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Khodadadi RB, Yetmar ZA, Domonoske CL, Razonable RR. Factors associated with infectious diseases fellowship academic success. MEDICAL EDUCATION ONLINE 2024; 29:2352953. [PMID: 38720561 PMCID: PMC11086035 DOI: 10.1080/10872981.2024.2352953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/05/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND A multitude of factors are considered in an infectious disease (ID) training program's meticulous selection process of ID fellows but their correlation to pre and in-fellowship academic success as well as post-fellowship academic success and short-term outcomes is poorly understood. Our goal was to investigate factors associated with subsequent academic success in fellowship as well as post-fellowship short-term outcomes. METHODS In 2022, we retrospectively analyzed deidentified academic records from 39 graduates of the Mayo Clinic Rochester ID Fellowship Program (1 July 2013- 30 June 2022). Data abstracted included demographics, degrees, honor society membership, visa/citizenship status, medical school, residency training program, United States Medical Licensure Exam (USMLE) scores, letters of recommendation, in-training examination (ITE) scores, fellowship track, academic rank, career choice, number of honors, awards, and abstracts/publications prior to fellowship, during training, and within 2 years of graduation. RESULTS Younger fellows had higher USMLE step 1 scores, pre and in-fellowship scholarly productivity, and higher ITE performance. Female fellows had significantly higher USMLE step 3 scores. Prior research experience translated to greater in-fellowship scholarly productivity. Higher USMLE scores were associated with higher ID ITE performance during multiple years of fellowship, but USMLE step 2 clinical knowledge and 3 scores were associated with higher pre and in-fellowship scholarly productivity and receiving an award during fellowship. The USMLE step 1 score did not correlate with fellowship performance beyond year 1 and 2 ITE scores. CONCLUSIONS Multiple aspects of a prospective fellow's application must be considered as part of a holistic review process for fellowship selection. USMLE step 2 CK and 3 scores may predict fellowship performance across multiple domains.
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Affiliation(s)
- Ryan B. Khodadadi
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachary A. Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cynthia L. Domonoske
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Raymund R. Razonable
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
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2
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Fukushima S, Hagiya H, Kuninaga N, Haruki Y, Yamada H, Iwamoto Y, Yoshida M, Sato K, Hanayama Y, Tanaka S, Miyoshi T, Otsuka Y, Ueda K, Otsuka F. Adherence to and clinical utility of "quality indicators" for Staphylococcus aureus bacteremia: a retrospective, multicenter study. Infection 2024; 52:1527-1538. [PMID: 38727926 PMCID: PMC11289132 DOI: 10.1007/s15010-024-02284-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND We aimed to improve the prognosis, treatment, and management of Staphylococcus aureus bacteremia (SAB) by evaluating the association between adherence to quality indicators (QIs) and clinical outcomes in patients with their clinical outcomes. METHODS We retrospectively collected clinical and microbiological data on hospitalized patients with SAB from 14 hospitals (three with > 600, two with 401-600, five with 201-400, and four with ≤ 200 beds) in Japan from January to December 2022. The SAB management quality was evaluated using the SAB-QI score (ranging from 0 to 13 points), which consists of 13 QIs (grouped into five categories) based on previous literature. RESULTS Of the 4,448 positive blood culture episodes, 289 patients with SAB (6.5%) were enrolled. The SAB-QI scores ranged from 3 to 13, with a median score of 9 points. The SAB-QI score was highest in middle-sized hospitals with 401-600 beds. Adherence to each of the four QI categories (blood culture, echocardiography, source control, and antibiotic treatment) was significantly higher in survived cases than in fatal cases. Kaplan-Meier curves with log-rank tests demonstrated that higher adherence to SAB-QIs indicated a better prognosis. Logistic regression analysis revealed that age, methicillin resistance, multiple comorbidities (≥ 2), and low SAB-QI score were significantly associated with 30-day mortality in patients with SAB. CONCLUSIONS Our study highlights that greater adherence to the SAB-QIs correlates with improved patient outcomes. Management of patients with SAB should follow these recommended indicators to maintain the quality of care, especially for patients with poor prognosticators.
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Affiliation(s)
- Shinnosuke Fukushima
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Bacteriology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan
| | - Hideharu Hagiya
- Department of Infectious Diseases, Okayama University Hospital, 2-5-1 Shikata-Cho, Kitaku, Okayama, 700-8558, Japan.
| | - Naoki Kuninaga
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Yuto Haruki
- Department of Pharmacy, Tsuyama Chuo Hospital, Okayama, Japan
| | - Haruto Yamada
- Department of General Medicine, Okayama City Hospital, Okayama, Japan
| | - Yoshitaka Iwamoto
- Department of General Medicine, Okayama Medical Center, Okayama, Japan
| | - Masayo Yoshida
- Department of General Medicine, Okayama Kyoritsu Hospital, Okayama, Japan
| | - Kota Sato
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shuichi Tanaka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoko Miyoshi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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3
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Klingspor HT, Hällgren A. Factors influencing outcomes in candidemia: A retrospective study of patients in a Swedish county. Mycoses 2024; 67:e13758. [PMID: 38932675 DOI: 10.1111/myc.13758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Candidemia is a diverse condition and associated with a broad spectrum of clinical presentation. As mortality is high, timely diagnosis of candidemia and start of correct therapeutic treatment are essential. OBJECTIVES To investigate characteristics and factors influencing outcomes for patients with candidemia in a Swedish setting. METHOD All positive blood cultures for any Candida species in Östergötland County from 2012 to 2016 were screened. Medical records of patients fulfilling all inclusion criteria and no exclusion criteria were retrospectively reviewed to obtain data on risk factors, diagnostic and therapeutic procedures and at what wards candidemia was diagnosed. Univariate logistic regression and multivariable regression analysis were used to obtain odds ratio to determine risk factors for 30-day all-cause mortality associated with candidemia. A p-value <.05 was considered statistically significant. RESULTS Of all analysed risk factors, increasing age, renal failure with haemodialysis, immunosuppressant treatment, and severity of the infection (i.e. if septic shock was present) were significantly associated with 30-day mortality in univariate analysis (p < .05). Removal of a central venous catheter or an infectious diseases consultant was associated with a significantly lower odds ratio for death at 30 days (p < .05). With multivariable analysis, age, time to start of treatment and infectious disease consultant remained significant (p < .05). CONCLUSION In conclusion, this study provides an update of the epidemiology and outcomes of candidemia in a Swedish setting, highlighting that patients with candidemia are present at various departments and indicates the importance of an infectious disease consultant when candidemia is present.
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Affiliation(s)
- Hanna Thorold Klingspor
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anita Hällgren
- Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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4
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Cranis M, Elamin A, Hatch-Vallier B, Collins CD, Malani AN. Impact of infectious diseases consultation for hospitalized patients with Clostridioides difficile infection. Infect Control Hosp Epidemiol 2024; 45:770-773. [PMID: 38356353 DOI: 10.1017/ice.2024.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Clostridioides difficile infection (CDI) is associated with substantial morbidity and mortality. This study described outcomes associated with mandatory infectious diseases (ID) consultation in hospitalized patients with CDI. ID consultation was associated with increased appropriate concomitant antibiotic use, however longer courses of concomitant antibiotics were administered.
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Affiliation(s)
- Mara Cranis
- Department of Infection Prevention and Control, Trinity Health, Ann Arbor, MI, USA
- Department of Infection Prevention and Control, Trinity Health, Livonia, MI, USA
| | - Azza Elamin
- Department of Internal Medicine, Infectious Diseases, Trinity Health, Ann Arbor, MI, USA
| | - Brianna Hatch-Vallier
- Department of Internal Medicine, Infectious Diseases, Trinity Health, Ann Arbor, MI, USA
| | - Curtis D Collins
- Department of Pharmacy Services, Trinity Health, Ann Arbor, MI, USA
| | - Anurag N Malani
- Department of Infection Prevention and Control, Trinity Health, Ann Arbor, MI, USA
- Department of Internal Medicine, Infectious Diseases, Trinity Health, Ann Arbor, MI, USA
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Hofmann J, Coe K, Young JD. Speed, Spectrum, and Satisfaction: Assessment of an Infectious Diseases eConsult Program. Open Forum Infect Dis 2024; 11:ofae281. [PMID: 38813258 PMCID: PMC11134458 DOI: 10.1093/ofid/ofae281] [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: 02/12/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
This report examines the implementation and early functioning of a new infectious diseases (ID) eConsult program. We recorded the reasons for placing ID eConsults, time to eConsult completion, in-person clinic wait times, and referring provider satisfaction following implementation of our outpatient eConsult program. Our data suggest that this ambulatory eConsult program led to improved access to ID subspecialty care, both via eConsults directly, and by reducing clinic wait times for patients who required an in-person evaluation.
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Affiliation(s)
- Justin Hofmann
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
| | - Kelci Coe
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
| | - Jeremy D Young
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus Ohio, USA
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6
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Özden A, Dalgıç B, Demir M, Hazırolan G, Uzun Ö, Metan G. Impact of a hospital sepsis management protocol on the selection of empirical antibiotics in infectious disease consultations. J Chemother 2024; 36:190-197. [PMID: 38131316 DOI: 10.1080/1120009x.2023.2296146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
It is well-established that Infectious Diseases consultation (IDC) enhances the prognosis of bloodstream infections. However, it is unclear if adoption of an institutional sepsis protocol would lead to any further improvement in a setting where IDC and infectious diseases approval (IDA) - available throughout 7 days/24 hours -are mandatory for administering broad spectrum antibiotics. We aimed to evaluate the influence of the institutional sepsis protocol developed by Department of Infectious Diseases and Clinical Microbiology on the selection of appropriate empirical antibiotics by IDC through focusing on patients who had bloodstream infections caused by Extended-spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae, which poses a therapeutic challenge. One hundred and fifty-three adult patients (58 patients in the pre-protocol period and 95 patients in the post-protocol period), who received empirical antibiotic treatment for ESBL-producing E. coli and K. pneumoniae, in whom at least one systemic antibiotic was started either on the day blood cultures were drawn or not later than 24 hours were included in the study, retrospectively. The primary outcome was whether the empirical treatment regimen included a carbapenem that was accepted as the appropriate treatment based on the results of the MERINO trial. Secondary outcomes included empirical treatment based on pre-defined risk factors suggesting multidrug resistance (MDR), 30-day inpatient mortality, and appropriate antibacterial treatment according to antimicrobial susceptibility test (AST) results. The median age (Interquartile range) was 61 (48-70.5) years and 76 (49.7%) out of 153 patients were male. The patients in the post-protocol period were older compared to the pre-protocol period (54 years vs 64 years, p = 0.045). The Charlson Comorbidity Index was higher during the post-protocol period compared to the pre-protocol period (4 vs 5, p=0.038). At least one risk factor for MDR bacteria infection was present in 147 (96.1%) of the 153 patients. While the rate of risk factors for MDR bacteria infections did not differ significantly between the pre-protocol and post-protocol periods, the post-protocol period showed a significantly higher level of appropriate antibiotic treatment according to the presence of MDR risk factors compared to the pre-protocol period (44.8% vs 64.2%, p=0.019). There was a significant increase in the use of carbapenems in the post-protocol period compared to the pre-protocol period (34.5% vs. 56.8%, p=0.007). When the subgroup of patients who were likely to have infection caused by ESBL-producing bacteria is taken into consideration, the carbapenem use was more frequent in the post-protocol period (37.8% vs 68.9%, p=0.002). The rate of appropriate empirical treatment according to AST was not statistically different between pre-protocol and post-protocol period. The 30-day mortality rates were similar in both periods (24.1% vs 31.5, p=0.33). However, the rate of susceptibility to piperacillin-tazobactam was statistically higher in the pre-protocol period (82.6% vs 46.2%, p=0.016) when 39.7% of the patients received piperacillin-tazobactam as the empirical treatment. This study highlights the significance of using a structured protocol to attain appropriate empirical treatment for patients suspected of sepsis, even in a setting where IDC is readily available.
