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Enoch DA, Phillimore N, Karas JA, Horswill L, Mlangeni DA. Relapse of enterococcal prosthetic valve endocarditis with aortic root abscess following treatment with daptomycin in a patient not fit for surgery. J Med Microbiol 2009; 59:482-485. [PMID: 20019148 DOI: 10.1099/jmm.0.016253-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Daptomycin is a novel lipopeptide with activity against Gram-positive organisms including enterococci. It is licensed for the treatment of Staphylococcus aureus bacteraemia and right-sided endocarditis, but not endocarditis due to Enterococcus spp. We report a case of enterococcal prosthetic valve endocarditis with an aortic root abscess in an elderly patient who was not fit for surgery. The patient's endocarditis relapsed 9 weeks after a 6 week course of daptomycin.
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Affiliation(s)
- D A Enoch
- Clinical Microbiology and Public Health Laboratory, Peterborough DistrictHospital, Thorpe Road, Peterborough PE3 6JW, UK
| | - N Phillimore
- Clinical Microbiology and Public Health Laboratory, Peterborough DistrictHospital, Thorpe Road, Peterborough PE3 6JW, UK
| | - J A Karas
- Clinical Microbiology and Public Health Laboratory, Peterborough DistrictHospital, Thorpe Road, Peterborough PE3 6JW, UK
| | - L Horswill
- Clinical Microbiology and Public Health Laboratory, Peterborough DistrictHospital, Thorpe Road, Peterborough PE3 6JW, UK
| | - D A Mlangeni
- Clinical Microbiology and Public Health Laboratory, Peterborough DistrictHospital, Thorpe Road, Peterborough PE3 6JW, UK
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gemella haemolysans Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e318191766e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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55
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Kasivisvanathan V, Levine A, Kasivisvanathan R, Brown DFM, Nadel ES. Dyspnea and multiple pulmonary nodules. J Emerg Med 2009; 37:300-4. [PMID: 19717265 DOI: 10.1016/j.jemermed.2009.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 07/23/2009] [Indexed: 11/19/2022]
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NIXON PP, LITTLER P, DAVIES K, KRISHNAM MS. Does sialography require antibiotic prophylaxis? Br J Radiol 2009; 82:732-4. [DOI: 10.1259/bjr/23033283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1230] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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58
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Andrews JM. BSAC standardized disc susceptibility testing method (version 8). J Antimicrob Chemother 2009; 64:454-89. [DOI: 10.1093/jac/dkp244] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Combination Antimicrobial Treatment Versus Monotherapy: The Contribution of Meta-analyses. Infect Dis Clin North Am 2009; 23:277-93. [DOI: 10.1016/j.idc.2009.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gonzalez-Ruiz A, Richardson J. Are glycopeptides still appropriate and convenient for empiric use? J Chemother 2009; 20:531-41. [PMID: 19028614 DOI: 10.1179/joc.2008.20.5.531] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The glycopeptides vancomycin and teicoplanin are widely used, and indeed recommended for, the treatment of severe or resistant Gram-positive infections. Therapeutic drug monitoring is widely used for vancomycin but less commonly for teicoplanin, and remains controversial. We report the cost savings of a formulary decision to replace teicoplanin with daptomycin for the empiric treatment of complicated skin and soft tissue infections (CSSTIs), staphylococcal bacteraemia and hospital-acquired Gram-positive sepsis. In the Intensive Therapy Unit (ITU) we optimised treatment of serious Gram-positive infections by substituting teicoplanin with vancomycin administered by continuous infusion. Costs were calculated using British National Formulary (BNF) prices and costs for therapeutic drug monitoring. Daptomycin (350 mg/d) use was associated with a cost saving per 7 days of treatment of 86 pounds and vancomycin with 51 pounds (4 g/d) to 276 pounds (2 g/d) compared to the 600 mg teicoplanin dose. Our own formulary re-positioning of glyco/lipopeptides, i.e. the preferential use of vancomycin in the ITU and substitution of teicoplanin with daptomycin, is cost-effective and provides better therapeutic alternatives. Continuous vancomycin infusion in the ITU setting guarantees optimal dosing for severely ill patients. Daptomycin use on surgical and medical wards, apart from being marginally cheaper than teicoplanin, guarantees optimal dosing without the need for drug monitoring.
