S. aureus
bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with
S. aureus
bacteremia and evaluate the role of early source control. This ...retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of
S. aureus
bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of
S. aureus
bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (
P
< 0.001), nosocomial bacteremia (
P
0.019), time to blood culture positivity ≤ 13 h (
P
0.004), persistent bacteremia for ≥ 48 h (
P
0.004), sepsis (
P
< 0.001), bacteremia of unknown origin (
P
0.036) and lower respiratory tract infection (
P
< 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (
P
< 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (
P
< 0.001) was associated with better survival. Mortality among patients with
S. aureus
bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality.
Background
Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU).
Objective and methods
To review the current ...management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review of the literature and an European expert panel discussion.
Results and conclusions
Empiric and directed treatment for invasive candidiasis are predicated on the hemodynamic status of the patient. Unstable patients may benefit from broad-spectrum antifungal agents, which can be narrowed once the patient has stabilized and the identity of the infecting species is established. In stable patients, a more classical approach using fluconazole may be satisfactory provided that the patient is not colonized with fluconazole resistant strains or there has been recent past exposure to an azole (<30 days). In contrast, pre-emptive therapy is based on the presence of surrogate markers.
Streptococcal bacteremia is associated with high mortality. The study aims to identify predictors of mortality among patients with streptococcal bacteremia.
This retrospective study was conducted at ...the Lausanne University Hospital, Switzerland and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023.
During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P 0.001; HR 2.87, CI 1.58-5.22), S. pyogenes (P 0.011; HR 2.54, CI 1.24-5.21), sepsis (P < 0.001; HR 7.48, CI 3.86-14.47), lower respiratory tract infection (P 0.002; HR 2.62, CI 1.42-4.81), and absence of source control interventions within 48 hours despite being warranted (P 0.002; HR 2.62, CI 1.43-4.80) were associated with 14-day mortality. Conversely, interventions performed within 48 hours of bacteremia onset, such as infectious diseases consultation (P < 0.001; HR 0.29, CI 0.17-0.48), and appropriate antimicrobial treatment (P < 0.001; HR 0.28, CI 0.14-0.57) were associated with improved outcome.
Our findings underscore the pivotal role of infectious diseases consultation in guiding antimicrobial treatment and recommending source control interventions for patients with streptococcal bacteremia.
Abstract Purpose To determine predictors of mortality among patients with Pseudomonas aeruginosa bacteraemia. Methods Retrospective study. Setting This study conducted at the Lausanne University ...Hospital, Switzerland included adult patients with P. aeruginosa bacteraemia from 2015 to 2021. Results During the study period, 278 episodes of P. aeruginosa bacteraemia were included. Twenty (7%) isolates were multidrug-resistant. The most common type of infection was low respiratory tract infection (58 episodes; 21%). Sepsis was present in the majority of episodes (152; 55%). Infectious diseases consultation within 48 h of bacteraemia onset was performed in 203 (73%) episodes. Appropriate antimicrobial treatment was administered within 48 h in 257 (92%) episodes. For most episodes (145; 52%), source control was considered necessary, with 93 (64%) of them undergoing such interventions within 48 h. The 14-day mortality was 15% (42 episodes). The Cox multivariable regression model showed that 14-day mortality was associated with sepsis ( P 0.002; aHR 6.58, CI 1.95–22.16), and lower respiratory tract infection ( P < 0.001; aHR 4.63, CI 1.78–12.06). Conversely, interventions performed within 48 h of bacteraemia onset, such as infectious diseases consultation ( P 0.036; HR 0.51, CI 0.27–0.96), and source control ( P 0.009; aHR 0.17, CI 0.47–0.64) were associated with improved outcome. Conclusion Our findings underscore the pivotal role of early infectious diseases consultation in recommending source control interventions and guiding antimicrobial treatment for patients with P. aeruginosa bacteraemia.
This retrospective study, conducted at Lausanne University Hospital (2015–2021), compared
Staphylococcus aureus
bacteraemia (SABA) patients with or without concomitant bacteriuria (SABU). Among 448 ...included bacteraemic patients, 62 (13.8%) had
S. aureus
concurrently isolated from urine. In multivariate analysis, there was a significant difference in the odds of community-onset bacteraemia (
P
0.030), malignancy (
P
0.002), > 1 pair of positive blood cultures (
P
0.037), and persistent bacteraemia for at least 48 h (
P
0.045) in patients with concurrent SABU. No difference concerning mortality was found. On the other hand, SABU was associated with higher rates of SABA recurrence after antibiotic cessation.
Abstract
Background
Cerebral embolic events (CEEs) are common complications of infective endocarditis (IE), and their presence can modify diagnosis and therapeutic plans. The aim of the present study ...was to assess the role of cerebral imaging (Cer-Im) on diagnosis and management of patients with suspected IE.
Methods
This study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. CEEs and IE were defined according to modified Duke criteria of the European Society of Cardiology (ESC) guidelines.
Results
Among 573 patients with IE suspicion and Cer-Im, 239 (42%) patients had neurological symptoms. At least 1 CEE was found in 254 (44%) episodes. Based on Cer-Im findings, episodes were reclassified from rejected to possible or from possible to definite IE in 3 (1%) and 25 (4%) patients, respectively (0% and 2% in asymptomatic patients, respectively). Among the 330 patients with possible or definite IE, at least 1 CEE was found in 187 (57%) episodes. A new surgical indication (in association with left-side vegetation >10 mm) was established in 74/330 (22%) IE patients and 30/155 (19%) asymptomatic IE patients, respectively.
Conclusions
Cer-Im in asymptomatic patients with IE suspicion showed limited potential for improving the diagnosis of IE. In contrast, performing Cer-Im in asymptomatic patients with IE may be useful for decision making, because Cer-Im findings led to the establishment of new operative indication for valvular surgery in one fifth of patients according to ESC guidelines.
Cerebral imaging among patients suspected of infective endocarditis failed to substantially reclassify patients according to Duke criteria. On the other hand, it led to the establishment of a new surgical indication for embolic events prevention in one fifth of patients.
Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/role-of-cerebral-imaging-on-diagnosis-and-management-in-patients-with-suspected-infective-endocarditis-39f43dba-0494-4dc6-bc42-58a3e79befef
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