2851
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Bučková M, Puškárová A, Kalászová V, Kisová Z, Pangallo D. Essential oils against multidrug resistant gram-negative bacteria. Biologia (Bratisl) 2018; 73:803-8. [DOI: 10.2478/s11756-018-0090-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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2852
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Abstract
INTRODUCTION Despite active antiretroviral therapy (ART), community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients and incurs high health costs. Areas covered: This article reviews the most recent publications on bacterial CAP in the HIV-infected population, focusing on epidemiology, prognostic factors, microbial etiology, therapy, and prevention. The data discussed here were mainly obtained from a non-systematic review using Medline, and references from relevant articles. Expert commentary: HIV-infected patients are more susceptible to bacterial CAP. Although ART improves their immune response and has reduced CAP incidence, these patients continue to present increased risk of pneumonia in part because they show altered immunity and because immune activation persists. The risk of CAP in HIV-infected patients and the probability of polymicrobial or atypical infections are inversely associated with the CD4 cell count. Mortality in HIV-infected patients with CAP ranges from 6% to 15% but in well-controlled HIV-infected patients on ART the mortality is low and similar to that seen in HIV-negative individuals. Vaccination and smoking cessation are the two most important preventive strategies for bacterial CAP in well-controlled HIV-infected patients on ART.
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Affiliation(s)
- Catia Cillóniz
- a Department of Pulmonary Medicine Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
| | - Carolina García-Vidal
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Asunción Moreno
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - José M Miro
- b Infectious Diseases Service, Hospital Clinic-IDIBAPS , University of Barcelona , Barcelona , Spain
| | - Antoni Torres
- a Department of Pulmonary Medicine Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) , University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes) , Barcelona , Spain
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2853
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Abstract
INTRODUCTION Flexible bronchoscopy has been well established for diagnostic and therapeutic purposes in critically ill patients. Areas covered: This review outlines the clinical evidence of the utility and safety of flexible bronchoscopy in the intensive care unit, as well as specific considerations, including practical points and potential complications, in critically ill patients. Expert commentary: Its ease to learn and perform and its capacity for bedside application with relatively few complications make flexible bronchoscopy an indispensable tool in the intensive care unit setting. The main indications for flexible bronchoscopy in the intensive care unit are the visualization of the airways, sampling for diagnostic purposes and management of the artificial airways. The decision to perform flexible bronchoscopy can only be made by trade-offs between potential risks and benefits because of the fragile nature of the critically ill. Flexible bronchoscopy-associated serious adverse events are inevitable in cases of a lack of expertise or appropriate precautions.
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Affiliation(s)
- Begum Ergan
- a Department of Pulmonary and Critical Care , School of Medicine, Dokuz Eylul University , Izmir , Turkey
| | - Stefano Nava
- b Department of Clinical , Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University , Bologna , Italy
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2854
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Ricciardi BF, Muthukrishnan G, Masters E, Ninomiya M, Lee CC, Schwarz EM. Staphylococcus aureus Evasion of Host Immunity in the Setting of Prosthetic Joint Infection: Biofilm and Beyond. Curr Rev Musculoskelet Med 2018; 11:389-400. [PMID: 29987645 DOI: 10.1007/s12178-018-9501-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The incidence of complications from prosthetic joint infection (PJI) is increasing, and treatment failure remains high. We review the current literature with a focus on Staphylococcus aureus pathogenesis and biofilm, as well as treatment challenges, and novel therapeutic strategies. RECENT FINDINGS S. aureus biofilm creates a favorable environment that increases antibiotic resistance, impairs host immunity, and increases tolerance to nutritional deprivation. Secreted proteins from bacterial cells within the biofilm and the quorum-sensing agr system contribute to immune evasion. Additional immunoevasive properties of S. aureus include the formation of staphylococcal abscess communities (SACs) and canalicular invasion. Novel approaches to target biofilm and increase resistance to implant colonization include novel antibiotic therapy, immunotherapy, and local implant treatments. Challenges remain given the diverse mechanisms developed by S. aureus to alter the host immune responses. Further understanding of these processes should provide novel therapeutic mechanisms to enhance eradication after PJI.
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Affiliation(s)
- Benjamin F Ricciardi
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Gowrishankar Muthukrishnan
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Elysia Masters
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Mark Ninomiya
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Charles C Lee
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA
| | - Edward M Schwarz
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 665, Rochester, NY, 14642, USA.
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2855
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Ayerbe Algaba R, Álvarez-Marín R, Praena J, Smani Y. Escherichia coli causing meningitis in an adult: A case report and experimental characterization of its virulence. Enferm Infecc Microbiol Clin 2019; 37:418-9. [PMID: 30115543 DOI: 10.1016/j.eimc.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/18/2018] [Accepted: 06/01/2018] [Indexed: 11/23/2022]
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2856
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Badiee P, Farhodi F, Ghayomi MA, Jafarian H. Fungi Identified in Patients with Recurrent Lung Disorders. Jundishapur J Microbiol 2018; 11. [DOI: 10.5812/jjm.66135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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2857
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Abstract
IMPORTANCE Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings. OBSERVATIONS Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries. As medical interventions are increasingly performed on older patients, the disease incidence from cardiac implanted electronic devices is also increasing. In addition, younger patients involved with intravenous drug use has increased in the past decade and with it the proportion of US hospitalization has increased to more than 10%. These epidemiological factors have led to Staphylococcus aureus being the most common cause in high-income countries, accounting for up to 40% of cases. The mainstays of diagnosis are still echocardiography and blood cultures. Adjunctive imaging such as cardiac computed tomographic and nuclear imaging can improve the sensitivity for diagnosis when echocardiography is not conclusive. Serological studies, histopathology, and polymerase chain reaction assays have distinct roles in the diagnosis of infective endocarditis when blood culture have tested negative with the highest yield obtained from serological studies. Increasing antibiotic resistance, particularly to S aureus, has led to a need for different antibiotic treatment options such as newer antibiotics and combination therapy regimens. Surgery can confer a survival benefit to patients with major complications; however, the decision to pursue surgery must balance the risks and benefits of operations in these frequently high-risk patients. CONCLUSIONS AND RELEVANCE The epidemiology and management of infective endocarditis are continually changing. Guidelines provide specific recommendations about management; however, careful attention to individual patient characteristics, pathogen, and risk of sequela must be considered when making therapeutic decisions.
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Affiliation(s)
- Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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2858
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Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is a common complication in the critically ill population, is multifactorial and associated with increased mortality. Drug-induced kidney injury is a significant contributor to the development of AKI. The purpose of this review is to provide updates in the epidemiology, susceptibility and management of drug-induced kidney disease (DIKD). RECENT FINDINGS Recent changes in guidelines for the management of serious infections in the critically ill have resulted in an increased frequency of DIKD. Varying definitions employed in clinical trials has complicated the awareness of this adverse event. Causality assessment is often missing from studies as it is complicated by the need to evaluate competing AKI risk factors. This has led to uncertainty in the nephrotoxic risk of commonly used drugs. SUMMARY Standard criteria for DIKD should be applied in clinical trials to improve our understanding of the frequency of these events. Adjudication of these events will improve the clinician's ability to evaluate the causal relationship and relative contribution of specific drugs to the AKI event.
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2859
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Abstract
INTRODUCTION Infectious endocarditis (IE) is a potentially deadly disease without therapy and can cause a wide number of findings and symptoms, often resembling a flu-like illness, which makes diagnosis difficult. OBJECTIVE This narrative review evaluates the presentation, evaluation, and management of infective endocarditis in the emergency department, based on the most current literature. DISCUSSION IE is due to infection of the endocardial surface, most commonly cardiac valves. Major risk factors include prior endocarditis (the most common risk factor), structural heart damage, IV drug use (IVDU), poor immune function (vasculitis, HIV, diabetes, malignancy), nosocomial (surgical hardware placement, poor surgical technique, hematoma development), and poor oral hygiene, and a wide variety of organisms can cause IE. Patients typically present with flu-like illness. Though fever and murmur occur in the majority of cases, they may not be present at the time of initial presentation. Other findings such as Roth spots, Janeway lesions, Osler nodes, etc. are not common. An important component is consideration of risk factors. A patient with IVDU (past or current use) and fever should trigger consideration of IE. Other keys are multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms. If endocarditis is likely based on history and examination, admission for further evaluation is recommended. Blood cultures and echocardiogram are key diagnostic tests. CONCLUSIONS Emergency physicians should consider IE in the patient with flu-like symptoms and risk factors. Appropriate evaluation and management can significantly reduce disease morbidity and mortality.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
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2860
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Mootien J, Zahar JR. Entérobactéries productrices de carbapénémases en médecine intensive : thérapeutique. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les infections à entérobactéries productrices de carbapénémases peuvent représenter une pathologie redoutable, notamment dans les situations cliniques graves, en raison des possibilités thérapeutiques limitées. En France, les mécanismes OXA-48 et OXA-48-like (78 %) sont les plus fréquemment retrouvés. Les stratégies thérapeutiques actuelles limitées ont mis en exergue l’intérêt de certaines vieilles molécules et des associations d’antibiotiques avec une optimisation de leurs modalités d’administration. Dans l’attente de l’apport des futures options thérapeutiques, les essais contrôlés randomisés sont plus que nécessaires. Nous devons nous inspirer de l’expérience de ceux qui prennent en charge ces infections. La maîtrise du bon usage des antibiotiques reste toujours d’actualité afin de préserver l’efficacité des molécules existantes.
