Staphylococcus aureus Bacteremia Among Elderly vs Younger Adult Patients

McClelland, R. Scott; Fowler, Vance G.; Sanders, Linda; Gottlieb, Geoffrey S.; Kong, Li; Sexton, Daniel J.; Schmader, Kenneth E.; Lanclos, Kevin; Corey, G. Ralph

doi:10.1001/archinte.159.11.1244

Cited by 121 publications

(94 citation statements)

References 36 publications

(39 reference statements)

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“…In fact, the only independent factor in our population that influenced the attributable mortality was age. Age has been described as correlated to attributable mortality in elderly patients with SAB [19,20]. It is possible that the mortality rate in our cohort was not only attributable to SAB but rather to age which might have annihilated the influence of TTP on mortality.…”

Section: Time To Positivity: Univariate Analysis and Predictive Valuementioning

confidence: 85%

The Association between Time to Positivity and Staphylococcus Aureus Bacteremia in a Geriatric Population

Maillart¹

2012

J Med Microb Diagn

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Background: Time to Positivity (TTP) of blood cultures is defined as the time elapsed between the start of incubation and the automated alert signal indicating growth in the culture bottle.This study evaluates the TTP of blood cultures in patients with Staphylococcus aureus Bacteremia (SAB) and assesses the relationship between TTP and mortality, Methods:We performed a retrospective study involving adults who had SAB between May 2007 and May 2010 in a tertiary hospital. TTP was defined as the time between onset of incubation and growth detection using an automated blood culture system. Results:A total of 167 SAB were evaluated. Patient's median age was 72 years (range, 18-95 years). The median TTP was 13.6 h (range, 3.6-95.2 h). Attributable mortality rate (27.5%) was not related to the TTP (P=0.558) nor to the comorbidities. Age >60 years was the only independent predictor of attributable mortality (P<0.001). Univariate analysis revealed a significantly shorter TTP in persistent bacteremia, endovascular source of infection, catheter-related infection and in community-acquired SAB. A TTP >11.3 h had a negative predictive value of 96.4% for endocarditis. TTP was not related to methicillin susceptibility nor resistance of Staphylococcus aureus (P=0.934). Conclusion:In our elderly population, shorter TTP was significantly associated with a central source of infection and a persistent SAB. In addition for the first time, community-acquired SAB was associated with a shorter TTP. TTP may contribute to a better management of SAB by facilitating clinical decisions, especially in endocarditis.

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Section: Time To Positivity: Univariate Analysis and Predictive Valuementioning

confidence: 85%

The Association between Time to Positivity and Staphylococcus Aureus Bacteremia in a Geriatric Population

Maillart¹

2012

J Med Microb Diagn

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“…Se han identificado factores del huésped que se asocian con un desenlace adverso, como edad mayor de 60 años e inicio de la bacteriemia en la comunidad (56)(57)(58)(59)(60). En este sentido también se han encontrado elementos de la anamnesis o del examen físico, como la presencia de cuerpos extraños o prótesis (52), la incapacidad de identificar el foco de la bacteriemia (12,51,59,61), la morbilidad asociada grave y previa (52,56,59,62), la presencia de lesiones vasculares cutáneas (16), las metástasis infecciosas y la presencia de choque séptico al ingreso (6).…”

Section: Factores De Riesgo Y Pronósticosunclassified

“…Regurgitación valvular nueva (no es suficiente el incremento o cambio en soplo preexistente) Si el germen aislado es SARM, la elección es la vancomicina con dosis empírica de 30 mg/kg al día, dividida en 2-4 dosis diarias, buscando obtener niveles séricos aproximados de 30 mg/ml y ajustada a la función renal (33,54,57). Debido a la aparición de cepas de S. aureus con resistencia intermedia a la vancomicina o SARV, se han introducido nuevos antibióticos, entre los que se encuentran linezolid (familia oxazolidinona), quinupristin/dalfopristin (familia estreptogramina, no disponible en Colombia), daptomicina (lipopéptido cíclico, no disponible en Colombia), entre otros (1,13,15,33,-34,54,63,64,71,73); no hay que olvidar otros antibióticos como trimetoprim-sulfametoxazol, clindamicina, rifampicina, fluoroquinolonas, teniendo en mente que el gen MecA puede conferir resistencia variable a uno o varios de estos antibióticos (15,18,54,63,64,71,74).…”

Section: Evidencia De Compromiso Endocárdicounclassified

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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“…Staphylococcus aureus is widely recognized as a significant pathogen, but due to the increased use of indwelling devices, coagulase-negative staphylococci have been implicated as presenting an increased risk of morbidity and mortality as well (9,37). Appropriate early treatment of bloodstream infections has been associated with improved outcomes in patients (12,21,23,36), and clinical outcome studies have shown that reducing the time to diagnosis decreases the patient's length of stay and rates of morbidity and mortality (2,4,26,32). Recently described real-time PCR-based formats for methicillin-resistant S. aureus (MRSA) identification have reduced the time of diagnosis from a range of 24 to 48 h using standard microbiological approaches to 1 to 2 h (39,43).…”

mentioning

confidence: 99%

Staph ID/R: a Rapid Method for Determining Staphylococcus Species Identity and Detecting the mecA Gene Directly from Positive Blood Culture

Pasko¹,

Hicke²,

Dunn³

et al. 2012

J Clin Microbiol

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Rapid diagnosis of staphylococcal bacteremia directs appropriate antimicrobial therapy, leading to improved patient outcome. We describe herein a rapid test (<75 min) that can identify the major pathogenic strains of Staphylococcus to the species level as well as the presence or absence of the methicillin resistance determinant gene, mecA. The test, Staph ID/R, combines a rapid isothermal nucleic acid amplification method, helicase-dependent amplification (HDA), with a chip-based array that produces unambiguous visible results. The analytic sensitivity was 1 CFU per reaction for the mecA gene and was 1 to 250 CFU per reaction depending on the staphylococcal species present in the positive blood culture. Staph ID/R has excellent specificity as well, with no cross-reactivity observed. We validated the performance of Staph ID/R by testing 104 frozen clinical positive blood cultures and comparing the results with rpoB gene or 16S rRNA gene sequencing for species identity determinations and mecA gene PCR to confirm mecA gene results. Staph ID/R agreed with mecA gene PCR for all samples and agreed with rpoB/16S rRNA gene sequencing in all cases except for one sample that contained a mixture of two staphylococcal species, one of which Staph ID/R correctly identified, for an overall agreement of 99.0% (P < 0.01). Staph ID/R could potentially be used to positively affect patient management for Staphylococcus-mediated bacteremia.

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Staphylococcus aureus Bacteremia Among Elderly vs Younger Adult Patients

Cited by 121 publications

References 36 publications

The Association between Time to Positivity and Staphylococcus Aureus Bacteremia in a Geriatric Population

The Association between Time to Positivity and Staphylococcus Aureus Bacteremia in a Geriatric Population

Enfoque terapéutico de la bacteriemia por Staphylococcus aureus

Staph ID/R: a Rapid Method for Determining Staphylococcus Species Identity and Detecting the mecA Gene Directly from Positive Blood Culture

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