Clinical Identifiers of Complicated Staphylococcus aureus Bacteremia

Fowler, Vance G.; Olsen, Maren K.; Corey, G. Ralph; Woods, Christopher W.; Cabell, Christopher H.; Reller, L. Barth; Cheng, Allen; Dudley, Tara K.; Oddone, Eugene Z.

doi:10.1001/archinte.163.17.2066

Cited by 575 publications

(473 citation statements)

References 55 publications

(63 reference statements)

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“…Fowler et al 7 proposed a prognostic model of complicated SAB using the predictors from their study; community acquisition of organisms, persistent bacteremia, persistent fever over 72 hours, and skin examination suggestive of an acute systemic infection. Muder et al 8 reported a relationship between SABU and subsequent SAB, but they did not examine the association between SABU and the risk of complicated SAB.…”

Section: Discussionmentioning

confidence: 99%

“…5 Risk stratification for these complications is a clinical challenge. Fowler et al 7 postulated some clinical identifiers of complicated SAB; however, predicting which patients will develop a complication from SAB remains very difficult. Muder et al 8 demonstrated that the presence of SA bacteriuria (SABU) correlates with subsequent SAB, but a possible association of SABU with complicated bacteremia was not examined.…”

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Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Perez-Jorge

Burdette

Markert

et al. 2010

Journal of Hospital Medicine

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BACKGROUND AND OBJECTIVES:Staphylococcus aureus (SA) bacteremia (SAB) is associated with a high rate of complications, most of which are related to hematogenous seeding into deep tissues or prosthetic material. SA bacteriuria (SABU) has been described in association with SAB, but has not been evaluated as a predictor for complicated bacteremia, which was the objective of our study.METHODS (DESIGN, SETTING, AND PATIENTS):We conducted a retrospective study of patients admitted to the hospital with SAB. The 118 patients included in the study were divided in 2 cohorts: a group with SABU and a group without SA in the urine. We followed the 2 cohorts for an average of 8 months and evaluated the differences in complications and mortality.RESULTS:SABU was found in 28 of 118 patients with SAB. Eighteen patients (64%) in this group had complications from the bacteremia, while in the group without SABU only 33% (30/90 patients) had complications (P = 0.004). The SABU group also had more deaths (32% vs. 14%; P = 0.036).CONCLUSIONS:In this population of hospitalized patients with SAB, the presence of SABU was associated with an increased risk of early complications, including septic shock, and with higher mortality. A routine urine culture in search of SABU may be a helpful tool for detection of those patients with SAB who are at increased risk of complications and death. Journal of Hospital Medicine 2010;5:208–211. © 2010 Society of Hospital Medicine.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Perez-Jorge

Burdette

Markert

et al. 2010

Journal of Hospital Medicine

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“…Producción de penicilinasas. Las bacteriemias por S. aureus presentaban tasas de mortalidad que se acercaban al 80%, y hasta el 70% desarrollaban metástasis infecciosas en la era preantibiótica (1,16,32). La introducción de las benzilpenicilinas al ámbito clínico en 1941, produjo una mejoría notable en el pronóstico de los pacientes, pero en 1942 se identificaron las primeras cepas de S. aureus resistentes a la penicilina.…”

Section: Mecanismos De Resistencia Antibiótica Del S Aureusunclassified

“…El SCCmec puede transportar en forma variable genes de resistencia a otros antibióticos como aminoglucósidos, clindamicina, eritromicina, rifampicina, tetraciclina y trimetoprimsulfametoxazol (16,(32)(33)(34); los SARM adquiridos en el hospital son los que presentan más comúnmente resistencia a estos antibióticos. La expresión fenotípica de estos perfiles de sensibilidad antibiótica se ha utilizado como una herramienta más para clasificar el origen de las cepas de SARM.…”

