Challenges of Treating Patients With Staphylococcus aureus
Bruce Jones, PharmD, FIDSA, BCPS provided insights on challenging patients with comorbidities such as type 2 diabetes and higher BMI.
Contagion: What is the clinical challenges of treating Staphylococcus aureus?
Jones: When considering serious infections, particularly those like bacteremia, patient outcomes can be severe. Bacteremia, for example, comes with a high mortality rate—often 25-30%, with some studies reporting even higher rates. Complications, such as dissemination or endovascular involvement, are common in these patients, and resistance profiles, such as MRSA versus MSSA, play a critical role.
For our institution, 2023 marked one of the first years we saw MRSA rates dip below 50%, while previous years have been higher. The national average tends to run around 42-45%. Dealing with MRSA presents challenges, as it limits our treatment options, increases healthcare costs, and extends hospital stays, making it difficult to manage these patients effectively. Interestingly, some of the most severe cases of bacteremia I've encountered have been MSSA bacteremias, but MRSA still complicates treatment due to its resistance profile.
We've made efforts to improve outcomes in bacteremia cases through standardized protocols, including pathways, bundling, and more consistent care practices. For instance, MRSA or any staphylococcus aureus bacteremia now requires an infectious disease (ID) consult to ensure optimal management. This includes ensuring an echocardiogram is performed, blood cultures are repeated, and overall treatment is optimized to manage these serious infections appropriately.
Contagion: What are some of the difficulties in treating complicated patients with comorbidities, such as obesity, type 2 diabetes, you need to factor in during treatment?
Jones: We always aim to include patients with real-world characteristics in phase three trials, right? Because we want to ensure these trials reflect the types of patients we see daily. From a pharmacist's perspective, comorbidities are a frequent consideration. When I see comorbidities, I immediately think about the treatments they’ll need, which often leads to concerns about drug-drug interactions, drug-disease interactions, side effects, and adverse events—factors that all require careful management and additional thought.
Looking at the big picture, these patients, depending on the type of infection, are known for having higher 30-day readmission rates. They also have a greater likelihood of harboring resistant organisms due to frequent healthcare exposure, which increases the risk of C difficile and other complications that demand extra attention and management.
The conversation was edited for grammar and clarity.
