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Kreutz J, Müller C, Chatzis G, Syntila S, Choukeir M, Schäfer AC, Betz S, Schieffer B, Patsalis N, Markus B. Microbiological Profiles after Out-of-Hospital Cardiac Arrest: Exploring the Relationship between Infection, Inflammation, and the Potential Effects of Mechanical Circulatory Support. J Clin Med 2024; 13:4297. [PMID: 39124564 PMCID: PMC11312496 DOI: 10.3390/jcm13154297] [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: 06/27/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Cardiogenic shock (CS) following an out-of-hospital cardiac arrest (OHCA) poses significant management challenges, exacerbated by inflammatory responses and infectious complications. This study investigates the microbiological profiles and impacts of mechanical circulatory support (MCS) on inflammation and infection in OHCA patients. Methods: We retrospectively analyzed microbiological data from various specimens of 372 OHCA patients, who were treated at the Cardiac Arrest Center of the University Hospital of Marburg from January 2018 to December 2022. Clinical outcomes were evaluated to investigate the potential impact of MCS on infection and inflammation. Results: Of the study cohort, 115 patients received MCS. The microbiological analysis revealed a higher incidence of positive blood cultures in the MCS group vs. the non-MCS group (39% vs. 27.7%, p = 0.037), with predominantly Gram-positive bacteria. Patients with positive microbiological findings had longer in-hospital stays and prolonged periods of mechanical ventilation. The levels of inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT) differed, suggesting a more pronounced inflammatory response in MCS patients, especially in the later ICU stages. Notably, despite the higher infection rate in the MCS group, the survival rates did not significantly differ in the two groups. Conclusions: MCS appears to influence the microbiological and inflammatory landscape in OHCA patients, increasing the susceptibility to certain infections but not affecting the overall mortality. This study underscores the complexity of managing post-resuscitation care and highlights the need for tailored therapeutic strategies to effectively mitigate infectious and inflammatory complications.
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Affiliation(s)
- Julian Kreutz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
- Center for Emergency Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany
| | - Charlotte Müller
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
| | - Georgios Chatzis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
| | - Styliani Syntila
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
| | - Maryana Choukeir
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
- Center for Emergency Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany
| | - Ann-Christin Schäfer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
| | - Susanne Betz
- Center for Emergency Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany
| | - Bernhard Schieffer
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
- Center for Emergency Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany
| | - Nikolaos Patsalis
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
| | - Birgit Markus
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital, Philipps University of Marburg, 35043 Marburg, Germany (B.M.)
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Lecomte R, Deschanvres C, Bourreau A, Ruffier d'Epenoux L, Le Turnier P, Gaborit B, Chauveau M, Michel M, Le Tourneau T, Bémer P, Corvec S, Boutoille D. Comparative effectiveness of empirical antibiotic treatments in methicillin-susceptible Staphylococcus aureus infective endocarditis: A post hoc analysis of a prospective French cohort study. Int J Infect Dis 2024; 142:106989. [PMID: 38428479 DOI: 10.1016/j.ijid.2024.106989] [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: 12/05/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES The empirical treatment of infective endocarditis is still debated. The aim of this study was to compare the impact of empirical treatment with antistaphylococcal penicillin (ASP) or cefazolin vs. other treatments in methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis. METHODS A post hoc analysis of a prospective cohort study of patients hospitalized in a French reference centre with MSSA endocarditis was conducted between 2013 and 2022. The primary outcome was the duration of bacteraemia under treatment. RESULTS Of the 208 patients included, 101 patients (48.6%) were classified in the reference group (ASP or cefazolin) and 107 (52.4%) in the non-reference group. Empirical treatment with ASP/cefazolin was associated with a shorter duration of bacteraemia compared to other treatments (3.6 d vs. 4.6 d, P = 0.01). This difference was not corrected by the addition of an aminoglycoside (3.6 d vs. 4.7 d, P < 0.01). In multivariate analysis, empirical treatment with ASP/cefazolin was associated with a duration of bacteraemia ≤72 h (P = 0.02), whereas endocarditis on native valves (P = 0.01), and intracardiac abscess were associated with longer duration of bacteraemia (P = 0.01). CONCLUSIONS Empirical treatment of endocarditis with ASP or Cefazolin is more effective than other treatments in MSSA endocarditis, even when the other treatments are combined with aminoglycosides.