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2861
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Rangan A, Falworth M, Watts AC, Scarborough M, Thomas M, Kulkarni R, Rees J. Investigation and Management of Periprosthetic Joint Infection in the Shoulder and Elbow: Evidence and consensus based guidelines of the British Elbow and Shoulder Society. Shoulder Elbow 2018; 10:S5-S19. [PMID: 29796102 PMCID: PMC5958475 DOI: 10.1177/1758573218772976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Amar Rangan
- United Kingdom of Great Britain and Northern
Ireland
| | - Mark Falworth
- United Kingdom of Great Britain and Northern
Ireland
| | - Adam C Watts
- United Kingdom of Great Britain and Northern
Ireland
| | | | | | | | - Jonathan Rees
- United Kingdom of Great Britain and Northern
Ireland
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2862
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Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A, Muñoz P, Fernández-Cruz A, Valerio M, Fariñas MC, Gutiérrez-Cuadra M, Miró JM, Ruiz-Morales J, Sousa-Regueiro D, Montejo JM, Gálvez-Acebal J, HidalgoTenorio C, Domínguez F. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 2018; 24:555-562. [PMID: 29628387 DOI: 10.1016/j.jiac.2018.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/23/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Muñoz Serrano
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Arístides de Alarcón González
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Grupo de Investigación sobre Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla / CSIC / Universidad Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Ana Fernández-Cruz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Carmen Fariñas
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Ma Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS. Universidad de Barcelona, Barcelona, Spain.
| | - Josefa Ruiz-Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
| | | | - José Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS. Universidad de Sevilla, Sevilla, Spain.
| | - Carmen HidalgoTenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Granada, Spain.
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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2863
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Gofman N, To K, Whitman M, Garcia-Morales E. Successful treatment of ventriculitis caused byPseudomonas aeruginosaand carbapenem-resistantKlebsiella pneumoniaewith i.v. ceftazidime–avibactam and intrathecal amikacin. Am J Health Syst Pharm 2018; 75:953-957. [DOI: 10.2146/ajhp170632] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
| | - Kim To
- Capital Health Regional Medical Center, Trenton, NJ
| | - Marc Whitman
- Department of Medicine, Capital Health Regional Medical Center, Trenton, NJ
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2864
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Slullitel PA, Oñativia JI, Buttaro MA, Sánchez ML, Comba F, Zanotti G, Piccaluga F. State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty. EFORT Open Rev 2018; 3:434-441. [PMID: 30233819 PMCID: PMC6129958 DOI: 10.1302/2058-5241.3.170032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent.Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert.Given DAIR's unclear control of infection, with successful outcomes in the range of 30% to 95%, one- or two-stage revision protocols may play a role in certain cases of acute infections; nonetheless, further prospective, randomized studies are necessary to compare long-term outcomes between DAIR and revision surgeries.Following surgical treatment, length of antibiotherapy is in the range of six weeks to six months, without any difference in outcomes between short and long protocols. Treatment should be adjusted to the isolated bacteria and controlled further with post-operative serum biomarker levels. Cite this article: EFORT Open Rev 2018;3:434-441. DOI: 10.1302/2058-5241.3.170032.
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Affiliation(s)
| | | | | | | | - Fernando Comba
- Hip Surgery Unit, Italian Hospital of Buenos Aires, Argentina
| | - Gerardo Zanotti
- Hip Surgery Unit, Italian Hospital of Buenos Aires, Argentina
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2865
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Schechter MC, Spicer JO, del Mar Aldrete S, Kraft CS. Serratia marcescens Infectious Endocarditis: Injection Drug Use, Left-Sided Heart Disease, and Poor Outcomes. Infect Dis Clin Pract 2018; 26:216-9. [DOI: 10.1097/ipc.0000000000000614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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2866
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Garrido RQ, Brito JODR, Fernandes R, Barbosa GF, Correia MG, Golebiovski WF, Weksler C, Lamas CC. Early Onset Prosthetic Valve Endocarditis: Experience at a Cardiothoracic Surgical Hospital, 2006-2016. Surg Infect (Larchmt) 2018; 19:529-534. [PMID: 29957138 DOI: 10.1089/sur.2018.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early onset prosthetic valve endocarditis (EO-PVE) is an serious complication associated with heart valve replacement surgery. OBJECTIVES To describe the epidemiologic, clinical, and laboratory profile of patients with EO-PVE in a cardiac surgical hospital. PATIENTS AND METHODS A retrospective analysis of an endocarditis database, implemented prospectively, with a post hoc study driven by analysis of cases of adults with definite endocarditis occurring up to 12 months after heart valve surgery. RESULTS We identified 26 cases in 2,496 surgeries in the period 2006-2016. The average annual incidence was 1.04%. The median time between valve replacement and the diagnosis of EO-PVE was 33 days (interquartile range [IQR] 19.25-118.75). Biologic and mechanical prostheses were affected in 53.8% and 46.2%, respectively. Rheumatic disease was present in 57.7% of patients. The most common causative pathogens were Staphylococcus epidermidis (23.1%). No Staphylococcus aureus infection was reported. Complications were present in 73.1% of cases, including embolism (65.4%), acute renal failure (38.5%), and heart failure (23.1%). The mortality rate at 30 days and 12 months was 3.8% and 34.6%, respectively. CONCLUSIONS In our cohort EO-PVE was an serious complication of heart valve replacement with a high morbidity and mortality, despite its low frequency.
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Affiliation(s)
- Rafael Quaresma Garrido
- 1 Infection Control Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
- 5 Universidade Estacio de Sá , Rio de Janeiro, Brazil
- 7 Instituto Nacional de Infectologia , Rio de Janeiro, Brazil
| | | | | | | | | | - Wilma Felix Golebiovski
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
| | - Clara Weksler
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
- 6 Universidade do Grande Rio , Duque de Caxias, Brazil
- 7 Instituto Nacional de Infectologia , Rio de Janeiro, Brazil
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2867
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Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to provide a critical review of peer-reviewed literature over the last 5 years related to low virulent organisms associated with periprosthetic joint infection (PJI). We evaluated the most common organisms, the diagnostic challenges, and the novel tools available in the perioperative workup of PJI as well as the current understanding of how biofilm potentiates the indolent clinical presentation and explore a possible shift in the surgical management of these patients. RECENT FINDINGS Biofilm actively prevents macrophage phagocytosis by suppressing proinflammatory activity through the recruitment of myeloid-derived suppressor cells. Given the appropriate host and organism conditions, increased utilization of one-stage exchange arthroplasty in the surgical treatment of these low virulent infections may be on the rise. Biomarkers and molecular techniques offer encouraging results to diagnose low virulent organisms and future research focused on the disruption of biofilm may ultimately give rise to improved treatment strategies.
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2868
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Gras J, De Castro N, Montlahuc C, Champion L, Scemla A, Matignon M, Lachâtre M, Raskine L, Grall N, Peraldi MN, Molina JM. Clinical characteristics, risk factors, and outcome of tuberculosis in kidney transplant recipients: A multicentric case-control study in a low-endemic area. Transpl Infect Dis 2018; 20:e12943. [DOI: 10.1111/tid.12943] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/05/2018] [Accepted: 05/28/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Julien Gras
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
| | - Nathalie De Castro
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
| | - Claire Montlahuc
- Service de Biostatistiques et Information médicale; Hôpital Saint Louis APHP; Paris ECSTRA Team; UMR 1153 INSERM; Université Paris Diderot; Sorbonne Paris Cité; Paris France
| | - Laure Champion
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Bichat; Paris France
| | - Anne Scemla
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Necker Enfants Malades; Paris France
| | - Marie Matignon
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Henri Mondor; Créteil France
| | - Marie Lachâtre
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Bichat; Paris France
| | - Laurent Raskine
- Service de bactériologie; APHP-Hôpital Lariboisière; Paris France
| | - Nathalie Grall
- Laboratoire de microbiologie; APHP-Hôpital Bichat; INSERM; IAME; UMR 1137; Paris France
| | - Marie Noëlle Peraldi
- Service de Néphrologie et transplantation rénale; APHP-Hôpital Saint Louis; Paris France
- Université Paris Diderot-Paris VII; Paris France
| | - Jean Michel Molina
- Service de Maladies infectieuses et tropicales; APHP-Hôpital Saint Louis; Paris France
- Université Paris Diderot-Paris VII; Paris France
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2869
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Lakota EA, Landersdorfer CB, Nation RL, Li J, Kaye KS, Rao GG, Forrest A. Personalizing Polymyxin B Dosing Using an Adaptive Feedback Control Algorithm. Antimicrob Agents Chemother 2018; 62:e00483-18. [PMID: 29760144 DOI: 10.1128/AAC.00483-18] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 04/12/2018] [Indexed: 01/11/2023] Open
Abstract
Polymyxin B is used as an antibiotic of last resort for patients with multidrug-resistant Gram-negative bacterial infections; however, it carries a significant risk of nephrotoxicity. Herein we present a polymyxin B therapeutic window based on target area under the concentration-time curve (AUC) values and an adaptive feedback control algorithm (algorithm) which allows for the personalization of polymyxin B dosing. The upper bound of this therapeutic window was determined through a pharmacometric meta-analysis of polymyxin B nephrotoxicity data, and the lower bound was derived from murine thigh infection pharmacokinetic (PK)/pharmacodynamic (PD) studies. A previously developed polymyxin B population pharmacokinetic model was used as the backbone for the algorithm. Monte Carlo simulations (MCS) were performed to evaluate the performance of the algorithm using different sparse PK sampling strategies. The results of the nephrotoxicity meta-analysis showed that nephrotoxicity rate was significantly correlated with polymyxin B exposure. Based on this analysis and previously reported murine PK/PD studies, the target AUC0–24 (AUC from 0 to 24 h) window was determined to be 50 to 100 mg · h/liter. MCS showed that with standard polymyxin B dosing without adaptive feedback control, only 71% of simulated subjects achieved AUC values within this window. Using a single PK sample collected at 24 h and the algorithm, personalized dosing regimens could be computed, which resulted in >95% of simulated subjects achieving AUC0–24 values within the target window. Target attainment further increased when more samples were used. Our algorithm increases the probability of target attainment by using as few as one pharmacokinetic sample and enables precise, personalized dosing in a vulnerable patient population.
