Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection

Powers, Caroline; Bookstaver, P Brandon; Caulder, Celeste R.; Bouknight, Abigail; Justo, Julie Ann; Kohn, Joseph; Winders, Hana R; Al-Hasan, Majdi N.

doi:10.1007/s15010-022-01754-6

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Source control included removal of the invasive device, surgery, debridement, incision and drainage. Clinical stability was defined as achieving normal systolic blood pressure (≥100 mmHg), temperature (36 to 38 °C), heart rate (≤100 beats/min) and respiratory rate (<22 breaths/min) after appropriate treatment [ 20 ]. Length of stay was defined as length of time that elapsed between ASE BSI and discharge/death.…”

Section: Methodsmentioning

confidence: 99%

Clinical Impact of Vancomycin Treatment in Ampicillin-Susceptible Enterococci Bloodstream Infections

2022

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Enterococci are major causes of bacteremia. Although the mortality rate of ampicillin- susceptible enterococci (ASE) bloodstream infections (BSI) is lower, compared with that of ampicillin-resistant enterococci BSI, the role of treatment regimens in ASE BSI remains to be determined. This retrospective study aimed to evaluate the treatment outcomes and factors associated with mortality among patients with ASE BSI. The charts of 145 enrolled patients with ASE BSI between January 2013 and April 2022 at Phramongkutklao Hospital were reviewed. The 30-day and in-hospital mortality rates were 28.8 and 41.9%, respectively. The 30-day mortality rate was higher in the vancomycin treatment group than in the beta-lactam treatment group (61.5 vs. 26%; p = 0.02). Pitt bacteremia score (OR 1.44, 95% CI 1.20–1.71); age-adjusted Charlson Comorbidity Index (OR 1.34, 95% CI 1.14–1.58); and vancomycin treatment (OR 4.07, 95% CI 1.02–16.22) were independent factors associated with 30-day mortality. The severity of illness, comorbidity and definitive therapy with vancomycin increased the mortality rate of patients with ASE BSI. Anti-enterococcal beta-lactams remain the first line antibiotics for ASE bacteremia.

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Section: Methodsmentioning

confidence: 99%

Clinical Impact of Vancomycin Treatment in Ampicillin-Susceptible Enterococci Bloodstream Infections

2022

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“…Patients may be transitioned to oral antibiotics after nearly 4 days of intravenous therapy in those with a favorable initial clinical response to treatment, as determined by ECFC between 72 and 96 h from index BSIs. The ECFC were previously derived and validated to predict mortality and HLOS in patients with Gram-negative and Enterococcus species BSIs, respectively [ 19 , 20 ]. In the current study, ECFC ≥ 2 were associated with an increased risk of treatment failure and a longer HLOS.…”

Section: Discussionmentioning

confidence: 99%

“…Early clinical failure criteria (ECFC) were used to determine initial response to antibiotic therapy within 72–96 h of an index BSI [ 19 ]. These criteria were derived and validated in patients with a BSI due to Gram-negative and Gram-positive bacteria to predict clinical outcomes such as mortality and HLOS based on initial response to antibiotic therapy [ 19 , 20 ]. ECFC include systolic blood pressure < 100 mmHg or vasopressor use, heart rate > 100 beats per minute, respiratory rate ≥ 22 breaths/minute or mechanical ventilation, altered mental status, and peripheral white blood cell count > 12,000/mm 3 [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Broermann,

Al-Hasan,

Withers

et al. 2023

Microorganisms

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This retrospective cohort study examines effectiveness of partial oral antibiotic regimens in uncomplicated bloodstream infections (BSIs) due to Streptococcus species compared to standard intravenous therapy. Adult patients with uncomplicated streptococcal BSIs from April 2016 to June 2020 in seven hospitals in South Carolina, USA, were evaluated. Multivariate Cox proportional hazards regression was used to examine the time to treatment failure within 90 days of a BSI after adjustment for the propensity to receive partial oral therapy. Multivariate linear regression was used to examine the hospital length of stay (HLOS). Among the 222 patients included, 99 received standard intravenous antibiotics and 123 received partial oral therapy. Of the standard intravenous therapy group, 46/99 (46.5%) required outpatient parenteral antibiotic therapy (OPAT). There was no difference in the risk of treatment failure between partial oral and standard intravenous therapy (hazards ratio 0.53, 95% CI 0.18, 1.60; p = 0.25). Partial oral therapy was independently associated with a shorter HLOS after adjustments for the propensity to receive partial oral therapy and other potential confounders (−2.23 days, 95% CI −3.53, −0.94; p < 0.001). Transitioning patients to oral antibiotics may be a reasonable strategy in the management of uncomplicated streptococcal BSIs. Partial oral therapy does not seem to have a higher risk of treatment failure and may spare patients from prolonged hospitalizations and OPAT complications.

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Incidence and predictors of complications in Gram-negative bloodstream infection

Mondal,

Warren,

Bookstaver

et al. 2024

Infection

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Background The incidence of metastatic complications in Gram-negative bloodstream infection (GN-BSI) remains undefined. This retrospective cohort study examines the incidence and predictors of complications within 90 days of GN-BSI. Methods Patients with GN-BSIs hospitalized at two Prisma Health-Midlands hospitals in Columbia, South Carolina, USA from 1 January 2012 through 30 June 2015 were included. Complications of GN-BSI included endocarditis, septic arthritis, osteomyelitis, spinal infections, deep-seated abscesses, and recurrent GN-BSI. Kaplan–Meier analysis and multivariate Cox proportional hazards regression were used to examine incidence and risk factors of complications, respectively. Results Among 752 patients with GN-BSI, median age was 66 years and 380 (50.5%) were women. The urinary tract was the most common source of GN-BSI (378; 50.3%) and Escherichia coli was the most common bacteria (375; 49.9%). Overall, 13.9% of patients developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from initial GN-BSI. Independent risk factors for complications were presence of indwelling prosthetic material (hazards ratio [HR] 1.73, 95% confidence intervals [CI] 1.08–2.78), injection drug use (HR 6.84, 95% CI 1.63–28.74), non-urinary source (HR 1.98, 95% CI 1.18–3.23), BSI due to S. marcescens, P. mirabilis or P. aeruginosa (HR 1.78, 95% CI 1.05–3.03), early clinical failure criteria (HR 1.19 per point, 95% CI 1.03–1.36), and persistent GN-BSI (HR 2.97, 95% CI 1.26–6.99). Conclusions Complications of GN-BSI are relatively common and may be predicted based on initial clinical response to antimicrobial therapy, follow-up blood culture results, and other host and microbiological factors.

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Evaluation of early clinical failure criteria in Enterococcus species bloodstream infection

Cited by 3 publications

References 15 publications

Clinical Impact of Vancomycin Treatment in Ampicillin-Susceptible Enterococci Bloodstream Infections

Clinical Impact of Vancomycin Treatment in Ampicillin-Susceptible Enterococci Bloodstream Infections

Intravenous versus Partial Oral Antibiotic Therapy in the Treatment of Uncomplicated Bloodstream Infection Due to Streptococcus Species

Incidence and predictors of complications in Gram-negative bloodstream infection

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