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Affiliation(s)
- Aslı Özden
- Faculty of Medicine, Hacettepe University, Ankara, Turkiye
| | - Büşra Dalgıç
- Faculty of Medicine, Hacettepe University, Ankara, Turkiye
| | - Mervenur Demir
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkiye
- Infection Control Committee Hacettepe University Hospitals, Ankara, Turkiye
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Martin T, Wilber E, Advani S, Torrisi J, Patel M, Rebolledo PA, Wang YF, Kandiah S. The impact of implementation of rapid blood culture identification panels on antimicrobial optimization: a retrospective cohort study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e44. [PMID: 38628375 PMCID: PMC11019579 DOI: 10.1017/ash.2024.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
Objective Determine the impact of limited implementation of a rapid blood culture identification (BCID) panel. Design Retrospective cohort study. Methods From February to April 2022, positive blood cultures identified via e-Plex BCID (Roche, Carlsbad, CA) were compared to those identified using standard microbial identification techniques. The primary outcomes assessed were time to optimal therapy, time to de-escalation of anti-MRSA (methicillin-resistant Staphylococcus aureus) agents, and time to de-escalation of anti-pseudomonal agents. Additional analysis investigated the impact of the availability of antimicrobial stewardship program support. This study was conducted at Grady Health System, a large metropolitan safety-net hospital in the southeastern United States. Results A total of 253 blood cultures were included in this study (153 BCID and 100 standard). Blood culture identification use was associated with a reduction in median time to optimal antimicrobial therapy (43.4 vs 72.1 h, P < .001) and median time to de-escalation of anti-MRSA agents (27.7 vs 46.7 h, P = .006), and a trend towards reduction of median time to de-escalation of anti-pseudomonal agents (38.8 vs 54.8 h, P = .07). These reductions persisted when controlling for patient age, sex, intensive care unit status, Charlson Comorbidity Index, and antimicrobial stewardship program availability. Conclusions Despite restricted use and lack of 24/7 antimicrobial stewardship program availability, BCID panel utilization was associated with earlier initiation of optimal therapy and pathogen identification with subsequent de-escalation of broad-spectrum antimicrobials, as compared to standard antimicrobial techniques. This suggests the potential for benefit from adopting novel diagnostic technologies outside of idealized fully-resourced settings.
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Affiliation(s)
- Tyler Martin
- Department of Pharmacy, Grady Health System, Atlanta, GA, USA
| | - Eli Wilber
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Shreena Advani
- Department of Pharmacy, Grady Health System, Atlanta, GA, USA
| | - Joseph Torrisi
- Department of Pharmacy, Grady Health System, Atlanta, GA, USA
| | - Manish Patel
- Department of Pharmacy, Grady Health System, Atlanta, GA, USA
| | - Paulina A. Rebolledo
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Yun F. Wang
- Clinical Microbiology Laboratory, Grady Health System, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheetal Kandiah
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
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Linde-Ozola Z, Classen AY, Giske CG, Göpel S, Eliakim-Raz N, Semret M, Simonsen GS, Vehreschild JJ, Jørgensen SB, Kessel J, Kleppe LKS, Oma DH, Vehreschild MJGT, Vilde A, Dumpis U. Quality, availability and suitability of antimicrobial stewardship guidance: a multinational qualitative study. JAC Antimicrob Resist 2024; 6:dlae039. [PMID: 38486662 PMCID: PMC10939443 DOI: 10.1093/jacamr/dlae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Antimicrobial stewardship (AMS) programmes are established across the world to treat infections efficiently, prioritize patient safety, and reduce the emergence of antimicrobial resistance. One of the core elements of AMS programmes is guidance to support and direct physicians in making efficient, safe and optimal decisions when prescribing antibiotics. To optimize and tailor AMS, we need a better understanding of prescribing physicians' experience with AMS guidance. Objectives To explore the prescribing physicians' user experience, needs and targeted improvements of AMS guidance in hospital settings. Methods Semi-structured interviews were conducted with 36 prescribing physicians/AMS guidance users from hospital settings in Canada, Germany, Israel, Latvia, Norway and Sweden as a part of the international PILGRIM trial. A socioecological model was applied as an overarching conceptual framework for the study. Results Research participants were seeking more AMS guidance than is currently available to them. The most important aspects and targets for improvement of AMS guidance were: (i) quality of guidelines; (ii) availability of infectious diseases specialists; and (iii) suitability of AMS guidance to department context. Conclusions Achieving prudent antibiotic use not only depends on individual and collective levels of commitment to follow AMS guidance but also on the quality, availability and suitability of the guidance itself. More substantial commitment from stakeholders is needed to allocate the required resources for delivering high-quality, available and relevant AMS guidance to make sure that the prescribers' AMS needs are met.
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Affiliation(s)
| | - Annika Y Classen
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Siri Göpel
- Department of Internal Medicine I, Division of infectious diseases, University Hospital Tübingen, Tübingen, Germany
- Clinical Research Unit for Healthcare Associated and Antibiotic Resistant Bacterial Infections, German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Noa Eliakim-Raz
- Internal Medicine E, Rabin Medical Center Beilinson Campus, Petah-Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Makeda Semret
- Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- UiT-The Arctic University of Norway, Tromsø, Norway
| | - Jörg Janne Vehreschild
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department II of Internal Medicine, Haematology/Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Silje Bakken Jørgensen
- Department of Medical Microbiology and Infection Control and Department of Emergency Care, Akershus University Hospital, Lørenskog, Norway
| | - Johanna Kessel
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Lars Kåre Selland Kleppe
- Department of Infection Prevention and Control, Stavanger University Hospital, Stavanger, Norway
| | - Dorthea Hagen Oma
- Section for Patient Safety, Haukeland University Hospital, Bergen, Norway
| | - Maria J G T Vehreschild
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department I for Internal Medicine, University Hospital Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Aija Vilde
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Uga Dumpis
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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Varon B, Palacios-Baena ZR, de Kraker MEA, Rodríguez-Baño J, Leibovici L, Paul M. Universal Risk Factors for Mortality in Bloodstream Infections (UNIFORM): a systematic review and Delphi survey. Clin Microbiol Infect 2024; 30:453-461. [PMID: 38182050 DOI: 10.1016/j.cmi.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Significant variations in the variables collected in clinical studies focusing on bacteraemia lead to inconsistency in the evaluation of risk factors for mortality. OBJECTIVE We aimed to define a minimum set of risk factors that should be assessed and reported in all studies assessing survival in bacteraemia. STUDY ELIGIBILITY We conducted a systematic review including observational prospective and retrospective cohort studies that assessed all-cause mortality among patients with bacteraemia. We included only studies computing an adjusted analysis for mortality, with >500 participants. EXPOSURES Independently significant risk factors for all-cause, preferably 30-day, mortality. DATA SOURCES PubMed was used to identify eligible studies published between 2000 and 2020. A Delphi survey among experts was used to evaluate and prioritize the factors identified by the systematic review. RISK OF BIAS SIGN checklist complemented by risk of bias assessment of the adjusted analysis. DATA SYNTHESIS Definite universal risk factors were defined as those assessed in >50% of all included studies and significant in >50% of those. Potential universal risk factors were defined as those significant in >50% of studies evaluating the factor and a subgroup analysis was performed for studies of Staphylococcus aureus bacteraemia. RESULTS We included in the systematic review 62 studies, comprising more than 300,000 patients, from which a list of 17 risk factors was derived, whose association with all-cause mortality was statistically significant in most studies. The factors address baseline patient variables, the setting of infection acquisition, factors associated with the specific infection, the inflammatory response at onset of sepsis and management parameters where relevant. There were 14 risk factors for S. aureus bacteraemia. CONCLUSION We identified a minimum set of universal factors to be collected, reported, and assessed, in all future studies evaluating factors associated with mortality in bacteraemia to improve study quality and harmonization.
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Affiliation(s)
- Ben Varon
- Medicine B and H, Rambam Healthcare Campus, Haifa, Israel
| | - Zaira R Palacios-Baena
- Infectious Diseases Division, Hospital Universitario Virgen Macarena, Seville, Spain; Department of Medicine, University of Seville/Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jesús Rodríguez-Baño
- Infectious Diseases Division, Hospital Universitario Virgen Macarena, Seville, Spain; Department of Medicine, University of Seville/Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Healthcare Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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10
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Barfield RK, Brown ML, Albrecht B, Barber KE, Bouchard J, Carr AL, Chahine EB, Cluck D, Covington EW, Deri CR, Durham SH, Faulkner-Fennell C, Freeman LK, Gauthier TP, Gibson GM, Green SB, Hobbs ALV, Jones BM, Jozefczyk CC, Marx AH, McGee EU, McKamey LJ, Musgrove R, Perez E, Slain D, Stover KR, Turner MS, White C, Bookstaver PB, Bland CM. A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2022. Open Forum Infect Dis 2024; 11:ofad687. [PMID: 38434614 PMCID: PMC10906711 DOI: 10.1093/ofid/ofad687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship-related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation.
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Affiliation(s)
- Reagan K Barfield
- Department of Pharmacy, University of South Carolina College of Pharmacy, Columbia, South Carolina, USA
| | - Matthew L Brown
- Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA
| | - Benjamin Albrecht
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA
| | - Katie E Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Jeannette Bouchard
- Liaison Clinical Pharmacist, Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, North Carolina, USA
| | - Amy L Carr
- Department of Pharmacy, AdventHealth Orlando, Orlando, Florida, USA
| | - Elias B Chahine
- Department of Pharmacy Practice, Palm Beach Atlantic University Gregory School of Pharmacy, West Palm Beach, Florida, USA
| | - David Cluck
- Department of Pharmacy Practice, East Tennessee State University—Gatton College of Pharmacy, Johnson City, Tennessee, USA
| | - Elizabeth W Covington
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, Alabama, USA
| | - Connor R Deri
- Department of Pharmacy, Duke University Hospital, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Spencer H Durham
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, Alabama, USA
| | | | - Lauren K Freeman
- Department of Pharmacy, McLeod Regional Medical Center, Florence, South Carolina, USA
| | - Timothy P Gauthier
- Clinical Pharmacy Enterprise, Baptist Health South Florida, Miami, Florida, USA
| | - Geneen M Gibson
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Sarah B Green
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Bruce M Jones
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Caroline C Jozefczyk
- Department of Pharmacy, Prisma Health Greenville Memorial Hospital, Greenville, South Carolina, USA
| | - Ashley H Marx
- Department of Pharmacy, UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Edoabasi U McGee
- Department of Pharmacy Practice, Philadelphia College of Osteopathic Medicine, School of Pharmacy, GA Campus, Suwanee, Georgia, USA
| | - Lacie J McKamey
- System Pharmacy, Novant Health, Charlotte, North Carolina, USA
| | - Rachel Musgrove
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Emily Perez
- Department of Pharmacy, ECU Health Medical Center, Greenville, North Carolina, USA
| | - Douglas Slain
- School of Pharmacy and Section of Infectious Diseases, West Virginia University, Morgantown, West Virginia, USA
| | - Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Michelle S Turner
- Department of Pharmacy, Cone Health, Greensboro, North Carolina, USA
| | - Cyle White
- Department of Pharmacy, Erlanger Health System, Chattanooga, Tennessee, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, University of South Carolina College of Pharmacy, Columbia, South Carolina, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, Georgia, USA
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11
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Bavaro DF, Belati A, Bussini L, Cento V, Diella L, Gatti M, Saracino A, Pea F, Viale P, Bartoletti M. Safety and effectiveness of fifth generation cephalosporins for the treatment of methicillin-resistant staphylococcus aureus bloodstream infections: a narrative review exploring past, present, and future. Expert Opin Drug Saf 2024; 23:9-36. [PMID: 38145925 DOI: 10.1080/14740338.2023.2299377] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/21/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) is a major issue in healthcare, since it is often associated with endocarditis or deep site foci. Relevant morbidity and mortality associated with MRSA-BSIs forced the development of new antibiotic strategies; in particular, this review will focus the attention on fifth-generation cephalosporins (ceftaroline/ceftobiprole), that are the only ß-lactams active against MRSA. AREAS COVERED The review discusses the available randomized controlled trials and real-world observational studies conducted on safety and effectiveness of ceftaroline/ceftobiprole for the treatment of MRSA-BSIs. Finally, a proposal of MRSA-BSI treatment flowchart, based on fifth-generation cephalosporins, is described. EXPERT OPINION The use of anti-MRSA cephalosporins is an acceptable choice either in monotherapy or combination therapy for the treatment of MRSA-BSIs due to their relevant effectiveness and safety. Particularly, their use may be advisable in combination therapy in case of severe infections (including endocarditis or persistent bacteriemia) or in monotherapy in subjects at higher risk of drugs-induced toxicity with older regimens. On the contrary, caution should be taken in case of suspected/ascertained central nervous system infections due to inconsistent data regarding penetration of these drugs in cerebrospinal fluid and brain tissues.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Belati
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Linda Bussini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Valeria Cento
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Microbiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Lucia Diella
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari "Aldo Moro", Bari, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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12
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Reece R, Beckwith CG. The Infectious Diseases Specialist, At Risk of Extinction. J Infect Dis 2023; 228:1649-1651. [PMID: 37192330 DOI: 10.1093/infdis/jiad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/07/2023] [Accepted: 05/12/2023] [Indexed: 05/18/2023] Open
Abstract
The results of the Infectious Diseases (ID) fellowship match over the past decade have raised concerns that the future of our specialty is in peril, despite the unprecedented demand for ID expertise as exemplified by the COVID-19 pandemic. While there was a modest increase in ID fellowships applicants attributable to the pandemic, the disappointing 2023 match results indicate that the increase was short-lived. Multiple factors contribute to low interest in ID including but not only low salaries relative to other specialties. Solutions to grow the ID workforce are urgently needed and are critical to the public health of this nation.
