Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Heriot, G; Tong, Steven Y. C.; Cheng, Allen; Liew, Danny

doi:10.1093/ofid/ofy303

Cited by 10 publications

(16 citation statements)

References 67 publications

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“…group (P ϭ 0.03). This is consistent with recent evidence suggesting a limited benefit from echocardiography in LR-SAB (27)(28)(29). Much of the echocardiography done in both groups was not under the recommendation of the ID service, since we do not typically request it for patients with LR-SAB.…”

Section: Discussionsupporting

confidence: 91%

Efficacy of Early Oral Switch with β-Lactams for Low-Risk Staphylococcus aureus Bacteremia

Bupha‐Intr

Blackmore

Bloomfield

2020

Antimicrob Agents Chemother

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The aim of this study was to assess the safety of early oral switch (EOS) prior to 14 days for low-risk Staphylococcus aureus bacteremia (LR-SAB), which is the primary treatment strategy used at our institution. The usual recommended therapy is 14 days of intravenous (i.v.) antibiotics. All patients with SAB at our hospital were identified between 1 January 2014 and 31 December 2018. Those meeting low-risk criteria (health care-associated, no evidence of deep infection or demonstrated involvement of prosthetic material, and no further positive blood cultures after 72 h) were included in the study. The primary outcome was occurrence of a SAB-related complication within 90 days. There were 469 SAB episodes during the study period, 100 (21%) of whom met inclusion criteria. EOS was performed in 84 patients. In this group, line infection was the source in 79%, methicillin-susceptible S. aureus caused 95% of SABs and 74% of patients received i.v. flucloxacillin. The median durations of i.v. and oral antibiotics in the EOS group were 5 days (interquartile range [IQR], 4 to 6) and 10 days (IQR, 9 to 14), respectively. A total of 71% of patients received flucloxacillin as their EOS agent. Overall, 86% of oral step-down therapy was with beta-lactams. One patient (1%) undergoing EOS had SAB relapse within 90 days. No deaths attributable to SAB occurred within 90 days. In this low-MRSA-prevalence LR-SAB cohort, EOS was associated with a low incidence of SAB-related complications. This was achieved with oral beta-lactam therapy in most patients. Larger prospective studies are needed to confirm these findings.

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Section: Discussionsupporting

confidence: 91%

Efficacy of Early Oral Switch with β-Lactams for Low-Risk Staphylococcus aureus Bacteremia

Bupha‐Intr

Blackmore

Bloomfield

2020

Antimicrob Agents Chemother

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“…Similarly, performing an echocardiogram was also a protective factor, albeit not statistically significantly in our study. In cases of SAB at low risk for infective endocarditis (IE), echocardiography is not associated with survival (Heriot et al, 2018); nonetheless, up to 22% of SAB have IE and differences in mortality are evident at 180 days when IE is present (Rasmussen et al, 2011). A systematic screening of SAB patients with echocardiography revealed that 25% of patients were diagnosed with IE although clinical suspicion was only present in 7% (Fowler et al, 1997); these findings suggest that echocardiography should be performed in all SAB patients.…”

Section: Discussionmentioning

confidence: 99%

Adherence to standards of care and mortality in the management of Staphylococcus aureus bacteraemia in Peru: A prospective cohort study

Schwalb

Cachay

Flor

et al. 2020

International Journal of Infectious Diseases

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Background: Despite high mortality rates, physicians can alter the course of the Staphylococcus aureus bacteraemia (SAB) by following recommended standards of care. We aim to assess the adherence of these guidelines and their impact on mortality. Methods: Substudy from a prospective cohort of hospitalized patients with SAB from three hospitals from Peru. Hazard ratios were calculated using Cox proportional regression to evaluate the association between 30-day mortality and the performance of standards of care: removal of central venous catheters (CVC), follow-up blood cultures, echocardiography, correct duration, and appropriate definitive antibiotic therapy. Results: 150 cases of SAB were evaluated; 61.33% were MRSA. 30-day attributable mortality was 22.39%. CVC removal was done in 42.86% of patients. Follow-up blood cultures and echocardiograms were performed in 8% and 29.33% of cases, respectively. 81.33% of cases had appropriate empirical treatment, however, only 22.41% of MSSA cases were given appropriate definitive treatment, compared to 93.47% of MRSA. The adjusted regression for all-cause mortality found a substantial decrease in hazards when removing CVC (aHR 0.28, 95% CI: 0.10 -0.74) and instituting appropriate definitive treatment (aHR 0.27, 95% CI: 0.08 -0.86), while adjusting for standards of care, qPitt bacteraemia score, comorbidities, and methicillin susceptibility; similar results were found in the attributable mortality model (aHR 0.24, 95% CI: 0.08 -0.70 and aHR 0.21, 95% CI: 0.06 -0.71, respectively). Conclusions: Deficient adherence to standards of care was observed, especially definitive treatment for MSSA. CVC removal and the use of appropriate definitive antibiotic therapy reduced the hazard mortality of SAB.

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“…[ 34 ] It may be difficult to statistically demonstrate the non-inferiority of outcomes depending on testing strategy in a population with a low prevalence of the disease. [ 34 ]…”

Section: Discussionmentioning

confidence: 99%

“…However, it would be difficult to include enough patients at low risk of IE in the study to ensure sufficient statistical power. [ 34 ]…”

Section: Discussionmentioning

confidence: 99%

Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

et al. 2021

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Uncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan–Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography ( P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13–43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05–805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.

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Benefit of Echocardiography in Patients With Staphylococcus aureus Bacteremia at Low Risk of Endocarditis

Cited by 10 publications

References 67 publications

Efficacy of Early Oral Switch with β-Lactams for Low-Risk Staphylococcus aureus Bacteremia

Efficacy of Early Oral Switch with β-Lactams for Low-Risk Staphylococcus aureus Bacteremia

Adherence to standards of care and mortality in the management of Staphylococcus aureus bacteraemia in Peru: A prospective cohort study

Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections

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