Archive for July 11, 2016

Morbimortality in adult patients with septic arthritis: a three-year hospital-based study.

BMC Infect Dis. 2016 Jun 1;16(1):239.

Ferrand J1, El Samad Y2, Brunschweiler B3, Grados F1, Dehamchia-Rehailia N1, Séjourne A1, Schmit JL2, Gabrion A3, Fardellone P1, Paccou J4.

Author information

1Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France.

2Department of Infectious Diseases, Amiens University Hospital, F-80054, Amiens, France.

3Department of Orthopaedics, Amiens University Hospital, F-80054, Amiens, France.

4Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France. julienpaccou@yahoo.fr

Abstract

BACKGROUND:

The objective of this ambispective study was to determine outcomes and associated factors for adult patients with confirmed septic arthritis (SA).

METHODS:

All adult patients admitted to Amiens University Hospital between November 2010 and December 2013 with confirmed SA were included in the study. Patients with prosthetic joint infections were excluded. A statistical analysis was performed in order to identify risk factors associated with a poor outcome (including mortality directly attributable to SA).

RESULTS:

A total of 109 patients (mean ± SD age: 60.1 ± 20.1; 74 male/35 females) were diagnosed with SA during the study period. The most commonly involved sites were the small joints (n = 34, 31.2 %) and the knee (n = 25, 22.9 %). The most frequent concomitant conditions were cardiovascular disease (n = 45, 41.3 %) and rheumatic disease (n = 39, 35.8 %). One hundred patients (91.7 %) had a positive microbiological culture test, with Staphylococcus aureus as the most commonly detected pathogen (n = 59, 54.1 %). Mortality directly attributable to SA was relatively infrequent (n = 6, 5.6 %) and occurred soon after the onset of SA (median [range]: 24 days [1-42]). Major risk factors associated with death directly attributable to SA were older age (p = 0.023), high C-reactive protein levels (p = 0.002), diabetes mellitus (p = 0.028), rheumatoid arthritis and other inflammatory rheumatic diseases (p = 0.021), confusion on admission (p = 0.012), bacteraemia (p = 0.015), a low creatinine clearance rate (p = 0.009) and the presence of leg ulcers/eschars (p = 0.003). The median duration of follow-up (in patients who survived for more than 6 months) was 17 months [6-43]. The proportion of poor functional outcomes was high (31.8 %). Major risk factors associated with a poor functional outcome were older age (0.049), hip joint involvement (p = 0.003), the presence of leg ulcers/eschars (p = 0.012), longer time to presentation (0.034) and a low creatinine clearance rate (p = 0.013).

CONCLUSIONS:

In a university hospital setting, SA is still associated with high morbidity and mortality rates.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888402/pdf/12879_2016_Article_1540.pdf

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July 11, 2016 at 3:18 pm

Bacteremia due to ESKAPE pathogens: An emerging problem in cancer patients.

J Egypt Natl Canc Inst. 2016 Jun 3. pii: S1110-0362(16)30028-0.

El-Mahallawy HA1, Hassan SS2, El-Wakil M3, Moneer MM4.

Author information

1Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

2Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt. Electronic address: safaa_shawky@hotmail.com

3Clinical Oncology Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt.

4Biostatistics and Cancer Epidemiology Department, National Cancer Institute, Cairo University, Cairo, Egypt.

Abstract

BACKGROUND AND AIM:

In recent years, a few of the antibiotic-resistant bacteria, known as ESKAPE pathogens, have been found responsible for serious infections. We investigated the risk factors, and impact of ESKAPE pathogens on course of blood stream infections (BSIs) in cancer patients in comparison to coagulase negative Staphylococci (CoNS).

PATIENTS AND METHODS:

The data of patients with ESKAPE positive blood cultures at National Cancer Institute, Cairo University were analyzed. Identification and antimicrobial susceptibility of isolates were done using Microscan Walk Away 96.