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Affiliation(s)
- Rebecca Reece
- Section of Infectious Diseases, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Curt G Beckwith
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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13
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Swartz TH, Aberg JA. Preserving the Future of Infectious Diseases: Why We Must Address the Decline in Compensation for Clinicians and Researchers. Clin Infect Dis 2023; 77:1387-1394. [PMID: 37436703 DOI: 10.1093/cid/ciad416] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023] Open
Abstract
Infectious diseases (ID) physicians play a pivotal role in patient care and public health, yet concerns are mounting about their under-compensation compared with other medical specialties. This trend sees ID physicians, including new graduates, receiving lower remuneration than their general and hospital medicine peers, despite their significant contributions. The persistent disparity in compensation has been identified as a key factor behind the declining interest in the ID specialty among medical students and residents, potentially threatening patient care quality, research advancement, and diversity within the ID workforce. This viewpoint underscores the urgent need for the ID community to rally behind the Infectious Diseases Society of America in advocating for fair compensation for ID physicians and researchers. While focusing on wellness and work-life balance is vital, it is critical to address compensation, a significant source of distress for physicians. Failure to confront the issue of under-compensation promptly may jeopardize the future growth and sustainability of the ID specialty.
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Affiliation(s)
- Talia H Swartz
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judith A Aberg
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Shulder S, Tamma PD, Fiawoo S, Dzintars K, Escobar D, Livorsi DJ, Malani AN, Palacio D, Spivak ES, Zimmerman M, Bork JT. Infectious Diseases Consultation Associated With Reduced Mortality in Gram-Negative Bacteremia. Clin Infect Dis 2023; 77:1234-1237. [PMID: 37402637 DOI: 10.1093/cid/ciad383] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
Gram-negative bacteremia (GN-BSI) can cause significant morbidity and mortality, but the benefit of infectious diseases consultation (IDC) is not well defined. A 24-site observational cohort study of unique hospitalized patients with 4861 GN-BSI episodes demonstrated a 40% decreased risk of 30-day mortality in patients with IDC compared to those without IDC.
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Affiliation(s)
- Stephanie Shulder
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York, USA
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Suiyini Fiawoo
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathryn Dzintars
- Department of Infectious Diseases, Johns Hopkins University School of Pharmacy, Baltimore, Maryland, USA
| | - Daniel Escobar
- Department of Medicine, Division of Infectious Disease, University of California San Francisco, San Francisco, California, USA
| | - Daniel J Livorsi
- Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
- Iowa City Veterans Affairs (VA) Health Care System, Iowa City, Iowa, USA
| | - Anurag N Malani
- Trinity Health Michigan, Section of Infectious Diseases, Ann Arbor, Michigan, USA
| | - Danica Palacio
- Trinity Health Michigan, Section of Infectious Diseases, Ann Arbor, Michigan, USA
| | - Emily S Spivak
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matty Zimmerman
- Department of Infectious Diseases, Johns Hopkins University School of Pharmacy, Baltimore, Maryland, USA
| | - Jacqueline T Bork
- Department of Medicine, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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Dotel R, Gilbert GL, Hutabarat SN, Davis JS, O'Sullivan MVN. Effectiveness of adjunctive rifampicin for treatment of Staphylococcus aureus bacteraemia: a systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2023; 78:2419-2427. [PMID: 37583062 DOI: 10.1093/jac/dkad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/24/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To assess whether the addition of rifampicin to conventional treatment of Staphylococcus aureus bacteraemia (SAB) reduces bacteriological or clinical failure or death. DATA SOURCES PubMed, Embase and Cochrane CENTRAL databases were searched from inception to 31 December 2022. Reference lists and PubMed citations of eligible studies were checked. REVIEW METHODS Two study authors independently identified randomized controlled trials (RCTs) involving adult participants with SAB, in which an intervention group received adjunctive rifampicin and the control group received usual care with or without a placebo. Dichotomous data (bacteriological and clinical failure and deaths) were analysed and pooled across studies using risk ratio (RR) with 95% confidence intervals (CI) using a Mantel-Haenszel random-effect model. The key variable of interest being whether rifampicin was used. RESULTS Six RCTs including 894 participants-of which 758 (85%) were from one trial-met the inclusion criteria. The addition of rifampicin to conventional treatment of SAB significantly reduced bacteriological failure by 59% (RR 0.41, 95% CI 0.21-0.81, I2 = 0%, number need to treat 27). However, it did not reduce clinical failure (RR 0.70, 95% CI 0.47-1.03, I2 = 0%) or deaths (RR 0.96, 95% CI 0.70-1.32, I2 = 0%). Further, it did not reduce the duration of bacteraemia, or the length of hospital stay. Adjunctive rifampicin reduced SAB recurrences (1% versus 4%, P = 0.01). Emergence of rifampicin resistance during treatment was uncommon (<1%). CONCLUSION Although adjunctive rifampicin reduced the risk of bacteriological failure and recurrences, we found no mortality benefit to support its use in SAB.
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Affiliation(s)
- R Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, New South Wales, Australia
| | - G L Gilbert
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia
| | - S N Hutabarat
- Department of Microbiology and Infectious Diseases, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - J S Davis
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- John Hunter Hospital, University of Newcastle, Newcastle, Australia
| | - M V N O'Sullivan
- Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, New South Wales, Australia
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16
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Nakamura K, Hayakawa K, Tsuzuki S, Ide S, Nomoto H, Nakamoto T, Yamada G, Yamamoto K, Ohmagari N. Clinical outcomes and epidemiological characteristics of bacteremia in the older Japanese population. J Infect Chemother 2023; 29:971-977. [PMID: 37355094 DOI: 10.1016/j.jiac.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/01/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND The characteristics and clinical consequences of bacteremia in older people, who are highly susceptible to infections, need to be clarified. This study aimed to determine the epidemiological characteristics, prognosis, and predictors of 7-day mortality in patients with community-acquired (CA), healthcare-associated (HCA), and hospital-onset (HO) bacteremia in older adults aged ≥65 years. METHODS Patients aged ≥65 years with positive blood cultures between April 1, 2015, and March 31, 2018, were divided into three groups: pre-old (65-74 years), old (75-89 years), and super-old (≥90 years). Characteristics based on medical exposure, including CA, HCA, and HO, were also compared and factors related to mortality were identified. RESULTS Overall, 1716 episodes of bacteremia were identified in 1415 patients. Of the 1211 episodes without contamination, 32.8%, 54.3%, and 12.9% occurred in pre-old, old, and super-old patients. Central line-associated bloodstream infections were more common in pre-old patients and urinary tract infections in the old and super-old. The 7-day mortality rates in the pre-old, old, and super-old groups were 7.4%, 5.8%, and 14.2% (P = 0.002), respectively. Multivariable logistic regression showed that super-old age (adjusted odds ratio, aOR: 2.09 [1.13-3.88], P = 0.019) and HO bacteremia (aOR: 1.97 [1.18-3.28], P = 0.010) were independent risk factors for 7-day mortality. Infectious disease consultation had a protective effect on 7-day mortality (aOR: 0.59 [0.35-0.99], P = 0.047). CONCLUSIONS The epidemiology of bacteremia differs among older people; thus, they should not be treated as a single entity. A careful approach is needed for the optimal management of bacteremia in these vulnerable patients.
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Affiliation(s)
- Keiji Nakamura
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.
| | - Kayoko Hayakawa
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Satoshi Ide
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Hidetoshi Nomoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Takato Nakamoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Gen Yamada
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan; Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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17
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Tholany J, Suzuki H, Livorsi DJ, Perencevich EN, Goto M. The association of infectious diseases consultation and 30-day mortality rates among veterans with enterococcal bacteraemia: a propensity score-matched retrospective cohort study. Clin Microbiol Infect 2023; 29:1039-1044. [PMID: 36914070 DOI: 10.1016/j.cmi.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES Infectious disease consultation (IDC) has been associated with improved outcomes in several infections, but the benefit of IDC among patients with enterococcal bacteraemia has not been fully evaluated. METHODS We performed a 1:1 propensity score-matched retrospective cohort study evaluating all patients with enterococcal bacteraemia at 121 Veterans Health Administration acute-care hospitals from 2011 to 2020. The primary outcome was 30-day mortality. We performed conditional logistic regression to calculate the OR to determine the independent association of IDC and 30-day mortality adjusted for vancomycin susceptibility and the primary source of bacteraemia. RESULTS A total of 12,666 patients with enterococcal bacteraemia were included; 8400 (63.3%) had IDC, and 4266 (36.7%) did not have IDC. Two thousand nine hundred seventy-two patients in each group were included after propensity score matching. Conditional logistic regression revealed that IDC was associated with a significantly lower 30-day mortality rate compared with patients without IDC (OR = 0.56; 95% CI, 0.50-0.64). The association of IDC was observed irrespective of vancomycin susceptibility, and when the primary source of bacteraemia was a urinary tract infection, or from an unknown primary source. IDC was also associated with higher appropriate antibiotic use, blood culture clearance documentation, and the use of echocardiography. DISCUSSION Our study suggests that IDC was associated with improved care processes and 30-day mortality rates among patients with enterococcal bacteraemia. IDC should be considered for patients with enterococcal bacteraemia.
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Affiliation(s)
- Joseph Tholany
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.
| | - Daniel J Livorsi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Eli N Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Michihiko Goto
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Center for Access & Delivery Research & Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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18
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Chuzi S, Colvin M, Mohammed SF, Wilcox J, Sweitzer NK. Markets, Messaging, and Mastery: Reframing the Conversation Around the Heart Failure Physician Workforce. Circ Heart Fail 2023; 16:e010908. [PMID: 37462030 DOI: 10.1161/circheartfailure.123.010908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.C., J.W.)
| | - Monica Colvin
- Department of Cardiology, University of Michigan, Ann Arbor (M.C.)
| | - Selma F Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE (S.F.M.)
| | - Jane Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.C., J.W.)
| | - Nancy K Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (N.K.S.)
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19
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Dalai S, Bai AD. Enter Enterococcus: should we add it to the list of bloodstream infection pathogens for which infectious diseases consultation improves mortality? Clin Microbiol Infect 2023; 29:963-965. [PMID: 37182644 DOI: 10.1016/j.cmi.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Soma Dalai
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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20
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Khodadadi RB, Yetmar ZA, Domonoske CL, Razonable RR. Factors Associated with Infectious Diseases Fellowship Academic Success. RESEARCH SQUARE 2023:rs.3.rs-3140095. [PMID: 37546853 PMCID: PMC10402197 DOI: 10.21203/rs.3.rs-3140095/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Background A multitude of factors are considered in an infectious diseases (ID) training program's meticulous selection process of ID fellows but their correlation to pre and in-fellowship academic success as well as post-fellowship academic success and short-term outcomes is poorly understood. Our goal was to investigate factors associated with subsequent academic success in fellowship as well as post-fellowship short-term outcomes. Methods In 2022, we retrospectively analyzed deidentified academic records from 39 graduates of the Mayo Clinic Rochester ID Fellowship Program (July 1, 2013- June 30, 2022). Data abstracted included demographics, degrees, honor society membership, visa/citizenship status, medical school, residency training program, United States Medical Licensure Exam (USMLE) scores, letters of recommendation, in-training examination (ITE) scores, fellowship track, academic rank, career choice, number of honors, awards, and abstracts/publications prior to fellowship, during training, and within 2 years of graduation. Results Younger fellows had higher USMLE step 1 scores, pre and in-fellowship scholarly productivity, and higher ITE performance. Female fellows had significantly higher USMLE step 3 scores. Prior research experience translated to greater in-fellowship scholarly productivity. Higher USMLE scores were associated with higher ID ITE performance during multiple years of fellowship, but USMLE step 2 clinical knowledge and 3 scores were associated with higher pre and in-fellowship scholarly productivity and receiving an award during fellowship. USMLE step 1 score did not correlate with fellowship performance beyond year 1 and 2 ITE scores. Conclusions Multiple aspects of a prospective fellow's application must be considered as part of a holistic reviewprocess for fellowship selection. USMLE step 2 CK and 3 scores may predict fellowship performance across multiple domains.
