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  • 1
    Online Resource
    Online Resource
    Staphylococcus aureus Bacteremia After Median Sternotomy : Clinical Utility of Blood Culture Results in the Identification of Postoperative Mediastinitis
    Ovid Technologies (Wolters Kluwer Health) ; 2003
    In:  Circulation Vol. 108, No. 1 ( 2003-07-08), p. 73-78
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 108, No. 1 ( 2003-07-08), p. 73-78
    Abstract: Background— Mediastinitis is a complication of coronary artery bypass graft surgery (CABG) that can be difficult to diagnose. This study evaluated the utility of blood culture results in identifying patients with mediastinitis. Methods and Results— All unique patients undergoing CABG at our institution over a 60-month study period (n=5500) and all blood cultures performed on these patients ≤90 days after CABG were identified. Mediastinitis was identified by prospective active infection control surveillance. Eight hundred fifty-five (15.5%) patients had ≥1 blood culture drawn within 90 days of CABG. Mediastinitis occurred in 46 of 60 (76.7%) patients with blood cultures positive for Staphylococcus aureus , 15 of 126 (11.9%) patients with blood cultures positive for other pathogens, 37 of 669 (5.5%) patients with blood cultures with no growth, and 44 of 4645 (0.9%) patients with no blood cultures obtained. The isolation of S aureus from even 1 blood culture drawn after ≤90 days of CABG was strongly associated with mediastinitis (likelihood ratio [LR], 25; 95% CI, 14.7 to 44.4). Bacteremia attributable to other organisms did not alter pretest suspicion for mediastinitis (LR, 1.0; 95% CI, 0.6 to 1.7). Patients with negative blood cultures were less likely to have mediastinitis (LR, 0.45; 95% CI, 0.35 to 0.58). The association between S aureus bacteremia and mediastinitis remained highly significant when all unique patients undergoing CABG were analyzed in a logistic regression model and when a case-control analysis was used to evaluate patients with ≥1 blood culture obtained after CABG. Conclusions— Among patients with blood cultures drawn after CABG, S aureus bacteremia strongly suggests the presence of mediastinitis.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/01.CIR.0000079105.65762.DB
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2003
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    Costs and Outcomes Among Hemodialysis-Dependent Patients With Methicillin-Resistant or Methicillin-Susceptible Staphylococcus aureus Bacteremia
    Cambridge University Press (CUP) ; 2005
    In:  Infection Control & Hospital Epidemiology Vol. 26, No. 2 ( 2005-02), p. 175-183
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 26, No. 2 ( 2005-02), p. 175-183
    Abstract: Comorbid conditions have complicated previous analyses of the consequences of methicillin resistance for costs and outcomes of Staphylococcus aureus bacteremia. We compared costs and outcomes of methicillin resistance in patients with S. aureus bacteremia and a single chronic condition. Design, Setting, and Patients: We conducted a prospective cohort study of hemodialysis-dependent patients with end-stage renal disease and S. aureus bacteremia hospitalized between July 1996 and August 2001. We used propensity scores to reduce bias when comparing patients with methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus bacteremia. Outcome measures were resource use, direct medical costs, and clinical outcomes at 12 weeks after initial hospitalization. Results: Fifty-four patients (37.8%) had MRSA and 89 patients (62.2%) had MSSA. Compared with patients with MSSA bacteremia, patients with MRSA bacteremia were more likely to have acquired the infection while hospitalized for another condition (27.8% vs 12.4%; P = .02). To attribute all inpatient costs to S. aureus bacteremia, we limited the analysis to 105 patients admitted for suspected S. aureus bacteremia from a community setting. Adjusted costs were higher for MRSA bacteremia for the initial hospitalization ($21,251 vs $13,978; P = .012) and after 12 weeks ($25,518 vs $17,354; P = .015). At 12 weeks, patients with MRSA bacteremia were more likely to die (adjusted odds ratio, 5.4; 95% confidence interval, 1.5 to 18.7) than were patients with MSSA bacteremia. Conclusions: Community-dwelling, hemodialysis-dependent patients hospitalized with MRSA bacteremia face a higher mortality risk, longer hospital stays, and higher inpatient costs than do patients with MSSA bacteremia.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/502523
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2005
    detail.hit.zdb_id: 2106319-9
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  • 3
    Online Resource
    Online Resource
    Risk Factors for Burkholderia cepacia Complex Bacteremia Among Intensive Care Unit Patients Without Cystic Fibrosis: A Case-Control Study
    Cambridge University Press (CUP) ; 2007
    In:  Infection Control & Hospital Epidemiology Vol. 28, No. 8 ( 2007-08), p. 951-958
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 28, No. 8 ( 2007-08), p. 951-958
    Abstract: The Burkholderia cepacia complex is associated with colonization or disease in patients with cystic fibrosis (CF). For patients without CF, this complex is poorly understood apart from its presence in occasional point source outbreaks. Objective. To investigate risk factors for B. cepacia bacteremia in hospitalized, intensive care unit patients without CF. Methods. We identified patients with 1 or more blood cultures positive for B. cepacia between May 1, 1996, and March 31, 2002, excluding those with CF. Control patients were matched to case patients by ward, duration of hospitalization, and onset date of bacteremia. Matched analyses were used to identify risk factors for B. cepacia bacteremia. Results. We enrolled 40 patients with B. cepacia bacteremia into the study. No environmental or other point source for B. cepacia complex was identified, although horizontal spread was suspected. Implementation of contact precautions