Coagulase-negative Staphylococci Infections Research Articles

Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades

BackgroundInfective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. MethodsWere studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978–1988, 1989–1999, 2000–2010 and 2011–2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. FindingsValve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulase-negative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted in-hospital mortality from 34% to 25% (p = 0.019). InterpretationIn the 44 years studied, there was an increase in the mean age of patients, healthcare-related, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.

Proteomics identifies lipocalin-2 in neonatal inflammation associated with cerebrovascular alteration in mice and preterm infants

Staphylococcus (S.) epidermidis is the most common nosocomial coagulase-negative staphylococci infection in preterm infants. Clinical signs of infection are often unspecific and novel markers to complement diagnosis are needed. We investigated proteomic alterations in mouse brain after S.epidermidis infection and in preterm infant blood. We identified lipocalin-2 (LCN2) as a crucial protein associated with cerebrovascular changes and astrocyte reactivity in mice. We further proved that LCN2 protein expression was associated with endothelial cells but not astrocyte reactivity. By combining network analysis and differential expression approaches, we identified LCN2 linked to blood C-reactive protein levels in preterm infants born <28weeks of gestation. Blood LCN2 levels were associated with similar alterations of cytokines and chemokines in both infected mice and human preterm infants with increased levels of C-reactive protein. This experimental and clinical study suggests that LCN2 may be a marker of preterm infection/inflammation associated with cerebrovascular changes and neuroinflammation.

VERTEBRAL OSTEOMİYELİT: SON 10 YILDA NELER DEĞİŞTİ?

Objective: This study was conducted to describe the demographic, clinical, and microbiological characteristics of vertebral osteomyelitis in the last decade, mainly by comparing literature and the previous case series performed in our center.&#x0D; Material and Methods: This is a retrospective, observational, descriptive study performed between 2009-2019 at Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine. All patients were divided into three main groups: pyogenic (PVO), tuberculous (TVO) and brucellar (BVO). &#x0D; Results: A total of 100 cases were included in this study. Of these 100 patients, 59 had pyogenic, 15 had brucellar and 26 had tuberculous spondylodiscitis. The disease developed postoperatively in 22 (37.4%) of the 59 PVO cases. The common isolated microorganism was Staphylococcus aureus (n = 11), followed by coagulase negative staphylococci (n = 6). BVO rate was lower than previous case series (15 vs. 24). The median time to improvement in the laboratory findings after the administration of the appropriate treatment was 14 days. PET-CT was diagnostic in 81.8% of PVO patients, similar to MRI. However, PET-CT diagnosis rate was significantly low in TVO patients (3 out of 9, p = 0.040).&#x0D; Conclusion: S. aureus remained the most common etiologic agent. Coagulase negative staphylococci infection rate, mainly related to spinal surgery, and postoperative spondylodiscitis rate is higher than before. Brucellar VO rate is lower, which is mostly related to effective animal vaccination and pasteurization. Although, MRI is the gold standard, PET-CT is a promising technique in diagnosis for PVO.

A case report on recurrent alternating Tolosa-Hunt syndrome due to bacterial sphenoid sinusitis: rediscussing the diagnostic terminology and classification

BackgroundTolosa-Hunt syndrome (THS) is characterized by painful ophthalmoplegia caused by idiopathic granulomatous inflammation involving the cavernous sinus region. Patients respond well to steroid therapy. THS is included in the differential diagnosis of cavernous sinus syndrome, so it is important to fully exclude other lesions in this area before treatment, otherwise steroid treatment may lead to fatal outcomes. Here we describe a patient who initially presented with symptoms that simulated THS symptoms and developed recurrent alternating painful ophthalmoplegia during follow-up, and the patient was finally diagnosed with cavernous sinusitis caused by bacterial sphenoid sinusitis.Case presentationA 34-year-old woman presented with left painful ophthalmoplegia. Magnetic resonance imaging (MRI) revealed abnormal signals in the left cavernous sinus area, and these abnormal signals were suspected to be THS. After steroid treatment, the patient obtained pain relief and had complete recovery of her ophthalmoplegia. However, right painful ophthalmoplegia appeared during the follow-up period. MRI showed obvious inflammatory signals in the right cavernous sinus and right sphenoid sinus. Then nasal sinus puncture and aspiration culture were performed, and the results showed a coagulase-negative staphylococcus infection. After antibiotic treatment with vancomycin, the painful ophthalmoplegia completely resolved, and the neurological examination and MRI returned to normal.ConclusionSome other causes of painful ophthalmoplegia also fulfill the diagnostic criteria for THS in the International Classification of Headache Disorders third edition (ICHD-3) and respond well to steroid therapy. Early diagnosis of THS may be harmful to patients, and clinicians should exercise great caution when dealing with similar cases without a biopsy. Using “cavernous sinus syndrome” instead of “Tolosa-Hunt syndrome” as a diagnostic category may provide a better clinical thinking for etiological diagnosis.

