Open Access
Incidence of Endocarditis, Risk Factors for Mortality, and Clinical Impact of Methicillin Resistance
Feng Yee Chang,Brent B. Macdonald,James E. Peacock,Daniel M. Musher,Patricia Triplett,Joseph M. Mylotte,Marilyn M. Wagener,Victor L. Yu +7 more
TLDR
In this article, the authors conducted a prospective observational study in 6 university teaching hospitals and evaluated 505 consecutive patients with S. aureus bacteremia, including 21% with community-acquired S. annealing, 5% with hospital- acquired BAs, and 12% on hemodialysis, and the 30-day mortality was 31% among patients with endocarditis compared to 21% in patients who had BAs.Abstract:
Our objectives were to determine the incidence of endocarditis in patients whose Staphylococcus aureus bacteremia was community-acquired, related to hemodialysis, or hospital- acquired; to assess clinical factors that would reliably distinguish between S. aureus bacteremia and S. aureus endocarditis; to assess the emergence of methicillin-resistant S. aureus (MRSA) as a cause of endocarditis; and to examine risk factors for mortality in patients with S. aureus endocarditis. We conducted a prospective observational study in 6 university teaching hospitals; we evaluated 505 consecutive patients with S. aureus bacteremia. Thirteen percent of patients with S. aureus bacteremia were found to have endocarditis, including 21% with community-acquired S. aureus bacteremia, 5% with hospital- acquired bacteremia, and 12% on hemodialysis. Infection was due to MRSA in 31%. Factors predictive of endocarditis included underlying valvular heart disease, history of prior endocarditis, intravenous drug use, community acquisition of bacteremia, and an unrecognized source. Twelve patients with bacteremia had a prosthetic valve; 17% dev- eloped endocarditis. Unexpectedly, nonwhite race proved to be an independent risk factor for endocarditis by both univariate and multivariate analyses. Persistent bacteremia (positive blood cultures at day 3 of appropriate therapy) was identified as an independent risk factor for both endocarditis and mortality, a unique observation not reported in other prospective studies of S. aureus bacteremia. Patients with endocarditis due to MRSA were significantly more likely to have complicating renal insufficiency and to experience persistent bacteremia than those with endocarditis due to methicillin-susceptible S. aureus (MSSA). The 30-day mortality was 31% among patients with endocarditis compared to 21% in patients who had bacteremia without endocarditis (p = 0.055). Risk factors for death due to endocarditis included severity of illness at onset of bacteremia (as measured by Apache III and Pitt bacteremia score), MRSA infection, and presence of atrioventricular block on electrocardiogram. Patients with S. aureus bacteremia who have community acquisition of infection, underlying valvular heart disease, intravenous drug use, unknown portal of entry, history of prior endocarditis, and possibly, nonwhite race should undergo echocardiography to screen for the presence of endocarditis. We recommend that blood cultures be repeated 3 days following initiation of antistaphylococcal antibiotic therapy in all patients with S. aureus bacteremia. Positive blood cultures at 3 days may prove to be a useful marker in promoting more aggressive management, including more potent antibiotic therapy and surgical resection of the valve in endocarditis cases. MRSA as the infecting organism should be added to the list of risk factors for consideration of valvular resection in cases of endocarditis. .Medicine 2003;82:322-32)read more
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Course and outcome of Staphylococcus aureus bacteraemia: a retrospective analysis of 308 episodes in a Swiss tertiary-care centre.
TL;DR: Mortality in patients with SAB remained high, despite effective antibiotic therapy, and patients with community-acquired SAB were twice as likely to die as patients with nosocomial SAB.
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Alkyl gallates, intensifiers of beta-lactam susceptibility in methicillin-resistant Staphylococcus aureus.
Hirofumi Shibata,Kyoko Kondo,Ryo Katsuyama,Kazuyoshi Kawazoe,Yoichi Sato,Kotaro Murakami,Yoshihisa Takaishi,Naokatu Arakaki,Tomihiko Higuti +8 more
TL;DR: It is clearly demonstrates that the length of the alkyl chain has a key role in the elevation of susceptibility to β-lactam antibiotics.
Journal ArticleDOI
Predictors of mortality in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: the role of empiric antibiotic therapy
J. Gómez,Elisa García-Vázquez,R. Baños,Manuel Canteras,J. Ruiz,V. Baños,J.A. Herrero,Mariano Valdés +7 more
TL;DR: The main prognostic factors associated with mortality in patients with MRSA bacteraemia are complications, acute severe clinical condition at onset, and inappropriate empiric treatment.
Journal ArticleDOI
Morbidity and mortality of Staphylococcal bacteremia in children.
TL;DR: SAB occurred most often as a hospital-acquired infection in the neonatal intensive care unit, and methicillin-resistant Staphylococcal aureus accounted for one third of the episodes.
Journal ArticleDOI
Community-acquired MRSA infection: an update.
TL;DR: Infection often begins on the skin—where it may be mistaken for a spider bite—but MRSA can quickly cause deadly systemic illnesses such as toxic shock syndrome and necrotizing pneumonia.
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TL;DR: Modifications of the Duke criteria for the diagnosis of infective endocarditis are proposed, including that positive Q-fever serology should be changed to a major criterion and the minor criterion "echocardiogram consistent with IE but not meeting major criterion" should be eliminated.
Journal ArticleDOI
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TL;DR: Application of the proposed new criteria increases the number of definite diagnoses and should be useful for more accurate diagnosis and classification of patients with suspected endocarditis and provide better entry criteria for epidemiologic studies and clinical trials.