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61
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McLellan E, Partridge D. Prosthetic valve endocarditis caused by Pseudomonas mosselii. J Med Microbiol 2009; 58:144-145. [PMID: 19074668 DOI: 10.1099/jmm.0.005553-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We describe a case of Pseudomonas mosselii prosthetic valve endocarditis that was successfully treated with antibiotic therapy in the absence of valve replacement. P. mosselii is a highly unusual cause of endocarditis and there are few case reports of curative treatment of pseudomonal prosthetic valve endocarditis with antibiotics alone.
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Affiliation(s)
- Elizabeth McLellan
- Department of Microbiology, Northern General Hospital, Herries Road, Sheffield S17 3QU, UK
| | - David Partridge
- Department of Microbiology, Northern General Hospital, Herries Road, Sheffield S17 3QU, UK
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Buchholtz K, Larsen CT, Hassager C, Bruun NE. Severity of gentamicin's nephrotoxic effect on patients with infective endocarditis: a prospective observational cohort study of 373 patients. Clin Infect Dis 2009; 48:65-71. [PMID: 19046065 DOI: 10.1086/594122] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Gentamicin is often used to treat infective endocarditis (IE). Gentamicin is highly effective, but its applicability is reduced by its nephrotoxic effect. The aim of this study was to quantify the nephrotoxic effect of gentamicin and the association between the nephrotoxic effect and mortality in patients with IE. METHODS A prospective observational cohort study was performed at 2 tertiary university hospitals in Copenhagen from October 2002 through October 2007; 373 consecutive patients with IE were included. A total of 287 (77%) of the patients received gentamicin treatment (median duration, 14 days); dosage was adjusted according to daily serum creatinine and trough serum gentamicin levels. Kidney function was determined by estimated endogenous creatinine clearance (EECC). Statistical correlation between gentamicin and EECC change was analyzed, and the association between mortality and nephrotoxicity was investigated. RESULTS The primary bacteriological etiologies were as follows: Streptococcus species (37.1%), Staphylococcus aureus (18.2%), and Enterococcus species (16.1%). In the gentamicin group, the mean EECC change was an 8.6% decrease, but in the no-gentamicin group, the mean change was an increase of 2.3% (P = .05). The decrease in EECC was significantly correlated with the duration of gentamicin treatment: a 0.5% EECC decrease per day of gentamicin treatment (P = .002). The decrease in EECC during hospitalization was not related to postdischarge mortality. The mean duration of follow-up was 562 days. CONCLUSIONS The nephrotoxic effect of gentamicin is directly related to treatment duration, with a decrease in EECC of 0.5% per day of gentamicin treatment. In patients treated with gentamicin, the in-hospital decrease in EECC was not related to postdischarge mortality. Consequently, this study does not support abolishment of gentamicin in treatment of IE.
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Affiliation(s)
- Kristine Buchholtz
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
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63
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Kachhia AB, Wan D, Whittaker A, Shaukat N, Nishtar SS, Cullen J. Culture-negative endocarditis: "whatever remains, however improbable, must be the truth"; the importance of asking the right questions! BMJ Case Rep 2009; 2009:bcr11.2008.1288. [PMID: 21931578 DOI: 10.1136/bcr.11.2008.1288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The complicated case of a patient with recurrent culture-negative endocarditis with a history of repeated mitral valve replacement is described. Investigations disqualified common pathology but serology revealed a diagnosis of Q fever endocarditis. The ongoing problematic management of this patient is described, followed by a brief review of the clinical features, investigations and treatment of Q fever.