Factors associated with daptomycin consumption in French hospitals between 2019 and 2020: A nationwide surveillance study

ObjectivesThis study aimed to investigate factors associated with daptomycin consumption in French healthcare facilities (HCF) between 2019 and 2020. MethodsAntibiotic consumption expressed as number of defined daily doses (DDD) per 1,000 patient-days (PD) and antimicrobial resistance (AMR) expressed as incidence densities per 1,000PD were extracted each year from the nationwide surveillance network run by the SPARES project (Surveillance and Prevention of Antimicrobial RESistance in hospitals), collecting data at ward level among voluntary HCFs using standardized methodology and webtool. All HCF participating both in 2019 and 2020 were included. A multivariable linear regression was fitted. ResultsAmong 622 HCFs, we analyzed daptomycin consumption and AMR data in 1,637 clinical wards. Incidence densities of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci (MRCNS) were the highest in intensive care unit wards (0.54 and 6.83 respectively in 2020). On the most adjusted model, the year 2020 was correlated with a higher daptomycin consumption (1.53; p = 0.01). A greater number of inpatient beds (0.01; p < 0.001), the presence of orthopedic surgery activity in the HCF (1.66; p < 0.02), MRSA (4.38; p < 0.001) and MRCNS (0.61; p < 0.001) incidence densities were associated with a higher daptomycin use. The final model explained 18% of the observed variance. ConclusionsThis study showed that daptomycin consumption was correlated to MRSA and MRCNS incidence densities, to the year 2020 and to non-modifiable HCF-related factors. Prevention of coagulase-negative staphylococci infections should be considered by antimicrobial stewardship teams when daptomycin use is going up in HCF.

Need for standardized vancomycin dosing for coagulase-negative staphylococci in hospitalized infants

In high-income countries, coagulase-negative staphylococci (CoNS) are the most commonly implicated pathogens in late-onset sepsis (LOS) (sepsis occurring after 72 hours of age) in neonates [ [1] Jean-Baptiste N. Benjamin Jr., D.K. Cohen-Wolkowiez M. Fowler Jr., V.G. Laughon M. Clark R.H. et al. Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp Epidemiol. 2011; 32: 679-686https://doi.org/10.1086/660361 Crossref PubMed Scopus (68) Google Scholar ]. They are responsible for more than 50% of neonatal LOS cases [ [2] Cailes B. Kortsalioudaki C. Buttery J. Pattnayak S. Greenough A. Matthes J. et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network. Arch Dis Child Fetal Neonatal Ed. 2018; 103: F547-F553https://doi.org/10.1136/archdischild-2017-313203 Crossref PubMed Scopus (77) Google Scholar ]. Overall mortality rates from LOS caused by CoNS are low; however, low birth-weight and preterm infants carry the highest burden. Morbidity related to LOS caused by CoNS has been associated with poor neurodevelopment, visual impairment, chronic lung disease, and necrotizing enterocolitis and can prolong the length of hospitalization [ [3] Dong Y. Speer C.P. Glaser K. Beyond sepsis: Staphylococcus epidermidis is an underestimated but significant contributor to neonatal morbidity. Virulence. 2018; 9: 621-633https://doi.org/10.1080/21505594.2017.1419117 Crossref PubMed Scopus (47) Google Scholar ]. CoNS are frequently multi-drug resistant, and the emergence of the multi-drug resistant Staphylococcus capitis NRCS-A clone worldwide, found almost exclusively as a pathogen within neonatal units, is concerning [ [4] Laurent F. Butin M. Staphylococcus capitis and NRCS-A clone: the story of an unrecognized pathogen in neonatal intensive care units. Clin Microbiol Infect. 2019; 25: 1081-1085https://doi.org/10.1016/j.cmi.2019.03.009 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar ]. A recent survey of French neonatal units demonstrated that S capitis accounted for 14.2% of nosocomial bloodstream infections, with most infections being attributed to the NRCS-A clone [ [5] Decalonne M. Dos Santos S. Gimenes R. Goube F. Abadie G. Aberrane S. et al. Staphylococcus capitis isolated from bloodstream infections: a nationwide 3-month survey in 38 neonatal intensive care units. Eur J Clin Microbiol Infect Dis. 2020; 39: 2185-2194https://doi.org/10.1007/s10096-020-03925-5 Crossref PubMed Scopus (1) Google Scholar ].

