Treatment Duration for Uncomplicated Staphylococcus aureus Bacteremia To Prevent Relapse: Analysis of a Prospective Observational Cohort Study

Chong, Yong Pil; Moon, Song Mi; Bang, Kyung-Mi; Park, Hyun Jung; Park, So-Youn; Kim, Mina; Park, Ki Ho; Kim, Sung-Han; Lee, Sang‐Oh; Choi, Sang‐Ho; Jeong, Jin‐Yong; Woo, Jun Hee; Kim, Yang Soo

doi:10.1128/aac.01021-12

Cited by 108 publications

(75 citation statements)

References 42 publications

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“…Similarly, while AHA guidelines suggest at least 14 days of antimicrobial therapy to treat bacteremia after device removal, our respondents favored longer durations (more than 29 days) for occult S. aureus bacteremia. This may reflect shifts in practice based on studies that demonstrated increased risk of relapsed S. aureus bacteremia with shorter treatment times [12,13].…”

Section: Discussionmentioning

confidence: 99%

Current Management of Cardiac Implantable Electronic Device Infections by Infectious Disease Specialists

et al. 2016

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Management guidelines for cardiac implantable electronic device infections exist, but practice patterns of infectious disease (ID) specialists are not well known. We found that while many ID specialist practices mirror existing guidelines, a combination of complete device removal and prolonged antimicrobial therapy is favored when Staphylococcus aureus is involved.Keywords. device-related infection; cardiac implantable electronic device; infectious disease specialists.Cardiac implantable electronic devices (CIEDs) including percutaneous pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy devices have revolutionized the management of arrhythmias and congestive heart failure. However, infections can complicate the use of these devices, with rates ranging from <1% to 4% [1][2][3][4]. Guidelines for treatment of CIED infections exist [5], but little is known about current practice patterns for these challenging infections. METHODSThe Infectious Diseases Society of America's Emerging Infections Network (EIN) is a provider-based network of practicing infectious disease (ID) specialists in the United States and Canada, funded by the Centers for Disease Control and Prevention [6]. With input from a subset of experienced EIN members, we developed a 7-question multiple-choice query to assess ID specialist practice patterns related to the management of CIED infections based on commonly encountered clinical scenarios (Supplementary Material). This query was distributed by e-mail or facsimile with 2 weekly reminders. Our query process and EIN members are described elsewhere [6].Nonresponse bias was assessed by comparing geographic and practice characteristics of nonrespondents and respondents. Respondents who had treated 1 or more CIED infections in the past year were included in further analyses, and respondents were not required to answer all questions. Categorical variables were compared using a χ 2 test or Fisher exact test with SAS, version 9.3 (Cary, North Carolina). P values <.05 were considered significant. RESULTSThe electronic query was available to EIN members from 29 Complete vs Partial Device RemovalWhen treating occult bacteremia in a patient with a CIED, 146/358 (46%) respondents preferred (ie, usually or almost always recommended) complete device removal. In contrast, only 25/345 (7%) preferred partial device removal. When bacteremia was attributable to a noncardiovascular infection (eg, pneumonia), fewer respondents (40/355; 11%) preferred complete device removal, and only 9/345 (3%) preferred partial device removal. For a patient with CIED-related pocket infection that required incision and drainage, most (293/359; 82%) preferred complete device removal; 102/347 (29%) also preferred partial device removal as an alternative. For lead-associated endocarditis, nearly all respondents (356/ 360; 99%) preferred complete device removal, whereas only 70/345 (20%) also preferred partial device removal as an alternative.Nearly three quarters (73%) of respondents endorsed comple...

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Section: Discussionmentioning

confidence: 99%

Current Management of Cardiac Implantable Electronic Device Infections by Infectious Disease Specialists

et al. 2016

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“…antibiotics for uncomplicated SAB is at least 2 weeks. In a recent prospective cohort study of uncomplicated SAB (as defined by IDSA criteria), receipt of antibiotic therapy for Ͻ2 weeks was associated with a relapse rate of 8% (compared to 0% for those treated for at least 2 weeks) (99). This relapse rate is consistent with the 6% rate of late complications (inclusive of relapse and metastatic complications) for intravascular catheter-associated SAB treated for Ͻ2 weeks identified in a 1993 meta-analysis of 11 studies (100).…”

Section: Outcomes and Managementmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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“…Staphylococcus aureus infections are associated with significant morbidity and mortality. Inappropriate antimicrobial therapy leads to increased healthcare associated costs, prolonged hospital stay and even increased mortality rates [12,13). Current International and United Kingdom guidelines recommend a minimum of 14 days treatment for uncomplicated bacteraemia and longer treatment such as 4-6 weeks in deep seated infections three [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

An Audit of Staphylococcus aureus Bacteraemia Treatment in a UK District General Hospital

Scarsbrook¹,

Raja²,

Hardman³

et al. 2017

Journal of Microbiology and Infectious Diseases

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Objective: Recent guidelines from Healthcare Improvement Scotland recommend that uncomplicated Staphylococcus aureus bacteraemia (SAB) be treated with effective antibiotics for at least 14 days. This audit aimed to see whether Medway Hospital, UK, was following these guidelines, and whether a simple intervention could improve compliance and therefore treatment.Method: All patients with SAB between April 2013 and September 2014 were identified and their clinical notes, laboratory findings and drug charts were reviewed. Starting in January 2014 all SAB were reported on the online pathology results system with the following advice; 'Staphylococcus aureus bacteraemia warrants a minimum of 14 days treatment. Treatment may be longer in cases of deep seated infection.' Outcome measures included 14 days antimicrobial treatment readmission rate with SAB, 3 month mortality post treatment and whether echocardiography was performed. Results:The demographics of all patients (35 pre and 39 post intervention) were comparable between groups (average age 63 vs 56, 54.3% vs 69.2% male) although the sources of bacteraemia differed slightly. More patients had indwelling lines in 2013 and there were a higher proportion of IV drug users in 2014; all other risk factors were similar between groups. More patients received appropriate antibiotics post intervention (74% vs 49%). Three month mortality with community acquired SAB increased but mortality with hospital acquired SAB decreased post intervention. Echocardiography uptake improved, and readmission rates with SAB decreased. Conclusion:The introduction of guidance with blood culture results has demonstrated better compliance with a 14 day minimum treatment length for SAB. Although sample size limits obtaining a statistically significant difference in readmission and mortality rates, this intervention still has the potential to improve treatment of SAB in aiding clinicians to follow guidelines. J Microbiol Infect Dis 2017; 7(4):188-193

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Treatment Duration for Uncomplicated Staphylococcus aureus Bacteremia To Prevent Relapse: Analysis of a Prospective Observational Cohort Study

Cited by 108 publications

References 42 publications

Current Management of Cardiac Implantable Electronic Device Infections by Infectious Disease Specialists

Current Management of Cardiac Implantable Electronic Device Infections by Infectious Disease Specialists

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

An Audit of Staphylococcus aureus Bacteraemia Treatment in a UK District General Hospital

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