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Lane J, Read JM, Rahmany Z, Reely K, Hicks CM, Martin DE. Development of Palpable Purpura in a Patient With Infective Endocarditis: A Case Report. Cureus 2024; 16:e63601. [PMID: 39087182 PMCID: PMC11290593 DOI: 10.7759/cureus.63601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Infective endocarditis (IE) can present with a variety of signs and symptoms, including skin lesions. The few papers describing a relationship between IE and vasculitis are split between IE being able to mimic vasculitis and between IE indeed being associated with a vasculitis involving the skin, kidney, gastrointestinal tract, or peripheral nerves. It is important for clinicians to distinguish between an isolated vasculitis, infective endocarditis, and IE-associated vasculitis because the treatments and outcomes are different. We report a case of a patient with a history of intravenous (IV) drug use who initially presented with chest pain, was started on vancomycin following diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) IE, left against medical advice (AMA), and then returned to the hospital due to development of a purpuric rash. We contend that while he did not have a skin biopsy due to time delay, his symmetrically distributed purpura was consistent with cutaneous vasculitis. His symptoms, including his rash and an acute kidney injury (AKI), improved with antibiotics to treat the endocarditis.
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Affiliation(s)
- Jordan Lane
- Internal Medicine, Unity Health, Searcy, USA
| | - John M Read
- Internal Medicine, Unity Health, Searcy, USA
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Randrianarisoa RMF, Raulin O, Merlin A, Tonnelier M, Lecapitaine AL. A Case of Confusion in an Obese Patient Treated With Daptomycin: Neurotoxicity. Cureus 2024; 16:e62254. [PMID: 39006728 PMCID: PMC11245046 DOI: 10.7759/cureus.62254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Daptomycin (DAP) is a cyclic lipopeptide antibiotic with bactericidal activity against gram-positive bacteria. The most common adverse reaction is myotoxicity characterized by rhabdomyolysis. Other reported adverse reactions include gastrointestinal symptoms, skin lesions, bleeding, and pulmonary involvement. Neurotoxicity is rare and its mechanism remains partially elucidated. We report a case of confusion consistent with DAP-induced neurotoxicity. A 73-year-old obese man was treated with DAP 9 mg/kg for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia associated with foot osteitis and cervical posterior inter-apophyseal arthritis. On the fifth day of treatment, he developed spatial disorientation, and serum DAP concentrations were very high. DAP-induced neurotoxicity was suggested. His neurological status returned to normal after treatment was stopped. This observation describes a relationship between confusion and DAP that is favored by obesity. Clinicians should be alert for neurologic disorders associated with DAP. It is prudent to reduce doses in obese patients.
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Affiliation(s)
| | - Olivia Raulin
- Medical Biology, Compiègne-Noyon Hospital, Compiègne, FRA
| | - Anthony Merlin
- Internal Use Pharmacy, Compiègne-Noyon Hospital, Compiègne, FRA
| | - Mathilde Tonnelier
- Infectious and Tropical Diseases, Compiègne-Noyon Hospital, Compiègne, FRA
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Stamate E, Ciobotaru OR, Arbune M, Piraianu AI, Duca OM, Fulga A, Fulga I, Balta AAS, Dumitrascu AG, Ciobotaru OC. Multidisciplinary Perspectives of Challenges in Infective Endocarditis Complicated by Septic Embolic-Induced Acute Myocardial Infarction. Antibiotics (Basel) 2024; 13:513. [PMID: 38927180 PMCID: PMC11201065 DOI: 10.3390/antibiotics13060513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/27/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) management is challenging, usually requiring multidisciplinary collaboration from cardiologists, infectious disease specialists, interventional cardiologists, and cardiovascular surgeons, as more than half of the cases will require surgical procedures. Therefore, it is essential for all healthcare providers involved in managing IE to understand the disease's characteristics, potential complications, and treatment options. While systemic embolization is one of the most frequent complications of IE, the coronary localization of emboli causing acute myocardial infarction (AMI) is less common, with an incidence ranging from 1% to 10% of cases, but it has a much higher rate of morbidity and mortality. There are no guidelines for this type of AMI management in IE. METHODS This narrative review summarizes the current knowledge regarding septic coronary embolization in patients with IE. Additionally, this paper highlights the diagnosis and management challenges in such cases, particularly due to the lack of protocols or consensus in the field. RESULTS Data extracted from case reports indicate that septic coronary embolization often occurs within the first two weeks of the disease. The aortic valve is most commonly involved with vegetation, and the occluded vessel is frequently the left anterior descending artery. Broad-spectrum antibiotic therapy followed by targeted antibiotic therapy for infection control is essential, and surgical treatment offers promising results through surgical embolectomy, concomitant with valve replacement or aspiration thrombectomy, with or without subsequent stent insertion. Thrombolytics are to be avoided due to the increased risk of bleeding. CONCLUSIONS All these aspects should constitute future lines of research, allowing the integration of all current knowledge from multidisciplinary team studies on larger patient cohorts and, subsequently, creating a consensus for assessing the risk and guiding the management of this potentially fatal complication.