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Affiliation(s)
- Raphaël Lecomte
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France.
| | - Colin Deschanvres
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Alexis Bourreau
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | | | - Paul Le Turnier
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Benjamin Gaborit
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Marie Chauveau
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Magali Michel
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - Thierry Le Tourneau
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | | | - Stéphane Corvec
- Department of Bacteriology, Nantes, France; Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
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Słabisz N, Leśnik P, Żybura-Wszoła K, Dudek-Wicher R, Nawrot U, Majda J. Assessing the Interpretation of Molecular Test Results in the Diagnosis of Bloodstream Infections. Diagnostics (Basel) 2024; 14:915. [PMID: 38732329 PMCID: PMC11083173 DOI: 10.3390/diagnostics14090915] [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: 03/12/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study at the 4th Military Clinical Hospital in Wroclaw, Poland, assessed PCR testing alongside blood cultures to guide antimicrobial therapy decisions in hospitalized patients, to determine how much time the results of the molecular tests preceded conventional methods. Among 118 patients, Staphylococcus aureus (37%) and Escherichia coli (21%) were the most common bloodstream infection agents. Blood cultures utilized the BacT/ALERT 3D system, and molecular diagnostics were conducted using the FilmArray platform with the BIOFIRE BCID2 panel. Methicillin susceptibility was observed in 66% of S. aureus strains, while 26% of Gram-negative bacilli exhibited an ESBL phenotype. Therapeutic decisions based on molecular test results were often incorrect for S. aureus infections, particularly MSSA (64.5%), but generally accurate for Gram-negative bacilli. The median times from positive blood culture to BCID2 and pathogen identification/susceptibility were 10 h and 52 h, respectively. Molecular diagnostics facilitated faster initiation of appropriate antibiotic therapy, highlighting the need to educate medical staff on proper interpretation. Consulting within an antimicrobial stewardship program (ASP) could enhance the benefits of implementing molecular methods in bloodstream infection diagnostics.
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Affiliation(s)
- Natalia Słabisz
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Patrycja Leśnik
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, 50-386 Wroclaw, Poland;
| | - Katarzyna Żybura-Wszoła
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
| | - Ruth Dudek-Wicher
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Urszula Nawrot
- Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Wroclaw Medical University, 50-367 Wroclaw, Poland; (R.D.-W.); (U.N.)
| | - Jacek Majda
- Department of Laboratory Diagnostic, 4th Military Clinical Hospital in Wroclaw, 53-114 Wroclaw, Poland; (K.Ż.-W.); (J.M.)
- Department of Preclinical Sciences, Pharmacology and Medical Diagnostics, Faculty of Medicine, Wroclaw University of Science and Technology, 58-376 Wroclaw, Poland
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Maan M, Goyal H, Joshi S, Barman P, Sharma S, Kumar R, Saini A. DP1, a multifaceted synthetic peptide: Mechanism of action, activity and clinical potential. Life Sci 2024; 340:122458. [PMID: 38266815 DOI: 10.1016/j.lfs.2024.122458] [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: 07/28/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 01/26/2024]
Abstract
AIMS Microbial infections remain a leading cause of mortality worldwide, with Staphylococcus aureus (S. aureus) being a prominent etiological agent, responsible for causing persistent bacterial infections in humans. It is a nosocomial, opportunistic pathogen, capable to propagate within the bloodstream and withstand therapeutic interventions. In the current study, a novel, indigenously designed synthetic antimicrobial peptide (sAMP) has been evaluated for its antimicrobial potential to inhibit the growth and proliferation of S. aureus. MAIN METHODS The sAMP, designed peptide (DP1) was evaluated for its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against a panel of pathogenic bacterial strains. Membrane mechanistic studies were performed by measuring membrane conductivity via dielectric spectroscopy and visualizing changes in bacterial membrane structure through field emission scanning electron microscopy (FE-SEM). Further, DP1 was tested for its in vivo antimicrobial potential in an S. aureus-induced systemic infection model. KEY FINDINGS The results indicated that DP1 has the potential to inhibit the growth and proliferation of a broad spectrum of Gram-positive, Gram-negative and multidrug-resistant (MDR) bacterial strains. Strong bactericidal effect attributed to change in electrical conductivity of the bacterial cells leading to membrane disruption was observed through dielectric spectroscopy and FE-SEM micrographs. Further, in the in vivo murine systemic infection study, 50 % reduction in S. aureus bioburden was observed within 1 day of the administration of DP1. SIGNIFICANCE The results indicate that DP1 is a multifaceted peptide with potent bactericidal, antioxidant and therapeutic properties. It holds significance as a novel drug candidate to effectively combat S. aureus-mediated systemic infections.
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Affiliation(s)
- Mayank Maan
- Department of Biophysics, Panjab University, Chandigarh, U.T. 160014, India
| | - Hemant Goyal
- Department of Biophysics, Panjab University, Chandigarh, U.T. 160014, India
| | - Shubhi Joshi
- Department of Biophysics, Panjab University, Chandigarh, U.T. 160014, India
| | - Panchali Barman
- Institute of Forensic Science and Criminology (UIEAST), Panjab University, Chandigarh, U.T. 160014, India
| | - Sheetal Sharma
- Department of Biophysics, Panjab University, Chandigarh, U.T. 160014, India
| | - Rajesh Kumar
- Department of Physics, Panjab University, Chandigarh, U.T. 160014, India
| | - Avneet Saini
- Department of Biophysics, Panjab University, Chandigarh, U.T. 160014, India.
