Aureus Bacteremia Research Articles

Successful drainage of periaortic graft abscess and transcatheter aortic valve replacement in the same setting—A hybrid approach

81-year-old man with a history of Bio-Bentall surgery presented to the emergency department with fever, chills and back pain. Initial physical examination was inconclusive apart from sudden onset of delirium. Elevated white blood cells, anemia, and neutrophilia. Further studies revealed gram-positive cocci on the initial blood culture, which was then confirmed to be Methicillin Sensitive Staph Aureus bacteremia. Subsequently, a transesophageal echocardiography showed a periaortic abscess, moderate aortic regurgitation and severe aortic stenosis with no evidence of endocarditis. Antibiotics were started and urgent abscess drainage was planned. In a hybrid operative setting, a multidisciplinary team of cardiology, and cardiac surgery managed the periaortic graft abscess drainage through a median sternotomy and transcatheter aortic valve replacement. Postoperatively, the complications included bradycardia, and right heart failure. Six-week course of IV Rifampin, Probenecid, and Cefazolin was initiated, and patient was to remain on lifelong Cefadroxil. A hybrid approach should be considered for patients with high morality risks in the field of cardiovascular medicine as it offers the best available combination of treatments.

Clinical Characteristics and Outcomes of S. Aureus Bacteremia in Patients Receiving Total Parenteral Nutrition.

Background: Patients on total parenteral nutrition (TPN) are at risk of developing central line-associated infections. Specifically, Staphylococcus aureus bacteremia (SAB) is feared for its high complication rates. This prospective cohort study compares characteristics, clinical course and outcome of SAB in patients with and without TPN support. Methods: Clinical and microbiological data from all patients with positive blood cultures for S. aureus from two facilities, including our referral center for TPN support, were retrieved (period 2013–2020). Primary outcome was overall mortality, and included survival analysis using a multivariate Cox regression model. Secondary outcomes comprised a comparison of clinical characteristics and outcomes between both patient groups and analysis of factors associated with complicated outcome (e.g., endocarditis, deep-seated foci, relapse and death) in patients on TPN specifically. Results: A total of 620 SAB cases were analyzed, of which 53 cases received TPN at the moment the blood culture was taken. Patients in the TPN group were more frequently female, younger and had less comorbidity (p < 0.001). In-hospital death and overall mortality were significantly lower in TPN patients (4% vs. 18%, p = 0.004 and 10% vs. 34%, p < 0.001, respectively). Positive follow-up blood cultures, delayed onset of therapy and previous catheter problems were associated with a higher incidence of complicated SAB outcome in patients on TPN. Conclusion: Our data show that patients on TPN have a milder course of SAB with lower mortality rates compared to non-TPN SAB patients.

289 Reduction of Hospital-Acquired Methicillin Resistant Staphylococcal Aureus Bacteremia in a High Volume Adult Burn Center

289 Reduction of Hospital-Acquired Methicillin Resistant Staphylococcal Aureus Bacteremia in a High Volume Adult Burn Center

Hospital Onset Staphylococcus aureus Bacteremia is a Better Measure than MRSA Bacteremia in Assessing Infection Prevention: Evaluation of 51 US Hospitals

Background Hospital Onset (HO) Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is publicly reported and tied to the Hospital-Acquired Conditions Reduction program. It reflects a surrogate of risk of infection of MRSA invasive disease in the hospital setting, and reported as a standardized infection ratio that adjusts for admission MRSA prevalence, hospital size and medical school affiliation. However, it may not adequately represent all HO S. Aureus bacteremia, which is unaffected by the prevalence of resistance to methicillin.Methods We compared the rates of NHSN-defined laboratory ID events for HO methicillin susceptible S. Aureus (MSSA) and MRSA bacteremia in 51 hospitals (small, <100 beds, n = 15; medium, 100–300 beds, n = 15; large, >300 beds, n = 21) from a single health system over a 12-month period abstracting data from one clinical decision support system. We also compared the rates of HO S. Aureus bacteremia based on hospital size.Results340 HO S. Aureus bacteremia events (1.22 per 10,000 patient-days) occurred during calendar year 2016 (MSSA n = 218, 64%; MRSA n = 122, 36%). 14/15 small hospitals did not have any HO S. Aureus bacteremia events during the study period. HO MSSA bacteremia rates were 0.58 and 0.77 per 10,000 patient-days for medium size and large-size hospitals respectively (P = 0.094). In contrast, HO MRSA bacteremia rates were 0.71 and 0.47 per 10,000 patient-days for medium size and large-size hospitals respectively (P = 0.045). There was no correlation between HO MSSA and MRSA bacteremia for large and medium size hospitals (Figure).Conclusion By measuring only HO MRSA, a significant portion of patients with increased morbidity and mortality are overlooked. HO S. Aureus bacteremia may provide a better measure to use to evaluate invasive S. Aureus risk in the hospital setting, and would mitigate the MRSA prevalence factor. These findings are important when we evaluate policy related to what is considered a hospital acquired condition.Figure:Relation between HO MSSA and MRSA Bacteremia for Based on Hospital Size.Disclosures All authors: No reported disclosures.

Evaluation of an App: STAB-IT™ Staphylococcus aureus Bacteremia Is Terrible

STAPHYLOCOCCUS AUREUS BACTEREMIA IS TERRIBLE Debra A. Goff, PharmD, FCCP, Kim Hawksworth, RPh, Julie E. Mangino, MD, FSHEA Department of Pharmacy, The Ohio State University Wexner Medical Center, OH, USA; Division of Infectious Diseases in the Department of Internal Medicine, The Ohio State University, OH, USA; Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, OH, USA Corresponding Author: debbie.goff@osumc.edu

Large vegetation associated with implantable cardioverter‐defibrillator lead

A 79‐year‐old‐male presented with a 2‐month history of recurrent septic shock and bacteremia. His history is relevant for hypertension and ischemic cardiomyopathy with an ejection fraction of 20%, with an implantable cardioverter‐defibrillator (ICD) placement one month prior to presentation.A transesophageal echocardiogram (TEE) was performed due to persistent S. Aureus bacteremia despite antimicrobial therapy, demonstrating an attached vegetation to the ICD lead (Figure ). The patient underwent successful surgical extraction of intracardiac leads, and his condition improved and has remained afebrile with negative blood cultures. Figure 1 Transesophageal echocardiogram demonstrating 1.5×1.3 cm vegetation attached to the ICD lead (arrow). RA, right atrium. LA, left atrium.ICD related endocarditis is an uncommon but serious complication. Incidence rate ranging from 0.5–0.8% and mortality rates close to 35% have been reported , with a projected increase in incidence secondary to the expanded indications for ...