Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the outcome of Staphylococcus aureus bacteremia (SAB) on mortality, including the impact of methicillin resistance and an initial delay (< or =48 h) of appropriate antibiotics, a retrospective cohort study including 238 patients with SAB was performed. By logistic regression, noneradicable or noneradicated foci, underlying cirrhosis, and cancer were found to be independent predictors of mortality. In patients with eradicable foci, there were no significant differences in the associated mortality rate between methicillin-resistant SAB (11%) and methicillin-susceptible SAB (13%), and between inappropriate (13%) and appropriate (10%) empirical therapy, respectively (P=.79 and P=.78, respectively). By logistic regression, it was found that, in the subgroup of patients with noneradicable foci, underlying cirrhosis (odds ratio [OR], 3.1) and methicillin-resistant SAB (OR, 2.4) were independently associated with mortality.
 ...
PMID:Outcome of Staphylococcus aureus bacteremia in patients with eradicable foci versus noneradicable foci. 1295 40

Pericardial abscess is a rare complication of Staphylococcus aureus bacteremia. We report the case of a 40-year-old man with hepatitis C and liver cirrhosis who presented with high-grade fever and chest pain. Transthoracic echocardiography showed a pericardial mass and computed tomographic scanning and transesophageal echocardiography confirmed the presence of a loculated fluid collection. His illness persisted despite i.v. antibiotics and video-assisted thoracoscopic drainage. The patient was cured after surgical drainage and pericardiectomy.
 ...
PMID:Staphylococcus aureus pericardial abscess in a patient with liver cirrhosis: case report. 1451 75

Staphylococcus aureus bacteremia is associated with substantial morbidity. Recurrence is common, but incidence and risk factors for recurrence are uncertain. The emergence of methicillin resistance and the ease of administering vancomycin, especially in patients who have renal insufficiency, have led to reliance on this drug with the assumption that it is as effective as beta-lactam antibiotics, an assumption that remains open to debate. We initiated a multicenter, prospective observational study in 6 university hospitals and enrolled 505 consecutive patients with S. aureus bacteremia. All patients were monitored for 6 months and patients with endocarditis were followed for 3 years. Recurrence was defined as return of S. aureus bacteremia after documentation of negative blood cultures and/or clinical improvement after completing a course of antistaphylococcal antibiotic therapy. All blood isolates taken from patients with recurrent bacteremia underwent pulsed-field gel electrophoresis testing. Recurrence was subclassified as reinfection (different pulsed-field gel electrophoresis patterns) or relapse (same pulsed-field gel electrophoresis pattern).Forty-two patients experienced 56 episodes of recurrence (79% were relapses and 21% were reinfection). Relapse occurred earlier than reinfection (median, 36 versus 99 d, p < 0.06). Risk factors for relapse of S. aureus bacteremia included valvular heart disease, cirrhosis of the liver, and deep-seated infection (including endocarditis). Nafcillin was superior to vancomycin in preventing bacteriologic failure (persistent bacteremia or relapse) for methicillin-susceptible S. aureus (MSSA) bacteremia. Failure to remove infected intravascular devices/catheters and vancomycin therapy were common factors in patients experiencing multiple (greater than 2) relapses. However, by multivariate analysis, only endocarditis and therapy with vancomycin (versus nafcillin) were significantly associated with relapse. Recurrences occurred in 9.4% of S. aureus bacteremias following antistaphylococcal therapy, and most were relapses. Duration of antistaphylococcal therapy was not associated with relapse, but type of antibiotic therapy was. Nafcillin was superior to vancomycin in efficacy in patients with MSSA bacteremia.
 ...
PMID:Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. 1453 Jul 82

Time-to-positivity is useful in the diagnosis of catheter-related bacteraemia and as a predictor of an endovascular source in patients with Staphylococcus aureus bacteraemia. However, this parameter has been evaluated for only a limited number of microorganisms. In the present study, time-to-positivity was recorded for 1872 episodes of significant monomicrobial bacteraemia diagnosed at a teaching hospital during a 2-year period, and the associated microbial and clinical variables were investigated. According to multivariate analysis, Streptococcus pneumoniae, beta-haemolytic streptococci, Escherichia coli, Klebsiella, Enterobacter, Citrobacter and Aeromonas were characterised by fast growth, with an endovascular source, shock, liver cirrhosis and neutropenia also predicting a short time-to-positivity. For patients not receiving appropriate antibiotics, detection of Gram-positive cocci in clusters within 14 h was predictive of Staph. aureus; a time-to-positivity of >21 h ruled out the possibility that a Gram-positive organism in chains was a beta-haemolytic streptococcus or Strep. pneumoniae, and a time-to-positivity of < or =12 h meant that it was very unlikely that a Gram-negative bacillus was a non-fermenter. A time-to-positivity of < or =8 h was predictive of a non-urinary tract source in patients with E. coli bacteraemia, and detection of growth within 13 h predicted an endovascular source in those with Staph. aureus bacteraemia. In conclusion, time-to-positivity depended on the microorganism, original source and clinical variables involved. Although this measurement may provide some early clues concerning the microorganisms involved and the source of bacteraemia, its clinical impact remains to be defined.
 ...
PMID:Microbial and clinical determinants of time-to-positivity in patients with bacteraemia. 1748 63