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21
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McDonald EG, Aggrey G, Tarik Aslan A, Casias M, Cortes-Penfield N, Dong MQD, Egbert S, Footer B, Isler B, King M, Maximos M, Wuerz TC, Azim AA, Alza-Arcila J, Bai AD, Blyth M, Boyles T, Caceres J, Clark D, Davar K, Denholm JT, Forrest G, Ghanem B, Hagel S, Hanretty A, Hamilton F, Jent P, Kang M, Kludjian G, Lahey T, Lapin J, Lee R, Li T, Mehta D, Moore J, Mowrer C, Ouellet G, Reece R, Ryder JH, Sanctuaire A, Sanders JM, Stoner BJ, So JM, Tessier JF, Tirupathi R, Tong SYC, Wald-Dickler N, Yassin A, Yen C, Spellberg B, Lee TC. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2023; 6:e2326366. [PMID: 37523190 DOI: 10.1001/jamanetworkopen.2023.26366] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence. Objective To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength. Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches. Findings A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)-only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions. Conclusions and Relevance In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Abdullah Tarik Aslan
- The University of Queensland, Faculty of Medicine, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Michael Casias
- Jersey Shore University Medical Center, Neptune, New Jersey
| | | | | | - Susan Egbert
- Department of Chemistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Footer
- Providence Portland Medical Center, Portland, Oregon
| | - Burcu Isler
- University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | | | - Mira Maximos
- Women's College Hospital, Toronto, Ontario, Canada
| | - Terence C Wuerz
- Departments of Internal Medicine & Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed Abdul Azim
- Division of Infectious Diseases, Allergy and Immunology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tom Boyles
- Right to Care, NPC, Centurion, South Africa and London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juan Caceres
- Division of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Devin Clark
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Kusha Davar
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Justin T Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Fergus Hamilton
- Infection Science, North Bristol NHS Trust, Bristol, United Kingdom
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Minji Kang
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas
| | | | - Tim Lahey
- University of Vermont Medical Center, Burlington
| | | | | | - Timothy Li
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Dhara Mehta
- Bellevue Hospital Center, New York, New York
| | | | - Clayton Mowrer
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha
| | | | - Rebecca Reece
- Section of Infectious Diseases, West Virginia University, Morgantown
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha
| | - Alexandre Sanctuaire
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, Canada
| | | | | | - Jessica M So
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | | | | | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Noah Wald-Dickler
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Arsheena Yassin
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Christina Yen
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas
| | - Brad Spellberg
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Todd C Lee
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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22
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Cole JC, Jankowski CA, Verdecia JL, Isache CL, Ravi MS, McCarter YS, Casapao AM. The Time for Action Is Now: The Impact of Timing of Infectious Disease Consultation for Staphylococcus aureus Bacteremia. Clin Infect Dis 2023; 76:2007-2009. [PMID: 36869697 DOI: 10.1093/cid/ciad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
This retrospective cohort study was performed to compare clinical outcomes between patients with Staphylococcus aureus bacteremia who received an early versus late infectious disease consultation. Early consultation resulted in significantly greater adherence to quality care indicators and shorter hospital stays.
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Affiliation(s)
- J Chase Cole
- Department of Pharmacy, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Christopher A Jankowski
- Department of Pharmacy, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Jorge L Verdecia
- Department of Medicine, Division of Infectious Disease, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Carmen L Isache
- Department of Medicine, Division of Infectious Disease, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Malleswari S Ravi
- Department of Medicine, Division of Infectious Disease, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Yvette S McCarter
- Department of Pathology and Laboratory Medicine, University of Florida Health Jacksonville, Jacksonville, Florida, USA
| | - Anthony M Casapao
- Department of Pharmacy, University of Florida Health Jacksonville, Jacksonville, Florida, USA
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Jacksonville, Florida
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23
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Ioannou P, Zacharioudaki M, Spentzouri D, Koutoulakou A, Kitsos-Kalyvianakis K, Chontos C, Karakonstantis S, Maraki S, Samonis G, Kofteridis DP. A Retrospective Study of Staphylococcus aureus Bacteremia in a Tertiary Hospital and Factors Associated with Mortality. Diagnostics (Basel) 2023; 13:1975. [PMID: 37296829 PMCID: PMC10253165 DOI: 10.3390/diagnostics13111975] [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: 04/18/2023] [Revised: 05/17/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023] Open
Abstract
Staphylococcus aureus bacteremia (SAB) is a severe infection frequently associated with significant morbidity and mortality. Recent studies have shown that SAB mortality has decreased during the last decades. However, about 25% of patients suffering from the disease will ultimately die. Hence, there is an urgent need for more timely and efficient treatment of patients with SAB. The aim of the present study was to retrospectively evaluate a cohort of SAB patients hospitalized in a tertiary hospital and to identify factors independently associated with mortality. All 256 SAB patients hospitalized from January 2005 to December 2021 in the University Hospital of Heraklion, Greece, were evaluated. Their median age was 72 years, while 101 (39.5%) were female. Most SAB patients were cared for in medical wards (80.5%). The infection was community-acquired in 49.5%. Among all strains 37.9% were methicillin-resistant S. aureus (MRSA), however, definite treatment with an antistaphylococcal penicillin was given only in 22% of patients. Only 14.4% of patients had a repeat blood culture after the initiation of antimicrobial treatment. Infective endocarditis was present in 8%. In-hospital mortality has reached 15.9%. Female gender, older age, higher McCabe score, previous antimicrobial use, presence of a central venous catheter, neutropenia, severe sepsis, septic shock, and MRSA SAB were positively associated with in-hospital mortality, while monomicrobial bacteremia was negatively associated. The multivariate logistic regression model identified only severe sepsis (p = 0.05, odds ratio = 12.294) and septic shock (p = 0.007, odds ratio 57.18) to be independently positively associated with in-hospital mortality. The evaluation revealed high rates of inappropriate empirical antimicrobial treatment and non-adherence to guidelines, as shown, by the lack of repeat blood cultures. These data underline the urgent need for interventions with antimicrobial stewardship, increased involvement of infectious diseases physicians, educational sessions, and creation and implementation of local guidelines for improvement of the necessary steps for timely and efficient SAB treatment. Optimization of diagnostic techniques is needed to overcome challenges such as heteroresistance that may affect treatment. Clinicians should be aware of the factors associated with mortality in patients with SAB to identify those who are at a higher risk and optimize medical management.
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Affiliation(s)
- Petros Ioannou
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Maria Zacharioudaki
- Pediatrics Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Despoina Spentzouri
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | | | - Christoforos Chontos
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - George Samonis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 71003 Heraklion, Greece
- Internal Medicine Department, University Hospital of Heraklion, 71110 Heraklion, Greece
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24
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Hollingshead CM, Khazan AE, Franco JH, Ciricillo JA, Haddad MN, Berry JT, Kammeyer JA. A Needs Assessment for Infectious Diseases Consultation in Community Hospitals. Infect Dis Ther 2023:10.1007/s40121-023-00810-4. [PMID: 37243912 DOI: 10.1007/s40121-023-00810-4] [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: 02/08/2023] [Accepted: 04/14/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Infectious diseases (ID) consultations have been demonstrated to improve patient outcomes in the treatment of severe infections. However, ID consultation is often unavailable to patients that live in rural communities. Little is known regarding the treatment of infections in rural hospitals with no coverage from an ID specialist. We characterized the outcomes of patients cared for in hospitals without coverage from an ID physician. METHODS Patients aged 18 years or older admitted to eight community hospitals without access to ID consultation during a 6.5-month period were assessed. All patients had received at least three days of continuous antimicrobial therapy. The primary outcome was the need for transfer to a tertiary facility for ID services. The secondary outcome was the characterization of antimicrobials received. Antimicrobial courses were evaluated independently by two board-certified ID physicians. RESULTS 3706 encounters were evaluated. Transfers for ID consultation occurred in 0.01% of patients. The ID physician would have made modifications in 68.5% of patients. Areas for improvement included treatment of chronic obstructive pulmonary disease exacerbations, broad-spectrum treatment of skin and soft tissue infection, long courses of azithromycin, and management of Staphylococcus aureus bacteremia, including choice and length of therapy, as well as obtaining echocardiography. Patients evaluated received 22,807 days of antimicrobial therapy. CONCLUSIONS Patients hospitalized in community hospitals are rarely transferred for ID consultation. Our work demonstrates a need for ID consultation in community hospitals, identifying opportunities to enhance patient care by modifying antimicrobial regimens to improve antimicrobial stewardship and avoid inappropriate antimicrobials. Efforts to expand the ID workforce to include coverage at rural hospitals will likely improve antibiotic utilization.
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Affiliation(s)
- Caitlyn M Hollingshead
- Division of Infectious Diseases, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Mail Stop: 1186, Toledo, OH, 43614, USA.
| | - Ana E Khazan
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Justin H Franco
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Jacob A Ciricillo
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Michael N Haddad
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH, USA
| | - Julia T Berry
- Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Joel A Kammeyer
- Division of Infectious Diseases, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Mail Stop: 1186, Toledo, OH, 43614, USA.
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25
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Caniff KE, Rebold N, Rybak MJ. Oral stepdown in Gram-positive bloodstream infections: A step in the right direction. Pharmacotherapy 2023; 43:247-256. [PMID: 36727285 DOI: 10.1002/phar.2775] [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: 11/15/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
Bloodstream infections (BSIs) due to Gram-positive organisms have traditionally been treated with prolonged courses of intravenous antimicrobials. However, this dogma is associated with substantial burden to the patient and health care system. Consequently, there is growing interest in the utilization of oral stepdown therapy, defined as the transition of intravenous therapy to an active oral agent, for this indication. This review highlights available literature examining oral stepdown in adult patients with BSI due to commonly encountered Gram-positive pathogens, including Staphylococcus aureus, Streptococcus spp., and Enterococcus spp. Support for oral stepdown in this setting is primarily derived from observational studies subject to selection bias. Nevertheless, this treatment strategy exhibits promising potential in carefully selected patients as it is consistently associated with reductions in hospital length of stay without jeopardizing clinical cure or survivability. Prospective, randomized trials are needed for validation of oral stepdown in Gram-positive BSI and to identify the optimal patient population and regimen.
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Affiliation(s)
- Kaylee E Caniff
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Nicholas Rebold
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Department of Clinical & Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, District of Columbia, USA
| | - Michael J Rybak
- Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA.,Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA.,Department of Pharmacy, Detroit Receiving Hospital, Detroit, Michigan, USA
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26
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Yanık-Yalçın T, Erol Ç, Demirkaya MH, Durukan E, Kurt-Azap Ö. Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:31-39. [PMID: 38633900 PMCID: PMC10986690 DOI: 10.36519/idcm.2023.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/21/2023] [Indexed: 04/19/2024]
Abstract
Objective Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Materials and Methods Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. Results In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. Conclusion SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.
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Affiliation(s)
- Tuğba Yanık-Yalçın
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Çiğdem Erol
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
| | - Melike Hamiyet Demirkaya
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Elif Durukan
- Department of Public Health, Başkent University School of Medicine, Ankara, Turkey
| | - Özlem Kurt-Azap
- Department of Infectious Diseases and Clinical Microbiology, Başkent University School of Medicine, Ankara, Turkey
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27
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Parsons JB, Westgeest AC, Conlon BP, Fowler VG. Persistent Methicillin-Resistant Staphylococcus aureus Bacteremia: Host, Pathogen, and Treatment. Antibiotics (Basel) 2023; 12:455. [PMID: 36978320 PMCID: PMC10044482 DOI: 10.3390/antibiotics12030455] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a devastating pathogen responsible for a variety of life-threatening infections. A distinctive characteristic of this pathogen is its ability to persist in the bloodstream for several days despite seemingly appropriate antibiotics. Persistent MRSA bacteremia is common and is associated with poor clinical outcomes. The etiology of persistent MRSA bacteremia is a result of the complex interplay between the host, the pathogen, and the antibiotic used to treat the infection. In this review, we explore the factors related to each component of the host-pathogen interaction and discuss the clinical relevance of each element. Next, we discuss the treatment options and diagnostic approaches for the management of persistent MRSA bacteremia.
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Affiliation(s)
- Joshua B. Parsons
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Annette C. Westgeest
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Department of Infectious Diseases, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Brian P. Conlon
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Vance G. Fowler
- Department of Medicine, Division of Infectious Disease, Duke University Medical Center, Durham, NC 27710, USA
- Duke Clinical Research Institute, Durham, NC 27710, USA
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28
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Arias Ramos D, Alzate JA, Moreno Gómez GA, Hoyos Pulgarín JA, Olaya Gómez JC, Cortés Bonilla I, Vargas Mosquera C. Empirical treatment and mortality in bacteremia due to extended spectrum β-lactamase producing Enterobacterales (ESβL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia. Ann Clin Microbiol Antimicrob 2023; 22:13. [PMID: 36797734 PMCID: PMC9933341 DOI: 10.1186/s12941-023-00566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Infections caused by extended spectrum β-lactamase (ESβL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality. METHODS A retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum β-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established. RESULTS The prevalence of bacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC). CONCLUSIONS bacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.