RESULTS:

In a 6month period, ESKAPE pathogens were isolated from non-duplicate blood cultures in 81 episodes of 72 cases of pediatric cancer patients, while CoNS were isolated from 135 blood cultures of 116 patients. The ESKAPE pathogens isolated were Enterobacter spp., methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococci in 12%, 23%, 37%, 10%, 9%, and 9% of episodes, respectively. Health-care acquired infections constituted 75% of ESKAPE infections. Duration of episodes and overall mortality were significantly higher in ESKAPE BSIs when compared to CoNS (14.5±7.6 versus 09.9±6.9), and (26% versus 4%); respectively, p value <0.001.

CONCLUSIONS:

ESKAPE pathogens were significantly associated with higher rates of morbidity and mortality indicating the need for improving the means of prevention of these types of infections within health care premises. Microbiology laboratories have a role in defining more dangerous infections and rapid diagnostics are required in the era of resistance.

PDF

http://ac.els-cdn.com/S1110036216300280/1-s2.0-S1110036216300280-main.pdf?_tid=976f4954-4759-11e6-be2b-00000aab0f26&acdnat=1468236260_e529acd92aab96e31a63dadcb9d569b3

July 11, 2016 at 3:17 pm

Antibiotic susceptibility and genomic variations in Staphylococcus aureus associated with Skin and Soft Tissue Infection (SSTI) disease groups.

BMC Infect Dis. 2016 Jun 10;16(1):276.

Changchien CH1, Chen SW2, Chen YY1, Chu C3.

Author information

1Department of Plastic and Reconstructive Surgery, Chiayi Christian Hospital, 539 Jhongsiao Rd., Chiayi City, 60002, Taiwan, Republic of China.

2Department of Microbiology, Immunology, and Biopharmaceuticals, National Chiayi University, No 300, University Road, Chiayi, 60004, Taiwan, Republic of China.

3Department of Microbiology, Immunology, and Biopharmaceuticals, National Chiayi University, No 300, University Road, Chiayi, 60004, Taiwan, Republic of China. cschu@mail.ncyu.edu.tw

Abstract

BACKGROUND:

Staphylococcus aureus is associated with human skin and soft tissue infections (SSTIs); however, the involvement of virulence factors in different clinical presentations is unclear.

METHODS:

We analyzed methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains from Taiwan to determine correlations among the clinical characteristics of SSTIs, antimicrobial susceptibility and virulence factors of S. aureus with specific genetic backgrounds.

RESULTS:

We identified 177 MRSA isolates and 130 MSSA isolates among the 307 SSTI-associated S. aureus isolates. Hospital-acquired (HA)- and community-acquired (CA)-MRSA isolates accounted for 61.6 % and 38.4 % of the isolates, respectively. Clinical presentations in SSTI patients differed significantly for the disease groups. Deep-seated MRSA infections presented with higher amputation rate than MSSA infections. MRSA isolates were all susceptible to linezolid, teicoplanin, and vancomycin, and >94 % of isolates were erythromycin- and clindamycin-resistant. Staphylococcal cassette chromosome (SCCmec) types IV, V, and VII were the most frequent in the CA-MRSA group (n = 68); types III, IV and V were the most frequent in the HA-MRSA group (n = 109). Panton-Valentine leukocidin (PVL) genes were significantly more frequent in CA-MRSA strains (75.0 %) than in HA-MRSA (33.0 %) and MSSA (24.6 %) and were found in 66.7 % (74/111) strains isolated from the abscess group. Exfoliatin A genes were more common in catheter-related exit-site MSSA infections (37.5 %) compared with other MSSA disease groups (P < 0.05). Exfoliatin B and superantigen exotoxin genes were uncommon in all SSTI disease types. Pulsotypes A (ST239), C, and D (ST59) were the predominant MRSA genotypes in deep-seated infections.

CONCLUSIONS:

If not treated appropriately, deep-seated MRSA-associated infections present with higher amputation rates than deep-seated MSSA-associated infections. PVL-positive MRSA strains caused more frequently pus-forming lesions and less bacteremia and invasive diseases. Methods for discriminating CA-MRSA from HA-MRSA strains are now unreliable due to circulation of both ST 239 and ST 59 strains in the community and nosocomial settings. Initial antibiotic treatments should consider MRSA for patients with SSTIs in areas where MRSA is prevalent.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902997/pdf/12879_2016_Article_1630.pdf

July 11, 2016 at 3:15 pm

Sending repeat cultures: is there a role in the management of bacteremic episodes? (SCRIBE study).