Azathioprine Induced Pancytopenia in a Patient with Vogt-Koyanagi-Harada Disease: A Case Report

case reports; pancytopenia; steroid.

Gram-Positive Bacterial Infections and Antibiotics Resistance in Jordan: Current Status and Future Perspective

Background: Antibiotic resistance is expanding worldwide at alarming rates. Middle East countries including Jordan have high prevalence of antibiotic resistance.&#x0D; Aims: The main aims of this review are to summarize the situation with Gram-positive bacterial infections and antibiotic resistance in Jordan, identify areas where further investigation is required, and suggest strategies to combat antibiotic resistance.&#x0D; Methods: A systematic literature search was conducted by two independent researchers using general and specific combinations of MeSH search terms using Embase, PubMed, Web of Science, and Google Scholar databases.&#x0D; Results: Staphylococci and Streptococci were commonly isolated from environmental, animal, and human samples, while Staphylococci, Enterococci, and Listeria were commonly isolated from food. Staphylococci, Streptococci, and Enterococci human colonization were documented at variable but high rates. Methicillin-resistant S. aureus (MRSA) and methicillin-resistance coagulase-negative Staphylococci (MR-CoNS) infections were common with high rates of antibiotic resistance. S. pneumoniae showed increased resistance rates to most antimicrobials. Enterococci and C. difficile resistance rates were moderate, while group B Streptococci (GBS), viridans group streptococci (VGS), C. perfringens and L. monocytogenes antibiotic susceptibility patterns were not reported. All MRSA and vancomycin-resistant Enterococci (VRE) isolates were mec-A positive, while resistance genes among CoNS, S. pneumoniae, S. pyogenes, S. agalactia, C. perfringens, and L. monocytogenes were not investigated.&#x0D; Conclusions: Gram-positive bacterial infections and antibiotic resistance rates were high in Jordan. Molecular epidemiology studies, a nationwide surveillance program, and action plans are urgently required to combat antibiotic resistance.

Coagulase-negative staphylococci as an evolving mastitis causing organism in cows: A review

The present review attempts to address the emergence of a fast-growing mastitis causing pathogen – coagulase-negative staphylococci (CNS) – and its multi-facet roles in dairy farms. CNS is divided into numerous species, but only a few succeed in bovine mastitis. The two predominant CNS species causing mastitis are Staphylococcus chromogenes and Staphylococcus simulans. These two mostly known CNS affects dairy cows at varied parities and at different lactation stages. CNS have been judged to be the most common bovine mastitis isolate in several countries of the world. However, CNS may not likely be as pathogenic as the other primary mastitis pathogens such as Staphylococcus aureus and its infection mostly remains subclinical. Conversely, CNS is capable of triggering persistent infections among dairy herds, resulting in reduced milk quality and high milk somatic cell count (SCC). One negative impact of CNS infection in dairy herds is that it can destroy cow udder tissue, hereby leading to a drop in milk production of dairy cows. CNS mastitis has a high cure rate when treated with anti-biotics as their infection in cows are not known to be a therapeutic problem. Judging from several literatures, it cannot be said whether CNS species act as an ecological or contagious pathogens. Regulator procedures, including pre- and post-milking teat disinfection, may reduce contagious mastitis pathogens of CNS infections in the dairy herd. Phenotypic methods for identification of CNS are not adequately dependable, and molecular techniques of identification may be better substitute for identification. Dairy farmers may benefit greatly from more empirical research on the epidemiology of CNS mastitis and more reliable methods for species identification.

