Prevalence and Mortality Associated with Bloodstream Organisms: a Population-Wide Retrospective Cohort Study

Verway, Mark; Brown, Kevin A.; Marchand-Austin, Alex; Diong, Christina; Lee, Samantha; Langford, Bradley J; Schwartz, Kevin L; MacFadden, Derek R.; Patel, Samir N.; Sander, Beate; Johnstone, Jennie; Garber, Gary; Daneman, Nick

doi:10.1128/jcm.02429-21

Cited by 47 publications

(47 citation statements)

References 15 publications

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“…In Australia in 2017, 30-day mortality related to episodes of methicillin-resistant S. aureus (MRSA) infection was 18.9% [4]. Overall unadjusted inhospital mortality in the USA between 2012 and 2017 was 18%, within the range of case fatality reports from other high-income countries between 15 and 23% [5][6][7]. Additionally, up to 40% of patients with MRSA bacteraemia experience acute kidney injury (AKI) [8].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Nephrotoxicity in Methicillin-Resistant Staphylococcus aureus Bacteraemia: A Post Hoc Analysis of the CAMERA2 Trial

et al. 2022

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Background Clinical risk factors for nephrotoxicity in Staphylococcus aureus bacteraemia remain largely undetermined, despite its common occurrence and clinical significance. In an international, multicentre, prospective clinical trial (CAM-ERA2), which compared standard therapy (vancomycin monotherapy) to combination therapy (adding an anti-staphylococcal beta-lactam) for methicillin-resistant S. aureus bacteraemia, significantly more people in the combination therapy arm experienced acute kidney injury compared with those in the monotherapy arm (23% vs 6%). Objective The aim of this post hoc analysis was to explore in greater depth the risk factors for acute kidney injury from the CAMERA2 trial. Methods Among participants of the CAMERA2 trial, demographic-related, infection-related and treatment-related risk factors were assessed for their relationship with acute kidney injury by univariable and multivariable logistic regression. Acute kidney injury was defined by a modified-KDIGO (Kidney Disease: Improving Global Outcomes) criteria (not including urinary output). Results Of the 266 participants included, age (p = 0.04), randomisation to combination therapy (p = 0.002), vancomycin area under the concentration-time curve (p = 0.03) and receipt of (flu)cloxacillin as the companion beta-lactam (p < 0.001) were significantly associated with acute kidney injury. On a multivariable analysis, concurrent use of (flu)cloxacillin increased the risk of acute kidney injury over four times compared with the use of cefazolin or no beta-lactam. The association of vancomycin area under the concentration-time curve with acute kidney injury also persisted in the multivariable model. Conclusions For participants receiving vancomycin for S. aureus bacteraemia, use of (flu)cloxacillin and increased vancomycin area under the concentration-time curve were risk factors for acute kidney injury. These represent potentially modifiable risk factors for nephrotoxicity and highlight the importance of avoiding the use of concurrent nephrotoxins.Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Nephrotoxicity in Methicillin-Resistant Staphylococcus aureus Bacteraemia: A Post Hoc Analysis of the CAMERA2 Trial

et al. 2022

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“…The study was made possible by the availability of province-wide microbiology results from the Ontario Laboratories Information System (OLIS), combining data form more than 100 hospital, community and public health laboratories into a single repository. 2 , 3 OLIS is linkable to administrative datasets from Ontario's universal healthcare system, via a unique and confidential identifier held at ICES (formerly, the Institute for Clinical Evaluative Sciences). ICES is an independent, non-profit research institute whose legal status under Ontario's health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement.…”

Section: Methodsmentioning

confidence: 99%

“…In Ontario, Canada's most populous province with more than 14 million residents, we have recently linked microbiology test results to healthcare administrative datasets, 2 such that it is now possible to study the relative risk of death among drug-resistant versus drug-susceptible pathogens, after accounting for patient risk factors allowing for a more accurate estimate of mortality associated with bacterial drug resistance. In this study, we focused on bloodstream infections with E. coli , the most common bloodstream pathogen and the leading pathogen among AMR-associated deaths, 1 , 2 to determine the extent to which AMR is associated with an increased odds of death in the context of a well-resourced healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial resistance and mortality following E. coli bacteremia