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2870
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Abstract
INTRODUCTION The octapeptins are a family of cyclic lipopeptides first reported in the 1970s then largely ignored. At the time, their reported antibiotic activity against polymyxin-resistant bacteria was a curiosity. Today, the advent of widespread drug resistance in Gram-negative bacteria has prompted their 'rediscovery.' The paucity of new antibiotics in the clinical pipeline is coupled with a global spread of increasing antibiotic resistance, particularly to meropenem and polymyxins B and E (colistin). Areas covered: We review the original discovery of octapeptins, their recent first chemical syntheses, and their mode of action, then discuss their potential as a new class of antibiotics to treat extensively drug-resistant (XDR) Gram-negative infections, with direct comparisons to the closely related polymyxins. Expert commentary: Cyclic lipopeptides in clinical use (polymyxin antibiotics) have significant dose-limiting nephrotoxicity inherent to their chemotype. This toxicity has prevented improved polymyxin analogs from progressing to the clinic, and tainted the perception of lipopeptide antibiotics in general. We argue that the octapeptins are fundamentally different from the polymyxins, with a disparate mode of action, spectra of action against MDR and XDR bacteria and a superior preclinical safety profile. They represent early-stage candidates that can help prime the antibiotic discovery pipeline.
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Affiliation(s)
- Mark A T Blaskovich
- a Institute for Molecular Bioscience , The University of Queensland , Brisbane , Queensland , Australia
| | - Miranda E Pitt
- a Institute for Molecular Bioscience , The University of Queensland , Brisbane , Queensland , Australia
| | - Alysha G Elliott
- a Institute for Molecular Bioscience , The University of Queensland , Brisbane , Queensland , Australia
| | - Matthew A Cooper
- a Institute for Molecular Bioscience , The University of Queensland , Brisbane , Queensland , Australia
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2871
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Iacovelli A, Spaziante M, Al Moghazi S, Giordano A, Ceccarelli G, Venditti M. A challenging case of carbapenemase-producing Klebsiella pneumoniae septic thrombophlebitis and right mural endocarditis successfully treated with ceftazidime/avibactam. Infection 2018; 46:721-724. [PMID: 29926399 DOI: 10.1007/s15010-018-1166-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The emergence of carbapenemase-producing Klebsiella pneumonia (KPC-Kp) has become a significant problem in terms of public health and clinical outcome in many hospitals in Southern Europe. Treatment options are usually limited and effective treatment of infections caused by these pathogens is a considerable challenge for clinicians. Ceftazidime-avibactam has been recently approved for the treatment of difficult-to-treat infections due to aerobic Gram-negative organisms in patients with limited treatment options. CASE REPORT We reported the first case of KPC-Kp septic thrombophlebitis and right atrial endocarditis associated with metastatic lung abscesses successfully treated with a prolonged ceftazidime/avibactam plus ertapenem treatment course, suggesting that this combination therapy could be safe and effective for serious Gram-negative infections. Interestingly, we also observed an apparent discrepancy between clinical and microbiological courses: the patient became rapidly afebrile; hemodynamically stable and his procalcitonin levels showed a prompt decreasing trend. Nevertheless, blood cultures remained persistently positive for a prolonged period. CONCLUSION In conclusion, ceftazidime-avibactam plus ertapenem was a safe and effective therapy of serious endovascular infection due to KPC-Kp. Moreover, in this setting, follow-up blood cultures might represent an irreplaceable tool to guide the therapy.
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Affiliation(s)
- Alessandra Iacovelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Martina Spaziante
- Department of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Samir Al Moghazi
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Giordano
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy.
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2872
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Abstract
Coronary artery disease is currently one of the leading causes of mortality in patients with HIV. Severe left main disease (LMD) occurs in ~6% of the HIV-infected patients. We describe a case report of an atypical presentation of silent critical LMD in an HIV-infected patient who underwent a low-risk exercise stress test. The cardiovascular disease team should be vigilant for this latent phenomenon, specifically within this subpopulation despite the high Duke treadmill score.
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Affiliation(s)
- Rajeev Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Valmiki Seecheran
- Cardiovascular Services Division, North West Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Sangeeta Persad
- Cardiovascular Services Division, North West Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | - Taarik Dookie
- Cardiology Unit, Advanced Cardiovascular Institute, Port of Spain, Trinidad and Tobago
| | - Naveen Anand Seecheran
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
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2873
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Jordal S, Kittang BR, Salminen PR, Eide GE, Kommedal Ø, Wendelbo Ø, Haaverstad R, Sjursen H. Infective endocarditis in Western Norway: a 20-year retrospective survey. Infect Dis (Lond) 2018; 50:757-763. [PMID: 29916753 DOI: 10.1080/23744235.2018.1482419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND To investigate epidemiological trends of infective endocarditis (IE) in western Norway a retrospective study was performed. METHODS Characteristics of 706 IE admissions from 1996 to 2005 and 2006 to 2015 were analysed and compared using the Chi-square test for categorical variables and the t-test for age. Survival was analysed by multiple Cox regression and reported by the hazard ratio (HR). RESULTS Mean annual incidence rates increased from 4.6 to 7.4 per 100,000 inhabitants (rate ratio: 1.97, 95% confidence interval: 1.52-2.56, p < .001). Non-viridans streptococci, enterococci and Staphylococcus aureus (S. aureus), were all independently associated with increased mortality. The frequency of IE caused by enterococci increased from 3.7 to 13.0% (p < .001). The proportion of intravenous drug users (IVDU) increased from 16.5 to 23.5% (p = .015) and had increasing aortic valve involvement (p = .023). Prosthetic valve endocarditis (PVE) constituted 30% of IE cases in both decades with biological PVE increasing from 9.4 to 22.1% (p < .001) and mechanical PVE decreasing from 18.7 to 8.9% (p < .001). In the last decade, valve replacement surgery was performed in 37.6% of the patients, of which 85.5% received a bioprosthesis. CONCLUSIONS The incidence of IE increased significantly. Non-viridans streptococci, enterococci and S. aureus were all significantly associated with increased mortality. The increased number of enterococcal IE and the increased number of IVDUs with left-sided IE constituted new challenges. Biological implants were preferred in a majority of patients requiring surgery.
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Affiliation(s)
- Stina Jordal
- a Section of Infectious Disease, Department of Medicine , Haukeland University Hospital , Bergen , Norway
| | | | - Pirjo-Riitta Salminen
- c Section of Cardiothoracic Surgery , Department of Heart Disease , Haukeland University Hospital , Bergen , Norway
| | - Geir Egil Eide
- d Centre for Clinical Research , Haukeland University Hospital , Bergen , Norway.,e Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway
| | - Øyvind Kommedal
- f Department of Microbiology , Haukeland University Hospital , Bergen , Norway
| | - Øystein Wendelbo
- a Section of Infectious Disease, Department of Medicine , Haukeland University Hospital , Bergen , Norway
| | - Rune Haaverstad
- c Section of Cardiothoracic Surgery , Department of Heart Disease , Haukeland University Hospital , Bergen , Norway
| | - Haakon Sjursen
- a Section of Infectious Disease, Department of Medicine , Haukeland University Hospital , Bergen , Norway
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2874
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Zegri-Reiriz I, de Alarcón A, Muñoz P, Martínez Sellés M, González-Ramallo V, Miro JM, Falces C, Gonzalez Rico C, Kortajarena Urkola X, Lepe JA, Rodriguez Alvarez R, Reguera Iglesias JM, Navas E, Dominguez F, Garcia-Pavia P. Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse. J Am Coll Cardiol 2018; 71:2731-2740. [PMID: 29903346 DOI: 10.1016/j.jacc.2018.03.534] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. OBJECTIVES This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. METHODS This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). RESULTS BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. CONCLUSIONS IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered.