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Affiliation(s)
- Amar Bhavin Kachhia
- Cardiology, Kettering General Hospital NHS Trust, Rothwell Road, Kettering, Northamptonshire, NN16 8UZ, UK
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Jin SJ, Bae SC, Kim HW, Kim HK, Na EJ, Ahn BS, Choi JY, Kim CO, Kim JM, Song YG. Evaluation of the Effect of Initial dose of Vancomycin using Serum Cystatin C as a Marker in Elderly Patients. Infect Chemother 2009. [DOI: 10.3947/ic.2009.41.4.224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Joon Jin
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Chang Bae
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Won Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Kyung Kim
- Therapeutic Drug Monitoring Team, Gangnam Severance Hospital, Seoul, Korea
| | - Eun Joo Na
- Therapeutic Drug Monitoring Team, Gangnam Severance Hospital, Seoul, Korea
| | - Bo Sook Ahn
- Therapeutic Drug Monitoring Team, Gangnam Severance Hospital, Seoul, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Oh Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Myung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Goo Song
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Therapeutic Drug Monitoring Team, Gangnam Severance Hospital, Seoul, Korea
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Leibovici L, Vidal L, Paul M. Aminoglycoside drugs in clinical practice: an evidence-based approach. J Antimicrob Chemother 2008; 63:246-51. [PMID: 19022778 DOI: 10.1093/jac/dkn469] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resistant bacteria have renewed our interest in the aminoglycoside drugs. Evidence on the efficiency of aminoglycosides in their different clinical uses is available from numerous randomized controlled trials and has been accrued and examined in recent systematic reviews and meta-analyses. Their results show that aminoglycosides should not be added to broad-spectrum beta-lactams to achieve synergism in treating Gram-negative infections as combination does not improve efficacy and adds side effects. The evidence from randomized trials in humans does not support the use of aminoglycosides in staphylococcal or streptococcal endocarditis, and is lacking for endocarditis caused by enterococci. Aminoglycosides are efficacious and safe as single drugs for the treatment of pyelonephritis and sepsis of a urinary source, but their efficacy might be lower than that of beta-lactams in Gram-negative infections of other sources. In patients with no risk factors, aminoglycosides are as safe as beta-lactams regarding side effects. They probably induce less resistance. Pragmatic large trials are needed to answer open clinical questions on the use of aminoglycosides.
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Affiliation(s)
- Leonard Leibovici
- Department of Medicine E, Beilinson Campus, Petah-Tiqva 49100, Israel.
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66
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Livermore DM. Future directions with daptomycin. J Antimicrob Chemother 2008; 62 Suppl 3:iii41-iii49. [DOI: 10.1093/jac/dkn371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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67
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Brown DFJ, Hope R, Livermore DM, Brick G, Broughton K, George RC, Reynolds R. Non-susceptibility trends among enterococci and non-pneumococcal streptococci from bacteraemias in the UK and Ireland, 2001-06. J Antimicrob Chemother 2008; 62 Suppl 2:ii75-85. [DOI: 10.1093/jac/dkn354] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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68
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Pavleas J, Skiada A, Daikos GL, Pefanis A, Giamarellos-Bourboulis E, Kanellakopoulou K, Tsaganos T, Perrea D, Donta I, Karayannakos P, Giamarellou H. Efficacy of teicoplanin, administered in two different regimens, in the treatment of experimental endocarditis due to Enterococcus faecalis. J Chemother 2008; 20:208-12. [PMID: 18467247 DOI: 10.1179/joc.2008.20.2.208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Using a rabbit model of endocarditis, we studied the efficacy of teicoplanin against a strain of Enterococcus faecalis resistant to ampicillin. Rabbits were randomly assigned to receive no antibiotics, teicoplanin 12 or 18 mg/kg of body weight every 12h, for 9 days. The effect of treatment on bacterial counts of vegetations and survival of the animals was evaluated at the end of treatment and 10 days thereafter. The two treatment regimens of teicoplanin produced peak serum levels 18.51+/-1.84 and 34.66+/-4.19 microg/ml, and trough levels above 10 x MIC of teicoplanin for the infecting organism. Both regimens resulted in significant bacterial reduction in the vegetations as compared to the control group (p<0.001). The drug prevented relapse of the infection 10 days after discontinuation of treatment. By increasing the teicoplanin dosage no additional therapeutic benefit was observed in terms of bacterial killing, sterilization of the vegetations, and survival of the animals, although the higher doses gave numerically superior results. These findings may have meaning for the optimum use of teicoplanin in the treatment of enterococcal endocarditis.