Optimal exposure targets for vancomycin in the treatment of neonatal coagulase-negative Staphylococcus infection: A retrospective study based on electronic medical records

The currently advocated ratio of area under the curve (AUC) over 24h to minimum inhibitory concentration (AUC/MIC)>400 and AUC<600mgh/L as the therapeutic drug monitoring (TDM) target of vancomycin is based on data from multiple observational studies in adult patients with methicillin-resistant Staphylococcus aureus (MRSA) infection. It may not be applicable to newborns with coagulase-negative Staphylococcus (CoNS) infection. We conducted a retrospective study to identify the optimal exposure targets for vancomycin in the treatment of neonatal CoNS infection. Based on the inclusion and exclusion criteria, serum vancomycin concentration, demographics, clinical data, and related laboratory data of newborns who received vancomycin intravenous infusion from June 1, 2016 to February 1, 2021 were collected retrospectively. The AUC was calculated using the maximum a posteriori Bayesian (MAPB) method. The vancomycin exposure threshold of AUC/MIC for efficacy and AUC for toxicity (acute kidney injury, AKI) were determined based on receiver operating characteristic (ROC) curve analysis. The correlation between vancomycin exposure and both clinical effect and nephrotoxicity was analyzed using logistic multivariate regression. In total, 153 patients and 245 vancomycin concentrations (160 trough and 85 peak concentrations) were included. The ROC curve analysis showed that the exposure thresholds of AUC/MIC for clinical efficacy and AUC for nephrotoxicity were 281 and 602mgh/L, respectively. The multivariate regression analysis showed that AUC/MIC>280 was a predictor of efficacy (OR: 13.960, 95% CI: 1.891-103.078, P<0.05) and AUC>600mgh/L was associated with AKI (OR: 9.008, 95% CI: 2.706-29.983, P<0.05). The vancomycin AUC/MIC threshold for treating neonatal CoNS infection with vancomycin is lower than the currently advocated AUC/MIC >400. The optimal exposure targets for vancomycin in neonatal CoNS infection were AUC/MIC>280 and AUC<600mgh/L.

Bioactivities and Structure-Activity Relationships of Fusidic Acid Derivatives: A Review.

Fusidic acid (FA) is a natural tetracyclic triterpene isolated from fungi, which is clinically used for systemic and local staphylococcal infections, including methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci infections. FA and its derivatives have been shown to possess a wide range of pharmacological activities, including antibacterial, antimalarial, antituberculosis, anticancer, tumor multidrug resistance reversal, anti-inflammation, antifungal, and antiviral activity in vivo and in vitro. The semisynthesis, structural modification and biological activities of FA derivatives have been extensively studied in recent years. This review summarized the biological activities and structure–activity relationship (SAR) of FA in the last two decades. This summary can prove useful information for drug exploration of FA derivatives.

Sex-based differences in bacterial meningitis in adults: Epidemiology, clinical features, and therapeutic outcomes

BackgroundTo investigate the sex-based differences in clinical features, causative pathogens, and outcomes of hospital-based culture-proven adult bacterial meningitis. ObjectiveThis retrospective study enrolled 621 patients at a tertiary medical center. To compare changes over time, the presentation of disease among the enrolled patients was divided into two equal time periods: the first study period (1986–2002) and the second study period (2003–2019). ResultsOf the 621 patients enrolled in this study, 396 were males and 225 were females. The overall case fatality rate was 30.4% with 30.1% and 31.1% in males and females, respectively. Regarding the causative pathogens, there was a rising incidence of coagulase-negative staphylococcal infections and a decreasing incidence of Klebsiella pneumoniae infection in both male and female in the second study period. The prevalence of patients with nosocomial infection in a postneurosurgical state were 41.9% (68/162) in the first study period and 58.1% (94/162) in the second study period in male group, and 34.8% (32/92) in the first study period and 65.2% (60/92) in the second study period in female group, respectively. Significant factors between the sexes difference included age (P = 0.004), traumatic brain injury (P = 0.01), alcoholism (P < 0.001), brain tumor (P < 0.001), systemic lupus erythematosus (SLE) (P = 0.004), presence of diabetic ketoacidosis/hyperglycemic hyperosmolar state (P = 0.033), brain abscess (P = 0.042), and total protein (P = 0.002) and white blood cell count (P = 0.036) of cerebrospinal fluid data. ConclusionOur study revealed an increase in the number of patients with nosocomial infection with a postneurosurgical state in both male and female in the second study period. Males were younger and frequently presented with a history of head trauma and alcoholism with concomitant brain abscesses while females presented with SLE and brain tumor. The therapeutic outcome did not show differences between the sexes.

