Clinical Impact of Staphylococcus aureus Skin and Soft Tissue Infections

Antibiotics, Journal Year: 2023, Volume and Issue: 12(3), P. 557 - 557

Published: March 11, 2023

The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) United States. Most S. SSTIs are caused by epidemic clone USA300 USA. These can be serious; 2019, with were associated an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations vary from superficial local symptoms to monomicrobial necrotizing fasciitis, which cause systemic manifestations and may lead serious complications or death. In order skin infections, employs a host virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored molecules used for immune evasion. response involves initial responders such as keratinocytes neutrophils, supported dendritic cells T-lymphocytes later during infection. Treatment usually oral therapy, parenteral therapy reserved severe presentations; it ranges cephalosporins penicillin agents oxacillin, generally methicillin-sensitive (MSSA), vancomycin methicillin-resistant (MRSA). challenges include adverse effects, risk Clostridioides difficile infection, potential antibiotic resistance.

Language: Английский

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Efficacy and safety of an early oral switch in low-risk Staphylococcus aureus bloodstream infection (SABATO): an international, open-label, parallel-group, randomised, controlled, non-inferiority trial

The Lancet Infectious Diseases, Journal Year: 2024, Volume and Issue: 24(5), P. 523 - 534

Published: Jan. 17, 2024

Language: Английский

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Redefining Staphylococcus aureus bacteremia: A structured approach guiding diagnostic and therapeutic management

Journal of Infection, Journal Year: 2022, Volume and Issue: 86(1), P. 9 - 13

Published: Nov. 9, 2022

Language: Английский

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Management of Staphylococcus aureus Bacteremia

JAMA, Journal Year: 2025, Volume and Issue: unknown

Published: April 7, 2025

Importance Staphylococcus aureus , a gram-positive bacterium, is the leading cause of death from bacteremia worldwide, with case fatality rate 15% to 30% and an estimated 300 000 deaths per year. Observations causes metastatic infection in more than one-third cases, including endocarditis (≈12%), septic arthritis (7%), vertebral osteomyelitis (≈4%), spinal epidural abscess, psoas splenic pulmonary emboli, seeding implantable medical devices. Patients S commonly present fever or symptoms infection, such as pain back, joints, abdomen extremities, and/or change mental status. Risk factors include intravascular devices cardiac dialysis vascular catheters, recent surgical procedures, injection drug use, diabetes, previous infection. detected blood cultures. Prolonged (≥48 hours) associated 90-day mortality risk 39%. All patients should undergo transthoracic echocardiography; transesophageal echocardiography be performed at high for endocarditis, those persistent bacteremia, fever, foci, Other imaging modalities, computed tomography magnetic resonance imaging, based on localizing signs categorized methicillin-susceptible (MSSA) methicillin-resistant (MRSA) susceptibility β-lactam antibiotics. Initial treatment typically includes antibiotics active against MRSA vancomycin daptomycin. Once antibiotic results are available, adjusted. Cefazolin antistaphylococcal penicillins used MSSA vancomycin, daptomycin, ceftobiprole MRSA. Phase 3 trials demonstrated noninferiority daptomycin standard care (treatment success, 53/120 [44%] vs 48/115 [42%]) 132/189 [70%] 136/198 [69%]). Source control critical component treating may removal infected implanted devices, drainage abscesses, debridement. Conclusions relevance has year worldwide. Empirical which susceptibilities known, treated cefazolin penicillin. Additional clinical management consists identifying sites pursuing source identified foci

Language: Английский

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Contemporary Management ofStaphylococcus aureusBacteremia—Controversies in Clinical Practice

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(11), P. e57 - e68

Published: Aug. 22, 2023

Abstract Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication 2011 Infectious Diseases Society America (IDSA) guidelines on methicillin-resistant infections, field SAB has evolved with emergence newer diagnostic strategies therapeutic options. In review, we seek provide comprehensive overview evaluation SAB, special focus areas where highest level evidence is lacking inform best practices.

Language: Английский

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Global Differences in the Management of Staphylococcus aureus Bacteremia: No International Standard of Care

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(8), P. 1092 - 1101

Published: June 13, 2023

Abstract Background Despite being the leading cause of mortality from bloodstream infections worldwide, little is known about regional variation in treatment practices for Staphylococcus aureus bacteremia (SAB). The aim this study was to identify global management, diagnostics, and definitions SAB. Methods During a 20-day period 2022, physicians throughout world were surveyed on SAB practices. survey distributed through listservs, e-mails, social media. Results In total, 2031 71 different countries 6 continents (North America [701, 35%], Europe [573, 28%], Asia [409, 20%], Oceania [182, 9%], South [124, 6%], Africa [42, 2%]) completed survey. Management-based responses differed significantly by continent preferred methicillin-susceptible S. (MSSA) methicillin-resistant (MRSA) bacteremia, use adjunctive rifampin prosthetic material infection, oral antibiotics (P < .01 all comparisons). 18F-FDG PET/CT scans most commonly used (94%) least frequently (13%) North (51%; P .01). Although respondents defined persistent as 3–4 days positive blood cultures, ranged 2 31% European 7 38% Asian Conclusions Large practice variations exist world, reflecting paucity high-quality data absence an international standard care management

