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Price J. IDSA 2012 abs.428

1 of 2. Application of whole genome sequencing (WGS) in understanding the role of patients in nosocomial transmission of Staphylococcus aureus (SA).

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Price J. IDSA 2012 abs.428

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  1. 1 of 2 Application of whole genome sequencing (WGS) in understanding the role of patients in nosocomial transmission of Staphylococcus aureus (SA) Prospective single-centre study in 1,093 patients admitted to ICU (period 2010-2011) to assess acquisition* of SA and patient-to-patient transmission# Weekly serial swabs: isolates were spa-typed and underwent WGS to assess relatedness by comparing single nucleotide variants (SNVs) 15.6% of screened patients had SA (4.2% methicillin-resistant SA) 39/676 patients (5.8%) with >1 swab acquired SA Price J. IDSA 2012 abs.428

  2. 2 of 2 Application of whole genome sequencing (WGS) in understanding the role of patients in nosocomial transmission of Staphylococcus aureus (SA) • 4/39 patients had patient-to-patient transmission • 3 of 4 appeared MRSA spa type t032 outbreak-related BUT • 2 of 4: true transmissions according to WGS (>40 SNVs) • 10/35 acquisitions: • No epidemiological or spa type evidence for transmission BUT • WGS revealed clusters of highly related isolates (15-38 SNVs) suggesting pre-ICU transmission events In this study, minority of apparent SAacquisitions in ICU seem to be attributable to direct patient-to-patient transmission Price J. IDSA 2012 abs.428

  3. 1 of 2 Removal of catheter and therapy duration in cancer patients with Staphylococcus aureus central line-associated bloodstream infection (BSI) Single-centre, retrospective study in cancer patients with suspected Staphylococcus aureus central line-associated BSI (SA-CLBSI; period 2005-2011) Of 762 patients, 299 patients (304 episodes) fulfilled the CDC definition of SA-CLBSI Patient characteristics*: 52% with haematological malignancy 23% with neutropenia 69% had fever 76% had sepsis 28% had signs of inflammation at the catheter site 64% developed complications El Zakhem A. IDSA 2012 abs.897

  4. 2 of 2 Removal of catheter and therapy duration in cancer patients with Staphylococcus aureus central line-associated bloodstream infection (BSI) • Staphylococcus aureus isolates*: • 51% had MIC of 2 to vancomycin • 47% were methicillin resistant (MRSA) • Catheter: • 64% removed/exchanged within 3 days (80% within 7 days) • Removal within 3 days associated with lower relapse compared with no/late removal after 7 days (P=0.009) • BSI episodes: • 109/304 (36%) was uncomplicated at time of presentation • 29/109 (27%) became late complications • No association between therapy duration (≤14 days vs. >14 days) and late complications, relapse/recurrence, all-cause mortality in uncomplicated group Catheter removal within 3 days of SA-CLABSI onset seems associated with a lower relapse rate in cancer patiens; for uncomplicated infections, therapy duration beyond 14 days may not be necessary El Zakhem A. IDSA 2012 abs.897

  5. 1 of 3 Dilated fundoscopic examination (DFE) for ocular candidiasis and echocardiography for infective endocarditis (IE) in patients with Candida bloodstream infection (BSI) Retrospective review of lab surveillance data from active residents in metropolitan Atlanta and Baltimore city and county (period March 2008-May 2010) For adults (≥20 yr) and children with Candida positive blood culture: review of screening DFE and echocardiography documentation (≤14 days after positive blood culture), demographic and clinical data Doshi SS. IDSA 2012 abs.128;Doshi SS. IDSA 2012 abs. 699

  6. 2 of 3 Dilated fundoscopic examination (DFE) for ocular candidiasis and echocardiography for infective endocarditis (IE) in patients with Candida bloodstream infection (BSI) Adults with ocular candidiasis (N=8; 5 albicans, 2 glabrata, 1 tropicalis): median age 54 yr, 5 black, 4 male, 6 with >1 positive Candida blood culture day, all required ICU admission Doshi SS. IDSA 2012 abs.128;Doshi SS. IDSA 2012 abs. 699

