14 Chapter 1 treatments for complicated MRSA carriage is analyzed. Another potential influencing factor on effective decolonization is the genetic composition of the MRSA strain, as well as the host [33]. The complex genetic host-pathogen interaction in MRSA decolonization is relatively undiscovered, but is starting to gain interest as a result of the rapid developments in the field of molecular biology, especially whole genome sequencing. Chapter 5 describes an explorative study on genomic characteristics of MRSA isolates that are associated with decolonization failure. Challenges in Staphylococcus aureus bacteremia management S. aureus bacteremia (caused by both MSSA and MRSA) is a highly variable disease affecting a heterogenous patient population. Consequently, the disease course varies greatly, ranging from transient uncomplicated bacteremia to disseminated infection, metastatic infections or persistent bacteremia despite appropriate antimicrobial therapy. All combined, the incidence of S. aureus bacteremia is estimated at 30 per 100,000 person years, and the overall 90-day mortality amounting to 20-30% [34, 35]. In the past decades the disease has been extensively studied, learning us that infectious disease consultation, follow-up blood cultures, and routine echocardiography all improve patients’ outcomes [36, 37]. However, many challenges in the optimal management of S. aureus bacteremia remain. Different strategies are practiced throughout the world regarding optimal antibiotic regimen, oral switch therapy, treatment duration and defining persistence. Chapter 6 describes the results of a survey of over 2,000 clinicians from 71 countries and 6 continents, about their treatment practices. It focuses on identifying global variation in management, diagnostics, and definitions of S. aureus bacteremia. In clinical practice, a frequent complication in patients with S. aureus bacteremia is acute kidney injury. The complexity of this phenomenon lies in the combination of the diverse etiology – including prerenal, toxic/drug-related, immune-mediated, tubulointerstitial nephritis, and postrenal pathophysiology – and the lack of diagnostic tests to differentiate between them. Moreover, acute kidney injury has a significant impact on patient management and outcome [38]. Still, knowledge on acute kidney injury in S. aureus bacteremia is limited. In chapter 7, we evaluated the incidence, reversibility and risk factors for the development of acute kidney injury in patients with S. aureus bacteremia. As mentioned before, S. aureus has the ability to persist in the bloodstream despite adequate antimicrobial treatment. Persistent bacteremia has been associated with increased mortality compared to those whose bacteremia promptly resolves [39, 40].
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