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Affiliation(s)
- Isabel Zegri-Reiriz
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | - Patricia Muñoz
- Department of Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERES, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez Sellés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Victor González-Ramallo
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose M Miro
- Department of Infectious Diseases, Hospital Clínic- Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Carles Falces
- Department of Cardiology, Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Claudia Gonzalez Rico
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Antonio Lepe
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infecious Diseases Research Group, Institute of Biomedicine of Seville, University of Seville/CSIC/University Hospitals Virgen del Rocío and Virgen Macarena, Seville, Spain
| | | | | | - Enrique Navas
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Madrid, Spain; University Francisco de Vitoria, Pozuelo de Alarcon, Madrid, Spain.
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2875
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Mittal R, Jhaveri VM, Kay SIS, Blackwelder P, Patel K. Pseudomonas aeruginosa Invades Human Aortic Endothelial Cells and Induces Cell Damage in vitro. Cardiovasc Hematol Disord Drug Targets 2018; 19:45-50. [PMID: 29886837 DOI: 10.2174/1871529x18666180611094928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/16/2017] [Accepted: 03/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiovascular diseases such as endocarditis are the second most common cause of death worldwide. Infective Endocarditis (IE) is the most severe infection of the heart associated with significant mortality and morbidity. The binding and invasion of Human Aortic Endothelial Cells (HAECs) by pathogenic microbes can play an important role in the pathogenesis of IE. OBJECTIVE Pseudomonas aeruginosa is an emerging pathogen that has been associated with IE. However, it is not known whether P. aeruginosa can bind and interact with HAECs. The aim of this study was to determine whether P. aeruginosa can bind and colonize HAECs. METHODS The invasion of HAECs by P. aeruginosa was assessed by gentamicin protection assay. Cytokine levels were determined by enzyme-linked Immunosorbent Assay (ELISA) kits. Cell damage was determined by Lactate Dehydrogenase (LDH) assay. RESULTS P. aeruginosa can bind and invade HAECs. Infection of HAECs with P. aeruginosa induces TNF-α IL-1β, IL-6 and IL-8 cytokine production leading to the generation of inflammatory milieu that can cause tissue damage as observed in human clinical cases of IE. We also observed that P. aeruginosa induces cell damage in HAECs. CONCLUSION In this study, we demonstrate for first time that P. aeruginosa can invade and survive inside HAECs. This cell culture model can be of immense importance to determine the efficacy of drug targets against IE.
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Affiliation(s)
- Rahul Mittal
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, FL-33136, United States
| | - Vasanti M Jhaveri
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, FL-33136, United States
| | - Sae-In Samantha Kay
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, FL-33136, United States
| | - Patricia Blackwelder
- Center for Advanced Microscopy, University of Miami, Coral Gables, Florida, FT, United States.,RSMAS, University of Miami, Key Biscayne, Florida, FL-33136, United States
| | - Kunal Patel
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, FL-33136, United States
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2876
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Buonomo AR, Zappulo E, Viceconte G, Scotto R, Borgia G, Gentile I. Risk of opportunistic infections in patients treated with alemtuzumab for multiple sclerosis. Expert Opin Drug Saf 2018; 17:709-717. [PMID: 29848085 DOI: 10.1080/14740338.2018.1483330] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Alemtuzumab is a monoclonal anti CD-52 antibody recently approved for use in relapsing-remitting multiple sclerosis(MS). Given that the targeted antigen is primarily expressed on B and T lymphocytes, the administration of this biological drug is associated with rapid but protracted peripheral lymphopenia. AREAS COVERED The impact on infective risk of this immune impairment is still to be fully understood. In this review, we attempt to summarize all the available literature concerning opportunistic infections occurring in patients with MS receiving alemtuzumab. Infective adverse events were observed in more than 70% of patients in phase 2/3 RCTs, mainly of mild-to-moderate severity. Nevertheless, several post-marketing reports documented cases of serious, rare, and unexpected infections. EXPERT OPINION Predictive risk factors and prognostic features of opportunistic infections in this setting still need to be exactly assessed. At present, the only recommended preventive measures consist in anti-herpetic prophylaxis, Listeria-free diet, Tuberculosis prophylaxis and annual Papillomavirus screening. Given the non-negligible risk of unpredicted infective events, we advise physicians to take into account patients' history of infectious diseases and vaccine status and to consider supplementary prophylactic strategies, including screening for Toxoplasma gondii and viral hepatitis serostatus as well as pre-emptive approaches to avert CMV reactivation and Pneumocystosis.
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Affiliation(s)
- Antonio Riccardo Buonomo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Emanuela Zappulo
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Giulio Viceconte
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Riccardo Scotto
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Guglielmo Borgia
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
| | - Ivan Gentile
- a Department of Clinical Medicine and Surgery - Section of Infectious Diseases , University of Naples "Federico II" , Naples , Italy
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2877
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Oordt-Speets AM, Bolijn R, van Hoorn RC, Bhavsar A, Kyaw MH. Global etiology of bacterial meningitis: A systematic review and meta-analysis. PLoS One 2018; 13:e0198772. [PMID: 29889859 PMCID: PMC5995389 DOI: 10.1371/journal.pone.0198772] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/24/2018] [Indexed: 12/16/2022] Open
Abstract
Bacterial meningitis is a global public health concern, with several responsible etiologic agents that vary by age group and geographical area. The aim of this systematic review and meta-analysis was to assess the etiology of bacterial meningitis in different age groups across global regions. PubMed and EMBASE were systematically searched for English language studies on bacterial meningitis, limited to articles published in the last five years. The methodological quality of the studies was assessed using a customized scoring system. Meta-analyses were conducted to determine the frequency (percentages) of seven bacterial types known to cause meningitis: Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, Streptococcus pneumoniae, group B Streptococcus agalactiae, Staphylococcus aureus, and Listeria monocytogenes, with results being stratified by six geographical regions as determined by the World Health Organization, and seven age groups. Of the 3227 studies retrieved, 56 were eligible for the final analysis. In all age groups, S. pneumoniae and N. meningitidis were the predominant pathogens in all regions, accounting for 25.1-41.2% and 9.1-36.2% of bacterial meningitis cases, respectively. S. pneumoniae infection was the most common cause of bacterial meningitis in the 'all children' group, ranging from 22.5% (Europe) to 41.1% (Africa), and in all adults ranging from 9.6% (Western Pacific) to 75.2% (Africa). E. coli and S. pneumoniae were the most common pathogens that caused bacterial meningitis in neonates in Africa (17.7% and 20.4%, respectively). N. meningitidis was the most common in children aged ±1-5 years in Europe (47.0%). Due to paucity of data, meta-analyses could not be performed in all age groups for all regions. A clear difference in the weighted frequency of bacterial meningitis cases caused by the different etiological agents was observed between age groups and between geographic regions. These findings may facilitate bacterial meningitis prevention and treatment strategies.
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Affiliation(s)
| | - Renee Bolijn
- Pallas Health Research and Consultancy BV, Rotterdam, The Netherlands
| | - Rosa C. van Hoorn
- Pallas Health Research and Consultancy BV, Rotterdam, The Netherlands
| | | | - Moe H. Kyaw
- Sanofi Pasteur Inc, Swiftwater, Pennsylvania, United States of America
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2878
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Bene N, Li X, Nandi S. Increased antibiotic duration improves reoperation free survival after total hip arthroplasty irrigation and debridement. J Orthop 2018; 15:707-710. [PMID: 29881225 DOI: 10.1016/j.jor.2018.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/06/2018] [Indexed: 01/16/2023] Open
Abstract
Background We aimed to determine if reoperation-free survival following irrigation and debridement (I&D) with head and liner exchange of infected primary THA is affected by: 1) postoperative antibiotic duration; 2) patient characteristics; 3) infecting organism; or 4) postoperative versus hematogenous infection. Methods Revision THAs from 2006 to 2012 (n = 1184) were observed; 26 underwent I&D with head and liner exchange with mean 4.1-year follow-up. Patients with reoperation for infection (n = 2) versus those without reoperation (n = 24) were analyzed. Results Increased postoperative antibiotic therapy duration (p = 0.0333) decreased risk of reoperation for infection. Conclusion Chronic antibiotic suppression should be considered following THA I&D with head and liner exchange.
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Affiliation(s)
- Nicholas Bene
- Tufts University School of Medicine, Boston, MA, United States
| | - Xing Li
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Sumon Nandi
- Department of Orthopaedic Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
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2879
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Lourtet-Hascoët J, Félicé MP, Bicart-See A, Bouige A, Giordano G, Bonnet E. Species and antimicrobial susceptibility testing of coagulase-negative staphylococci in periprosthetic joint infections. Epidemiol Infect 2018; 146:1771-6. [PMID: 29880073 DOI: 10.1017/S0950268818001437] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The objective was to evaluate the distribution of coagulase-negative staphylococci (CNS) involved in periprosthetic-joint infections (PJIs) and to describe their susceptibility profile to antibiotics. We conducted a multicentre retrospective study in France, including 215 CNS PJIs between 2011 and 2015. CNS PJIs involved knees in 54% of the cases, hips in 39%, other sites in 7%. The distribution of the 215 strains was: Staphylococcus epidermidis 129 (60%), Staphylococcus capitis 24 (11%), Staphylococcus lugdunensis 21 (10%), Staphylococcus warneri 8 (4%), Staphylococcus hominis 7 (3%), Staphylococcus haemolyticus 7 (3%). More than half of the strains (52.1%) were resistant to methicillin, 40.9% to ofloxacin, 20% to rifampicin. The species most resistant to antibiotics were S. hominis, S. haemolyticus, S. epidermidis, with 69.7% of the strains resistant to methicillin and 30% simultaneously resistant to clindamycin, cotrimoxazole, ofloxacin and rifampicin. No strain was resistant to linezolid or daptomycin. In this study on CNS involved in PJIs, resistance to methicillin is greater than 50%. S. epidermidis is the most frequent and resistant species to antibiotics. Emerging species such S. lugdunensis, S. capitis and Staphylococcus caprae exhibit profiles more sensitive to antibiotics. The antibiotics most often active in vitro are linezolid and daptomycin.