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Affiliation(s)
- Elena Stamate
- Department of Cardiology, University Emergency Hospital of Bucharest, 169 Splaiul Independentei St., 050098 Bucharest, Romania;
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
| | - Oana Roxana Ciobotaru
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Railway Hospital Galati, 6 Alexandru Moruzzi St., 800223 Galati, Romania
| | - Manuela Arbune
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Infectious Diseases Clinic Hospital “Sf. Cuv. Parascheva”, 393 Traian St., 800179 Galati, Romania
| | - Alin Ionut Piraianu
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Emergency County Hospital Braila, 2 Sos. Buzaului St., 810325 Braila, Romania
| | - Oana Monica Duca
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Emergency County Hospital Braila, 2 Sos. Buzaului St., 810325 Braila, Romania
| | - Ana Fulga
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Saint Apostle Andrew Emergency County Clinical Hospital, 177 Brailei St., 800578 Galati, Romania
| | - Iuliu Fulga
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Saint Apostle Andrew Emergency County Clinical Hospital, 177 Brailei St., 800578 Galati, Romania
| | - Alexia Anastasia Stefania Balta
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Saint Apostle Andrew Emergency County Clinical Hospital, 177 Brailei St., 800578 Galati, Romania
| | - Adrian George Dumitrascu
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA;
| | - Octavian Catalin Ciobotaru
- Faculty of Medicine and Pharmacy, Dunarea de Jos University of Galati, 35 AI Cuza St., 800010 Galati, Romania; (O.R.C.); (O.M.D.); (A.F.); (I.F.); (A.A.S.B.); (O.C.C.)
- Railway Hospital Galati, 6 Alexandru Moruzzi St., 800223 Galati, Romania
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MacLeod CS, Nagy J, Radley A, Khan F, Rae N, Wilson MSJ, Suttie SA. REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00352-6. [PMID: 38663765 DOI: 10.1016/j.ejvs.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. METHODS A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. RESULTS Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computerised tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. CONCLUSION This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
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Affiliation(s)
- Caitlin S MacLeod
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK; Division of Systems Medicine, University of Dundee, Dundee, UK.
| | - John Nagy
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Andrew Radley
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK; Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Nikolas Rae
- Department of Infectious Diseases, Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - Stuart A Suttie
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK
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Trappe HJ. [Gustav Mahler: tragic life, mysterious illness, early death : Could intensive care medicine have saved him today?]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01137-9. [PMID: 38634866 DOI: 10.1007/s00063-024-01137-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/20/2024] [Accepted: 03/17/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Gustav Mahler was a composer of the late Romantic period, one of the most famous conductors of his time and, as opera director, one of the most important reformers of musical theatre. Mahler's life, illnesses, death and dying are little or not at all known to many. OBJECTIVES Which illnesses determined Mahler's life? Could his early death have been avoided? From today's point of view, could modern intensive care medicine have helped him? MATERIAL AND METHODS A detailed analysis of Mahler's diseases was performed using scientific databases (medline, pubmed). All published articles were examined in detail. RESULTS Gustav Mahler was born in 1860 in Kalischt (Bohemia) and learned to play the accordion and piano at an early age. He studied music at the Vienna Conservatory from 1875 and completed his composition studies in 1878. Kapellmeister positions followed in several cities, from 1887 at the Vienna Court Opera and from 1908 at the Metropolitan Opera in New York. Mahler suffered from many illnesses, especially tonsillitis and haemorrhoids. In 1907 he was diagnosed with a mitral valve defect, in 1911 he developed bacterial endocarditis caused by streptococci, as a result of which Mahler died in Vienna in 1911. His life was marked by personal and health tragedies. DISCUSSION Mahler was an outstanding personality who left behind an extensive oeuvre. Among the compositional highlights are his 10 symphonies and the song compositions. Recurrent streptococcal infections led to mitral valve disease and endocarditis, the consequences of which caused Mahler's untimely death. Today's modern cardiology and intensive care medicine could have prolonged his life, but unfortunately this was not possible at the time when he was diagnosed with endocarditis.
