“Meningitis por Staphylococcus aureus”. Estudio comparativo entre Staphylococcus aureus

La meningitis por S.aureus (MSA) es una infección infrecuente cuya incidencia está aumentando por las cepas SAMR (MSAMR). Publicamos un estudio multicéntrico, tipo caso-control que incluyó 86 M-SAMR y 134 M-SAMS. El estudio comparativo no detectó diferencias en la patologia basal ni en la clínica; aunque M-MRSA fue con más frecuencia neuroquirúrgica y polimicrobiana y cursó con alteración mental; mientras que la respuesta inflamatoria y la bacteriemia fueron menos frecuentes. La infección previa por SAMR, el sondaje urinario y la estancia prolongada son factores de riesgo de M-SAMR. La adecuación antibiótica fue elevada y no se demostró benefícios con la terapia combinada, la vancomicina intraventricular o el uso de dexametasona, pero si, con la retirada de la derivación. La MSA se asocia con mortalidad elevada siendo factores pronóstico independientes el shock séptico, la gravedad de la enfermedad basal, la ausencia de patologia neuroquirúrgica y la infección por SAMR. La hipótesis de mayor mortalidad de SAMR fue probada

Bloodstream Infections and Clinical Significance of Healthcare-associated Bacteremia: A Multicenter Surveillance Study in Korean Hospitals

Recent changes in healthcare systems have changed the epidemiologic paradigms in many infectious fields including bloodstream infection (BSI). We compared clinical characteristics of community-acquired (CA), hospital-acquired (HA), and healthcare-associated (HCA) BSI. We performed a prospective nationwide multicenter surveillance study from 9 university hospitals in Korea. Total 1,605 blood isolates were collected from 2006 to 2007, and 1,144 isolates were considered true pathogens. HA-BSI accounted for 48.8%, CA-BSI for 33.2%, and HCA-BSI for 18.0%. HA-BSI and HCA-BSI were more likely to have severe comorbidities. Escherichia coli was the most common isolate in CA-BSI (47.1%) and HCA-BSI (27.2%). In contrast, Staphylococcus aureus (15.2%), coagulase-negative Staphylococcus (15.1%) were the common isolates in HA-BSI. The rate of appropriate empiric antimicrobial therapy was the highest in CA-BSI (89.0%) followed by HCA-BSI (76.4%), and HA-BSI (75.0%). The 30-day mortality rate was the highest in HA-BSI (23.0%) followed by HCA-BSI (18.4%), and CA-BSI (10.2%). High Pitt score and inappropriate empirical antibiotic therapy were the independent risk factors for mortality by multivariate analysis. In conclusion, the present data suggest that clinical features, outcome, and microbiologic features of causative pathogens vary by origin of BSI. Especially, HCA-BSI shows unique clinical characteristics, which should be considered a distinct category for more appropriate antibiotic treatment