Language: Английский

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Does Adjunctive Clindamycin Have a Role in Staphylococcus aureus Bacteremia? A Protocol for the Adjunctive Treatment Domain of the Staphylococcus aureus Network Adaptive Platform (SNAP) Randomized Controlled Trial

Clinical Infectious Diseases, Journal Year: 2024, Volume and Issue: 79(3), P. 626 - 634

Published: May 24, 2024

Abstract Background The use of adjunctive antibiotics directed against exotoxin production in Staphylococcus aureus bacteremia (SAB) is widespread, and it recommended many guidelines, but this based on limited evidence. Existing guidelines are the theoretical premise toxin suppression, as strains S. produce toxins such leukocidins (eg, Panton-Valentine leukocidin, toxic shock syndrome 1, exfoliative toxins, various enterotoxins). Many clinicians therefore believe that limiting release by could reduce its virulence improve clinical outcomes. Clindamycin, a protein synthesis inhibitor antibiotic, commonly used for purpose. We report domain-specific protocol, embedded large adaptive, platform trial, seeking to definitively answer question. Methods Analysis Network Adaptive Platform (SNAP) trial pragmatic, randomized, multicenter adaptive aims compare different SAB therapies, simultaneously, 90-day mortality rates. treatment domain test effectiveness antibiotics, initially comparing clindamycin no future adaptations may include other agents. Individuals will be randomized receive either 5 days (or lincomycin) or antibiotic therapy alongside standard-of-care antibiotics. Most participants with (within 72 hours index blood culture contraindications) eligible participate domain. Prespecified analyses defined statistical appendix core secondary adjusted resistance clindamycin, disease phenotype (complicated uncomplicated SAB) leukocidin–positive isolate.

Language: Английский

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Whole-of-Life Inclusion in Bayesian Adaptive Platform Clinical Trials

JAMA Pediatrics, Journal Year: 2024, Volume and Issue: 178(10), P. 1066 - 1066

Published: Aug. 19, 2024

There is a recognized unmet need for clinical trials to provide evidence-informed care infants, children and adolescents. This Special Communication outlines the capacity of 3 distinct trial design strategies, sequential, parallel, unified adult-pediatric bayesian adaptive design, incorporate into transform this current state evidence inequity. A whole-of-life demonstrated through Staphylococcus aureus Network Adaptive Platform (SNAP) trial.

Language: Английский

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Deconstructing the Dogma: Systematic Literature Review and Meta-analysis of Adjunctive Gentamicin and Rifampin in Staphylococcal Prosthetic Valve Endocarditis

Open Forum Infectious Diseases, Journal Year: 2022, Volume and Issue: 9(11)

Published: Oct. 31, 2022

Based primarily on in vitro and animal models, with little data directly addressing patient outcomes, current guidelines recommend treating staphylococcal prosthetic valve endocarditis (PVE) antibiotic combinations including gentamicin rifampin. Here, we synthesize the clinical adjunctive rifampin PVE.We conducted a systematic review meta-analysis of PubMed- Cochrane-indexed studies reporting outcomes PVE treated rifampin, gentamicin, both agents, or neither (ie, glycopeptide β-lactam monotherapy). We recorded mortality, relapsed infection, length stay, nephrotoxicity, hepatotoxicity, important drug-drug interactions (DDIs).Four relevant were identified. Two (n = 117) suggested that adding to rifampin-containing regimens did not reduce failure (odds ratio [OR], 0.98 [95% confidence interval {CI}, .39-2.46]), 2 201) gentamicin-containing (OR, 1.29 CI, .71-2.33]). Neither nor was associated reduced infection relapse; 1 study found treatment longer hospitalizations (mean, 31.3 vs 42.3 days; P < .001). Comparative safety rarely reported, but be hepatoxicity, DDIs, leading discontinuation 31% patients.The existing do suggest benefit either PVE. Given other also these agents add risk DDIs without endovascular infections, recommendations for downgraded used within context trials.

Language: Английский

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Statistical considerations for the platform trial in COVID-19 vaccine priming and boosting

Trials, Journal Year: 2024, Volume and Issue: 25(1)

Published: July 26, 2024

The Platform trial In COVID-19 priming and BOOsting (PICOBOO) is a multi-site, adaptive platform designed to generate evidence of the immunogenicity, reactogenicity, cross-protection different booster vaccination strategies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) its variants, specific for Australian context. PICOBOO randomises participants receive one three vaccine brands (Pfizer, Moderna, Novavax) available use in Australia, where brand subtypes vary over time according national roll out strategy, employs Bayesian hierarchical modelling approach efficiently borrow information across consecutive doses, age groups subtypes. Here, we briefly describe structure report statistical considerations estimands, models decision making adaptations. This paper should be read conjunction with Core Protocol Sub-Study 1: Booster Vaccination. was registered on 10 February 2022 New Zealand Clinical Trials Registry ACTRN12622000238774.

Language: Английский

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