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Affiliation(s)
- Hans-Joachim Trappe
- Medizinische Klinik II (Schwerpunkte Kardiologie und Angiologie), Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Deutschland.
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Omrani AS, Abujarir SH, Ben Abid F, Shaar SH, Yilmaz M, Shaukat A, Alsamawi MS, Elgara MS, Alghazzawi MI, Shunnar KM, Zaqout A, Aldeeb YM, Alfouzan W, Almaslamani MA. Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trial. Clin Microbiol Infect 2024; 30:492-498. [PMID: 37858867 DOI: 10.1016/j.cmi.2023.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of switching from intravenous (IV) to oral antimicrobial therapy in patients with Enterobacterales bacteraemia, after completion of 3-5 days of microbiologically active IV therapy. METHODS A multicentre, open-label, randomized trial of adults with monomicrobial Enterobacterales bacteraemia caused by a strain susceptible to ≥1 oral beta-lactam, quinolone, or trimethoprim/sulfamethoxazole. Inclusion criteria included completion of 3-5 days of microbiologically active IV therapy, being afebrile and haemodynamically stable for ≥48 hours, and absence of an uncontrolled source of infection. Pregnancy, endocarditis, and neurological infections were exclusion criteria. Randomization, stratified by urinary source of bacteraemia, was to continue IV (IV Group) or to switch to oral therapy (Oral Group). Agents and duration of therapy were determined by the treating physicians. The primary endpoint was treatment failure, defined as death, need for additional antimicrobial therapy, microbiological relapse, or infection-related re-admission within 90 days. Non-inferiority threshold was set at 10% in the 95% CI for the difference in the proportion with treatment failure between the Oral and IV Groups in the modified intention-to-treat population. The protocol was registered at ClinicalTrials.gov (NCT04146922). RESULTS In the modified intention-to-treat population, treatment failure occurred in 21 of 82 (25.6%) in the IV Group, and 18 of 83 (21.7%) in the Oral Group (risk difference -3.7%, 95% CI -16.6% to 9.2%). The proportions of subjects with any adverse events (AE), serious AE, or AE leading to treatment discontinuation were comparable. DISCUSSION In patients with Enterobacterales bacteraemia, oral switch, after initial IV antimicrobial therapy, clinical stability, and source control, is non-inferior to continuing IV therapy.
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Affiliation(s)
- Ali S Omrani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Qatar University College of Medicine, Doha, Qatar.
| | - Sulieman H Abujarir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Ben Abid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Shahd H Shaar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Mesut Yilmaz
- Department of Infectious Diseases and Microbiology, Istanbul Medipol University, Istanbul, Turkiye
| | - Adila Shaukat
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Mussad S Alsamawi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar
| | - Mohamed S Elgara
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Islam Alghazzawi
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled M Shunnar
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Zaqout
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Yasser M Aldeeb
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar
| | - Wadha Alfouzan
- Department of Microbiology, Farwania Hospital, Kuwait City, Kuwait; Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Muna A Almaslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Qadir M, Mustafa W, Nizami AA, Iqbal H, Shahzad M, Ali A, Akbar A. Unveiling the Knowledge Gap Regarding Standard Antibiotic Prophylaxis for Infective Endocarditis Among Physicians, Dentists and Cardiologists in Pakistan: A Cross-Sectional Study. Cureus 2024; 16:e52938. [PMID: 38405996 PMCID: PMC10893973 DOI: 10.7759/cureus.52938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Infective endocarditis is a microbial infection of the endocardial surface of the native and prosthetic valves. This study aimed to evaluate knowledge regarding the current guidelines for antibiotic prophylaxis for infective endocarditis. METHODS This cross-sectional study was conducted among physicians, cardiologists, and dentists in Rawalpindi and Islamabad. The questionnaire was distributed as Google Forms among the required population, and responses were collected on a Google Response Sheet. RESULTS The participants viewed rheumatic heart disease (83.7%) and heart transplant (96.7%) as the most vulnerable conditions that warrant the need for antibiotic prophylaxis. The other questions yielded average responses. CONCLUSION The findings of this study emphasize the importance of adhering to standard guidelines and highlight the need for knowledge of the current guidelines.