Genomic investigation of clinically significant coagulase-negative staphylococci.

Introduction. Coagulase-negative staphylococci have been recognized both as emerging pathogens and contaminants of clinical samples. High-resolution genomic investigation may provide insights into their clinical significance.Aims. To review the literature regarding coagulase-negative staphylococcal infection and the utility of genomic methods to aid diagnosis and management, and to identify promising areas for future research.Methodology. We searched Google Scholar with the terms (Staphylococcus) AND (sequencing OR (infection)). We prioritized papers that addressed coagulase-negative staphylococci, genomic analysis, or infection.Results. A number of studies have investigated specimen-related, phenotypic and genetic factors associated with colonization, infection and virulence, but diagnosis remains problematic.Conclusion. Genomic investigation provides insights into the genetic diversity and natural history of colonization and infection. Such information allows the development of new methodologies to identify and compare relatedness and predict antimicrobial resistance. Future clinical studies that employ suitable sampling frames coupled with the application of high-resolution whole-genome sequencing may aid the development of more discriminatory diagnostic approaches to coagulase-staphylococcal infection.

Usage-evaluation study on Vancomycin among hospitalized pediatric patients: Experience from two tertiary care centers of Eastern India

Background: Vancomycin is a highly effective bactericidal antibiotic with excellent efficacy against resistant Gram-positive microorganisms. It is losing its antimicrobial efficacy due to its rampant usage in Food and Drug Administration/Centers for Diseases Control and Prevention as well as off-label clinical uses. To stop its emerging resistance, judicious use of vancomycin following antibiotic stewardship is required. Aims: This study aims to examine the rationality of vancomycin use with respect to its adherence to Hospital Infection Control Practices Advisory Committee guidelines as well as its dosing, duration, adverse effects, and final outcome. Methodology: A retrospective cross-sectional hospital record-based study was conducted at two medical colleges of Eastern India from January 1, 2020, till June 30, 2020, incorporating all admitted newborns and children till 12 years’ age who received vancomycin for any clinical conditions. However, the patients with renal diseases or incomplete history were excluded from the study. Results: A cohort of 388 patients was included of which majority of them (41.2%) were in the age group of 2–12 years and males (56.9%). Sepsis (24.2%) and pneumonia (20.8%) were the most common indications for vancomycin prescription. Overall, appropriate usage of vancomycin was found in 57.2% of patients with maximum appropriate usage which was seen among neonates (64.5%). The areas of inappropriate usage were empirical therapy in febrile neutropenia, surgical prophylaxis, treatment of coagulase-negative Staphylococcal infection, and failure to withdraw vancomycin even after negative culture report for Gram-positive organisms. The final outcome in terms of clinical improvement was seen in 72.4% of patients irrespective of appropriate/inappropriate usage. Conclusion: Monitoring vancomycin usage should be followed in institutional practice to stop the emergence of resistance of vancomycin.