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Affiliation(s)
- Deving Arias Ramos
- Universidad Tecnológica de Pereira, Pereira, Colombia. .,Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | - John Alexander Alzate
- grid.412256.60000 0001 2176 1069Hospital Universitario San Jorge, Pereira, Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Germán Alberto Moreno Gómez
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Julián Andrés Hoyos Pulgarín
- Oncólogos de Occidente, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan Camilo Olaya Gómez
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Isabella Cortés Bonilla
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Camila Vargas Mosquera
- grid.412256.60000 0001 2176 1069Hospital Universitario San Jorge, Pereira, Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
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29
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Al Sidairi H, Reid EK, LeBlanc JJ, Sandila N, Head J, Davis I, Bonnar P. Optimizing Treatment of Staphylococcus aureus Bloodstream Infections Following Rapid Molecular Diagnostic Testing and an Antimicrobial Stewardship Program Intervention. Microbiol Spectr 2023; 11:e0164822. [PMID: 36790177 PMCID: PMC10101007 DOI: 10.1128/spectrum.01648-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
Pending antibiotic susceptibility results, vancomycin is often used for bloodstream infections (BSIs) to ensure treatment of methicillin-resistant Staphylococcus aureus (MRSA). As rapid discrimination of methicillin-susceptible S. aureus (MSSA) from MRSA in BSIs could decrease vancomycin use and allow early optimization of beta-lactam therapy, this study evaluated the impact of the use of rapid molecular testing for MSSA and MRSA coupled with an antimicrobial stewardship program (ASP) intervention. Between January and July 2020, the Cepheid Xpert MRSA/SA blood culture assay was performed on blood cultures with Gram-positive cocci in clusters that were identified as S. aureus using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The ASP team member then consulted with the treating physician. The time to optimal therapy (TTOT) and clinical outcomes, including length of hospital stay (LOS), were compared between the intervention (n = 29) and historical (n = 27) cohorts. TTOT was defined as the time from the first blood culture draw to the use of appropriately dosed antistaphylococcal beta-lactam monotherapy without vancomycin. Molecular testing significantly reduced the median time to MSSA and MRSA discrimination to 7.8 h, compared to 24.3 h with culture-based methods (P < 0.001). Compared to the control group, the median TTOT in the ASP intervention group was significantly shorter (P = 0.041) at 38.0 h (versus 50.1 h). Rapid discrimination between MRSA and MSSA using molecular testing, paired with an ASP intervention, significantly reduced the TTOT in patients with MSSA BSIs. IMPORTANCE Our research shows that time to optimal antibiotic treatment for serious bloodstream infections can be improved with rapid molecular sensitivity testing and feedback to prescribers. This can be implemented in laboratories without full microbiology services or training to improve patient outcomes by improving antimicrobial use.
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Affiliation(s)
- Hilal Al Sidairi
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Emma K. Reid
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Navjot Sandila
- Research Methods Unit (RMU), Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Joline Head
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Ian Davis
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Bonnar
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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30
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Du Q, Xi X, Dong J, Zhang T, Li D, Dong Y, Li W, Huang G, Zhu J, Ran H, Gou J, Chen C, Bai Z, Liu Q, Yao W, Zhang L, Bi Y, Liu S. The impact of pharmacist early active consultation (PEAC) on multidrug resistance organism treatment outcomes: A prospective historically controlled study. Front Pharmacol 2023; 14:1128219. [PMID: 36937879 PMCID: PMC10017476 DOI: 10.3389/fphar.2023.1128219] [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: 12/20/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Background and aim: Infectious disease (ID) consultation can improve multidrug-resistant organism (MDRO) treatment outcomes. However, the impact of clinical pharmacists' ID consultation on MDRO therapy, especially early initiation, has not been reported. In this study, we try to explore the impact of the pharmacist early active consultation (PEAC) on MDRO patient management. Methods: We conducted a prospective historical controlled study based on PEAC in MDRO patients. The retrospective control group was patients hospitalized 18 months before the PEAC initiation, and the prospective PEAC group was patients hospitalized 18 months after the PEAC initiation. Primary endpoint was 30-day all-cause mortality. Secondary outcomes were MDRO clinical outcome, duration of antibiotic use, length of stay, antibiotic consumption and antibiotic costs. Further subgroup analysis of secondary outcomes was performed by the condition at admission, MDRO pathogenicity and MDRO clinical outcome. Results: 188 MDRO patients were included. After adjusting for potential predictors, PEAC reduced the 30-day all-cause mortality by 70% (HR 0.30, 95% CI 0.09-0.96, p = 0.042). PEAC group had clinical improvement than control group (89.47% vs. 65.59%, p < 0.001), especially in patients with non-severe clinical conditions at admission (98.41% vs. 70.18%, p < 0.001). However, no significant differences were found between groups in length of stay, antibiotics consumption, and antibiotics costs. Conclusion: Early active pharmacy ID consultation can reduce 30-day all-cause mortality and improve clinical outcomes in MDRO patients.
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Affiliation(s)
- Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Xi
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Dong
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tongyan Zhang
- Infectious Disease Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Dongxuan Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- College of Pharmacy, Chongqing Medical University, Chongqing, China
| | - Yuzhu Dong
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjun Li
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guili Huang
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hailong Ran
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinghui Gou
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Chen
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhanfeng Bai
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinglong Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Yao
- Department of Respiratory Medicine, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zhang
- Department of Intensive Care Unit, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yutian Bi
- Department of Medical Administration, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yutian Bi, ; Songqing Liu,
| | - Songqing Liu
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yutian Bi, ; Songqing Liu,
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Kufel WD, Parsels KA, Blaine BE, Steele JM, Mahapatra R, Paolino KM, Thomas SJ. Vancomycin plus ceftaroline for persistent methicillin-resistant Staphylococcus aureus bacteremia. Pharmacotherapy 2023; 43:15-23. [PMID: 36371648 DOI: 10.1002/phar.2741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE The preferred antibiotic salvage regimen for persistent methicillin-resistant Staphylococcus aureus bacteremia (MRSAB) is unclear. We sought to evaluate the effectiveness and safety of vancomycin plus ceftaroline for persistent MRSAB. The primary outcome was time to MRSAB clearance post-ceftaroline initiation. Secondary outcomes included microbiological cure, hospital length of stay, 90-day readmission for MRSAB, 90-day all-cause mortality, MRSAB-related mortality, and incidence of antibiotic-associated adverse effects. DESIGN Single-center, retrospective cohort study between January 1, 2016, and December 31, 2021. SETTING State University of New York Upstate University Hospital, a 748-bed tertiary care, academic medical center in Syracuse, NY. PATIENTS Adult patients were included if they had blood cultures positive for MRSA ≥72 h, received vancomycin monotherapy initially, and received vancomycin plus ceftaroline for ≥24 h. Patients were excluded if they received other anti-MRSA antibiotics, were pregnant, or were incarcerated. Of the 178 patients identified, 30 unique patients were evaluated. MEASUREMENTS AND MAIN RESULTS Patients were medically complex with a median Pitt bacteremia score of 3, 63.3% (19/30) were admitted to the intensive care unit, and 66.7% (20/30) had infective endocarditis. Vancomycin-associated acute kidney injury was observed in 10% (3/30) of patients, which resulted in dose adjustments. No patients experienced ceftaroline-associated neutropenia or Clostridioides difficile infection, but 6.7% (2/30) developed a rash attributed to ceftaroline. Median time to MRSAB clearance post-ceftaroline initiation was 2.6 days. Microbiologic cure occurred in nearly all patients 96.7% (29/30). Median hospital length of stay was 19.5 days, and 6.7% (2/30) of patients had 90-day readmission for MRSAB. 90-day all-cause mortality and MRSAB-related mortality occurred in 26.7% (8/30) and 13.3% (4/30) of patients, respectively. CONCLUSIONS Vancomycin plus ceftaroline may represent an effective and well-tolerated salvage regimen option for persistent MRSAB.
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Affiliation(s)
- Wesley D Kufel
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Binghamton, New York, USA
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Katie A Parsels
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | | | - Jeffrey M Steele
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Rahul Mahapatra
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Kristopher M Paolino
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
| | - Stephen J Thomas
- State University of New York Upstate Medical University, Syracuse, New York, USA
- State University of New York Upstate University Hospital, Syracuse, New York, USA
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Impact of specialty on the self-reported practice of using oral antibiotic therapy for definitive treatment of bloodstream infections. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2023; 3:e48. [PMID: 36970426 PMCID: PMC10031584 DOI: 10.1017/ash.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/11/2023]
Abstract
Abstract
Background:
No established guidelines exist regarding the role of oral antibiotic therapy (OAT) to treat bloodstream infections (BSIs), and practices may vary depending on clinician specialty and experience.
Objective:
To assess practice patterns regarding oral antibiotic use for treatment of bacteremia in infectious diseases clinicians (IDCs, including physicians and pharmacists and trainees in these groups) and non–infectious diseases clinicians (NIDCs).
Design:
Open-access survey.
Participants:
Clinicians caring for hospitalized patients receiving antibiotics.
Methods:
An open-access, web-based survey was distributed to clinicians at a Midwestern academic medical center using e-mail and to clinicians outside the medical center using social media. Respondents answered questions regarding confidence prescribing OAT for BSI in different scenarios. We used χ2 analysis for categorical data evaluated association between responses and demographic groups.
Results:
Of 282 survey responses, 82.6% of respondents were physicians, 17.4% pharmacists, and IDCs represented 69.2% of all respondents. IDCs were more likely to select routine use of OAT for BSI due to gram-negative anaerobes (84.6% vs 59.8%; P < .0001), Klebsiella spp (84.5% vs 69.0%; P < .009), Proteus spp (83.6% vs 71.3%; P < .027), and other Enterobacterales (79.5% vs 60.9%; P < .004). Our survey results revealed significant differences in selected treatment of Staphylococcus aureus syndromes. Fewer IDCs than NIDCs selected OAT to complete treatment for methicillin-resistant S. aureus (MRSA) BSI due to gluteal abscess (11.9% vs 25.6%; P = .012) and methicillin-susceptible S. aureus (MSSA) BSI due to septic arthritis (13.9% vs 20.9%; P = .219).
Conclusions:
Practice variation and discordance with evidence for the use of OAT for BSIs exists among IDCs versus NIDCs, highlighting opportunities for education in both clinician groups.
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Hamad Y, Nickel KB, Burnett YJ, Hamad T, George IA, Olsen MA. Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy. J Clin Pharm Ther 2022; 47:2188-2195. [PMID: 36257600 PMCID: PMC10336722 DOI: 10.1111/jcpt.13790] [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: 06/16/2022] [Revised: 08/30/2022] [Accepted: 09/24/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Vancomycin is commonly used during outpatient parenteral antimicrobial therapy (OPAT). Therapeutic drug monitoring (TDM) of vancomycin is recommended to ensure effective and safe therapy, as use has been associated with acute kidney injury (AKI). METHODS The MarketScan® Commercial Database was queried from 2010 to 2016 to identify patients aged 18-64 years discharged from an inpatient hospitalization on vancomycin OPAT. The primary endpoint was hospital readmission with AKI within 6 weeks of index hospital discharge. TDM was defined as at least one vancomycin level obtained during outpatient therapy. Bivariate analysis was used to examine associations with outcomes; significant factors were incorporated into a multivariable logistic regression model. RESULTS A total of 14,196 patients were included in the study; median age was 54 years and 53.8% were male. Readmission with AKI occurred in 385 (2.7%) and was independently associated with chronic kidney disease (aOR 2.63 [95%CI 1.96-3.52]), congestive heart failure (1.81 [1.34-2.44]), chronic liver disease (1.74 [1.17-2.59]), hypertension (1.73 [1.39-2.17]), septicemia (1.61 [1.30-2.00]), and concomitant OPAT with IV penicillins (1.73 [1.21-2.49]) while skin and soft tissue infection (0.67 [0.54-0.83]) and surgical site infection (0.74 [0.59-0.93]) were associated with lower risk of readmission with AKI. TDM was not associated with lower risk of readmission with AKI. CONCLUSION Chronic kidney disease, congestive heart failure, hypertension, chronic liver disease, septicemia, and concomitant OPAT with IV penicillins were significantly associated with higher risk of readmission with AKI during vancomycin OPAT.
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Affiliation(s)
- Yasir Hamad
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
- Department of Critical Care Medicine, National Institute of Health Clinical Center, Bethesda, MD
| | - Katelin B Nickel
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Yvonne J Burnett
- University of Health Sciences and Pharmacy in St. Louis, St. Louis, Missouri
| | - Tarig Hamad
- Università della Calabria, Department of Pharmacy and Health and Nutrition Sciences, Rende, Italy
| | - Ige A George
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
| | - Margaret A Olsen
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri
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van der Vaart TW, Prins JM, Soetekouw R, van Twillert G, Veenstra J, Herpers BL, Rozemeijer W, Jansen RR, Bonten MJM, van der Meer JTM. All-Cause and Infection-Related Mortality in Staphylococcus aureus Bacteremia, a Multicenter Prospective Cohort Study. Open Forum Infect Dis 2022; 9:ofac653. [PMID: 36589483 PMCID: PMC9792080 DOI: 10.1093/ofid/ofac653] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Staphylococcus aureus bacteremia (SAB) is a heterogeneous disease with changing epidemiology due to changing demographics and evolving clinical management. SAB is associated with high mortality, but the current fraction of infection-related mortality is less well quantified. Methods In a multicenter prospective cohort study of consecutive patients with SAB, we determined clinical features of SAB and determined 90-day mortality and risk factors of all-cause and infection-related mortality. Infection-related mortality was based on an adjudication committee evaluation. Results Four hundred ninety patients with SAB were included, with community-acquired (n = 166), health care-associated (n = 163), and hospital-acquired SAB (n = 161). Endocarditis (n = 90, 18.3%), peripheral intravenous catheter infection (n = 80, 16.3%), and septic arthritis (n = 58, 11.8%) were the most frequent diagnoses, but proportions differed for community, health care, and hospital acquisition. One hundred ninety-two patients (39%) had permanent implanted prosthetic material (eg, prosthetic joint, heart valve, pacemaker). Day 90 all-cause mortality was 33% (n = 161), with 60% adjudicated as infection-related, and 90% of infection-related deaths occurring in the first 30 days post-SAB. Infection-related deaths after 30 days were rare and mainly related to endocarditis. Determinants associated with day 90 infection-related mortality were age (odds ratio [OR], 1.09; 95% CI, 1.06-1.11), Charlson comorbidity index (OR, 1.13; 95% CI, 1.01-1.26), septic shock (OR, 9.78; 95% CI, 4.56-20.95), endocarditis (OR, 3.4; 95% CI, 1.75-6.61), and persistent SAB at 48 hours (OR, 2.36; 95% CI, 1.27-4.37). Conclusions Mortality due to S. aureus infection remains high and mainly occurs in the first 30 days, which could guide end points in future studies.