Bacteremia has rarely been reported in patients receiving treatment for hepatitis C virus (HCV) infection. We describe the features and investigation of four cases of Staphylococcus aureus bacteremia occurring between 3 November 2004 and 10 January 2005 in patients on therapy for chronic HCV infection. The unusual occurrence of S. aureus bacteremia in a series of patients led to an epidemiologic investigation and molecular typing methods were employed to assess the relatedness of cases. The mean time of bacteremia onset was week 10 of HCV treatment. No patient had neutropenia previously. The average duration of bacteremia was 2.6 days and complications included acute renal failure (2/4), disseminated intravascular coagulopathy (DIC) with sepsis syndrome (1/4), septic arthritis (1/4), spinal epidural abscess (1/4) and endocarditis (1/4). Two patients were in the same weight class for dosing, but no other epidemiologic links were found. One patient admitted to intravenous drug use (IVDU) and a second was suspected of IVDU. The two other patients were cirrhotic, but had no further identifiable risk factors. All bacterial isolates were methicillin-susceptible. By pulsed-field gel electrophoresis, two cases were found to have identical bacterial strains. However, fluorescent-based amplified fragment-length polymorphism analysis demonstrated distinct band patterns in all four cases. The epidemiologic data and molecular analysis of this cluster of S. aureus bacteremia cases among patients receiving combination therapy for treatment of chronic HCV infection suggest that these cases were not related. Additionally, IVDU and cirrhosis, but not neutropenia, are identified as potential risk factors for this uncommon complication of HCV therapy.
 ...
PMID:Staphylococcus aureus bacteremia in patients receiving pegylated interferon-alpha and ribavirin for chronic hepatitis C virus infection. 1765 Feb 90

Patients with liver cirrhosis (LC) have impaired immunity and thus are predisposed to infections. Few studies have attempted to evaluate Staphylococcus aureus bacteremia (SAB) in LC patients. Therefore, this study prospectively evaluated the clinical characteristics and outcomes of 642 episodes of SAB from August 1, 2008 to September 31, 2010. Of 642 patients with SAB, 109 (17.0 %) were classified as LC patients whereas the remaining 533 (83.0 %) were classified as non-LC patients. The 30-day mortality rate of LC patients was significantly higher than that of patients with other diseases (32 % vs. 22 %, respectively; P = 0.047). The 30-day mortality rates of patients with MSSA bacteremia and MRSA bacteremia were not significantly different among LC patients (35.1 % with MSSA vs. 26.9 % with MRSA; P = 0.41). A univariate analysis of the 30-day mortality rate of LC patients with SAB for survivors and non-survivors showed that rapidly fatal or ultimately fatal according to the criteria of McCabe and Jackson (OR 5.0; 95 % CI 1.60-15.65), septic shock at initial presentation (OR 3.5; 95 % CI 1.18-10.39) and Child-Pugh class C (OR 2.8; 95 % CI 1.20-6.59) were associated with increased mortality. In contrast, the removal of the eradicable focus was associated with decreased mortality (OR 0.14; 95 % CI 0.04-0.52). Disease severity and liver dysfunction may be useful for predicting the prognosis of SAB in LC patients.
 ...
PMID:Clinical significance of Staphylococcus aureus bacteremia in patients with liver cirrhosis. 2283 45

A 60-year-old man with a history of Child-Pugh class B cirrhosis was admitted to the hospital with 4-5 days of nausea, vomiting and altered mental status. Following the development of fever in the intensive care unit and methicillin-sensitive Staphylococcus aureus bacteraemia, a large (15 mm) vegetation was discovered on the anterolateral papillary muscle of the mitral valve. Following a thorough multidisciplinary evaluation, the patient was considered to be a poor surgical candidate due to the significant perioperative complications associated with Child-Pugh class B cirrhosis. The patient was treated with 6 weeks intravenous nafcillin as an outpatient. Echocardiography following the treatment course revealed that the vegetation had completely resolved without any valvular dysfunction. This case report emphasises that medical management remains an effective alternative to surgery in complicated cases of infective endocarditis.
...
PMID:Successful treatment, despite a non-surgical approach, of severe infective endocarditis. 2411 49

We aimed to describe the characteristics of patients with Staphylococcus aureus bacteremia and to evaluate the risk factors associated with early (7-day) and late (30-day) mortality. We performed an observational study including all consecutive episodes of Staphylococcus aureus bacteremia diagnosed at two Italian university hospitals during 2010-2014. A total of 337 patients were included. Mean age was 69 years (range, 57-78) and 65% were males. Methicillin-resistant S. aureus (MRSA) was identified in 132/337 (39%)cases. Overall 7- and 30-day mortality were 13% and 26%, respectively. Early mortality was associated with increased Charlson scores (OR 1.3, 95% CI 1.1-1.5), MRSA bacteremia (OR 3.2, 95% CI 1.4-8.1), presentation with septic shock (OR 13.5, 95% CI 5.4-36.4), and occurrence of endocarditis (OR 4.5, 95%CI 1.4-14.6). Similar risk factors were identified for late mortality, including increased Charlson scores (OR 1.2, 95% CI 1.1-1.4), MRSA bacteremia (OR 2.1, 95% CI 1.2-3.9), presentation with septic shock (OR 4, 95%CI 1.7-9.7), occurrence of endocarditis (OR 3.8, 95% CI 1.4-10.2) as well as Child C cirrhosis (OR 3.9, 95% CI 1.1-14.4) and primary bacteremia (OR 2.5, 95%CI 1.3-5). Infectious disease consultation resulted in better outcomes both at 7 (OR 0.1, 95% CI 0.05-0.4) and at 30 days (OR 0.4, 95% CI 0.2-0.7). In conclusion, our study highlighted high rates of MRSA infection in nosocomial Staphylococcus aureus bacteremia. Multiple comorbidities, disease severity and methicillin-resistance are key factors for early and late mortality in this group. In patients with Staphylococcus aureus bacteremia, infectious disease consultation remains a valuable tool to improve clinical outcome.
 ...
PMID:Characteristics of Staphylococcus aureus Bacteraemia and Predictors of Early and Late Mortality. 2815 67