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Affiliation(s)
- J Pavleas
- Intensive Care Unit, Laikon General Hospital, Athens, Greece.
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69
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Fujitani S, Rowlinson M, George W. Penicillin G–Resistant Viridans Group Streptococcal Endocarditis and Interpretation of the American Heart Association's Guidelines for the Treatment of Infective Endocarditis. Clin Infect Dis 2008; 46:1064-6. [DOI: 10.1086/529199] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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70
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Westling K, Aufwerber E, Ekdahl C, Friman G, Gårdlund B, Julander I, Olaison L, Olesund C, Rundström H, Snygg-Martin U, Thalme A, Werner M, Hogevik H. Swedish guidelines for diagnosis and treatment of infective endocarditis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2008; 39:929-46. [PMID: 18027277 DOI: 10.1080/00365540701534517] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Swedish guidelines for diagnosis and treatment of infective endocarditis (IE) by consensus of experts are based on clinical experience and reports from the literature. Recommendations are evidence based. For diagnosis 3 blood cultures should be drawn; chest X-ray, electrocardiogram, and echocardiography preferably transoesophageal should be carried out. Blood cultures should be kept for 5 d and precede intravenous antibiotic therapy. In patients with native valves and suspicion of staphylococcal aetiology, cloxacillin and gentamicin should be given as empirical treatment. If non-staphylococcal etiology is most probable, penicillin G and gentamicin treatment should be started. In patients with prosthetic valves treatment with vancomycin, gentamicin and rifampicin is recommended. Patients with blood culture negative IE are recommended penicillin G (changed to cefuroxime in treatment failure) and gentamicin for native valve IE and vancomycin, gentamicin and rifampicin for prosthetic valve IE, respectively. Isolates of viridans group streptococci and enterococci should be subtyped and MIC should be determined for penicillin G and aminoglycosides. Antibiotic treatment should be chosen according to sensitivity pattern given 2-6 weeks intravenously. Cardiac valve surgery should be considered early, especially in patients with left-sided IE and/or prosthetic heart valves. Absolute indications for surgery are severe heart failure, paravalvular abscess, lack of response to antibiotic therapy, unstable prosthesis and multiple embolies. Follow-up echocardiography should be performed on clinical indications.
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Affiliation(s)
- Katarina Westling
- Infective Endocarditis Working Group, Swedish Society of Infectious Diseases, Sweden.
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71
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Andrews JM. BSAC standardized disc susceptibility testing method (version 7). J Antimicrob Chemother 2008; 62:256-78. [DOI: 10.1093/jac/dkn194] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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72
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Burchard GD, Einsele H, Hebart H, Heinz WJ, Herrmann M, Hörauf A, Mertens T, von Müller L, Zimmerli W. Antimikrobielle Therapie. KLINISCHE INFEKTIOLOGIE 2008. [PMCID: PMC7158361 DOI: 10.1016/b978-343721741-8.50008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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73
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Bliziotis IA, Ntziora F, Lawrence KR, Falagas ME. Rifampin as adjuvant treatment of Gram-positive bacterial infections: a systematic review of comparative clinical trials. Eur J Clin Microbiol Infect Dis 2007; 26:849-56. [PMID: 17712583 DOI: 10.1007/s10096-007-0378-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We reviewed the bibliographic evidence from comparative trials regarding the role of rifampin as adjuvant treatment in the treatment of Gram-positive infections [PubMed (1/1950-7/2006)]. Only studies reporting comparative outcome data in patients treated with an antibiotic regimen with the addition or not of rifampin were included. Eight comparative studies were identified [all were randomized controlled trials (RCTs)], five reporting on infections caused by staphylococci (S. aureus in 97% of patients) and three by streptococci. There was no statistically significant difference in mortality between the treatment arms (with and without rifampin) in any of the included studies. Clinical cure was achieved more commonly (p < 0.05) in the rifampin treatment arm in 3/8 studies; in staphylococcal infections of orthopedic stable implants and in beta-hemolytic streptococcal pharyngitis in children (one RCT each), and in one RCT that reported on patients with various staphylococcal infections. However, no statistically significant difference in cure of the infection between the two groups was found after pooling data from two RCTs (121 patients) that reported on patients with various staphylococcal infections (odds ratio = 0.57; 95% confidence interval 0.27-1.17). No differences were noted between the two groups regarding relapse of infection or adverse events. There is only limited evidence from comparative trials regarding the role of rifampin as adjuvant therapeutic agent for infections caused by Gram-positive bacteria, not allowing for definitive conclusions on this important management question. More controlled trials are necessary for better evaluation of this practice.