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Affiliation(s)
- Mamoon Qadir
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Waqar Mustafa
- Cardiology, Combined Military Hospital, Muzaffarabad, PAK
| | | | - Hamid Iqbal
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Maria Shahzad
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Anwar Ali
- Cardiology, Kulsum International Hospital, Islamabad, PAK
| | - Amna Akbar
- Emergency and Accident, District Headquarter Jhelum, Muzaffarabad, PAK
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Gressens SB, Souhail B, Pilmis B, Lourtet-Hascoët J, Podglajen I, Fiore A, Fihman V, Mainardi JL, Lepeule R, Lebeaux D, Dubert M. Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration. Eur J Clin Microbiol Infect Dis 2024; 43:95-104. [PMID: 37964043 DOI: 10.1007/s10096-023-04705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. OBJECTIVES To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. METHODS This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. RESULTS The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). CONCLUSIONS Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.
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Affiliation(s)
- S B Gressens
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France.
| | - B Souhail
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
| | - B Pilmis
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J Lourtet-Hascoët
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - I Podglajen
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - A Fiore
- Service de Chirurgie Cardiaque, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 94000, Créteil, France
| | - V Fihman
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité de Bactériologie - Hygiène, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - J L Mainardi
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - R Lepeule
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
| | - D Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - M Dubert
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
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Lam JC, Bourassa-Blanchette S. Ten common misconceptions about antibiotic use in the hospital. J Hosp Med 2023; 18:1123-1129. [PMID: 37812004 DOI: 10.1002/jhm.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/28/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
Antimicrobials are one of the most administered medications in hospitals. Thoughtful and rational antibiotic prescribing by clinicians are important in reducing the adverse effects to both the host that takes the antibiotic and also the individuals in the host's community. Principles informing antibiotic prescribing in the hospital are commonly rooted in misconceptions. We review 10 common myths associated with antibacterial usage in hospitalized patients and share contemporary evidence in hopes of enhancing evidence-informed practice in this patient care setting.
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Affiliation(s)
- John C Lam
- Division of Infectious Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Samuel Bourassa-Blanchette
- Division of Infectious Diseases, Department of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
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10
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Errors in Table and Supplement 1. JAMA Netw Open 2023; 6:e2341784. [PMID: 37856131 PMCID: PMC10587789 DOI: 10.1001/jamanetworkopen.2023.41784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
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Monari C, Molinari D, Cornelli A, Alessio L, Coppolino F, Barbareschi C, De Pascalis S, Torella M, Cimmino G, De Feo M, Coppola N, Formisano T. An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature. Infect Dis Rep 2023; 15:494-503. [PMID: 37736996 PMCID: PMC10514809 DOI: 10.3390/idr15050049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/23/2023] Open
Abstract
Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Alessandro Cornelli
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Loredana Alessio
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy;
| | - Consiglia Barbareschi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
| | - Stefania De Pascalis
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Giovanni Cimmino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy
| | - Marisa De Feo
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, via L. Bianchi c/o Ospedale Monaldi, 80131 Naples, Italy; (M.T.); (M.D.F.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131 Naples, Italy; (C.M.); (A.C.); (L.A.); (S.D.P.)
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy; (D.M.); (C.B.); (G.C.); (T.F.)
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Error in Box 1. JAMA Netw Open 2023; 6:e2332858. [PMID: 37615990 PMCID: PMC10450564 DOI: 10.1001/jamanetworkopen.2023.32858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
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