was effective in decreasing the incidence of B. cepacia bacteremia. We selected 119 matched controls. Age, sex, and race were similar between cases and controls. In multivariable analysis, renal failure that required dialysis, recent abdominal surgery, 2 or more bronchoscopic procedures before detection of B. cepacia bacteremia, tracheostomy, and presence of a central line before detection of B. cepacia bacteremia were independently associated with development of B. cepacia bacteremia, whereas presence of a percutaneous feeding tube was associated with a lower risk of disease. Conclusions. B. cepacia complex is an important emerging group of nosocomial pathogens in patients with and patients without CF. Nosocomial spread is likely facilitated by cross-transmission, frequent pulmonary procedures, and central venous access. Infection control measures appear useful for limiting the spread of virulent, transmissible clones of B. cepacia complex.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/519177
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2007
    detail.hit.zdb_id: 2106319-9
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  • 4
    Online Resource
    Online Resource
    Staphylococcus aureus bacteremia in patients with prosthetic devices: Costs and outcomes
    Elsevier BV ; 2005
    In:  The American Journal of Medicine Vol. 118, No. 12 ( 2005-12), p. 1416.e19-1416.e24
    Details
    In: The American Journal of Medicine, Elsevier BV, Vol. 118, No. 12 ( 2005-12), p. 1416.e19-1416.e24
    Type of Medium: Online Resource
    ISSN: 0002-9343
    URL: Article
    DOI: 10.1016/j.amjmed.2005.06.011
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2005
    detail.hit.zdb_id: 2003338-2
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  • 5
    Online Resource
    Online Resource
    Predictors of Mortality in Patients with Bloodstream Infection Due to Ceftazidime-Resistant Klebsiella pneumoniae
    American Society for Microbiology ; 2006
    In:  Antimicrobial Agents and Chemotherapy Vol. 50, No. 5 ( 2006-05), p. 1715-1720
    Details
    In: Antimicrobial Agents and Chemotherapy, American Society for Microbiology, Vol. 50, No. 5 ( 2006-05), p. 1715-1720
    Abstract: Bloodstream infection (BSI) due to multidrug-resistant Klebsiella is associated with high rates of morbidity and mortality. The aim of this study was to identify predictors of in-hospital mortality among patients with BSI due to ceftazidime-resistant (CAZ-R) Klebsiella pneumoniae at a tertiary care medical center. Patients with CAZ-R K. pneumoniae BSI were identified by our microbiology laboratory between January 1995 and June 2003. Clinical data were collected retrospectively. Logistic regression was used to identify independent predictors of all causes of in-hospital mortality. Of 779 patients with K. pneumoniae BSI, 60 (7.7%) had BSI due to CAZ-R K. pneumoniae ; 43 (72%) of these were nosocomial infections. Pulsed-field gel electrophoresis identified a single predominant strain in 17 (28%) patients. The in-hospital mortality rate was 43% ( n = 26). Among patients with CAZ-R K. pneumoniae BSI, those who died were similar to survivors with respect to demographic, clinical, and antimicrobial susceptibility characteristics. Only 43 (72%) patients received effective therapy within 5 days of BSI. In bivariable analysis, delay in initiation of effective therapy for 〉 72 h after diagnosis of BSI was associated with death ( P = 0.03). Strain genotype was not predictive of outcome. In multivariable analysis, delay in initiation of effective therapy for 〉 72 h after diagnosis of BSI was an independent predictor of death (odds ratio, 3.32; 95% confidence interval, 1.07 to 10.3). Thus, among patients with BSI due to CAZ-R K. pneumoniae , a delay in the initiation of effective therapy of greater than 72 h after BSI was associated with a 〉 3-fold increase in mortality risk.
    Type of Medium: Online Resource
    ISSN: 0066-4804 , 1098-6596
    URL: Article
    DOI: 10.1128/AAC.50.5.1715-1720.2006
    RVK:
    XA 24552
    Language: English
    Publisher: American Society for Microbiology
    Publication Date: 2006
    detail.hit.zdb_id: 1496156-8
    SSG: 12
    SSG: 15,3
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  • 6
    Online Resource
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    Clinical Outcomes and Costs Due to Staphylococcus aureus Bacteremia Among Patients Receiving Long-Term Hemodialysis
    Cambridge University Press (CUP) ; 2005
    In:  Infection Control & Hospital Epidemiology Vol. 26, No. 6 ( 2005-06), p. 534-539
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 26, No. 6 ( 2005-06), p. 534-539
    Abstract: To examine the clinical outcomes and costs associated with Staphylococcus aureus bacteremia among hemodialysis-dependent patients. Design: Prospectively identified cohort study. Setting: A tertiary-care university medical center in North Carolina. Patients: Two hundred ten hemodialysis-dependent adults with end-stage renal disease hospitalized with S. aureus bacteremia. Results: The majority of the patients (117; 55.7%) underwent dialysis via tunneled catheters, and 29.5% (62) underwent dialysis via synthetic arteriovenous fistulas. Vascular access was the suspected source of bacteremia in 185 patients (88.1%). Complications occurred in 31.0% (65), and the overall 12-week mortality rate was 19.0% (40). The mean cost of treating S. aureus bacteremia, including readmissions and outpatient costs, was $24,034 per episode. The mean initial hospitalization cost was significantly greater for patients with complicated versus uncomplicated S. aureus bacteremia ($32,462 vs $17,011; P = .002). Conclusion: Interventions to decrease the rate of S. aureus bacteremia are needed in this high-risk, hemodialysis-dependent population ( Infect Control Hosp Epidemiol 2005;26:534-539).
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/502580
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2005
    detail.hit.zdb_id: 2106319-9
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