MD Conference Express ICAAC 2011 - (Page 12)
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C L I N I C A L
T R I A L
H I G H L I G H T S
Treatment success rates were significantly (p≤0.01) higher with combination therapy for infections that were associated with skin and soft tissues and for bacteremias of unknown origin. Overall treatment failures were greater for monotherapy. Overall mortality rates, deaths due to bacteremia, and treatment-related adverse events were similar between the two arms. Tigecycline in combination with piperacillin/tazobactam, compared with the standard regimen of piperacillin/ tazobactam, is more effective overall in bacteremias and clinically documented infections as well.
hospitals. Only the first episode of SAB per patient during the study period was analyzed. Patients were categorized according to onset: community onset (<48 hours from hospital admission) and nosocomial onset (≥48 hours from hospital admission). There were 1607 SAB episodes following deduplication; 861 (53.6%) MSSA, of which 437 (50.8%) were community onset and 424 (49.2%) were nosocomial onset, and 746 (46.4%) MRSA, of which 163 (21.8%) were community onset and 583 (78.2%) were nosocomial onset. MRSA rates started to decline in 2004, driven more by a reduction in nosocomial infections, with the largest decrease (53%) occurring during the 2006 to 2007 period. MSSA rates started to decline in 2006, driven again by reductions in nosocomial infections, with the largest decrease (59%) occurring during 2006–2007. Communityacquired infections remained stable over the same period (Figure 1). Hand washing affected MRSA transiently but not MSSA rates, while having a vascular access team and performing line care bundle had a large impact on decreases for both MRSA and MSSA. Extended MRSA screening may have contributed to the larger decline in MRSA infections. Potential confounders (hospital 1000 bed-day activity and number of blood cultures processed) did not influence results. Figure 1. Community Acquired Infection Rates.
0.40
Bacteria Rates/1000 Bad Days
Interventions Aimed at Reducing MRSA BSIs Led to Decreased Rates of Nosocomial MSSA BSIs: Ten-Year Data from a UK Center
Written by Eric Butterman
Addenbrooke’s Hospital in Cambridge, United Kingdom, once known for having high rates of Staphylococcus aureus bloodstream infections (BSIs), has been able to significantly reduce rates of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) BSIs using a number of infection control interventions under the lead of Infection Control Doctor Nick Brown, MD. Staff physician Theodore Gouliouris, MD, presented data from a study that showed a decline in MRSA and MSSA BSI rates that was driven by reductions in nosocomial infections. The purpose of the study was to analyze trends of MSSA and MRSA BSIs according to onset (community vs hospital) and assess the impact of infection control interventions. The interventions were initiated over several years and included: starting a hand hygiene campaign (November 2004), establishing a vascular access team (January 2006), improving line care bundles (June 2006), screening all emergency (April 2007) and elective (January 2009) admissions for MRSA carriage, and routinely decolonizing all MRSA-positive patients (entire study period). This was a retrospective study in a tertiary referral university hospital setting with 1200 beds and 70,000 in-patient admissions per year. All S. aureus bacteremia (SAB) episodes from January 2001 to December 2010 at Addenbrooke’s Hospital were included. The number of episodes was converted to rates per 1000 bed days, which allowed comparison with other
MRSA
0.35 0.30 0.25 0.20 0.15 0.10 0.05 0 2001 2002 2003 2004 2005 MRSA pre-48 hours 2006 2007 2008 2009 2010 MRSA post-48 hours Total MRSA
Year
0.35
Bacteria Rates/1000 Bad Days
MSSA
0.03 0.25 0.20 0.15 0.10 0.05 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 MSSA pre-48 hours MSSA post-48 hours Total MSSA
MRSA=methicillin-resistant Staphylococcus aureus; MSSA=methicillin-susceptible Staphylococcus aureus.
Year
Reproduced with permission from T. Gouliouris, MD.
12
November 2011
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Table of Contents for the Digital Edition of MD Conference Express ICAAC 2011
MD Conference Express ICAAC 2011
Contents
Infectious Disease Genomics
Emerging Resistance Among Gram-Negative Pathogens
Procalcitonin-Guided Antibiotic Therapy In Patients with Lower Respiratory Tract Infections
Combination Therapy with Flucytosine Improves Survival in AIDS-Related Cryptococcal Meningitis
CXA-201 Effective Against Common ICU Pathogens
Tigecycline Plus Standard Therapy Is More Effective For Treating Infections in Febrile Neutropenic Cancer Patients
Interventions Aimed at Reducing MRSA BSIs Led to Decreased Rates of Nosocomial MSSA BSIs
Is the Effectiveness of aP Vaccine in Pre-Adolescents Insufficient?
TMC435 Effective in the Treatment of HCV Genotype 1 Infection
HIV
Vaccines
Antibiotic Resistance
Drug Discovery
The Conundrum of MDR TB and Combination Therapy
New Drugs to Treat MDR Pathogens
Immunizations in Reproductive Health
Why Can’t Microbes Just Get Along?
The Role of Adjunctive Steroids in the Treatment of Bacterial Meningitis
Human and Animal Viruses Share “One World” and Emerging Zoonotic Infections Continue to Threaten
MD Conference Express ICAAC 2011
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