BMC Infect Dis. 2016 Jun 13;16(1):286.

Wiggers JB1, Xiong W2, Daneman N3,4,5,6.

Author information

1Department of Medicine, University of Toronto, Toronto, Canada.

2Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.

3Department of Medicine, University of Toronto, Toronto, Canada. nick.daneman@sunnybrook.ca

4Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. nick.daneman@sunnybrook.ca

5Institute for Clinical Evaluative Sciences, Toronto, Canada. nick.daneman@sunnybrook.ca

6Division of Infectious Diseases & Clinical Epidemiology, Sunnybrook Health Sciences Centre, University of Toronto, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave, G-wing Room 106, Toronto, M4N 3 M5, Canada. nick.daneman@sunnybrook.ca

Abstract

BACKGROUND:

In the management of bacteremia, positive repeat blood cultures (persistent bacteremia) are associated with increased mortality. However, blood cultures are costly and it is likely unnecessary to repeat them for many patients. We assessed predictors of persistent bacteremia that should prompt repeat blood cultures.

METHODS:

We conducted a retrospective cohort study of bacteremias at an academic hospital from April 2010 to June 2014. We examined variables associated with patients undergoing repeat blood cultures, and with repeat cultures being positive. A nested case control analysis was performed on a subset of patients with repeat cultures.

RESULTS:

Among 1801 index bacteremias, repeat cultures were drawn for 701 patients (38.9 %), and 118 persistent bacteremias (6.6 %) were detected. Endovascular source (adjusted odds ratio [aOR], 7.66; 95 % confidence interval [CI], 2.30-25.48), epidural source (aOR, 26.99; 95 % CI, 1.91-391.08), and Staphylococcus aureus bacteremia (aOR, 4.49; 95 % CI, 1.88-10.73) were independently associated with persistent bacteremia. Escherichia coli (5.1 %, P = 0.006), viridans group (1.7 %, P = 0.035) and β-hemolytic streptococci (0 %, P = 0.028) were associated with a lower likelihood of persistent bacteremia. Patients with persistent bacteremia were less likely to have achieved source control within 48 h of the index event (29.7 % vs 52.5 %, P < .001), but after variable reduction, source control was not retained in the final multivariable model.

CONCLUSIONS:

Patients with S. aureus bacteremia or endovascular infection are at risk of persistent bacteremia. Achieving source control within 48 h of the index bacteremia may help clear the infection. Repeat cultures after 48 h are low yield for most Gram-negative and streptococcal bacteremias

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4906775/pdf/12879_2016_Article_1622.pdf

July 11, 2016 at 8:43 am

Rapid, Culture-Free Detection of Staphylococcus aureus Bacteremia.

PLoS One. 2016 Jun 15;11(6):e0157234.

Burghardt EL1, Flenker KS1, Clark KC1, Miguel J1, Ince D1, Winokur P1, Ford B2, McNamara JO 2nd1.

Author information

1Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America.

2Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America.

Abstract

S. aureus bacteremia (SAB) is a common condition with high rates of morbidity and mortality. Current methods used to diagnose SAB take at least a day, and often longer. Patients with suspected bacteremia must therefore be empirically treated, often unnecessarily, while assay results are pending. In this proof-of-concept study, we describe an inexpensive assay that detects SAB via the detection of micrococcal nuclease (an enzyme secreted by S. aureus) in patient plasma samples in less than three hours. In total, 17 patient plasma samples from culture-confirmed S. aureus bacteremic individuals were tested. 16 of these yielded greater nuclease assay signals than samples from uninfected controls or individuals with non-S. aureus bacteremia. These results suggest that a nuclease-detecting assay may enable the rapid and inexpensive diagnosis of SAB, which is expected to substantially reduce the mortality and morbidity that result from this condition.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909304/pdf/pone.0157234.pdf

July 11, 2016 at 8:41 am

Association between Accessory Gene Regulator Polymorphism and Mortality among Critically Ill Patients Receiving Vancomycin for Nosocomial MRSA Bacteremia: A Cohort Study.