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Clarkson AM, Snape S. Clinical Effectiveness of Continuous Infusion Flucloxacillin in the Outpatient Parenteral Antimicrobial Therapy (OPAT) Setting in a UK Hospital: A Service Evaluation. Antibiotics (Basel) 2024; 13:153. [PMID: 38391538 PMCID: PMC10886366 DOI: 10.3390/antibiotics13020153] [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: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
The availability of stability data for the use of continuous intravenous flucloxacillin in an elastomeric device has enabled the treatment of serious Methicillin Sensitive Staphylococcus aureus (MSSA) in the outpatient parenteral antimicrobial therapy (OPAT) setting. This service review aimed to evaluate current standard of care to establish the clinical effectiveness and complication rates associated with its use since its introduction at our institution. A retrospective review of clinical outcomes and adverse events/complications, was undertaken for all patients who received continuous infusion flucloxacillin for complicated MSSA infection between January 2019 and July 2022 via our OPAT service. Thirty-nine patients were included. An OPAT treatment outcome of 'Treatment aim attained uncomplicated' was achieved in 29/39 (74%) patients. Two patients had an OPAT treatment outcome of treatment aim not attained, both of which required unexpected hospital re-admission. An adverse event/complication occurred in 8 patients. There were two relapses in the 12-month follow-up period. Our review supports the assertion that continuous infusion flucloxacillin is clinically effective and well tolerated for the treatment of complicated MSSA infection in the OPAT setting.
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Affiliation(s)
| | - Susan Snape
- Microbiology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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Hamad Y, Nickel KB, Olsen MA, George IA. Outcomes of Ceftriaxone Compared With Cefazolin or Nafcillin/Oxacillin for Outpatient Therapy for Methicillin-Sensitive Staphylococcus aureus Bloodstream Infections: Results From a Large United States Claims Database. Open Forum Infect Dis 2024; 11:ofad662. [PMID: 38352150 PMCID: PMC10863560 DOI: 10.1093/ofid/ofad662] [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: 08/28/2023] [Accepted: 12/22/2023] [Indexed: 02/16/2024] Open
Abstract
Background Ceftriaxone is a convenient option for methicillin-sensitive Staphylococcus aureus (MSSA) outpatient parenteral antimicrobial therapy (OPAT), but population-based studies for its effectiveness are lacking. Methods In this retrospective cohort, a large insurance claims database was queried from 2010 to 2018 for adults with MSSA bloodstream infection (BSI). Patients discharged on OPAT on cefazolin or oxacillin/nafcillin were compared with ceftriaxone with respect to 90-day hospital readmission with the same infection category and 90-day all-cause readmission using logistic regression models. Results Of 1895 patients with MSSA BSI, 1435 (75.7%) patients received cefazolin, oxacillin, or nafcillin and 460 (24.3%) ceftriaxone. Readmission due to the same infection category occurred in 366 (19.3%), and all-cause readmission occurred in 535 (28.3%) within 90 days. Risk factors significantly associated with readmission with the same infection category were the oldest sampled age group (61-64 years: adjusted odds ratio [aOR], 1.47 [95% confidence interval {CI}, 1.01-2.14]), intensive care unit stay during index admission (aOR, 2.33 [95% CI, 1.81-3.01]), prosthetic joint infection (aOR, 1.96 [95% CI, 1.18-2.23]), central line-associated BSI (aOR, 1.72 [95% CI, 1.33-2.94]), and endocarditis (aOR, 1.63 [95% CI, 1.18-2.23]). Ceftriaxone was not associated with increased risk of readmission with the same infection category (aOR, 0.89 [95% CI, .67-1.18]), or 90-day all-cause readmission (aOR, 0.86 [95% CI, .66-1.10]) when compared with oxacillin/nafcillin/cefazolin. Conclusions In this cohort of MSSA BSI patients discharged on OPAT, there were no differences in outcomes of readmission with the same infection and 90-day all-cause readmission in patients treated with ceftriaxone compared to oxacillin/nafcillin or cefazolin. Patients with complicated BSIs such as endocarditis and epidural abscess were more likely to be prescribed cefazolin or oxacillin/nafcillin.
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Affiliation(s)
- Yasir Hamad
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Ige A George
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Di Bella S, Gatti M, Principe L. Ceftriaxone for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia: a matter of dosages? Eur J Clin Microbiol Infect Dis 2023; 42:917-918. [PMID: 37119346 DOI: 10.1007/s10096-023-04612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy.
| | - Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Clinical Pharmacology Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, "San Giovanni di Dio" Hospital, Crotone, Italy
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