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Affiliation(s)
- Thomas W van der Vaart
- Correspondence: Thomas van der Vaart, MD, Amsterdam University Medical Centers, Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands ()
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Gitte van Twillert
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Jan Veenstra
- Department of Internal Medicine, OLVG, Amsterdam, the Netherlands
| | - Bjorn L Herpers
- Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands
| | - Wouter Rozemeijer
- Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Rogier R Jansen
- Department of Medical Microbiology, OLVG, Amsterdam, the Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Gatley EM, Boyles T, Dlamini S, Mendelson M, Namale PE, Raubenheimer PJ, Wasserman S. Adherence to a care bundle for Staphylococcus aureus bacteraemia: A retrospective cohort study. S Afr J Infect Dis 2022; 37:445. [PMID: 36483573 PMCID: PMC9724142 DOI: 10.4102/sajid.v37i1.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/31/2022] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia is associated with high hospital mortality. Improvements in outcome have been described with standardised bundles of care. OBJECTIVES To study the adherence of a standardised bundle of care (BOC) recommendations using a consultation pro forma, for all patients admitted with S. aureus bacteraemia to Groote Schuur Hospital over a year. The study further aimed to describe the 90-day mortality in these patients and to assess for an association between adherence to the bundle of care and outcome. METHOD A retrospective audit of all unsolicited infectious disease consultations for patients with S. aureus bacteraemia admitted to Groote Schuur Hospital during 2018. Adherence to recommendations of a standard bundle of care was audited. RESULTS A total of 86 patients were included in the study: 61 (71%) with hospital-associated infection and 25 (29%) with community-associated infection. Over 80% of adherence to treatment recommendations was achieved regarding antibiotic (including vancomycin) usage, source control and use of echocardiography as required. In-hospital mortality was 16%, while the overall 90-day mortality was 18%, with only age as an independent predictor of mortality. No association between adherence to the bundle of care and outcome was found. CONCLUSION Adherence to a simple, structured bundle of care was good when using standardised pro forma as communication tools for advice and a structured antibiotic chart for vancomycin administration. Although adherence was not associated with outcome, the overall mortality for S. aureus bacteraemia was improving in the institution under study. CONTRIBUTION Our findings support feasibility and ongoing use of bundles of care for S. aureus bacteraemia in similar settings.
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Affiliation(s)
- Elizabeth M Gatley
- Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Tom Boyles
- Department of Medicine, Faculty of Health Sciences, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sipho Dlamini
- Department of Medicine, Faculty of Health Sciences, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Marc Mendelson
- Department of Medicine, Faculty of Health Sciences, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Phiona E Namale
- Department of Medicine, Faculty of Health Sciences, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Peter J Raubenheimer
- Department of Medicine, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sean Wasserman
- Department of Medicine, Faculty of Health Sciences, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Veillette JJ, May SS, Gabrellas AD, Gelman SS, Albritton J, Lyons MD, Stenehjem EA, Webb BJ, Dalto JD, Throneberry SK, Stanfield V, Grisel NA, Vento TJ. A Fully Integrated Infectious Diseases and Antimicrobial Stewardship Telehealth Service Improves Staphylococcus aureus Bacteremia Bundle Adherence and Outcomes in 16 Small Community Hospitals. Open Forum Infect Dis 2022; 9:ofac549. [PMID: 36381624 PMCID: PMC9645643 DOI: 10.1093/ofid/ofac549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2024] Open
Abstract
Background Infectious diseases (ID) and antimicrobial stewardship (AS) improve Staphylococcus aureus bacteremia (SAB) outcomes. However, many small community hospitals (SCHs) lack on-site access to these services, and it is not known if ID telehealth (IDt) offers the same benefit for SAB. We evaluated the impact of an integrated IDt service on SAB outcomes in 16 SCHs. Methods An IDt service offering IDt physician consultation plus IDt pharmacist surveillance was implemented in October 2016. Patients treated for SAB in 16 SCHs between January 2009 and August 2019 were identified for review. We compared SAB bundle adherence and outcomes between patients with and without an IDt consult (IDt group and control group, respectively). Results A total of 423 patients met inclusion criteria: 157 in the IDt group and 266 in the control group. Baseline characteristics were similar between groups. Among patients completing their admission at an SCH, IDt consultation increased SAB bundle adherence (79% vs 23%; odds ratio [OR], 16.9; 95% CI, 9.2-31.0). Thirty-day mortality and 90-day SAB recurrence favored the IDt group, but the differences were not statistically significant (5% vs 9%; P = .2; and 2% vs 6%; P = .09; respectively). IDt consultation significantly decreased 30-day SAB-related readmissions (9% vs 17%; P = .045) and increased length of stay (median [IQR], 5 [5-8] days vs 5 [3-7] days; P = .04). In a subgroup of SAB patients with a controllable source, IDt appeared to have a mortality benefit (2% vs 9%; OR, 0.12; 95% CI, 0.01-0.98). Conclusions An integrated ID/AS telehealth service improved SAB management and outcomes at 16 SCHs. These findings provide important insights for other IDt programs.
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Affiliation(s)
- John J Veillette
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Stephanie S May
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Alithea D Gabrellas
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Stephanie S Gelman
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Jordan Albritton
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
- RTI International, Durham, North Carolina, USA
| | - Michael D Lyons
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
| | - Edward A Stenehjem
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brandon J Webb
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph D Dalto
- TeleHealth Services, Intermountain Healthcare, Midvale, Utah, USA
| | - S Kyle Throneberry
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Valoree Stanfield
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Nancy A Grisel
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
| | - Todd J Vento
- Infectious Diseases TeleHealth Service, Intermountain Medical Center, Murray, Utah, USA
- Division of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, Utah, USA
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Pliakos EE, Ziakas PD, Mylonakis E. Economic Analysis of Infectious Disease Consultation for Staphylococcus aureus Bacteremia Among Hospitalized Patients. JAMA Netw Open 2022; 5:e2234186. [PMID: 36173628 PMCID: PMC9523499 DOI: 10.1001/jamanetworkopen.2022.34186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Staphylococcus aureus bacteremia is associated with a significant burden of mortality, morbidity, and health care costs. Infectious disease consultation may be associated with reduced mortality and bacteremia recurrence rates. OBJECTIVE To evaluate the cost-effectiveness of infectious disease consultation for Staphylococcus aureus bacteremia. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, a decision-analytic model was constructed comparing infectious disease consult with no consult. The population was adult hospital inpatients with Staphylococcus aureus bacteremia diagnosed with at least 1 positive blood culture. Cost-effectiveness was calculated as deaths averted and incremental cost-effectiveness ratios. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Costs and outcomes were calculated for a time horizon of 6 months. The analysis was performed from a societal perspective and included studies that had been published by January 2022. INTERVENTIONS Patients received or did not receive formal bedside consultation after positive blood cultures for Staphylococcus aureus bacteremia. MAIN OUTCOMES AND MEASURES The main outcomes were incremental difference in effectiveness (survival probabilities), incremental difference in cost (US dollars) and incremental cost-effectiveness ratios (US dollars/deaths averted). RESULTS This model included 1708 patients who received consultation and 1273 patients who did not. In the base-case analysis, the cost associated with the infectious disease consult strategy was $54 137.4 and the associated probability of survival was 0.77. For the no consult strategy, the cost was $57 051.2, and the probability of survival was 0.72. The incremental difference in cost between strategies was $2913.8, and the incremental difference in effectiveness was 0.05. Overall, consultation was associated with estimated savings of $55 613.4/death averted (incremental cost-effectiveness ratio, -$55613.4/death averted). In the probabilistic analysis, at a willingness-to-pay threshold of $50 000, infectious disease consult was cost-effective compared with no consult in 54% of 10 000 simulations. In cost-effectiveness acceptability curves, the consult strategy was cost-effective in 58% to 73%) of simulations compared with no consult for a willingness-to-pay threshold ranging from $0 to $150 000. CONCLUSIONS AND RELEVANCE These findings suggest that infectious disease consultation may be a cost-effective strategy for management of Staphylococcus aureus bacteremia and that it is associated with health care cost-savings.
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Affiliation(s)
- Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Panayiotis D. Ziakas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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Ramanathan S, Albarillo FS, Fitzpatrick MA, Suda KJ, Poggensee L, Vivo A, Evans ME, Jones M, Safdar N, Pfeiffer C, Smith B, Wilson G, Evans CT. Infectious Disease Consults of Pseudomonas aeruginosa Bloodstream Infection and Impact on Health Outcomes. Open Forum Infect Dis 2022; 9:ofac456. [PMID: 36168551 PMCID: PMC9511117 DOI: 10.1093/ofid/ofac456] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/06/2022] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Infectious diseases (ID) consultation improves health outcomes for certain infections but has not been well described for Pseudomonas aeruginosa (PA) bloodstream infection (BSI). Therefore, the goal of this study was to examine ID consultation of inpatients with PA BSI and factors impacting outcomes. METHODS This was a retrospective cohort study from January 1, 2012, to December 31, 2018, of adult hospitalized veterans with PA BSI and antibiotic treatment 2 days before through 5 days after the culture date. Multidrug-resistant (MDR) cultures were defined as cultures with resistance to at least 1 agent in ≥3 antimicrobial categories tested. Multivariable logistic regression models were fit to assess the impact of ID consults and adequate treatment on mortality. RESULTS A total of 3256 patients had PA BSI, of whom 367 (11.3%) were multidrug resistant (MDR). Most were male (97.5%), over 65 years old (71.2%), and White (70.9%). Nearly one-fourth (n = 784, 23.3%) died during hospitalization, and 870 (25.8%) died within 30 days of their culture. Adjusted models showed that ID consultation was associated with decreased in-hospital (odds ratio [OR], 0.47; 95% CI, 0.39-0.56) and 30-day mortality (OR, 0.51; 95% CI, 0.42-0.62). CONCLUSIONS Consultation with ID physicians improves clinical outcomes such as in-hospital and 30-day mortality for patients with PA BSI. ID consultation provides value and should be considered for patients with PA BSI.
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Affiliation(s)
- Swetha Ramanathan
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Fritzie S Albarillo
- Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Margaret A Fitzpatrick
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Katie J Suda
- Department of Veterans Affairs, Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Linda Poggensee
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Amanda Vivo
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Martin E Evans
- Department of Veterans Affairs, Lexington VA Medical Center, Lexington, Kentucky, USA
| | - Makoto Jones
- Department of Veterans Affairs, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Nasia Safdar
- Department of Veterans Affairs, William S. Middleton Memorial VA Hospital, Madison, Wisconsin, USA
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Chris Pfeiffer
- Department of Veterans Affairs, Portland VA Healthcare System, Portland, Oregon, USA
- Division of Infectious Diseases, Department of Medicine, Oregon Health Science University, Portland, Oregon, USA
| | - Bridget Smith
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
| | - Geneva Wilson
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
- Division of Infectious Diseases, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Charlesnika T Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, Illinois, USA
- Center for Health Services and Outcomes Research and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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El Helou G, Vittor A, Mushtaq A, Schain D. Infectious diseases compensation in the USA: the relative value. THE LANCET INFECTIOUS DISEASES 2022; 22:1106-1108. [PMID: 35716701 PMCID: PMC9212813 DOI: 10.1016/s1473-3099(22)00360-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022]
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Arientová S, Jícha Z, Beran O, Holub M. Decreased quality of care for Staphylococcus aureus bacteremia during the COVID-19 pandemic. BMC Infect Dis 2022; 22:631. [PMID: 35854225 PMCID: PMC9297622 DOI: 10.1186/s12879-022-07607-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives Staphylococcus aureus bacteremia (SAB) is one of the most frequent bloodstream infections. High mortality of SAB can be significantly reduced by regular infectious disease (ID) consultations and appropriate clinical management. Because the pandemic of coronavirus disease 2019 (COVID-19) has had a negative impact on hospital ID service, it can be assumed that it has also led to decreased quality of care for SAB patients. Methods This study enrolled all (n = 68) patients with proven SAB who were hospitalized in Military University Hospital, Prague, in 2019 and 2020 and the quality of care indicators for SAB patients were compared. Results A total of 33 and 35 patients with SAB were hospitalized in our hospital in 2019 and 2020, respectively. The significant difference between the pandemic year 2020 and year 2019 was in ID consultations performed (74% vs. 100%; p = 0.002) and fulfilment of all quality of care indicators (66% vs. 93%; p = 0.012). Next, higher in-hospital mortality was observed in 2020 than in 2019 (6% vs. 23%; p = 0.085). There was no significant difference in the percentages of patients with performed echocardiographic examinations (66% vs. 83%; p = 0.156) and collected follow-up blood cultures (85% vs. 94%; p = 0.428). In addition, there was no difference between the two years in the adequate antibiotic therapy, sources, and bacterial origin of SAB. Conclusions The quality of care of SAB patients significantly decreased during the COVID-19 pandemic in our institution.