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2880
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Sousa R, Abreu MA. Treatment of Prosthetic Joint Infection with Debridement, Antibiotics and Irrigation with Implant Retention - a Narrative Review. J Bone Jt Infect 2018; 3:108-117. [PMID: 30013891 PMCID: PMC6043472 DOI: 10.7150/jbji.24285] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/04/2018] [Indexed: 12/12/2022] Open
Abstract
Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative. There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome. Along this paper, the authors will provide the readers with a critical narrative review of the currently available literature while trying to provide concise and practical treatment recommendations regarding adequate patient selection criteria, proper surgical technique and optimal antibiotic therapy.
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Affiliation(s)
- Ricardo Sousa
- Department of Orthopaedics, Centro Hospitalar do Porto, Porto, Portugal
- Grupo TrofaSaude - Hospital em Alfena, Valongo, Portugal
| | - Miguel Araújo Abreu
- Department of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal
- Grupo TrofaSaude - Hospital em Alfena, Valongo, Portugal
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2881
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Abstract
The good clinical result of lung transplantation is constantly undermined by the high incidence of infection, which negatively impacts on function and survival. Moreover, infections may also have immunological interactions that play a role in the acute rejection and in the development of chronic lung allograft dysfunction. There is a temporal sequence in the types of infection that affects lung allograft: in the first postoperative month bacteria are the most frequent cause of infection; following this phase, cytomegalovirus and Pneumocystis carinii are common. Fungal infections are particularly feared due to their association with bronchial complication and high mortality. Scrupulous postoperative surveillance is mandatory for the successful management of lung transplantation patients with respect to early detection and treatment of infections. This paper is aimed to address clinicians in the management of the major infectious complications that affect the lung transplant population.
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Affiliation(s)
- Mario Nosotti
- Thoracic Surgery and Lung Transplantation Unit, Milano, Italy
| | - Paolo Tarsia
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| | - Letizia Corinna Morlacchi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Centre, Ca' Granda Foundation IRCCS Ospedale Maggiore Policlinico, Milano, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
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2882
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Baldassarri SR, Lee I, Latham SR, D’Onofrio G. Debating Medical Utility, Not Futility: Ethical Dilemmas in Treating Critically Ill People Who Use Injection Drugs. J Law Med Ethics 2018; 46:241-251. [PMID: 30146983 PMCID: PMC6530472 DOI: 10.1177/1073110518782925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal.
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Affiliation(s)
- Stephen R. Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- Yale School of Medicine
| | | | | | - Gail D’Onofrio
- Yale School of Medicine
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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2883
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Pericàs JM, Moreno A, Almela M, García-de-la-Mària C, Marco F, Muñoz P, Peña C, de Alarcón A, Del Río A, Eworo A, Cruceta A, Paré JC, Mestres CA, Miró JM. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial. Clin Microbiol Infect 2018; 24:673-676. [PMID: 29408610 DOI: 10.1016/j.cmi.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J M Pericàs
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - M Almela
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - C García-de-la-Mària
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Marco
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - C Peña
- Infectious Diseases Service, Hospital de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A de Alarcón
- Infectious Diseases Service, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva Grupo de Investigacion en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)/CSIC/HU Virgen del Rocío, Sevilla, Spain
| | - A Del Río
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - A Cruceta
- Clinical Trials Unit, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J C Paré
- Cardiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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2884
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Bodilsen J, Brouwer MC, Kjærgaard N, Sirks MJ, van der Ende A, Nielsen H, van de Beek D. Community-acquired meningitis in adults caused by Escherichia coli in Denmark and The Netherlands. J Infect 2018; 77:25-29. [PMID: 29859862 DOI: 10.1016/j.jinf.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to examine risk factors, presenting characteristics and complications of Escherichia coli community-acquired bacterial meningitis in adults. METHODS Observational cohort study of adults > 16 years of age with cerebrospinal fluid culture-positive E. coli meningitis in Denmark and the Netherlands. Exclusion criteria were primary brain abscess, previous neurosurgery and nosocomial infections. We analysed baseline characteristics, concomitant infections and neurological complications. Outcome was assessed using the Glasgow Outcome Scale score (GOS) at discharge with GOS 1-4 categorised as unfavourable outcome. RESULTS We identified 36 patients with a median age of 69 years (interquartile range 61-83) of whom 15 (42%) were females. Immuno-compromise was present in 11 (31%) patients. Nineteen (53%) patients had concomitant infections consisting of urinary tract infections in 13 (36%), pneumonia in three (9%) and septic arthritis in two (6%). Bacteraemia with E. coli was found in 26 of 34 (76%) patients. Thirteen patients died (36%) and unfavourable outcome at discharge occurred in 23 (64%). Deaths were attributed to systemic complications in 12 (92%) patients. CONCLUSION Community-acquired E. coli meningitis in adults is a severe disease that primarily occurs in elderly patients with concomitant infections and an immunocompromised state. Outcome is often poor and mainly caused by systemic complications.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nicolai Kjærgaard
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Marc J Sirks
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Academic Medical Center, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
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2885
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Hischebeth GT, Gravius S, Molitor E, Kohlhof H, Hoerauf A, Hilgers C, Randau TM. Activity of ceftobiprole against Staphylococcus spec. isolates derived from foreign body associated infections. Diagn Microbiol Infect Dis 2018; 91:175-8. [DOI: 10.1016/j.diagmicrobio.2018.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/23/2017] [Accepted: 01/11/2018] [Indexed: 11/17/2022]
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2886
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Aydoğan BB, Yıldırım F, Zerman A, Gönderen K, Türkoğlu M, Aygencel G. Colistin nephrotoxicity in the ICU: Is it different in the geriatric patients? Aging Clin Exp Res 2018; 30:573-580. [PMID: 28866836 DOI: 10.1007/s40520-017-0827-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Most significant side effect of colistin therapy which is used for the treatment of multi-drug resistant Gram-negative infections is nephrotoxicity. Our aim was to investigate the differences of colistin nephrotoxicity between the geriatric age group (≥65 years) and the younger age group (<65 years) in critically ill medical intensive care unit (ICU) patients. MATERIAL AND METHOD The medical records of the 76 patients who were taken colistin therapy due to multi-resistant Gram-negative infections between January 2010 and June 2014 in the our medical ICU were retrospectively investigated. Demographic characteristics, reasons for colistin use, daily colistin dose, duration of colistin use were recorded. Colistin-dependent renal dysfunction was evaluated according to the risk, injury, failure, loss and end-stage renal failure (RIFLE) criterias. RESULTS The median age of the patients was 65 (65.8% male). Nephrotoxicity was developed in 36 (47.4%) patients. Thirty-nine (51.3%) patients were in geriatric age group, 37 (48.7%) were in younger age group. In geriatric age group, the rates of male gender (53.8 vs 78.4%, p = 0.031), pulmonary (48.7 vs 16.2%, p = 0.003) and cardiac diseases (71.8 vs 29.7%, p < 0.001), post-nephrotoxicity BUN levels (p = 0.023) and urine output during nephrotoxicity (p = 0.016) were higher than younger age group. Nephrotoxicity was developed in 22 (56.4%) patients of geriatric age group, and in 14 (37.8%) patients in younger age group (p = 0.115). The presence of cardiac disease, renal pathology and high creatinin value on admission, daily amount of colistin per body mass, total amount of colistin, use of colistin for pulmonary infection, use of amphotericin and vasopressor on admission were found as risk factors for colistin nephrotoxicity development in all study group; the daily amount of colistin per body mass (risk ratio:0.41; 95% CI 0.19-0.89) and vasopressor use during hospitalization were found independent risk factors (risk ratio:13.54; 95% CI 2.21-83.09). CONCLUSION In our study, in geriatric patient group colistin nephrotoxicity was not different from the younger age group. In the ICU, the age for nephrotoxicity does not appear to be a point to be considered for the initiation of colistin.
