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.
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.
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).
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.
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 name:||XXIst ISTH Congress|
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