Transcripts and protein levels of CSN1S1 and CSN3 genes in dairy cattle mammary gland secretory tissue during chronic staphylococcal infection

Our objective was to determine the influence of chronic coagulase-positive staphylococci (CoPS) or coagulase-negative staphylococci (CoNS) infection on the mRNA and protein levels of two main milk proteins responsible for cheese curd quantity and quality, alpha-S1-casein (CSN1S1) and kappa-casein (CSN3). Measurements were made in cow mammary parenchyma with a prevalence of secretory tissue (MGST). Samples of MGST were collected from the separate quarters and divided into CoPS, CoNS and bacteria-free (H) groups according to the microbiological status of the quarter milk. No differences in CSN1S1 and CSN3 mRNA level were found between groups, however, CSN1S1 protein level was significantly higher in the H group than the CoNS group, and CSN3 protein level was significantly higher in H than CoPS group. Hence, while the CSN1S1 and CSN3 genes appear to be constitutively expressed at the mRNA level in dairy cow MGST during mastitis, CoNS infection negatively affected CSN1S1 protein level, and CoPS infection negatively affected CSN3 protein level. The lack of change at the mRNA level suggests that staphylococcal infection may affect the post-transcriptional or post-translational modifications.

The predictive factors for poor outcomes in preterm infants with coagulase-negative staphylococci infection

Background: The main pathogen for neonatal nosocomial infections is coagulase-negative staphylococci (CoNS), particularly in very low-birth-weight and premature newborns. The current study is aimed to assess the outcomes of preterm infants with CoNS infection via a retrospective analysis, to determine the correlation between the clinical profile and mortality and morbidity, and to determine the factors associated with poor outcomes. Materials and Methods: This retrospective case–control study was conducted in the Children's and Women's Health Centre of King Fahad Medical City neonatal intensive care unit in Saudi Arabia. The study period was from January 2013 to December 2019. Results: There were 1333 controls and 137 cases of CoNS infection. There was a significant association between total parenteral nutrition use, surgical insertion of a central line, inotrope use, and spontaneous intestinal perforation and CoNS infection. There was a significant association between umbilical vein catheter (UVC) and peripherally inserted central catheter (PICC) line use and CoNS infection. The use of a UVC or PICC line significantly impacted. The presence of patent ductus arteriosus also significantly impacted. Conclusions: There was a significant association between UVC and PICC line use and outcome. The presence of patent ductus arteriosus or a perforated bowel and the need for inotrope use in CoNS infection was associated with poor outcomes. Mortality, retinopathy of prematurity, and necrotizing enterocolitis requiring surgery were more common in infants with CoNS infections.

The Use of Daptomycin in the Treatment of Persistent Coagulase-Negative Staphylococcal Sepsis in Premature Infants: A Case Series.

Daptomycin is a lipopeptide antibiotic with rapid bactericidal activity against Gram-positive bacteria. Reports regarding the use of daptomycin in infants are still limited. Thus, the objective of this report is to describe the safety and efficacy of daptomycin in premature infants with persistent coagulase-negative staphylococci (CoNS) infection. This was a retrospective chart review of 10 premature infants with persistent CoNS infection who received daptomycin therapy between January 2018 and September 2019. Four patients had endocarditis and 1 had bacterial meningitis and infectious endocarditis. The other 5 patients had persistent CoNS bacteraemia only. Daptomycin treatment was successful for 5 patients. The others died owing to multiple factors such as prematurity, sepsis, and chronic lung disease. Adverse drug reactions, including elevation of creatine phosphokinase and/or hepatotoxicity, were noted in 4 patients. Large and randomized studies are necessary to ensure daptomycin's safety and efficacy for the treatment of infants with persistent sepsis caused by Gram-positive bacteria.