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Affiliation(s)
- Simona Arientová
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské nemocnice 1200, 169 02, Prague 6, Czech Republic.
| | - Zdeněk Jícha
- Department of Orthopedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Ondřej Beran
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské nemocnice 1200, 169 02, Prague 6, Czech Republic
| | - Michal Holub
- Department of Infectious Diseases, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské nemocnice 1200, 169 02, Prague 6, Czech Republic
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Khan I, Brookes E, Yaftian N, Wilson A, Darby J, Newcomb A. Multivalve infective endocarditis in intravenous drug using patients: an epidemiological study. QJM 2022; 115:463-468. [PMID: 34487178 DOI: 10.1093/qjmed/hcab225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) remains a life-threatening condition. Intravenous drug use (IVDU) adds to the clinical challenge associated with IE due to clinical aberrations caused by the social issues associated with this population. AIM To improve survival, this study aimed to characterize the contemporary IVDU-associated IE population seen at our tertiary hospital, determine their long-term outcomes and find risk factors associated with mortality. DESIGN Retrospective observational cohort study. METHODS A total of 79 patients accounting for 89 presentations were treated for IVDU-associated IE at St Vincent's Hospital Melbourne (SVHM) between 1999 and 2015. Patients were followed-up until death or January 2021. The primary outcome was all-cause mortality and Kaplan-Meier survival analysis was used to calculate long-term survival estimates. Cox proportional hazards analysis was used to examine risk factors for mortality. RESULTS The IVDU population treated at SVHM had a high rate of multivalvular IE, at 18.98%. Multivariate analysis revealed that multivalvular IE is significantly associated with an increased risk of mortality in a dose-dependent relationship (two valves affected: HR = 4.73, P = 0.006, three valves affected: HR = 14.19, P = 0.014). The IVDU population has survival estimates of 83.78% (95%CI: 73.21-90.45%) at 1-year and 64.98% (95%CI: 50.94-75.92%) at 15-years. CONCLUSION IVDU patients have high rates of multivalvular endocarditis, which is associated with increased risk of mortality and difficult to identify on echocardiography. Clinicians should be suspicious of multivalve involvement in the IVDU population and decisions related to medical management/intervention should be made with the understanding that these patients are at a higher risk of death.
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Affiliation(s)
- Isa Khan
- Department of Cardiothoracic Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Elizabeth Brookes
- Department of Cardiothoracic Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nima Yaftian
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Andrew Wilson
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jonathan Darby
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Andrew Newcomb
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia
- Department of Surgery, University of Melbourne, Melbourne, Australia
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Krasaewes K, Yasri S, Khamnoi P, Chaiwarith R. Hospital-Wide Protocol Significantly Improved Appropriate Management of Patients with Staphylococcus aureus Bloodstream Infection. Antibiotics (Basel) 2022; 11:antibiotics11060827. [PMID: 35740233 PMCID: PMC9219980 DOI: 10.3390/antibiotics11060827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 02/05/2023] Open
Abstract
Background:Staphylococcus aureus bloodstream infection (SA-BSI) causes morbidity and mortality. We established a management protocol for patients with SA-BSI aimed at improving quality of care and patient outcomes. Methods: A retrospective pre−post intervention study was conducted at Maharaj Nakorn Chiang Mai Hospital from 1 October 2019 to 30 September 2020 in the pre-intervention period and from 1 November 2020 to 31 October 2021 in the post-intervention period. Results: Of the 169 patients enrolled, 88 were in the pre-intervention and 81 were in the post-intervention periods. There were similar demographic characteristics between the two periods. In the post-intervention period, evaluations for metastatic infections were performed more frequently, e.g., echocardiography (70.5% vs. 91.4%, p = 0.001). The appropriateness of antibiotic prescription was higher in the post-intervention period (42% vs. 81.5%, p < 0.001). The factors associated with the appropriateness of antibiotic prescription were ID consultation (OR 15.5; 95% CI = 5.9−40.8, p < 0.001), being in the post-intervention period (OR 9.4; 95% CI: 3.5−25.1, p < 0.001), and thorough investigations for metastatic infection foci (OR 7.2; 95% CI 2.1−25.2, p = 0.002). However, the 90-day mortality was not different (34.1% and 27.2% in the pre- and post-intervention periods, respectively). The factors associated with mortality from the multivariate analysis were the presence of alteration of consciousness (OR 11.24; 95% CI: 3.96−31.92, p < 0.001), having a malignancy (OR 6.64; 95% CI: 1.83−24.00, p = 0.004), hypoalbuminemia (OR 5.23; 95% CI: 1.71−16.02, p = 0.004), and having a respiratory tract infection (OR 5.07; 95% CI: 1.53−16.84, p = 0.008). Source control was the only factor that reduced the risk of death (OR 0.08; 95% CI: 0.01−0.53, p = 0.009). Conclusion: One-third of patients died. Hospital-wide protocol implementation significantly improved the quality of care. However, the mortality rate did not decrease.
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Affiliation(s)
- Kawisara Krasaewes
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.Y.)
| | - Saowaluck Yasri
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.Y.)
| | - Phadungkiat Khamnoi
- Diagnostic Laboratory, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Romanee Chaiwarith
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (S.Y.)
- Correspondence: ; Tel.: +66-5393-6457
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Gordon O, Peart Akindele N, Schumacher C, Hanlon A, Simner PJ, Carroll KC, Sick-Samuels AC. Increasing Pediatric Infectious Diseases Consultation Rates for Staphylococcus aureus Bacteremia. Pediatr Qual Saf 2022; 7:e560. [PMID: 35720864 PMCID: PMC9197366 DOI: 10.1097/pq9.0000000000000560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Staphylococcus aureus bacteremia (SAB) in children is associated with significant mortality and morbidity, including recurrent bacteremia. Infectious disease consultation (IDC) improves SAB outcomes in adult patients. However, increasing IDC and impact for pediatric patients with SAB is not well described. Methods This quality improvement project aimed to increase IDC for SAB events at a quaternary pediatric medical center. First, we evaluated the local practices regarding pediatric SAB and engaged stakeholders (July 2018-August 2020). We added an advisory comment supporting IDC for SAB to all blood culture results in September 2020. Using statistical process control charts, we monitored the number of SAB events with IDC before a SAB event without IDC. Finally, we evaluated SAB recurrences before and after initiating the advisory comment. Results In the baseline period, 30 of 49 (61%) SAB events received an IDC with a mean of 1.4 SAB events with IDC before a SAB event without IDC. Postintervention, 22 of 23 (96%) SAB events received IDC with a mean of 14 events with IDC before 1 event without IDC. The SAB recurrence rate was 8%, with 6 events in 4 children; none of the index cases resulting in recurrence received an IDC (P = 0.0002), and all occurred before any intervention. Conclusions An electronic advisory comment supporting IDC for SAB significantly increased the rate of pediatric IDC with no further SAB recurrence episodes following intervention. This low-resource intervention may be considered in other pediatric centers to optimize SAB management.
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Affiliation(s)
- Oren Gordon
- From the Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Nadine Peart Akindele
- From the Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christina Schumacher
- Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Md
| | - Ann Hanlon
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Patricia J. Simner
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Karen C. Carroll
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Anna C. Sick-Samuels
- From the Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
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Grillo S, Puig-Asensio M, Schweizer ML, Cuervo G, Oriol I, Pujol M, Carratalà J. The Effectiveness of Combination Therapy for Treating Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Systematic Literature Review and a Meta-Analysis. Microorganisms 2022; 10:microorganisms10050848. [PMID: 35630294 PMCID: PMC9145429 DOI: 10.3390/microorganisms10050848] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background: This meta-analysis aims to evaluate the effectiveness of combination therapy for treating MSSA bacteremia. Methods: We searched Ovid MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.gov for studies including adults with MSSA bacteremia. The monotherapy group used a first-line antibiotic active against MSSA and the combination group used a first-line antibiotic plus additional antibiotic/s. The primary outcome was all-cause mortality. Secondary outcomes included persistent bacteremia, duration of bacteremia, relapse, and adverse events. Random-effects models with inverse variance weighting were used to estimate pooled risk ratios (pRR). Heterogeneity was assessed using the I2 value and the Cochrane’s Q statistic. Results: A total of 12 studies (6 randomized controlled trials [RCTs]) were included. Combination therapy did not significantly reduce 30-day mortality (pRR 0.92, 95% CI, 0.70–1.20), 90-day mortality (pRR 0.89, 95% CI, 0.74–1.06), or any-time mortality (pRR 0.91, 95% CI, 0.76–1.08). Among patients with deep-seated infections, adjunctive rifampicin may reduce 90-day mortality (3 studies with moderate-high risk of bias; pRR 0.62, 95% CI, 0.42–0.92). For secondary outcomes, combination therapy decreased the risk of relapse (pRR 0.38, 95% CI, 0.22–0.66), but this benefit was not maintained when pooling RCTs (pRR 0.54, 95% CI, 0.12–2.51). Combination therapy was associated with an increased risk of adverse events (pRR 1.74, 95% CI, 1.31–2.31). Conclusions: Combination therapy not only did not decrease mortality in patients with MSSA bacteremia, but also increased the risk of adverse events. Combination therapy may reduce the risk of relapse, but additional high-quality studies are needed.
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Affiliation(s)
- Sara Grillo
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain; (S.G.); (G.C.); (M.P.); (J.C.)
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain; (S.G.); (G.C.); (M.P.); (J.C.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA;
- Correspondence: ; Tel.: +34-932-602487; Fax: +34-932-607637
| | - Marin L. Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA;
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA 52246, USA
| | - Guillermo Cuervo
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain; (S.G.); (G.C.); (M.P.); (J.C.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Isabel Oriol
- Hospital Sant Joan Despí Moisés Broggi, Oriol Martorell 12, 08970 Sant Joan Despí, Spain;
| | - Miquel Pujol
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain; (S.G.); (G.C.); (M.P.); (J.C.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Institute for Biomedical Research (IDIBELL), Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Spain; (S.G.); (G.C.); (M.P.); (J.C.)
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Barcelona, 08007 Barcelona, Spain
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Tholany J, Kobayashi T, Marra AR, Schweizer ML, Samuelson RJ, Suzuki H. Impact of infectious diseases consultation on the outcome of patients with enterococcal bacteremia: a systematic literature review and meta-analysis. Open Forum Infect Dis 2022; 9:ofac200. [PMID: 35794948 PMCID: PMC9251672 DOI: 10.1093/ofid/ofac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Enterococcal bacteremia carries significant mortality. While multiple studies have evaluated the impact of infectious disease consultation (IDC) on this condition, these studies were limited by the low numbers of patients enrolled. This systemic literature review and meta-analysis were conducted to determine whether IDC was associated with a mortality benefit among patients with enterococcal bacteremia.
Methods
We performed a systematic literature search using 5 databases for studies evaluating IDC among patients with enterococcal bacteremia. We conducted a meta-analysis to assess whether IDC was associated with reduced mortality. Random-effect models were used to calculated pooled odds ratios (pORs). Heterogeneity was evaluated using I2 estimation and the Cochrane Q statistic test.
Results
The systemic literature review revealed 6496 reports, from which 18 studies were evaluated in the systemic literature review and 16 studies in the meta-analysis. When all studies were pooled, the association between IDC and mortality was not statistically significant with a pOR of 0.81 (95% CI, 0.61-1.08) and there was substantial heterogeneity (I2=58%). When the studies were limited to those reporting multivariate analysis including IDC, there was a significant protective effect of IDC (pOR=0.40; 95% CI, 0.24-0.68) without heterogeneity (I2=0%). Some studies also showed additional benefits to IDC, including appropriate antibiotic therapy, and improved diagnostic use.