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Affiliation(s)
| | - Fatma Yıldırım
- Surgical Intensive Care Unit, Clinic of Pulmonary Medicine, Dışkapı Yıldırım Beyazıt Research and Education Hospital, Ankara, Turkey.
| | - Avşar Zerman
- Intensive Care Unit, Adana Numune Research and Education Hospital, Adana, Turkey
| | - Kamil Gönderen
- Intensive Care Unit, Dumlupınar University Evliya Çelebi Research and Education Hospital, Kütahya, Turkey
| | - Melda Türkoğlu
- Subdivision of Critical Care, Internal Medicine Intensive Care Unit, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gülbin Aygencel
- Subdivision of Critical Care, Internal Medicine Intensive Care Unit, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
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2887
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Ferraris L, Milazzo L, Rimoldi SG, Mazzali C, Barosi A, Gismondo MR, Vanelli P, Cialfi A, Sollima S, Galli M, Antona C, Antinori S. Epidemiological trends of infective endocarditis in a single center in Italy between 2003-2015. Infect Dis (Lond) 2018; 50:749-756. [PMID: 29842820 DOI: 10.1080/23744235.2018.1472806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Changes in the incidence, clinical features and microbiology of infective endocarditis (IE) observed in a single center in Italy were compared between the period 2003-2010 and 2011-2015. METHODS All cases of IE, defined as definite or possible according to the modified Duke criteria, observed at the 'L. Sacco' Hospital in Milan, Italy between 2003 and 2015 were retrospectively reviewed. RESULTS 366 episodes of IE were identified in 325 patients. The mean number of incident IE over the period 2003-2015 was 1.43 (range: 0.6-2.1) cases per 1000 admissions, with a significantly increasing trend from a mean of 1.28-1.72 cases per 1000 admissions/year in 2003-2010 and 2011-2015, respectively (+34%; p = .04). Staphylococci remain the leading pathogens causing IE (29%) with a relative increase of methicillin-resistant Staphylococcus aureus between the two periods. Streptococci and enterococci account for 26% and 18% of IE, respectively. We found an increase in the proportion of cases due to enterococci (from 14% in 2003-2010 to 22% in 2011-2015). The rate of in-hospital mortality was 19%, similar in the two periods studied. CONCLUSION The incidence of IE continuously increased in our cohort over the past decade and, along with the aging of the population, a raise in the incidence of health care-associated infections and a change in the distribution of prevalent pathogens were observed. Surgery was independently associated with higher in-hospital survival (AOR, 95% CI: 0.38, 0.19-0.74; p = .005). A constant surveillance is required to guide the optimal management of the changing epidemiology of IE.
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Affiliation(s)
- Laurenzia Ferraris
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Laura Milazzo
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Sara Giordana Rimoldi
- b Laboratory of Clinical Microbiology, Virology and Bioemergencies , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Cristina Mazzali
- c Department of Management, Economics and Industrial Engineering (DIG) , Politecnico di Milano , Milan , Italy
| | - Alberto Barosi
- d Department of Cardiology , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Maria Rita Gismondo
- b Laboratory of Clinical Microbiology, Virology and Bioemergencies , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Paolo Vanelli
- e Cardiosurgery Unit, ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Alessandro Cialfi
- d Department of Cardiology , ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Salvatore Sollima
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Massimo Galli
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
| | - Carlo Antona
- e Cardiosurgery Unit, ASST Fatebenefratelli Sacco, University Hospital "Luigi Sacco" , Milan , Italy
| | - Spinello Antinori
- a Department of Biomedical and Clinical Sciences "Luigi Sacco" , University of Milan , Milan , Italy
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2888
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Triffault-Fillit C, Ferry T, Laurent F, Pradat P, Dupieux C, Conrad A, Becker A, Lustig S, Fessy MH, Chidiac C, Valour F. Microbiologic epidemiology depending on time to occurrence of prosthetic joint infection: a prospective cohort study. Clin Microbiol Infect 2018; 25:353-358. [PMID: 29803842 DOI: 10.1016/j.cmi.2018.04.035] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 04/17/2018] [Accepted: 04/30/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The high microbiologic diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in cases of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum β-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiologic epidemiology of PJI according to the chronology of infection. METHODS This prospective cohort study (2011-2016) evaluated the microbiologic aetiology of 567 PJI according to time of occurrence from prosthesis implantation-early (<3 months), delayed (3-12 months) and late (>12 months)-as well as mechanism of acquisition. RESULTS Initial microbiologic documentation (n = 511; 90.1%) disclosed 164 (28.9%) Staphylococcus aureus (including 26 (16.1%) methicillin-resistant S. aureus), 162 (28.6%) coagulase-negative staphylococci (including 81 (59.1%) methicillin-resistant coagulase-negative staphylococci), 80 (14.1%) Enterobacteriaceae, 74 (13.1%) streptococci and 60 (10.6%) Cutibacterium acnes. Considering nonhaematogenous late PJI (n = 182), Enterobacteriaceae (n = 7; 3.8%) were less represented than in the first year after implantation (n = 56; 17.2%; p <0.001), without difference regarding nonfermenting GNB (4.6% and 2.7%, respectively). The prevalence of anaerobes (n = 40; 21.9%; including 32 (80.0%) C. acnes) was higher in late PJI (p <0.001). Consequently, a broad-spectrum β-lactam might be useful in 12 patients (6.6%) with late PJI only compared to 66 patients (20.3%) with early/delayed PJI (p <0.001). CONCLUSIONS Considering the minority amount of GNB in late postoperative PJI, the empirical use of a broad-spectrum β-lactam should be reconsidered, especially when a two-stage exchange is planned.
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Affiliation(s)
- C Triffault-Fillit
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France.
| | - T Ferry
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - F Laurent
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de microbiologie, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - P Pradat
- INSERM U1052, Center for Clinical Research, Croix-Rousse Hospital, Lyon, France
| | - C Dupieux
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de microbiologie, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - A Conrad
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - A Becker
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France
| | - S Lustig
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - M H Fessy
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service de chirurgie orthopédique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - C Chidiac
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
| | - F Valour
- Centre de référence interrégional pour la prise en charge des infections ostéo-articulaires complexes (CRIOAc Lyon), Lyon, France; Service des maladies infectieuses et tropicales, Hôpital de la Croix-Rousse, Lyon, France; CIRI-Centre International de Recherche en Infectiologie, Inserm U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Université Lyon, Lyon, France
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2889
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García-de-la-Mària C, Gasch O, García-Gonzalez J, Soy D, Shaw E, Ambrosioni J, Almela M, Pericàs JM, Tellez A, Falces C, Hernandez-Meneses M, Sandoval E, Quintana E, Vidal B, Tolosana JM, Fuster D, Llopis J, Pujol M, Moreno A, Marco F, Miró JM. The Combination of Daptomycin and Fosfomycin Has Synergistic, Potent, and Rapid Bactericidal Activity against Methicillin-Resistant Staphylococcus aureus in a Rabbit Model of Experimental Endocarditis. Antimicrob Agents Chemother 2018; 62:e02633-17. [PMID: 29610194 DOI: 10.1128/AAC.02633-17] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/26/2018] [Indexed: 11/20/2022] Open
Abstract
We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies using standard (106) and high (108) inocula. Combined therapy was compared to daptomycin monotherapy treatment in the MRSA experimental endocarditis model. A human-like pharmacokinetics model was applied, and the equivalents of cloxacillin at 2 g/4 h, fosfomycin at 2 g/6 h, and daptomycin at 6 to 10 mg/kg/day were administered intravenously. A combination of daptomycin and either fosfomycin or cloxacillin was synergistic in the five strains tested at both inocula. A bactericidal effect was detected in four of five strains tested with both combinations. The MRSA-277 strain (vancomycin MIC, 2 μg/ml) was used for the experimental endocarditis model. Daptomycin plus fosfomycin significantly improved the efficacy of daptomycin monotherapy at 6 mg/kg/day in terms of both the proportion of sterile vegetations (100% versus 72%, P = 0.046) and the decrease in the density of bacteria within the vegetations (P = 0.025). Daptomycin plus fosfomycin was as effective as daptomycin monotherapy at 10 mg/kg/day (100% versus 93%, P = 1.00) and had activity similar to that of daptomycin plus cloxacillin when daptomycin was administered at 6 mg/kg/day (100% versus 88%, P = 0.48). Daptomycin nonsusceptibility was not detected in any of the isolates recovered from vegetations. In conclusion, for the treatment of MRSA experimental endocarditis, the combination of daptomycin plus fosfomycin showed synergistic and bactericidal activity.
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2890
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Lupo A, Haenni M, Saras E, Gradin J, Madec JY, Börjesson S. Is bla CTX-M-1 Riding the Same Plasmid Among Horses in Sweden and France? Microb Drug Resist 2018; 24:1580-1586. [PMID: 29792781 DOI: 10.1089/mdr.2017.0412] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A predominance of the blaCTX-M-1/IncHI1 plasmid combination in horses has been reported in Czech-Republic, Denmark, and The Netherlands. To clarify a possible specific plasmid epidemiology of blaCTX-M-1 in horses in a European perspective, a collection of 74 extended-spectrum beta-lactamase-producing Escherichia coli recovered from diseased horses in France and Sweden during the period 2009-2014 was investigated in respect of their genetic relatedness, plasmid content, and molecular features. Overall, 80% of E. coli isolates from diseased horses harbored blaCTX-M-1 on large IncHI1 plasmids with plasmid sequence type (pST) 2 and pST9 more prevalent in Sweden and France, respectively. In French isolates, IncI1/pST3 plasmids were also identified. The CTX-M-1-producing E. coli belonged principally to the clonal complex 10. ST641, together with its single locus variant, and ST1730 constituted two other major groups. The rep-PCR clustering highlighted a clonal dissemination of E. coli CTX-M-1 producers in different regions of the same country and during several years. The STs found in our isolates were also reported in The Netherlands, suggesting a common source of contamination in Europe, although only further cooperative investigation will clarify this issue. On the other hand, the spread of IncI1/pST3 plasmids among horses constitutes another worrisome issue considering their successful spread in other animal hosts such as chicken or bovines. Monitoring evolution and propagation of antimicrobial resistance in equine environment is a priority to avoid further propagation of antimicrobial resistance mechanisms threatening human and animal health.