705. Factors Associated with Local Invasion in Infective Endocarditis: a Nested Case-control Study

BackgroundA substantial proportion of infective endocarditis (IE) cases are complicated by local invasion. The purpose of this study was to identify patient and disease characteristics that increase the odds of local invasion in surgically treated IE patients.MethodsThis was a nested case-control study. All episodes of IE for patients admitted to Cleveland Clinic from January 1st, 2013 – June 30th, 2016 were identified from the Cleveland Clinic IE Registry. Patients >18 years of age who underwent surgery for IE were included. Data was compiled by manual review of the Electronic Medical Record. Local invasion, defined as peri-annular extension, peri-valvular abscess, intra-cardiac fistula or pseudoaneurysm, was ascertained from the surgical operative note. Associations of selected factors with local invasion were examined in a multivariable logistic regression model.ResultsAmong 510 patients who met inclusion criteria, 206 had local invasion. Mean age was 56 years and 369 (72 %) were male. Overall 344 (67 %) had aortic valve, 228 (45%) mitral valve, and 66 (13%) tricuspid or pulmonic valve involvement. Aortic valve involvement (OR 5.76, 95% CI 3.44 – 9.98), mechanical valve (OR 7.63, 95% CI 3.63 – 17.07), bioprosthetic valve (OR 3.20, 95% CI 1.99 – 5.19), significant paravalvular leak (OR 2.27, 95% CI 1.09 – 4.97), new atrioventricular nodal block (OR 3.05, 95% CI 1.57 – 6.09), Staphylococcus aureus infection (OR 2.11, 95% CI 1.20 – 3.76), coagulase negative staphylococcal infection (OR 2.38, 95% CI1.27 – 4.54), and non- viridans group streptococcal infection (OR 4.21, 95% CI 1.81 – 10.06) were significantly associated with local invasion.ConclusionIntra-cardiac and microorganism factors, but not comorbid conditions, are associated with local invasion in IE.Disclosures All Authors: No reported disclosures

Abstract 17130: Systemic Infection From Non-Pocket Source is Associated With Worse Outcomes Compared With Pocket Source

Introduction: Systemic infection can occur in patients with cardiac devices due to spread from pocket infection or a non-pocket source. Data comparing outcomes of systemic infection from pocket vs. non-pocket source are lacking Hypothesis: We hypothesized that systemic infection from non-pocket source is associated with worse outcomes compared with pocket source. Methods: We collected data for all patients with systemic infection, who underwent transvenous lead extraction (TLE) between April 2004 and June 2015. Patients were divided into 2 groups- systemic infection from pocket source and non-pocket source. Results: Out of total 700 TLE procedures for infectious indication, 407 patients (58.1%) had evidence of systemic infection. Out of these, 167 (41%) had systemic infection from pocket source and 240 (59%) had systemic infection from non-pocket sources. Patients with pocket source were older (69.7± 13.4 vs. 66.3± 13.5 years, p value 0.011), less likely to be on dialysis (8.4% vs. 23.8%), and more likely to have CRT system (39.5% vs. 23.8%). Pocket source group had higher incidence of coagulase negative staphylococcus infection (32.3% vs. 19.6%) and presence of abandoned leads (32.3% vs. 10.8%).Patients with non-pocket source were more likely to have endocarditis (81.7% vs. 55.1%). There was no difference in TLE procedure outcomes, complications during hospital stay, and 30-day mortality (10.3% vs. 13.7%, p value 0.330). However, 1-year mortality was significantly higher in patients with non-pocket source (41% vs. 28.1%, p value 0.019). Kaplan-Meier survival curves showed worse survival in non-pocket source group up to 6 years of follow up. Conclusions: In conclusion, there is no difference in procedural or short-term outcomes between patients with systemic infection from pocket vs. non-pocket source after TLE. However, patients with systemic infection from non-pocket source are more likely to have endocarditis and have worse long-term mortality.

Prevalence of virulence genes in Staphylococcus saprophyticus isolated from women with urinary tract infections in Lagos State

Virulence factors and its expression is very important in the pathology of coagulase negative staphylococcal urinary tract infections. This study was carried out to determine the prevalence of virulence genes in Staphylococcus saprophyticus isolated from urine samples of patients diagnosed with urinary tract infections (UTIs) in government hospitals in Lagos State, Nigeria. A total of 88 S. saprophyticus clinical isolates were subjected to multiplex polymerase chain reaction procedure for the amplification of nine virulence genes (sdrl, ssp, uafA, dsdA, capD, aas, rot, sarA and agr). The results of the study showed that 43 (49%) of the 88 isolates tested, carried sarA gene closely followed by 26 (30%), 8 (9%), 6 (7%), 5 (6%), 3 (3%) and 1 (1%) of aas, ssp, dsdA, rot, agr, and capD genes respectively. Gene's uafA and sdrl were not detected in any of the isolates except the reference strain that harboured sdrl gene. The present results showed that S. saprophyticus is an important cause of UTIs among women in this geographical location with the presence of some of these virulence genes that encoded virulence factors of this organism.