Conclusions
IDC was associated with 60% lower odds of mortality when patients were well-matched, potentially through improvement in the care for patients with enterococcal bacteremia. IDC should be considered a part of routine care for patients with enterococcal bacteremia.
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Affiliation(s)
- Joseph Tholany
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Takaaki Kobayashi
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marin L Schweizer
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
| | - Riley J Samuelson
- Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, United States
| | - Hiroyuki Suzuki
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States
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Bai AD, Lo CK, Komorowski AS, Suresh M, Guo K, Garg A, Tandon P, Senecal J, Del Corpo O, Stefanova I, Fogarty C, Butler-Laporte G, McDonald EG, Cheng MP, Morris AM, Loeb M, Lee TC. Staphylococcus aureus bacteremia mortality: A systematic review and meta-analysis. Clin Microbiol Infect 2022; 28:1076-1084. [PMID: 35339678 DOI: 10.1016/j.cmi.2022.03.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Precise estimates of mortality in Staphylococcus aureus bacteremia (SAB) are important to convey prognosis and guide design of interventional studies. OBJECTIVE We performed a systematic review and meta-analysis to estimate the all-cause mortality in SAB and to explore how it changed with time. DATA SOURCES MEDLINE, Embase, and Cochrane Database of Systematic Reviews from January 1, 1991 to May 7, 2021. STUDY ELIGIBILITY CRITERIA Human observational studies on patients with S. aureus bloodstream infection. PARTICIPANTS Patients with a positive blood culture for S. aureus. METHODS Two independent reviewers extracted study data and assessed risk of bias using the Newcastle Ottawa Scale. A generalized linear mixed random effects model was used to pool estimates. RESULTS A total of 341 studies were included, which described 536,791 patients. From 2011 onwards, the estimated mortality was 10.4% (95% confidence interval (CI) 9.0%-12.1%) at 7 days, 13.3% (95% CI 11.1%-15.8%) at 2 weeks, 18.1% (95% CI 16.3%-20.0%) at 1 month, 27.0% (95% CI 21.5%-33.3%) at 3 months, and 30.2% (95% CI 22.4%-39.3%) at 1 year. In a meta-regression model of 1-month mortality, methicillin-resistant S. aureus (MRSA) had a higher mortality (adjusted odds ratio (aOR) 1.04 95% CI 1.02-1.06 per 10% increase in MRSA proportion), and compared to prior to 2001, more recent time periods had lower mortality (aORs 0.88 [95% CI 0.75-1.03] for 2001 to 2010; 0.82 [95% CI 0.69-0.97] for 2011 onwards). CONCLUSIONS SAB mortality has decreased over the last 3 decades. However, more than 1 in 4 patients will die within 3 months and continuous improvement in care remains necessary. REGISTRATION PROSPERO CRD42021253891.
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Affiliation(s)
- Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster, University, Hamilton, Ontario, Canada.
| | - Carson Kl Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Adam S Komorowski
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster, University, Hamilton, Ontario, Canada; Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mallika Suresh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Guo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Akhil Garg
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Pranav Tandon
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Julien Senecal
- Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Olivier Del Corpo
- Department of Medicine, Division of Experimental Medicine, Division of Infectious Diseases, McGill University, Montréal, QC, Canada
| | - Isabella Stefanova
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Clare Fogarty
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Guillaume Butler-Laporte
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Emily G McDonald
- Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Matthew P Cheng
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montréal, Quebec, Canada
| | - Andrew M Morris
- Division of Infectious Diseases, Department of Medicine, Sinai Health, University Health Network, and the University of Toronto, Toronto, Canada
| | - Mark Loeb
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd C Lee
- McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada; Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada
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Alsowaida YS, Benitez G, Bin Saleh K, Almangour TA, Shehadeh F, Mylonakis E. Effectiveness and Safety of Ceftriaxone Compared to Standard of Care for Treatment of Bloodstream Infections Due to Methicillin-Susceptible Staphylococcus aureus: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:375. [PMID: 35326838 PMCID: PMC8944781 DOI: 10.3390/antibiotics11030375] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Ceftriaxone is a potential alternative for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in acute care and outpatient parenteral antimicrobial therapy (OPAT) settings. We evaluated the effectiveness and safety of ceftriaxone for the treatment of MSSA BSIs. (2) Method: We searched PubMed, Embase, and Cochrane Library from their inception to October 30th 2021. Our outcomes included clinical cure, microbiological cure, 30- and 90-day mortality, 90-day hospital readmission, and adverse drug reactions (ADRs). We compared ceftriaxone against standard of care (SOC) therapy. We used the random-effects model for the meta-analysis, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals (CI). (3) Results: Twelve retrospective cohort studies were included, comprising 1037 patients in the ceftriaxone arms and 2088 patients in the SOC arms. The clinical cure rate of the ceftriaxone regimen was not statistically different from SOC: OR 0.65 (95% CI: 0.29-1.45). Ceftriaxone was also not statistically different from SOC in microbiological cure: OR 1.48 (95% CI: 0.29-7.51); 30-day mortality: OR 0.79 (95% CI: 0.14-4.65); 90-day mortality: OR 0.82 (95% CI: 0.38-1.80); 90-day hospital readmission: OR 1.20 (95% CI: 0.92-1.56); and ADRs: OR 0.92 (95% CI: 0.39-2.18). (4) Conclusion: Ceftriaxone could provide an alternative for the treatment of MSSA BSIs in acute care and OPAT settings (except in patients whose BSIs were due to infective endocarditis).
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Affiliation(s)
- Yazed Saleh Alsowaida
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, RI 02903, USA;
- Division of Infectious Diseases, Rhode Island Hospital, Providence, RI 02903, USA;
- Department of Clinical Pharmacy, College of Pharmacy, Hail University, P.O. Box 6166, Hail 81442, Saudi Arabia
| | - Gregorio Benitez
- Division of Infectious Diseases, Rhode Island Hospital, Providence, RI 02903, USA;
| | - Khalid Bin Saleh
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Pharmaceutical Care Department, King Abdulaziz Medical City, P.O. Box 3660, Riyadh 11481, Saudi Arabia;
| | - Thamer A. Almangour
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia;
| | - Fadi Shehadeh
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, RI 02903, USA;
- Division of Infectious Diseases, Rhode Island Hospital, Providence, RI 02903, USA;
- School of Electrical and Computer Engineering, National Technical University of Athens, 10682 Athens, Greece
| | - Eleftherios Mylonakis
- Division of Infectious Diseases, Alpert Medical School, Brown University, Providence, RI 02903, USA;
- Division of Infectious Diseases, Rhode Island Hospital, Providence, RI 02903, USA;
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Suneja M, Beekmann SE, Dhaliwal G, Miller AC, Polgreen PM. Diagnostic delays in infectious diseases. Diagnosis (Berl) 2022; 9:332-339. [PMID: 35073468 DOI: 10.1515/dx-2021-0092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/20/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Diagnostic delays are a major source of morbidity and mortality. Despite the adverse outcomes associated with diagnostic delays, few studies have examined the incidence and factors that influence diagnostic delays for different infectious diseases. The objective of this study was to understand the relative frequency of diagnostic delays for six infectious diseases commonly seen by infectious diseases (ID) consultants and to examine contributing factors for these delays. METHODS A 25-item survey to examine diagnostic delays in six infectious diseases was sent to all infectious diseases physicians in the Emerging Infections Network (EIN) who provide care to adult patients. Diseases included (1) tuberculosis, (2) non-tuberculous mycobacterial infections, (3) syphilis, (4) epidural abscess, (5) infective endocarditis, and (6) endemic fungal infections (e.g., histoplasmosis, blastomycosis). RESULTS A total of 533 of 1,323 (40%) EIN members responded to the survey. Respondents perceived the diagnosis not being considered initially and the appropriate test not being ordered as the two most important contributors to diagnostic delays. Unusual clinical presentations and not consulting ID physicians early enough were also reported as a contributing factor to delays. Responses recorded in open-text fields also indicated errors related to testing as a likely cause of delays; specifically, test-related errors included ordering the wrong laboratory test, laboratory delays (specialized labs not available at the facility), and lab processing delays. CONCLUSIONS Diagnostic delays commonly occur for the infectious diseases we considered. The contributing factors we identified are potential targets for future interventions to decrease diagnostic delays.
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Affiliation(s)
- Manish Suneja
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Susan E Beekmann
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Gurpreet Dhaliwal
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA
- Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Aaron C Miller
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Philip M Polgreen
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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Jin Y, Zhou W, Zhan Q, Chen Y, Luo Q, Shen P, Xiao Y. Genomic epidemiology and characterisation of penicillin-sensitive Staphylococcus aureus isolates from invasive bloodstream infections in China: an increasing prevalence and higher diversity in genetic typing be revealed. Emerg Microbes Infect 2022; 11:326-336. [PMID: 34991434 PMCID: PMC8786255 DOI: 10.1080/22221751.2022.2027218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Many countries have reported increasing rates of penicillin-susceptible methicillin-sensitive Staphylococcus aureus (MSSA-PENS). To date, there is relatively little known about the current situation and molecular characteristics of MSSA-PENS in China. In this study, we carried out a laboratory-based multi-region retrospective study to investigate the genomic epidemiology and characterisation of MSSA-PENS isolated from invasive bloodstream infections (BSIs) across 17 provinces. The prevalence of MSSA-PENS isolates increased significantly over the 6-year period, with the proportion increasing from 3.51% in 2014-8.80% in 2019, an average relative increase of 22.14% per year (95% confidence interval 9.67%-34.61%, P for trend <0.001), suggesting that China is experiencing a resurgence of MSSA-PENS. Phylogenetic analysis showed a higher strain diversity occurred; the most frequent clonal complexes (CCs) identified were CC188 (17.14%), CC398 (15.71%) and CC5 (15.71%). Over half of MSSA-PENS strains were pan-susceptible, with erythromycin the most frequent resistance observed. Moreover, 25 isolates were identified as immune evasion cluster negative, including CC15, CC188 and CC1, and 6 strains encoded the Panton-Valentine leucocidin gene. Importantly, virulence assays showed that MSSA-PENS exhibited a level of virulence comparable to that of penicillin-resistant MSSA (MSSA-PENR), indicating that more-sensitive strains should not be mistaken for lacking aggressiveness in vivo. Furthermore, 11 of these isolates were confirmed as blaZ positive but phenotype sensitive, with different amino acid changes in blaZ. Our data support the recommendation to clinicians regarding the usage of penicillin in invasive BSIs caused by MSSA-PENS, which might create a novel opportunity for better antimicrobial stewardship in the future.
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Affiliation(s)
- Ye Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wangxiao Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qing Zhan
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China
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50
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Punj J, Chaudhry R, Sagar T, Chandran D. Aerobic and anerobic contamination of mobile phones of health personnels with probable transfer of bacterial microbes to their hands at a tertiary care hospital of India. J Anaesthesiol Clin Pharmacol 2022; 38:405-410. [PMID: 36505191 PMCID: PMC9728432 DOI: 10.4103/joacp.joacp_535_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Mobile phone (MP) contamination of health personnels (HPs) in hospitals is a potential health hazard to the patients and the HP themselves. However, transfer of microbes from MPs of HP to their hands has not been demonstrated before, which would make potential threat into an actual peril. The primary objective was to determine aerobic and anerobic bacterial contamination of MP and hands of HP. The secondary objective was to determine probable transfer of bacterial microbes from MP to hands of tested HP. Material and Methods Three swabs each were taken from 374 HP first from their MP, second from their dominant hand and third from their dominant hand after cleaning with disinfectant followed by a mock phone call of one minute (DHM). Aerobic and anerobic bacterial microbes were identified with standard methods. Results Three hundred twenty-two HPs were recruited. Bacterial contamination was seen in 92% MP, 85% dominant hands, and 68% DHM of tested HP. Of these, contamination with potentially pathogenic bacterias (PPB) was 50% in MP, 25.6% in hands, and 31% in DHM. Anerobic contamination (1.6%) was present on MP but not in hands or DHM. In 54.7% HP, there was presence of similar bacterial microbes in MP and DHM of which 30% were PPB. When disinfectant was used in non-protocolized way in DHM, decrease in aerobic spore forming bacteria (ASB) was seen but not of gram-positive and gram-negative bacterial microbes. Conclusion There is significant aerobic bacterial contamination, including PPB, seen in MP, hands, and DHM of HP in a tertiary care hospital of India; however, anerobic bacterias are found only in MP. Similar bacterial microbes in MP and DHM point to probable transfer of aerobic bacterias from MP to hands of HP which does not decrease when hand disinfectants are used in non-protocolized way, which is a point of concern.
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Affiliation(s)
- Jyotsna Punj
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Jyotsna Punj, Department of Anesthesiology, Pain Medicine and Critical Care, Room No. 5016, Academic Block, All India Institute of Medical Sciences, New Delhi - 110 029, India. E-mail:
| | - Rama Chaudhry
- Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanu Sagar
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Dinu Chandran
- Physiology, All India Institute of Medical Sciences, New Delhi, India
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