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Affiliation(s)
- Agnese Lupo
- 1 Université de Lyon-ANSES , Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Marisa Haenni
- 1 Université de Lyon-ANSES , Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Estelle Saras
- 1 Université de Lyon-ANSES , Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Joanna Gradin
- 2 Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA) , Sweden, Uppsala, Sweden
| | - Jean-Yves Madec
- 1 Université de Lyon-ANSES , Unité Antibiorésistance et Virulence Bactériennes, Lyon, France
| | - Stefan Börjesson
- 2 Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute (SVA) , Sweden, Uppsala, Sweden
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2891
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Abstract
PURPOSE OF REVIEW Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management. RECENT FINDINGS Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial. A high clinical index of suspicion for PJI combined with data from multiple preoperative and intraoperative tests enables timely diagnosis and treatment. Biomarkers, molecular methods, and implant sonication are currently adjunctive to traditional diagnostic techniques. Shorter courses of antimicrobial therapies as well as the role of chronic suppressive therapy need confirmation by randomized controlled trials. Existing practices for preoperative dental prophylaxis and treatment of asymptomatic bacteriuria warrant revision based on evidence arguing against risk for PJI.
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Affiliation(s)
- C L Abad
- Department of Medicine, Section of Infectious Diseases, University of the Philippines, Philippine General Hospital, Taft Ave., Manila, Philippines
| | - A Haleem
- Department of Internal Medicine, Division of Infectious Diseases, University of Wisconsin Hospital and Clinics, Madison, WI, 53705, USA.
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2892
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Fritzenwanker M, Imirzalioglu C, Herold S, M. Wagenlehner F, Zimmer KP, Chakraborty T. Treatment Options for Carbapenem- Resistant Gram-Negative Infections. Dtsch Arztebl Int 2018; 115:345-352. [PMID: 29914612 PMCID: PMC6172649 DOI: 10.3238/arztebl.2018.0345] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/03/2017] [Accepted: 03/29/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Rates of colonization and infection with carbapenem-resistant Gram-negative pathogens are on the rise, particularly in southeastern European countries, and this is increasingly true in Germany as well. The organisms in question include enterobacteriaceae such as Klebsiella pneumoniae and Escherichia coli and non-fermenting bacteria such as Pseudomonas aeruginosa and Acinetobacter baumannii. As the carbapenems have been the gold standard to date for the systemic treatment of serious infections with Gram-negative bacteria, carbapenem resistance presents new and difficult challenges in therapeutic decision-making, particularly because of the high frequency of coresistance. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed and on other applicable literature. RESULTS Multiresistant Gram-negative (MRGN) pathogens are classified in Germany according to their resistance to four different classes of antibiotics; fluoroquinolones, piperacillin, third-generation cephalosporins, and carbapenems. Quadruple MRGN pathogens are resistant to all four groups, triple MRGN pathogens to three of them. There are a number of therapeutic alternatives to carbapenems that can be applied with the aid of sensitive microbiological and/or molecular genetic testing. The following antibiotics are often the only ones that can be used to treat quadruple MRGN pathogens: colistin, aminoglycosides, tigecycline, fosfomycin, ceftazidime/avibactam, and ceftolozan/tazobactam. Carbapenems, too, may still be an option in certain situations. There is also evidence that combinations of antibiotics against which the pathogen is resistant individually can some- times be a valid treatment option; these include combinations of colistin with one or two carbapenems. CONCLUSION The treatment of severe infection with carbapenem-resistant pathogens should be individualized and carried out in an interdisciplinary framework, in consideration of antibiotic pharmacokinetics and pharmacodynamics in each case. The treat- ment options are based on evidence from in vitro studies, retrospective studies, and case series, which must be interpreted with caution. Randomized clinical trials are needed to test each of the various combined approaches.
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Affiliation(s)
- Moritz Fritzenwanker
- German Center for Infection Research (DZIF)
- Institute for Medical Microbiology, University of Gießen
| | - Can Imirzalioglu
- German Center for Infection Research (DZIF)
- Institute for Medical Microbiology, University of Gießen
| | - Susanne Herold
- German Center for Infection Research (DZIF)
- Clinical Infectiology, Department of Medicine II, University of Gießen; German Center for Lung Research (DZL)
| | - Florian M. Wagenlehner
- German Center for Infection Research (DZIF)
- Department of Urology, Pediatric Urology, and Andrology, University of Gießen
| | - Klaus-Peter Zimmer
- German Center for Infection Research (DZIF)
- Department of General Pediatrics and Neonatology, Center for Pediatric and Adolescent Medicine, University of Gießen
| | - Trinad Chakraborty
- German Center for Infection Research (DZIF)
- Institute for Medical Microbiology, University of Gießen
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2893
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Wi YM, Rhee JY, Kang CI, Chung DR, Song JH, Peck KR. Clinical predictors of methicillin-resistance and their impact on mortality associated with Staphylococcus aureus bacteraemia. Epidemiol Infect 2018; 146:1326-36. [PMID: 29781425 DOI: 10.1017/S0950268818001255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We investigated the clinical predictors of methicillin-resistance and their impact on mortality in 371 patients with Staphylococcus aureus bacteraemia identified from two prospective multi-centre studies. Methicillin resistant S. aureus (MRSA) accounted for 42.2% of community-onset and 74.5% of hospital-onset cases. No significant clinical difference was found between patients infected with MRSA vs. methicillin-sensitive S. aureus (MSSA), except that the former were more likely to have had hospital-onset bacteraemia and received antibiotics in the preceding 90 days. After stratifying according to the acquisition site, prior antibiotic use was the only independent predictor of having MRSA in both community-onset and hospital-onset cases. The frequency of inappropriate empirical antibiotic therapy was higher in patients with MRSA than in those with MSSA bacteraemia. However, methicillin resistance was not a predictor of mortality in patients and the clinical characteristics and outcomes of both MRSA and MSSA bacteraemia were similar. This study indicates that there are no definitive clinical or epidemiological risk factors which could distinguish MRSA from MSSA cases with the exception of the previous use of antibiotics for having MRSA bacteraemia, which emphasises the prudent use of glycopeptide treatment of patients at risk for invasive MRSA infections.
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2894
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Newman MM, Kloepper LN, Duncan M, McInroy JA, Kloepper JW. Variation in Bat Guano Bacterial Community Composition With Depth. Front Microbiol 2018; 9:914. [PMID: 29867825 PMCID: PMC5958644 DOI: 10.3389/fmicb.2018.00914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022] Open
Abstract
Bats are known to be reservoirs for a variety of mammalian pathogens, including viruses, fungi, and bacteria. Many of the studies examining the microbial community inhabiting bats have investigated bacterial taxa found within specific bat tissues and isolated bat guano pellets, but relatively few studies have explored bacterial diversity within bat guano piles. In large bat caves, bat guano can accumulate over time, creating piles several meters deep and forming complex interactions with coprophagous organisms in a habitat with low light and oxygen. As the guano decays, the nutrient composition changes, but the bacterial communities deep within the pile have not been characterized. Here, we assess the bacterial communities across varying depths within the guano pile using both culture-independent and culture-dependent methods. We found that although similar taxa are found throughout the guano pile, the relative abundances of taxa within the pile shift, allowing certain taxa to dominate the bacterial community at varying depths. We also identified potential bacterial functions being performed within the bat guano as various depths within the pile and found little variation in terms of the dominant predicted functions, suggesting that although the relative abundances of bacterial taxa are changing, the functions being performed are similar. Additionally, we cultured 15 different bacterial species, including 2 not present in our culture-independent analysis, and discuss the pathogenicity potential of these taxa. This study represents the first characterization of the bacterial community from the extreme environment within a bat guano pile and demonstrates the potential for bat caves as resources for identifying new bacterial species.