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Affiliation(s)
- I A Bliziotis
- Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, Marousi, Athens, Greece
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74
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Abstract
Antibiotics are an essential part of modern medicine. The emergence of antibiotic-resistant mutants among bacteria is seemingly inevitable, and results, within a few decades, in decreased efficacy and withdrawal of the antibiotic from widespread usage. The traditional answer to this problem has been to introduce new antibiotics that kill the resistant mutants. Unfortunately, after more than 50 years of success, the pharmaceutical industry is now producing too few antibiotics, particularly against Gram-negative organisms, to replace antibiotics that are no longer effective for many types of infection. This paper reviews possible new ways to discover novel antibiotics. The genomics route has proven to be target rich, but has not led to the introduction of a marketed antibiotic as yet. Non-culturable bacteria may be an alternative source of new antibiotics. Bacteriophages have been shown to be antibacterial in animals, and may find use in specific infectious diseases. Developing new antibiotics that target non-multiplying bacteria is another approach that may lead to drugs that reduce the emergence of antibiotic resistance and increase patient compliance by shortening the duration of antibiotic therapy. These new discovery routes have given rise to compounds that are in preclinical development, but, with one exception, have not yet entered clinical trials. For the time being, the majority of new antibiotics that reach the marketplace are likely to be structural analogues of existing families of antibiotics or new compounds, both natural and non-natural which are screened in a conventional way against live multiplying bacteria.
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75
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Arda B, Sipahi OR, Yamazhan T, Tasbakan M, Pullukcu H, Tunger A, Buke C, Ulusoy S. Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance. J Infect 2007; 55:41-8. [PMID: 17512598 DOI: 10.1016/j.jinf.2007.02.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 01/18/2007] [Accepted: 02/27/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods. METHODS AND RESULTS Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (p<0.05). When all microbiologically confirmed nosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (p<0.05). Amikacin resistance in Escherichia coli and Acinetobacter baumannii increased significantly (p<0.05). CONCLUSION Antibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance.
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Affiliation(s)
- Bilgin Arda
- Ege University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bornova, Izmir, Turkey
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76
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Verhagen DWM, Hermanides J, Korevaar JC, Bossuyt PMM, van den Brink RBA, Speelman P, van der Meer JTM. Extension of antimicrobial treatment in patients with left-sided native valve endocarditis based on elevated C-reactive protein values. Eur J Clin Microbiol Infect Dis 2007; 26:587-90. [PMID: 17566799 DOI: 10.1007/s10096-007-0319-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this non-randomized study was to investigate whether there is any benefit in the extension of antimicrobial treatment in patients with left-sided native valve endocarditis in whom C-reactive protein levels are still elevated after a standard course of therapy. There was no statistically significant difference in outcome between the group of patients in which treatment was extended in comparison to the group in which treatment was ended at the recommended time. It is unlikely that there is much to gain from extending treatment based on elevated C-reactive protein levels alone.
