Predictors of septic shock in patients with methicillin-resistant Staphylococcus aureus bacteremia

SummaryObjectivesRisk factors for septic shock associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are not well described. We designed this study to assess the independent predictors of septic shock in patients with MRSA bacteremia.MethodsThis retrospective chart review included 234 patients with MRSA bacteremia admitted to a tertiary care academic medical center. Cases of septic shock and non-septic shock MRSA bacteremia were compared in terms of patient baseline characteristics and co-morbidities, modes of acquisition, and MRSA genotyping. Independent risk factors were determined by multivariable analysis.ResultsOn univariate analysis the presence of chronic kidney disease, respiratory failure, acute renal failure, staphylococcal cassette chromosome (SCCmec) type II, and higher APACHE II scores were significantly correlated with the presence of septic shock. On multivariate analysis, baseline APACHE II score (adjusted odds ratio (AOR) for 1-point increase 1.13, 95% confidence interval (CI) 1.04–1.22, p=0.005), acute renal failure (AOR 2.57, 95% CI 1.02–6.48, p=0.045), and SCCmec type II (AOR 2.60, 95% CI 1.01–6.75, p=0.049) were independently associated with MRSA bacteremic septic shock.ConclusionsThe development of septic shock associated with MRSA bacteremia was independently correlated with baseline severity of illness, presence of acute renal failure, and an MRSA genotyping consistent with nosocomially acquired MRSA infection

Assessment of antibiotic de-escalation by spectrum score in patients with nosocomial pneumonia: A single-center, retrospective cohort study

Background: Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) cause significant mortality. Guidelines recommend empiric broad-spectrum antibiotics followed by de-escalation (DE). This study sought to assess the impact of DE on treatment failure. Methods: This single-center retrospective cohort study screened all adult patients with a discharge diagnosis code for pneumonia from 2016 to 2019. Patients were enrolled if they met predefined criteria for HAP/VAP ≥48 hours after admission. Date of pneumonia diagnosis was defined as day 0. Spectrum scores were calculated, and DE was defined as a score reduction on day 3 versus day 1. Patients with DE were compared to patients with no de-escalation (NDE). The primary outcome was composite treatment failure, defined as all-cause mortality or readmission for pneumonia within 30 days of diagnosis. Results: Of 11860 admissions screened, 1812 unique patient-admissions were included (1102 HAP, 710 VAP). Fewer patients received DE (876 DE vs 1026 NDE). Groups were well matched at baseline, although more patients receiving DE had respiratory cultures ordered (56.6% vs 50.6%, Conclusions: De-escalation and NDE resulted in similar rates of 30-day treatment failure; however, DE was associated with fewer antibiotic days, episodes o

Evaluation of a hybrid antimicrobial restriction process at a large academic medical center

We conducted a retrospective review of a hybrid antimicrobial restriction process demonstrating adherence to appropriate use criteria in 72% of provisional-only orders, in 100% of provisional orders followed by ID orders, and in 97% of ID-initiated orders. Therapy interruptions occurred in 24% of provisional orders followed by ID orders

A Retrospective Multisite Case-Control Series of Concomitant Use of Daptomycin and Statins and the Effect on Creatine Phosphokinase

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America. Objective: Daptomycin has been associated with increased creatine phosphokinase (CPK) due to muscle injury leading to myalgias and muscle weakness. Statins have been proven to cause the same effects and it is recommended to discontinue the use of statins while on daptomycin. Evidence regarding this drug interaction is mixed. This study evaluated the risk of CPK elevation in concomitant use of daptomycin and statins compared to daptomycin alone. Method: This is a multisite retrospective case-control study of patients who received daptomycin therapy with monitoring of CPK. Rates of CPK elevations were compared in patients receiving daptomycin with a statin versus daptomycin alone. To estimate the association between CPK elevation and daptomycin therapy controlling for other risk factors, logistic regression was used to analyze data. Statistical significance was determined at ɑ of 0.05. Results: A total of 3658 patients were included in the study, with 2787 on daptomycin therapy alone and 871 with concurrent statin use. The incidence of CPK elevation was 90 events (3.2%) in the daptomycin group and 26 events (3.0%) in the concurrent statin group. Patients who received daptomycin therapy in addition to statins had no statistically significant difference from patients on daptomycin alone (hazard ratio, 1.05; P =. 85; 95% confidence interval, 0.61-1.84). After adjusting for potential risk factors, the hazards ratio remained almost the same. Conclusions: Concomitant use of daptomycin and statin did not show an increase risk of CPK elevation. Clinicians may consider concomitant use of daptomycin and statin therapy with weekly CPK monitoring