Dec 052014
Related Articles

Potential Role for Telavancin in Bacteremic Infections Due to Gram-Positive Pathogens: Focus on Staphylococcus aureus.

Clin Infect Dis. 2014 Dec 3;

Authors: Corey GR, Rubinstein E, Stryjewski ME, Bassetti M, Barriere SL

Staphylococcus aureus bacteremia (SAB) is one of the most common serious bacterial infections and the most frequent invasive infection due to methicillin-resistant S. aureus (MRSA). Treatment of SAB is challenging, with metastatic and relapsing infections commonplace, and is particularly difficult in patients with MRSA owing to limited treatment options. Telavancin is a bactericidal lipoglycopeptide antibiotic that is active against a range of clinically relevant Gram-positive pathogens, including MRSA. In experimental animal models of sepsis, using human exposures, telavancin has been shown to be more effective than vancomycin. In clinically evaluable patients enrolled in a pilot study of uncomplicated SAB, cure rates were 88% for telavancin and 89% for standard therapy. Among patients with infection due to only Gram-positive pathogens enrolled in the two phase 3 studies of telavancin for treatment of hospital-acquired pneumonia, cure rates for those with bacteremic S. aureus pneumonia were 41% (9/22, telavancin) and 40% (10/25, vancomycin) with identical mortality rates. These data support further evaluation of telavancin in larger, prospective studies of SAB.

PMID: 25472944 [PubMed - as supplied by publisher]

Link to Article at PubMed


Dec 032014

Clinical Presentation and Risk Factors for Cytomegalovirus Colitis in Immunocompetent Adult Patients.

Clin Infect Dis. 2014 Dec 1;

Authors: Ko JH, Peck KR, Lee WJ, Lee JY, Cho SY, Ha YE, Kang CI, Chung DR, Kim YH, Lee NY, Kim KM, Song JH

BACKGROUND:  Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ disease, which has typically been described in immunocompromised hosts. Recently, it has been noted that this also occurs in immunocompetent patients. To gather relevant data about clinical presentation, prognosis, and risk factors for development of CMV colitis in immunocompetent hosts, we analyzed all cases that occurred during a 19 year period at our institution.
METHODS:  A case-control study was performed to identify risk factors for CMV colitis in immunocompetent hosts. Electronic medical records of individuals who were admitted and diagnosed with CMV colitis between January 1995 and February 2014 at a tertiary care university hospital were reviewed. Two non-CMV colitis patients that were age- and sex-matched were selected as controls for each case.
RESULTS:  A total of 51 patients with CMV colitis were included in this study along with 102 control patients. Certain conditions including renal disease on hemodialysis, neurologic disease, rheumatologic disease, required ICU care, and exposure to antibiotics, antacids, steroids, or RBC transfusions within 1 month of diagnosis of colitis were associated with CMV colitis on univariate analysis. Among these, steroid use and RBC transfusion within 1 month were identified as independent risk factors for developing CMV colitis on multivariate analysis. The 30-day mortality rate was 7.8% without any attributable mortality.
CONCLUSIONS:  Steroid use and RBC transfusion within 1 month of the diagnosis of colitis were independent risk factors for development of CMV colitis in immunocompetent hosts.

PMID: 25452594 [PubMed - as supplied by publisher]

Link to Article at PubMed


Nov 282014

Staphylococcus aureus Skin Infection Recurrences among Household Members: An Examination of Host, Behavioral, and Pathogen Level Predictors.

Clin Infect Dis. 2014 Nov 26;

Authors: Miller LG, Eells SJ, David MZ, Ortiz N, Taylor AR, Kumar N, Cruz D, Boyle-Vavra S, Daum RS

BACKGROUND:  Many patients suffer from recurrent Staphylococcus aureus infections, but there are few data examining recurrence predictors.
METHODS:  We followed adults and children after treatment for S. aureus skin infections and their household contacts in Los Angeles and Chicago. We surveyed subjects for S. aureus body colonization, household fomite contamination, and behavioral and clinical factors at baseline and 3 and 6 months later. Using repeated measures modeling, we examined host, pathogen, behavior, and clinical factors associated with recurrence.
RESULTS:  Among 330 index subjects, 182 (55%) were infected with an isolate of the USA300 MRSA genetic background. Recurrences occurred in 39% by month 3 and 51% by month 6. Among 588 household contacts, 10% reported a skin infection by month 3 and 13% by month 6. Among index subjects, recurrence was associated with (P <0.05) Los Angeles site, diabetes, recent hospitalization, recent skin infection, recent cephalexin use, household S. aureus or MRSA fomite contamination; recurrence was inversely associated with recent contact sports participation. In the multivariate model, independent predictors of recurrence in index patients were recent hospitalization, household MRSA fomite contamination, and lack of recent contact sports participation. Among household contacts, independent predictors of subsequent skin infection were Chicago site, antibiotic use in the prior year, and skin infection in the prior 3 months.
CONCLUSIONS:  In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites.