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Affiliation(s)
- D W M Verhagen
- Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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77
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Andrews JM. BSAC standardized disc susceptibility testing method (version 6). J Antimicrob Chemother 2007; 60:20-41. [PMID: 17460026 DOI: 10.1093/jac/dkm110] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J M Andrews
- Department of Microbiology, City Hospital NHS Trust, Birmingham B18 7QH, UK.
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78
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79
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Shelburne SA, Greenberg SB, Aslam S, Tweardy DJ. Successful ceftriaxone therapy of endocarditis due to penicillin non-susceptible viridans streptococci. J Infect 2007; 54:e99-101. [PMID: 16824611 DOI: 10.1016/j.jinf.2006.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 05/23/2006] [Indexed: 11/30/2022]
Abstract
Viridans streptococci are a major cause of infective endocarditis, and penicillin non-susceptibility is increasing in these organisms. We present the initial reported case of infective endocarditis due to penicillin non-susceptible viridans streptococci successfully treated with ceftriaxone monotherapy. The lack of evidence supporting the recommendations for treatment of endocarditis due to penicillin non-susceptible viridans streptococci is discussed.
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Affiliation(s)
- Samuel A Shelburne
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, N-1319, BCM-286, 1 Baylor Plaza, Houston, TX 77030, USA.
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80
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Drew RH. Emerging Options for Treatment of Invasive, Multidrug-ResistantStaphylococcus aureusInfections. Pharmacotherapy 2007; 27:227-49. [PMID: 17253914 DOI: 10.1592/phco.27.2.227] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Limited established treatment options exist for the treatment of serious, invasive infections caused by multidrug-resistant Staphylococcus aureus, most notably nosocomially acquired methicillin-resistant S. aureus (MRSA). Although vancomycin represents the gold standard for therapy of such invasive infections, reports of increasing in vitro resistance to vancomycin, combined with reports of clinical failures (with this and other antistaphylococcal agents), underscore the need for alternative therapies. Older agents with favorable in vitro activity available in both oral and intravenous dose forms include trimethoprim-sulfamethoxazole and clindamycin. Limited clinical data exist to support their routine use as initial therapy in the treatment of invasive disease. However, these and other options (e.g., tetracyclines) are being reexplored in the setting of increasing concern over MRSA acquired in the community setting. Newer treatment options for MRSA include linezolid, quinupristin-dalfopristin, daptomycin, and tigecycline. With the exception of linezolid, these newer agents require intravenous administration. Combination therapy may be considered in select invasive diseases refractory to standard monotherapies. These diseases include infections such as endocarditis, meningitis, and prosthetic device infections. Additional alternatives to vancomycin are under clinical investigation. Those in later stages of development include oritavancin, dalbavancin, telavancin, and ceftobiprole.
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Affiliation(s)
- Richard H Drew
- Duke University School of Medicine, Durham, North Carolina, USA.
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81
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Affiliation(s)
- Rejith Paily
- Department of Internal Medicine, Saints Mary and Elizabeth Hospital, Louisville, Ky 40215, USA.
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82
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Jayawardena S, Eisdorfer J, Indulkar S, Zarkaria M. Infective endocarditis of native valve after anterior nasal packing. Am J Ther 2006; 13:460-2. [PMID: 16988543 DOI: 10.1097/01.mjt.0000209683.99205.4f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case report of a patient who was previously treated for spontaneous epistaxis with a petroleum jelly gauze (0.5 in x 72 in) anterior nasal packing filled with an antibiotic ointment, along with prophylactic oral clindamycin. The patient presented with fever and hypotension 3 days after the nasal packing. Her blood cultures grew methicillin-resistant Staphylococcus aureus and the transesophageal echocardiography showed vegetation on the atrial surface of the posterior mitral valve leaflet, confirming the diagnosis of bacterial endocarditis attributable to nasal packing. Several case reports discuss toxic shock syndrome after nasal packing, but none describe endocarditis of the native heart valves subsequent to anterior nasal packing. Current guidelines on endocarditis prophylaxis produced by the American Heart Association, European Cardiac Society, and British Cardiac Society together with published evidence do not recommend endocarditis prophylaxis for patients with native heart valves undergoing anterior nasal packing.