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Affiliation(s)
- Molli M. Newman
- Department of Biology, LaGrange College, LaGrange, GA, United States
| | - Laura N. Kloepper
- Department of Biology, Saint Mary’s College, Notre Dame, IN, United States
| | - Makenzie Duncan
- Department of Biology, Saint Mary’s College, Notre Dame, IN, United States
| | - John A. McInroy
- Department of Entomology and Plant Pathology, Auburn University, Auburn, AL, United States
| | - Joseph W. Kloepper
- Department of Entomology and Plant Pathology, Auburn University, Auburn, AL, United States
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2895
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Abad CLR, Razonable RR. Mycobacterium tuberculosis after solid organ transplantation: A review of more than 2000 cases. Clin Transplant 2018; 32:e13259. [PMID: 29656530 DOI: 10.1111/ctr.13259] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mycobacterium tuberculosis (TB) is a common pathogen worldwide, and it may cause significant infection after solid organ transplantation (SOT). We reviewed all reported TB cases to provide an update on its epidemiology, clinical presentation, management, and outcome after SOT. METHODS MEDLINE, EMBASE, and OVID were reviewed from January 1, 1998, to December 31, 2016, using keywords tuberculosis and solid organ transplant or transplantation. RESULTS There were 187 publications reporting 2082 cases of TB among kidney (n = 1719), liver (n = 253), heart (n = 77), lung (n = 25), and kidney-pancreas (n = 8) recipients. Among cohort studies, the median incidence was 2.37% (range, 0.05%-13.27%) overall. Most TB disease was considered reactivation of latent infection, occurring beyond the first year after SOT. Early-onset cases were seen among donor-derived TB cases. Fever was the most common symptom. Radiologic findings were highly variable. Extrapulmonary and disseminated TB occurred 29.84% and 15.96%, respectively. Multidrug-resistant TB was rare. Treatment using 4 or 5 drugs was commonly associated with hepatotoxicity and graft dysfunction. All-cause mortality was 18.84%. CONCLUSIONS This large review highlights the complexity of TB after SOT. Reactivation TB, donor-transmitted infection, extrapulmonary involvement, and disseminated disease are common occurrences. Treatment of TB is commonly associated with hepatotoxicity and graft dysfunction.
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Affiliation(s)
- Cybele Lara R Abad
- Section of Infectious Diseases, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, MN, USA
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2896
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Ilhão Moreira R, Coutinho Cruz M, Moura Branco L, Galrinho A, Coutinho Miranda L, Fragata J, Cruz Ferreira R. Infective endocarditis: Surgical management and prognostic predictors. Rev Port Cardiol 2018; 37:387-394. [PMID: 29731322 DOI: 10.1016/j.repc.2017.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/26/2017] [Accepted: 08/05/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION AND AIM Infective endocarditis (IE) is associated with high morbidity and mortality. It is important to determine which factors increase the risk of poor outcome in order to enable early detection and aggressive treatment, including surgery. The aim of our study was to identify factors predicting complications and in-hospital mortality in patients with IE and to analyze conditions predisposing to surgery and its outcome. METHODS We performed a retrospective study including patients with IE who underwent transesophageal echocardiography in a tertiary hospital center (2006-2014). RESULTS A total of 233 patients were analyzed (69.1% male; mean age 63.4±15.2 years; mean follow-up 28.4±30.7 months). The complication rate was 56.6% and in-hospital mortality was 16.3%. Independent predictors of mortality were chronic obstructive pulmonary disease (OR 4.89; CI 1.36-17.63; p=0.015), clinical course complicated by cerebral embolism (OR 9.38; CI 3.26-26.96; p<0.001), and IE due to Staphylococcus spp. (OR 3.78; CI 1.32-10.85; p=0.014) and non-HACEK Gram-negative bacilli (OR 12.85; CI 2.61-63.23; p=0.002). Surgery was performed in 36.9%. This group had higher percentages of males, younger patients, aortic valve IE, large vegetations, perivalvular extension, severe valvular regurgitation and heart failure. In patients with surgical indication (n=133), those who underwent surgery had lower in-hospital mortality (15.5% vs. 32.6%, p=0.028) and better long-term survival (log-rank p=0.029). CONCLUSION The results of this study may help to identify IE patients who are at increased risk of worse outcome, offering the opportunity to change the course of the disease and to improve prognosis with earlier and more aggressive intervention.
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Affiliation(s)
- Rita Ilhão Moreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
| | - Madalena Coutinho Cruz
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Luísa Moura Branco
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Ana Galrinho
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Luís Coutinho Miranda
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - José Fragata
- Serviço de Cirurgia Cardiotorácica, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Rui Cruz Ferreira
- Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
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2897
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Clauss M. CORR Insights®: Does the Alpha-defensin Immunoassay or the Lateral Flow Test Have Better Diagnostic Value for Periprosthetic Joint Infection? A Systematic Review. Clin Orthop Relat Res 2018; 476:1073-1075. [PMID: 29601396 PMCID: PMC5916616 DOI: 10.1007/s11999.0000000000000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Martin Clauss
- M. Clauss, Head Interdisciplinary Unit for Orthopedic Infections, Kantonsspital Baselland, Liestal, Switzerland, and Interdisciplinary Unit for Muscolo-Sceletal Infections University Hospital Basel, Basel, Switzerland
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2898
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Everett M, Sprynski N, Coelho A, Castandet J, Bayet M, Bougnon J, Lozano C, Davies DT, Leiris S, Zalacain M, Morrissey I, Magnet S, Holden K, Warn P, De Luca F, Docquier JD, Lemonnier M. Discovery of a Novel Metallo-β-Lactamase Inhibitor That Potentiates Meropenem Activity against Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e00074-18. [PMID: 29530861 DOI: 10.1128/AAC.00074-18] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are increasingly prevalent and have become a major worldwide threat to human health. Carbapenem resistance is driven primarily by the acquisition of β-lactamase enzymes, which are able to degrade carbapenem antibiotics (hence termed carbapenemases) and result in high levels of resistance and treatment failure. Clinically relevant carbapenemases include both serine β-lactamases (SBLs; e.g., KPC-2 and OXA-48) and metallo-β-lactamases (MBLs), such as NDM-1. MBL-producing strains are endemic within the community in many Asian countries, have successfully spread worldwide, and account for many significant CRE outbreaks. Recently approved combinations of β-lactam antibiotics with β-lactamase inhibitors are active only against SBL-producing pathogens. Therefore, new drugs that specifically target MBLs and which restore carbapenem efficacy against MBL-producing CRE pathogens are urgently needed. Here we report the discovery of a novel MBL inhibitor, ANT431, that can potentiate the activity of meropenem (MEM) against a broad range of MBL-producing CRE and restore its efficacy against an Escherichia coli NDM-1-producing strain in a murine thigh infection model. This is a strong starting point for a chemistry lead optimization program that could deliver a first-in-class MBL inhibitor-carbapenem combination. This would complement the existing weaponry against CRE and address an important and growing unmet medical need.
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2899
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Shields RK, Nguyen MH, Chen L, Press EG, Kreiswirth BN, Clancy CJ. Pneumonia and Renal Replacement Therapy Are Risk Factors for Ceftazidime-Avibactam Treatment Failures and Resistance among Patients with Carbapenem-Resistant Enterobacteriaceae Infections. Antimicrob Agents Chemother 2018; 62:e02497-17. [PMID: 29507064 DOI: 10.1128/AAC.02497-17] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/23/2018] [Indexed: 01/31/2023] Open
Abstract
Ceftazidime-avibactam was used to treat 77 patients with carbapenem-resistant Enterobacteriaceae (CRE) infections at our center. Thirty- and 90-day survival rates were 81% and 69%, respectively; these rates were higher than those predicted by SAPS II and SOFA scores at the onset of infection. Clinical success was achieved for 55% of patients but differed by the site of infection. Success rates were lowest for pneumonia (36%) and higher for bacteremia (75%) and urinary tract infections (88%). By multivariate analysis, pneumonia (P = 0.045) and receipt of renal replacement therapy (RRT) (P = 0.046) were associated with clinical failure. Microbiologic failures occurred in 32% of patients and occurred more commonly among patients infected with KPC-3-producing CRE than among those infected with KPC-2-producing CRE (P = 0.002). Pneumonia was an independent predictor of microbiologic failure (P = 0.007). Ceftazidime-avibactam resistance emerged in 10% of patients, including 14% of those infected with Klebsiella pneumoniae and 32% of those with microbiologic failure. RRT was an independent predictor of the development of resistance (P = 0.009). Resistance was identified exclusively among K. pneumoniae bacteria harboring variant KPC-3 enzymes. Upon phylogenetic analysis of whole-genome sequences, resistant isolates from 87.5% (7/8) of patients clustered within a previously defined sequence type 258 (ST258) clade II sublineage; resistant isolates from one patient clustered independently from other ST258 clade II isolates. In conclusion, our report offers new insights into the utility and limitations of ceftazidime-avibactam across CRE infection types. Immediate priorities are to identify ceftazidime-avibactam dosing and therapeutic regimens that improve on the poor outcomes among patients with pneumonia and those receiving RRT.
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2900
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Camon S, Quiros C, Saubi N, Moreno A, Marcos MA, Eto Y, Rofael S, Monclus E, Brown J, McHugh TD, Mallolas J, Perello R. Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients. BMC Infect Dis 2018; 18:189. [PMID: 29673334 PMCID: PMC5909258 DOI: 10.1186/s12879-018-3090-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). METHODS Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. RESULTS One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. CONCLUSION Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission.
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Affiliation(s)
- S. Camon
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - C. Quiros
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - N. Saubi
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - A. Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - M. A. Marcos
- Servicio de Microbiología, Hospital Clínic, Barcelona, Spain
| | - Y. Eto
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - S. Rofael
- Microbiology department, UCL, Royal Free Hospital, London, UK
| | - E. Monclus
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - J. Brown
- Pneumology department, Royal Free Hospital, London, UK
| | - T. D. McHugh
- Pneumology department, Royal Free Hospital, London, UK
| | - J. Mallolas
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - R. Perello
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
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