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Distinguished features in systemic staphylococcal infections with S. aureus and coagulase-negative staphylococci

Abstract number: r1996

Cochior  L., Miftode  E., Dorneanu  O., Leca  D., Luca  V., Dumitriu  D., Nastase  E.

Objectives: 

The aim of this study was to evaluate the actual epidemiological, clinical, bacteriological and evolutive differences in systemic infections with S. aureus (SA) and coagulase-negative staphylococci (CNS) in the era of major susceptibility variations of staphylococcal strains.

Methods: 

We analyzed 103 patients with systemic staphylococcal infection, between October 2002-September 2005. Staphylococcal strains were identified by conventional methods and using ID 32 Staph strips (bioMerieux®, France). Antibiotic susceptibility testing was performed by disk diffusion method according to NCCLS standards and using ATB Staph strips (bioMerieux®, France).

Results: 

We isolated 73 strains (71%) of S. aureus (40% methicillin resistant, SAMR) and 30 strains (29%) of CNS (67% methicillin resistant, MR-CNS). Clinical isolates were recovered from blood cultures: 62%-SA, 66%-CNS, pus: 15%-SA, 3%-CNS, blood and catheter cultures: 27%-CNS, 12%-SA and other specimens normally sterile. Predisposing conditions were identified as: recent skin and soft tissue infections: 34%-SA, 7%-CNS, catheters: 27%-CNS, 12%-SA, surgery: 23%-CNS, 14%-SA, sepsis recurrences: 20%-CNS, 4%-SA, hospitalization: 15%-SA, 13%-CNS prosthetic devices: 13%-CNS, 8%-SA. The dominant clinical presentation was fever of unknown origin: 30%- CNS, 15%-SA, pyodermitis: 19%-SA, pulmonary infection: 18%-SA, 13%-CNS, arthritis: 19%-SA, 16%-CNS, septic shock: 20%-SA, 16%-CNS. Multiple secondary foci of infections were found in 33% for SA and 17% for CNS. The complications rate was 55% for SA and 33% for CNS and a severe evolution (severe sepsis, septic shock and MSOF) marked 40% of SA infections and 26% with CNS. Antibiotic switch was made in 68% of SA infections and 50% with CNS. Effective therapy was represented by associations including - betalactames: 41%-SA, 17%-CNS, glycopeptides: 37%-CNS, 29%-SA, oxazolidinones: 20%-CNS, 10%-SA, fluoroquinolones: 14%-SA, 7%-CNS. The overall rate of mortality was 16, 50%, with 21% for SA and 12% for CNS.

Conclusion: 

The overall rate of methicillin resistance was 48%, with a higher rate for CNS. 24% of SAMR and 10% of MR-CNS were community acquired. SSI with SA had more severe evolution, higher rate of multiple determinations and complications and higher mortality rate, while SSI with CNS had a more insidious evolution, lower rate of complications and mortality.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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