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Affiliation(s)
- Suriya Jayawardena
- Department of Medicine, Coney Island Hospital, Maimonides Medical Center, Brooklyn, NY 11235, USA.
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83
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Abstract
A joint working party has produced evidence-based guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the U.K. These guidelines will help clinicians choose appropriate therapy and point to areas where further research is needed. This review summarizes the main recommendations and discusses their implementation into clinical practice.
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Affiliation(s)
- Gary French
- Department of Infection, St. Thomas' Hospital, London
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84
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French G. Review of new guidelines for prophylaxis and treatment of MRSA infections. Br J Hosp Med (Lond) 2006. [DOI: 10.12968/hmed.2006.67.sup9.22001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A joint working party has produced evidence-based guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. These guidelines will help clinicians choose appropriate therapy and point to areas where further research is needed. This review summarizes the main recommendations and discusses their implementation into clinical practice.
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Affiliation(s)
- Gary French
- Microbiology and Honorary Consultant Microbiologist, Department of Infection, St Thomas× Hospital, London SE1 7EH
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85
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Affiliation(s)
- Rhys P Beynon
- Department of Cardiology, Wythenshawe Hospital, Manchester M23 9LT
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86
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Sykes JE, Kittleson MD, Pesavento PA, Byrne BA, MacDonald KA, Chomel BB. Evaluation of the relationship between causative organisms and clinical characteristics of infective endocarditis in dogs: 71 cases (1992-2005). J Am Vet Med Assoc 2006; 228:1723-34. [PMID: 16740074 DOI: 10.2460/javma.228.11.1723] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate microbiologic findings in dogs with infective endocarditis (IE) and determine whether there were differences in clinical features of disease caused by different groups of infective agents. DESIGN Retrospective case series. ANIMALS 71 dogs with suspected or definite IE. PROCEDURES Medical records were reviewed for results of bacterial culture and susceptibility testing, serologic assays for vector-borne disease, and PCR testing on vegetative growths. Cases were grouped by causative organism and relationships among infectious agent group, and various hematologic, biochemical, and clinical variables were determined. Survival analyses were used to determine associations between infecting organisms and outcome. RESULTS Causative bacteria were identified in 41 of 71 (58%) dogs. Gram-positive cocci were the causative agents in most (21/41; 51%) infections, with Streptococcus canis associated with 24% of infections. Gram-negative organisms were detected in 9 of the 41 (22%) dogs. Infection with Bartonella spp was detected in 6 of 31 (19%) dogs with negative results for microbial growth on blood culture. Aortic valve involvement and congestive heart failure were more frequent in dogs with endocarditis from Bartonella spp infection, and those dogs were more likely to be afebrile. Infection with Bartonella spp was negatively correlated with survival. Mitral valve involvement and polyarthritis were more frequent in dogs with streptococcal endocarditis. CONCLUSIONS AND CLINICAL RELEVANCE Streptococci were the most common cause of IE and were more likely to infect the mitral valve and be associated with polyarthritis. Dogs with IE secondary to Bartonella spp infection were often afebrile, more likely to develop congestive heart failure, rarely had mitral valve involvement, and had shorter survival times.
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Affiliation(s)
- Jane E Sykes
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
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87
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Verhagen DWM, Vedder AC, Speelman P, van der Meer JTM. Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations. J Antimicrob Chemother 2006; 57:819-24. [PMID: 16549513 DOI: 10.1093/jac/dkl087] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment duration than currently advised by international guidelines. Also, high-dose antibiotics, as recommended today, have a predominantly pharmacokinetic and pharmacodynamic rationale that is based mostly on experimental animal studies. Shortening antimicrobial treatment in select patients with endocarditis would be of great benefit. As yet there are no predictors of cure that can be used to individualize treatment duration in patients with bacterial endocarditis.