Can J Infect Dis Med Microbiol. 2016;2016:8163456.

Cechinel A1, Machado DP1, Turra E1, Pereira D1, Dos Santos RP2, Rosa RG1, Goldani LZ1.

Author information

1Infectious Diseases Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 90035-903 Porto Alegre, RS, Brazil.

2Hospital Infection Control Section, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, 90035-903 Porto Alegre, RS, Brazil.

Abstract

Background. Polymorphism of the accessory gene regulator group II (agr) in methicillin-resistant Staphylococcus aureus (MRSA) is predictive of vancomycin failure therapy. Nevertheless, the impact of group II agr expression on mortality of patients with severe MRSA infections is not well established. Objective. The goal of our study was to evaluate the association between agr polymorphism and all-cause in-hospital mortality among critically ill patients receiving vancomycin for nosocomial MRSA bacteremia. Methods. All patients with documented bacteremia by MRSA requiring treatment in the ICU between May 2009 and November 2011 were included in the study. Cox proportional hazards regression was performed to evaluate whether agr polymorphism was associated with all-cause in-hospital mortality. Covariates included age, APACHE II score, initial C-reactive protein plasma levels, initial serum creatinine levels, vancomycin minimum inhibitory concentration, vancomycin serum levels, and time to effective antibiotic administration. Results. The prevalence of group I and group II agr expression was 52.4% and 47.6%, respectively. Bacteremia by MRSA group III or group IV agr was not documented in our patients. The mean APACHE II of the study population was 24.3 (standard deviation 8.5). The overall cohort mortality was 66.6% (14 patients). After multivariate analysis, initial plasma C-reactive protein levels (P = 0.01), initial serum creatinine levels (P = 0.008), and expression of group II agr (P = 0.006) were positively associated with all-cause in-hospital mortality. Patients with bacteremia by MRSA with group II agr expression had their risk of death increased by 12.6 times when compared with those with bacteremia by MRSA with group I agr expression. Conclusion. Group II agr polymorphism is associated with an increase in mortality in critically ill patients with bacteremia by MRSA treated with vancomycin.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4904565/pdf/CJIDMM2016-8163456.pdf

July 11, 2016 at 8:40 am

Analysis of Staphylococcal Toxins and Clinical Outcomes of MRSA Bacteremia.

Biol Pharm Bull. 2016;39(7):1195-200.

Maeda M1, Shoji H, Shirakura T, Takuma T, Ugajin K, Fukuchi K, Niki Y, Ishino K.

Author information

1Division of Infection Control Sciences, Department of Pharmacotherapeutics, School of Pharmacy, Showa University.

Abstract

It is well known that methicillin-resistant Staphylococcus aureus (MRSA) produces many virulence factors, such as hemolysins, leukocidins, proteases, enterotoxins, exfoliative toxins, and immune-modulatory factors. The aim of study was to identify staphylococcal pathogenicity that may affect the prognosis of patients with MRSA bacteremia. We obtained 149 MRSA strains from blood cultures between January 2009 and December 2014 in our institution. We collected information on patient characteristics, laboratory data, staphylococcal toxin genes, and susceptibility of the strain toward anti-MRSA agent and analyzed them as factors contributing to 30-d mortality. The “survival” and “dead” groups consisted of 103 and 46 patients, respectively. Multiple logistic regression analysis showed a four-fold increase in the risk of mortality in patients exhibiting isolated MRSA with staphylococcal enterotoxins (SEs) genes as well as toxic shock syndrome toxin-1 (TSST-1) genes [odds ratio: 3.89; 95% confidence interval: 1.20-12.60; p=0.024]. Kaplan-Meier analysis also showed significantly higher mortality in patient with isolated MRSA with SEs and TSST-1 genes. After adjusting for confounders, the coexistence of SEs and TSST-1 were independently associated with the 30-d mortality compared with treatment and susceptibility. The coexistence of superantigenic toxin genes greatly affects the clinical course and prognosis of patients with MRSA bacteremia.

PDF

https://www.jstage.jst.go.jp/article/bpb/39/7/39_b16-00255/_pdf

July 11, 2016 at 8:38 am


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