Section: Mecanismos De Resistencia Antibiótica Del S Aureusunclassified

“…En los Estados Unidos, entre 1980 y 1990, se incrementaron los casos de bacteriemia por S. aureus en 283% en hospitales no universitarios y, en 176%, en hospitales universitarios (7,12,13). Según el lugar de adquisición de la bacteriemia por S. aureus se encuentra que 17% a 49% se originan en la comunidad, 51% a 83% son hospitalarias y 30% a 38% están asociadas con trabajadores de la salud (ver más adelante) (13)(14)(15)(16)(17).…”

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Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

et al. 2007

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Staphylococcus aureus es un patógeno importante que causa cerca de 11% a 33% de las bacteriemias hospitalarias y un porcentaje importante de las adquiridas en la comunidad, con una tasa de complicaciones cercana a 50%. En la siguiente revisión se destaca la epidemiología de la bacteriemia por S. aureus, con especial referencia a la situación de este patógeno en Colombia, la frecuencia y los mecanismos de resistencia a los medicamentos más frecuentemente usados en este contexto, y se discuten los elementos semiológicos, clínicos y de laboratorio que influyen en el enfoque diagnóstico y terapéutico de los pacientes con bacteriemia por este microorganismo.Palabras clave: Staphylococcus aureus/patogenicidad, bacteriemia/terapia, bacteriemia/ epidemiología, agentes antibacterianos/uso terapéutico. Therapeutic approach to Staphylococcus aureus bacteremiaStaphylococcus aureus is an important human pathogen, responsible for 11-33% of the bacteremias acquired in the hospital setting and nearly 50% of those acquired in the community at large. The epidemiology of S. aureus bacteremia is discussed, with an special emphasis on the situation in Colombia and the resistance mechanisms against the major drug groups used for the treatment. The clinical keys and laboratory support for the appropriate clinical approaches are presented together with the therapeutic strategies for the treatment of patients with S. aureus bacteremia.

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A Predictive Model of Recurrent Lower Extremity Cellulitis in a Population-Based Cohort

McNamara

Tleyjeh²,

Berbari³

et al. 2007

Arch Intern Med

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Background: Cellulitis is common and recurs in some patients. The study described herein derived a predictive model for the recurrence of lower extremity cellulitis in a population-based cohort. Methods: We conducted a retrospective, populationbased cohort study using the Rochester Epidemiology Project. We reviewed the medical records of Olmsted County, Minnesota, residents with lower extremity cellulitis occurring from January 1, 1999, to June 30, 2000. Univariate and multivariate Cox proportional hazards analyses were performed to evaluate risk factors in patients who experienced recurrent lower extremity cellulitis within 2 years. A predictive model was developed to estimate risk of recurrence based on a score of risk factors identified by multivariate analysis. Results: A total of 209 episodes met the definition of lower extremity cellulitis. Thirty-five patients (16.7%) experienced recurrence within 2 years. Multivariate analysis identified tibial area involvement, prior malignancy, and dermatitis affecting the ipsilateral limb as independent risk factors for recurrence, with hazard ratios of 5.02, 3.87, and 2.99 (PϽ.01), respectively. A score calculated from these variables (a count of 0, 1, 2, or 3) was developed to measure risk of recurrence. Based on the predictive model, the estimated probability of recurrence (95% confidence interval [CI]) within 2 years was 5.0% (95% CI, 1.6%-8.2%), 17.3% (95% CI, 11.1%-23.0%), 50.6% (95% CI, 34.2%-63.0%), or 92.8% (95% CI, 51.9%-98.9%) for a score of 0, 1, 2 or 3, respectively. Conclusions: We derived a model including tibial area involvement, history of cancer, and dermatitis to predict recurrence of lower extremity cellulitis. Potential interventions can be incorporated into treatment to diminish the proclivity for recurrence in high-risk patients.

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Clinical Identifiers of Complicated Staphylococcus aureus Bacteremia

Abstract: Readily available clinical variables can help identify patients at risk for complicated SAB.

Cited by 575 publications

References 55 publications

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Staphylococcus aureus bacteremia (SAB) with associated S. aureus bacteriuria (SABU) as a predictor of complications and mortality

Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

A Predictive Model of Recurrent Lower Extremity Cellulitis in a Population-Based Cohort

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