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Affiliation(s)
- D W M Verhagen
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Centre, Amsterdam, The Netherlands
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88
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Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother 2006; 57:589-608. [PMID: 16507559 DOI: 10.1093/jac/dkl017] [Citation(s) in RCA: 268] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
These evidence-based guidelines have been produced after a literature review of the treatment and prophylaxis of methicillin-resistant Staphylococcus aureus (MRSA) infection. The guidelines were further informed by antibiotic susceptibility data on MRSA from the UK. Recommendations are given for the treatment of common infections caused by MRSA, elimination of MRSA from carriage sites and prophylaxis of surgical site infection. There are several antibiotics currently available that are suitable for use in the management of this problem and potentially useful new agents are continuing to emerge.
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Affiliation(s)
- Curtis G Gemmell
- Department of Bacteriology, Royal Infirmary, Glasgow, Scotland, UK
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89
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90
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Abstract
Infective endocarditis (IE) is an evolving disease with a persistently high mortality and morbidity, even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy, and potentially curative surgery. Despite these improvements in health care, the incidence of the disease has remained unchanged over the past two decades and may even be increasing. Chronic rheumatic heart disease is now an uncommon antecedent, whereas degenerative valve disease of the elderly, mitral valve prolapse, intravenous drug misuse, preceding valve replacement, and vascular instrumentation have become increasingly common, coinciding with an increase in staphylococcal infections and those caused by fastidious organisms. The current understanding of this difficult condition is reviewed and recent developments in medical and surgical management are updated.
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Affiliation(s)
- B D Prendergast
- Department of Cardiology, Wythenshawe Hospital, Manchester, UK.
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91
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Perry JD. Endocarditis guidelines: authors' response. J Antimicrob Chemother 2005. [DOI: 10.1093/jac/dki188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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92
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Shah PM. Comment on: Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2005; 56:432; author reply 432-3. [PMID: 15946986 DOI: 10.1093/jac/dki187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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93
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Morris AJ, Drinković D, Pottumarthy S, MacCulloch D, Kerr AR, West T. Bacteriological Outcome after Valve Surgery for Active Infective Endocarditis: Implications for Duration of Treatment after Surgery. Clin Infect Dis 2005; 41:187-94. [PMID: 15983914 DOI: 10.1086/430908] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 02/22/2005] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There has been no systematic evaluation of outcome after surgery for infective endocarditis with respect to duration of antibiotic treatment. METHODS We performed a retrospective chart review of episodes of valve surgery for active infective endocarditis at Green Lane Hospital (Auckland, New Zealand) for 1963-1999. We recorded the duration of antibiotic treatment before and after valve surgery; the extent of infection at operation; Gram stain, culture, and histopathological testing results for valve samples; and the bacteriological outcome after surgery. The primary outcome measure was relapse, defined as endocarditis due to the same species within 1 year after surgery. RESULTS For the 358 patients in our study, the median duration of follow-up was 4.8 years. Thirty-two patients (9%) had 36 subsequent episodes of endocarditis. Relapse occurred after 3 (0.8%) of the operations (95% CI, 0.2%-2.0%). Relapse of infection was unrelated to the duration of antibiotic treatment before or after surgery, positive valve culture results, positive Gram stain results, or perivalvular infection. Since 1994, we have reduced the duration of antibiotic treatment by approximately 7 days for those with positive valve culture results and by approximately 14 days for those with negative valve culture results, without any increase in the number of relapses. CONCLUSIONS Relapse is an uncommon event following surgery for endocarditis. Commonly suggested indications for prolonging postoperative treatment are not associated with higher relapse rates, and their relevance is debatable. We conclude that it is unnecessary to continue treatment for patients with negative valve culture results for an arbitrary 4-6-week period after surgery. Two weeks of treatment appears to be sufficient, and, for those operated on near the end of the standard period of treatment, simply completing the planned course should suffice.
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Affiliation(s)
- Arthur J Morris
- Department of Microbiology, Green Lane Hospital, Auckland, New Zealand.
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