Levofloxacin does not decrease mortality in <i>Staphylococcus aureus</i> bacteraemia when added to the standard treatment: a prospective and randomized clinical trial of 381 patients

Ruotsalainen, Eeva; Järvinen, Asko; Koivula, Irma; Kauma, Heikki; Rintala, Esa; Lumio, Jukka; Kotilainen, Pirkko; Vaara, Martti; Nikoskelainen, J; Valtonen, Ville

doi:10.1111/j.1365-2796.2005.01598.x

Cited by 52 publications

(77 citation statements)

References 47 publications

(75 reference statements)

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“…The addition of gentamicin has similarly been associated with greater toxicity for no mortality benefit (43,122) and likewise is no longer recommended (172). With the exception of adjunctive levofloxacin, which did not result in improved outcomes for the treatment of quinolone-sensitive SAB episodes in a randomized trial (247), other combinations remain limited to in vitro data and case reports, with variable successes (211).…”

Section: Antibiotic Choicementioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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SUMMARY Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these patients will die from SAB. Comparatively, this accounts for a greater number of deaths than for AIDS, tuberculosis, and viral hepatitis combined. Multiple factors influence outcomes for SAB patients. The most consistent predictor of mortality is age, with older patients being twice as likely to die. Except for the presence of comorbidities, the impacts of other host factors, including gender, ethnicity, socioeconomic status, and immune status, are unclear. Pathogen-host interactions, especially the presence of shock and the source of SAB, are strong predictors of outcomes. Although antibiotic resistance may be associated with increased mortality, questions remain as to whether this reflects pathogen-specific factors or poorer responses to antibiotic therapy, namely, vancomycin. Optimal management relies on starting appropriate antibiotics in a timely fashion, resulting in improved outcomes for certain patient subgroups. The roles of surgery and infectious disease consultations require further study. Although the rate of mortality from SAB is declining, it remains high. Future international collaborative studies are required to tease out the relative contributions of various factors to mortality, which would enable the optimization of SAB management and patient outcomes.

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Section: Antibiotic Choicementioning

confidence: 99%

Predictors of Mortality in Staphylococcus aureus Bacteremia

et al. 2012

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“…24 We prospectively randomized 49 adult patients with SAB (trovafloxacin treatment) between January 1999 and May 1999, and 381 patients with SAB (levofloxacin treatment) between January 2000 and August 2002 in five university hospitals and in seven tertiary care hospitals in Finland. All patients were prospectively followed up for 3 months during the course of SAB.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…Definitions for other clinical manifestations have been introduced in our previously published articles. 11,24 Bacterial strains…”

Section: Definitionsmentioning

confidence: 99%

Methicillin-sensitive Staphylococcus aureus bacteraemia and endocarditis among injection drug users and nonaddicts: Host factors, microbiological and serological characteristics

Ruotsalainen¹,

Kardén-Lilja²,

Kuusela³

et al. 2008

Journal of Infection

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“…We prospectively collected 430 adult patients with blood cultures positive for methicillin-sensitive S. aureus (MSSA). Twelve university or central hospitals in Finland participated in this study between January 1999 and May 1999 and between January 2000 and August 2002 (36). In this study, 43 IDUs and 44 group-matched nonaddicts as controls were included (Table 1) (37).…”

Section: Methodsmentioning

confidence: 99%

“…aureus identification and DNA isolation. Routine bacteriological methods were used to detect S. aureus grown in blood (36). Total S. aureus DNA was isolated with the Promega Wizard DNA purification kit (Promega, Mannheim, Germany) according to the manufacturer's instructions.…”

Section: Methodsmentioning

confidence: 99%

Characterization of Infecting Strains and Superantigen-Neutralizing Antibodies in Staphylococcus aureus Bacteremia

Grumann

Ruotsalainen

Kolata

et al. 2011

Clin Vaccine Immunol

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Staphylococcus aureus superantigens (SAgs) are highly potent T cell mitogens. Antibodies against nonenterotoxin gene cluster (non-egc) SAgs are common in healthy adults, whereas neutralizing antibodies against egc SAgs are rare. We investigated the infecting S. aureus strains and the anti-SAg antibody response during S. aureus bacteremia (SAB). This prospective clinical study (www.clinicaltrials.gov, NCT00548002) included 43 injection drug users (IDUs) and 44 group-matched nonaddicts with SAB. spa genotypes and SAg gene patterns (multiplex PCR) of the S. aureus isolates were determined. The neutralizing capacities of sera obtained at the acute phase and the convalescent phase of SAB were tested against the SAg cocktail of the respective infecting strain and a panel of recombinant SAgs. The lineages CC59 and CC30 were more prevalent among bacteremia strains from IDUs than among strains from nonaddicts. SAg gene patterns in isolates from IDUs and nonaddicts were similar. At the acute phase of bacteremia, IDUs had more neutralizing antibodies against non-egc SAgs than did nonaddicts. Antibody titers frequently increased during infection. In contrast, there were no neutralizing antibodies against egc SAgs at disease onset and such antibodies were not induced by SAB. SAB triggers an antibody response only against non-egc SAgs. Preimmunization in IDU patients is probably due to previous exposure to the infecting strain.Staphylococcus aureus is a major human pathogen that causes a wide spectrum of infections, such as toxin-mediated diseases and systemic infections, for instance, bacteremia and endocarditis. At the same time, S. aureus is a commensal that colonizes approximately 35% of the healthy population in the nose (46,48).Among the numerous toxins of S. aureus are the 21 known staphylococcal superantigens (SAgs): the toxic shock syndrome toxin (TSST-1), the staphylococcal enterotoxins (SEA to SEE and SEG to SEJ), and the staphylococcal enterotoxin-like toxins (SElK to SElU) (13,24,33,35,38). They are encoded on mobile genetic elements, like phages and pathogenicity islands (25). SAgs are the causative agents of food poisoning and toxic shock syndrome, but their role in bacteremia is not well defined (13, 28). They can activate a large fraction of T lymphocytes by directly cross-linking certain T cell receptor V␤ domains with conserved structures on major histocompatibility complex class II (MHC II) molecules. This results in a polyclonal T cell activation and massive cytokine release.The more recently described enterotoxin gene cluster (egc) harbors five or six SAg genes (seg, sei, selm, seln, selo, and sometimes selu), which cluster on a staphylococcal pathogenicity island (Sa␤) (17,23). In contrast to the non-egc SAgs, the egc is organized as an operon, and its genes are transcribed into a polycistronic mRNA (17). The egc genes are the most prevalent SAg genes in commensal and invasive S. aureus isolates, with frequencies ranging between 52 and 66% (4, 9, 14).

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Levofloxacin does not decrease mortality in Staphylococcus aureus bacteraemia when added to the standard treatment: a prospective and randomized clinical trial of 381 patients

Cited by 52 publications

References 47 publications

Predictors of Mortality in Staphylococcus aureus Bacteremia

Predictors of Mortality in Staphylococcus aureus Bacteremia

Methicillin-sensitive Staphylococcus aureus bacteraemia and endocarditis among injection drug users and nonaddicts: Host factors, microbiological and serological characteristics

Characterization of Infecting Strains and Superantigen-Neutralizing Antibodies in Staphylococcus aureus Bacteremia

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