  7. 3 of 3 Dilated fundoscopic examination (DFE) for ocular candidiasis and echocardiography for infective endocarditis (IE) in patients with Candida bloodstream infection (BSI) • Adults with IE (N=30; 11 with albicans): median age 63 yr, 18 had prior antibacterials, 3 had non-healthcare-associated onset of Candida BSI, 7 died ≤30 days after initial positive blood culture, 13 (43%) had >1 positive Candida culture day • Children with IE (N=4; 3 with albicans): <60 days old, birth weight <1 kg, <28 weeks gestational age; 3 died ≤30 days after initial positive blood culture, all with >1 positive Candida culture day Although ocular candidiasis and IE may occur, few patients with Candida BSI are screened with DFE and echocardiography Doshi SS. IDSA 2012 abs.128;Doshi SS. IDSA 2012 abs. 699

  8. 1 of 2 Clinical and economical outcomes of meropenem and piperacillin-tazobactam treatment using extended compared with intermittent infusions in critically ill patients Single-centre retrospective chart review of patients Receiving ≥48h meropenem (500 mg Q6h) or piperacillin-tazobactam (PT; 3.375 g Q8h) Both treatments using intermittent infusions (period Jan-Dec 2010) and extended* infusions (period Nov 2011-April 2012) Outcomes: Primary: in-hospital all-cause mortality Secondary: length of hospital stay, length of ICU stay, time to normalisation of white blood cell count and temperature Baseline characteristics: Between meropenem groups (N=100): difference in continuous renal replacement therapy and solid organ transplant Between PT groups (N=148): no difference Ternes L. IDSA 2012 abs.786

  9. 2 of 2 Clinical and economical outcomes of meropenem and piperacillin-tazobactam treatment using extended compared with intermittent infusions in critically ill patients • Extended infusion in PT group: 13.2% reduction in average cost/patient/day Extended compared with intermittent infusion seems to result in faster progression to death (significant for meropenem and likely for PT) Ternes L. IDSA 2012 abs.786

  10. 1 of 2 Clinical outcome of linezolid vs vancomycin treatment in patients with ventilator-associated pneumonia (VAP) due to methicillin-resistant Staphylococcus aureus (MRSA) Multi-centre, retrospective observational IMPACT-HAP study in 144 ICU patients with VAP due to MRSA treated with linezolid vs vancomycin in the US VAP due to MRSA defined according to CDC/NHSN surveillance and if MRSA isolated from tracheal aspirate or bronchoalveolar lavage Exclusion: patients with do-not-resuscitate or do-not-intubate order Clinical success defined as symptom improvement or resolution by day 14 or at earlier hospital discharge Peyrani P. IDSA 2012 abs.1283

  11. 2 of 2 Clinical outcome of linezolid vs vancomycin treatment in patients with ventilator-associated pneumonia (VAP) due to methicillin-resistant Staphylococcus aureus (MRSA) • Propensity-adjusted logistic regression model: lowering clinical success rate with increasing APACHE II score for both treatment groups but significantly higher rates at each APACHE II score for linezolid compared with vancomycin (P<0.001) Patients with VAP due to MRSA treated with linezolid seem more likely to respond favourably compared with patients treated with vancomycin Peyrani P. IDSA 2012 abs.1283

  12. 1 of 2 Mortality outcomes and associated risk factors of Stenotrophomonas maltophilia bloodstream infections (BSI) Retrospective single-centre study of 116 patiens with Stenotrophomonas maltophilia BSI (period 2011-2011) Exclusion: patients with polymicrobial blood cultures Patient characteristics: 89% received previous antibiotics 91% had central venous catheter 44% were in ICU 55% had comorbid malignancy 79% was line-related, 17% secondary, 4% undetermined Of isolates tested (N=73): 90% sensitive to sulfamethoxazole-trimethoprim (SMX-TMP) and 16% to ticarcillin/clavulanate 65% were treated with appropriate antibiotics (88% of these with SMX-TMP) Alternative regimens were ticarcillin/clavulanate (N=5), tigecycline (N=13), moxifloxacin (N=2) Hunter AS. IDSA 2012 abs.1706

  13. 2 of 2 Mortality outcomes and associated risk factors of Stenotrophomonas maltophilia bloodstream infections (BSI) • All-cause 14-day mortality outcome: overall 18% • Similar between patients treated with SMX-TMP and alternatives • Survivors: trend towards longer median time before appropriate therapy • 30% when treated with tigecycline (N=13) and 0% when treated with moxifloxacin (N=2); 29% when having SMX-TMP-resistant isolates All-cause 14-day mortality seems comparable between SMX-TMP and alternative regimens in the treatment of S. Maltophilia BSI; independent risk factors could be dissociated Hunter AS. IDSA 2012 abs.1706

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