Daneman¹,

Fridman²,

Johnstone³

et al. 2023

eClinicalMedicine

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“…Gram-negative bacterial bloodstream infection (GN-BSI) is a common medical problem associated with high mortality rates of 13% to 20%. 1 , 2 Despite its frequency and severity, the optimal management of GN-BSI is unclear. For example, routinely obtaining follow-up blood cultures (FUBCs) to document clearance of bloodstream infection (BSI) is standard practice in patients with Staphylococcus aureus BSI but is controversial in patients with GN-BSI.…”

Section: Introductionmentioning

confidence: 99%

Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections

et al. 2022

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ImportanceObtaining follow-up blood cultures (FUBCs) in patients with Staphylococcus aureus bloodstream infection (BSI) is standard practice, although its utility in patients with gram-negative bacterial BSI (GN-BSI) is unclear.ObjectiveTo examine whether obtaining FUBCs is associated with decreased mortality (key question [KQ] 1) and whether positive vs negative FUBCs are associated with increased mortality (KQ2).Data SourcesMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and gray literature were searched from inception to March 11, 2022.Study SelectionTwo investigators used predefined eligibility criteria to independently screen titles, abstracts, and relevant full texts. Randomized clinical trials or observational studies that matched or statistically adjusted for differences in, at minimum, level of acute illness between patients in the intervention (eg, FUBCs obtained) and control (eg, FUBCs not obtained) groups were included in primary analyses. Articles published in languages other than English were excluded.Data Extraction and SynthesisData abstraction and quality assessments were performed by one investigator and verified by a second investigator. Risk of bias was assessed with the Newcastle-Ottawa Scale. Effect sizes were pooled using random-effects models. The study followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.Main Outcomes and MeasuresMortality before hospital discharge or up to 30 days from the index blood culture.ResultsFrom 3495 studies, 15 were included (all nonrandomized). In the 5 studies (n = 4378 patients) that met criteria for the KQ1 primary analysis, obtaining FUBCs was associated with decreased mortality (hazard ratio, 0.56; 95% CI, 0.45-0.71). For KQ2, 2 studies met criteria for the primary analysis (ie, matched or statistically adjusted for differences in patients with positive vs negative FUBCs), so an exploratory meta-analysis of all 9 studies that investigated KQ2 (n = 3243 patients) was performed. Positive FUBCs were associated with increased mortality relative to negative blood cultures (odds ratio, 2.27; 95% CI, 1.54-3.34). Limitations of the literature included a lack of randomized studies and few patient subgroup analyses.Conclusions and RelevanceIn this systematic review and meta-analysis, obtaining FUBCs in patients with GN-BSI was associated with decreased mortality. The benefit of FUBCs may stem from identification of patients with positive FUBCs, which was a poor prognostic marker.

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Prevalence and Mortality Associated with Bloodstream Organisms: a Population-Wide Retrospective Cohort Study

Abstract: Bloodstream infections (BSIs) represent a substantial mortality risk, yet most studies are limited to select pathogens or populations. The aim of this study was to describe the population-wide prevalence of BSIs and examine the associated mortality risk for the responsible microorganisms.

Cited by 47 publications

References 15 publications

Risk Factors for Nephrotoxicity in Methicillin-Resistant Staphylococcus aureus Bacteraemia: A Post Hoc Analysis of the CAMERA2 Trial

Risk Factors for Nephrotoxicity in Methicillin-Resistant Staphylococcus aureus Bacteraemia: A Post Hoc Analysis of the CAMERA2 Trial

Antimicrobial resistance and mortality following E. coli bacteremia

Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections

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