PMID: 25428411 [PubMed - as supplied by publisher]

Link to Article at PubMed


Nov 202014

Examining the Risks of Cardiac Arrhythmia and Mortality among New-Generation Macrolides, Fluoroquinolones, and Beta-Lactam/Beta-Lactamase Inhibitor: A Nationwide Study.

Clin Infect Dis. 2014 Nov 18;

Authors: Chou HW, Wang JL, Chang CH, Lai CL, Lai MS, Chan KA

BACKGROUND:  Previous studies have demonstrated increased cardiovascular mortality related to azithromycin and levofloxacin. Risks associated with alternative drugs in the same class, including clarithromycin and moxifloxacin, were unknown. We used the Taiwan National Health Insurance Database to perform a nationwide, population-based study that compares the risks of ventricular arrhythmia and cardiovascular death among these antibiotics.
METHOD:  A total of 10,684,100 patients prescribed oral azithromycin, clarithromycin, moxifloxacin, levofloxacin, ciprofloxacin, or amoxicillin/clavulanate at outpatient visit between January 2001 and November 2011. A logistic regression model adjusted for propensity score was used to calculate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for adverse cardiac outcomes occurring within 7 days after the initiation of antibiotic treatment.
RESULT:  Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin were associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs (95% CI) for ventricular arrhythmia were 4.32 (2.95-6.33) for azithromycin, 3.30 (2.07-5.25) for moxifloxacin, and 1.41 (0.91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs (95% CI) for azithromycin, moxifloxacin, and levofloxacin were 2.62 (1.69-4.06), 2.31 (1.39-3.84), and 1.77 (1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes.
CONCLUSION:  Healthcare professionals should consider the small but significant increased risk of ventricular arrhythmia and cardiovascular death when prescribing azithromycin and moxifloxacin. Additional research is needed to determine whether the increased risk of mortality is caused by the drugs, or related to the severity of infection or the pathogens themselves.

PMID: 25409476 [PubMed - as supplied by publisher]

Link to Article at PubMed


Nov 132014
Related Articles

Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis - Analysis in the International Collaboration of Endocarditis - Prospective Cohort Study.

Clin Infect Dis. 2014 Nov 10;

Authors: Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu V, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B, on behalf of the ICE Prospective Investigators

BACKGROUND:  The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study.
METHODS:  Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling, that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery, was used to evaluate the impact of EVS and one-year all-cause mortality on patients with definite left-sided SA PVIE and no history of injection drug use.
RESULTS:  EVS was performed in74 (44.3%) of the 168 patients. One-year mortality was significantly higher among patients with SA PVIE than in patients with non-SA PVIE (48.2% vs. 32.9%, p=0.003). SA PVIE patients who underwent EVS had a significantly lower one-year mortality rate (33.8% vs. 59.1%, p=0.001).In multivariate, propensity-adjusted models, EVS was not associated with one-year mortality (RR 0.67, 95% CI 0.39 - 1.15, p=0.15).
CONCLUSIONS:  In this prospective, multinational cohort of patients with SA PVIE ,: EVS was not associated with reduced one-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

PMID: 25389255 [PubMed - as supplied by publisher]

Link to Article at PubMed


Nov 062014
Related Articles

Bad Bugs Need Old Drugs: A Stewardship Program's Evaluation of Minocycline for Multidrug-Resistant Acinetobacter baumannii Infections.

Clin Infect Dis. 2014 Dec 1;59 Suppl 6:S381-7

Authors: Goff DA, Bauer KA, Mangino JE

BACKGROUND: Minocycline is an "old-drug" with Food and Drug Administration approval for the treatment of infection due to Acinetobacter species. The purpose of this study is to describe an Antimicrobial Stewardship Program's evaluation of minocycline for the treatment of patients with multidrug resistant A. baumannii (MDR-AB) infections.
METHODS: This study evaluated hospitalized adult patients (September 2010 through March 2013) who received minocycline intravenously (IV) for a MDR-AB infection. Clinical and microbiological outcomes were analyzed. Secondary outcomes included infection-related mortality, length of hospital stay (LOS), infection-related LOS, intensive care unit (ICU) LOS, mechanical ventilation days, and 30-day readmission.
RESULTS: A total of 55 patients received minocycline. Median age was 56 (23-85) years, 65% were male with an APACHE II score of 21 (4-41). Clinical success was achieved in 40/55 (73%) patients treated with minocycline monotherapy (n = 3) or in combination with a second active agent (n = 52). Overall 43 (78%) patients demonstrated documented or presumed microbiologic eradication. Infection-related mortality was 25%. Hospital LOS was 31 (5-132) and infection-related LOS was 16 (2-43) days. Forty-seven (85%) patients were admitted to the ICU for a LOS of 18 (2-78) days. Thirty-nine (71%) patients required mechanical ventilation for 6 (2-29) days. One patient had a 30-day readmission.
CONCLUSIONS: The response rate to minocycline monotherapy or in combination for the treatment of MDR-AB infections is encouraging as therapeutic options are limited. Prospective studies in patients with MDR-AB infections will help establish the role of minocycline alone or in combination with other antimicrobials.

PMID: 25371514 [PubMed - in process]

Link to Article at PubMed