycin was similar between older and younger patients. Older adults were less likely to have optimal vancomycin dosing and initial trough levels than younger patients. Efforts should be made to optimize dosing of medications such as vancomycin in older adults.
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Affiliation(s)
- Ravina Kullar
- College of Pharmacy, Oregon State University/Oregon Health and Science University, Portland, OR 97239, USA.
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Health care-associated infections in surgical patients undergoing elective surgery: are alcohol use disorders a risk factor? J Am Coll Surg 2012; 215:229-36. [PMID: 22727411 DOI: 10.1016/j.jamcollsurg.2012.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 02/17/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Health care-associated infections (HAI) result in 100,000 deaths/year. Alcohol use disorders (AUD) increase the risk of community-acquired infections and HAI. Small studies have shown that AUD increase the risk of HAI and surgical site infections (SSI). We sought to determine the risk of HAI and SSI in surgical patients undergoing elective inpatient joint replacement, coronary artery bypass grafting, laparoscopic cholecystectomy, colectomy, and hernia repair. STUDY DESIGN The Nationwide Inpatient Sample was analyzed (years 2007 and 2008). HAI were defined as health care-associated pneumonia, sepsis, SSI, and urinary tract infection. Primary outcomes were risk of HAI and SSI in patients with AUD. Secondary outcomes were mortality and hospital length of stay in patients with HAI and SSI, alpha = 10(-6). RESULTS There were 1,275,034 inpatient admissions analyzed; 38,335 (3.0%) cases of HAI were documented, and 5,756 (0.5%) cases of SSI were identified. AUD was diagnosed in 11,640 (0.9%) of cases. Multivariable analysis demonstrated that AUD was an independent predictor of developing HAI: odds ratio (OR) 1.70, p < 10(-6), and this risk was independent of type of surgery. By multivariable analysis, the risk of SSI in patients with AUD was also higher: OR 2.73, p < 10(-6). Hospital mortality in patients with HAI or SSI was not affected by AUD. However, hospital length of stay was longer in patients with HAI who had AUD (multivariable analysis 2.4 days longer, p < 10(-6)). Among patients with SSI, those with AUD did not have longer hospital length of stay. CONCLUSIONS Patients with AUD who undergo a variety of elective operations have an increased risk of infectious postoperative morbidity.
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Lorente L, Iceta R, Martín MM, López-Gallardo E, Solé-Violán J, Blanquer J, Labarta L, Díaz C, Jiménez A, Montoya J, Ruiz-Pesini E. Survival and mitochondrial function in septic patients according to mitochondrial DNA haplogroup. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R10. [PMID: 22251664 PMCID: PMC3396241 DOI: 10.1186/cc11150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 12/01/2011] [Accepted: 01/17/2012] [Indexed: 12/21/2022]
Abstract
Introduction We recently found that platelet cytochrome c oxidase (COX) activities and quantities in 6-month-survival septic patients are significantly higher than those of patients who died before 6 months. Other studies suggested that the mitochondrial DNA (mtDNA) genotype could play a major role in sepsis survival. Given that COX catalytic subunits are encoded by mtDNA, the objective of the present study was to explore whether mtDNA population genetic variation could affect COX activity and quantity and favors sepsis survival. Methods A prospective, multicenter, observational study was carried out in six Spanish ICUs. We included 96 patients with severe sepsis. We determined the mtDNA haplogroup, the COX specific activity/citrate synthase specific activity (COXa/CSa) ratio and the COX quantity/citrate synthase specific activity (COXq/CSa) ratio in circulating platelets at the time of diagnosis, day 4 and day 8. We used survival at 1 and 6 months as endpoints. Results Patients with the JT mtDNA haplogroup (n = 15) showed higher COXq/CSa ratio at day 4 (P = 0.04) and day 8 (P = 0.02) than those with other haplogroups (n = 81). Logistic regression analysis showed that the JT mtDNA haplogroup (odds ratio = 0.18; 95% confidence interval = 0.04 to 0.94; P = 0.04) and COXq/CSa ratio (odds ratio = 0.53; 95% confidence interval = 0.30 to 0.93; P = 0.03) were associated with 1-month survival after controlling for age and lactic acid levels. Conclusions The novel findings of our study are that 1-month surviving septic patients showed higher COXq/CSa ratio than nonsurviving individuals, that patients from the JT mtDNA haplogroup showed a higher COXq/CSa ratio and that JT patients had a higher 1-month survival than patients from other mtDNA haplogroups.
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Affiliation(s)
- Leonardo Lorente
- Intensive Care Unit, Hospital Universitario de Canarias, La Laguna 38320, Santa Cruz de Tenerife, Spain.
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