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Pallotto C, Bolla C, Penpa S, Genga G, Sarda C, Svizzeretto E, Tommasi A, Stolaj E, Salvaderi A, Piceni G, Maconi A, Chichino G, Francisci D. Adherence to 2015 ESC Guidelines for the Treatment of Infective Endocarditis: A Retrospective Multicentre Study (LEIOT Study). Antibiotics (Basel) 2023; 12:antibiotics12040705. [PMID: 37107067 PMCID: PMC10135336 DOI: 10.3390/antibiotics12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023] Open
Abstract
Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality.
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Affiliation(s)
- Carlo Pallotto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cesare Bolla
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Serena Penpa
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Giovanni Genga
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Cristina Sarda
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Elisabetta Svizzeretto
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Tommasi
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Elisa Stolaj
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
| | - Andrea Salvaderi
- Infectious Diseases Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Giorgia Piceni
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Guido Chichino
- Infectious Diseases, Department of Internal Medicine, Azienda Ospedaliera SS, Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, 06100 Perugia, Italy
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Cuervo G, Escrihuela-Vidal F, Gudiol C, Carratalà J. Current Challenges in the Management of Infective Endocarditis. Front Med (Lausanne) 2021; 8:641243. [PMID: 33693021 PMCID: PMC7937698 DOI: 10.3389/fmed.2021.641243] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/01/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a relatively rare, but deadly cause of sepsis, with an overall mortality ranging from 20 to 25% in most series. Although the classic clinical classification into syndromes of acute or subacute endocarditis have not completely lost their usefulness, current clinical forms have changed according to the profound epidemiological changes observed in developed countries. In this review, we aim to address the changing epidemiology of endocarditis, several recent advances in the understanding of the pathophysiology of endocarditis and endocarditis-triggered sepsis, new useful diagnostic tools as well as current concepts in the medical and surgical management of this disease. Given its complexity, the management of infective endocarditis requires the close collaboration of multidisciplinary endocarditis teams that must decide on the diagnostic approach; the appropriate initial treatment in the critical phase; the detection of patients needing surgery and the timing of this intervention; and finally the accurate selection of patients for out-of-hospital treatment, either at home hospitalization or with oral antibiotic treatment.
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Affiliation(s)
- Guillermo Cuervo
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Escrihuela-Vidal
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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Chirio D, Le Marechal M, Moceri P, de la Chapelle A, Chaillou-Optiz S, Mothes A, Foucault C, Maulin L, Parsaï C, Roger PM, Demonchy E. Factors associated with unfavorable outcome in a multicenter audit of 100 infective endocarditis. Eur J Clin Microbiol Infect Dis 2018; 38:109-115. [PMID: 30324540 DOI: 10.1007/s10096-018-3401-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022]
Abstract
We aimed to identify factors associated with unfavorable outcome in patients treated for infective endocarditis (IE), with a focus on departure from European guidelines. We conducted a retrospective audit of all adult patients treated for endocarditis during a 1-year period across a regional network of nine care centers in the south-east of France. Medical records were reviewed regarding patient and infection characteristics, antibiotic therapy, outcome, and compliance to the European Society of Cardiology guidelines. Antibiotic treatment appropriateness was evaluated regarding molecule, dosage, and duration, according to guidelines. Primary endpoint was the assessment of factors associated with unfavorable outcome, defined as in-hospital mortality or IE relapse at 1-year follow-up. Secondary endpoints were intensive care admission, iatrogenic events, and nosocomial infections that occurred during hospital stay. One hundred patients were included. Median age was 71 years old. Twenty-two patients died and IE relapse occurred in two patients, representing 24 patients with unfavorable outcome. Overall, antibiotic treatment was deemed appropriate in 28 cases. Thirty-three patients required intensive care, 34 iatrogenic events were found, including 19 acute kidney injuries, and 13 nosocomial infections occurred during care. Using a logistic regression, factors associated with unfavorable outcome were admission in the intensive care unit (adjusted odd ratio 7.26 [1.8-29.28]; p = 0.005), new-onset nosocomial infection (adjusted odd ratio 8.83 [1.42-54.6]; p = 0.019), and age > 71 years old (adjusted odd ratio 11.2 [2.76-46.17]; p < 0.001). Departure from guidelines was frequent but not related to unfavorable outcome in our study. Only intensive care, age, and nosocomial infections were associated with mortality and relapse. Iatrogenic events were numerous, with no impact on outcome.
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Affiliation(s)
- David Chirio
- Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, 151 Route de Saint Antoine, 06200, Nice, France.
| | - Marion Le Marechal
- Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, 151 Route de Saint Antoine, 06200, Nice, France
| | - Pamela Moceri
- Cardiologie, Hôpital Pasteur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Arnaud de la Chapelle
- Réanimation cardio-thoracique, Institut Arnault Tzanck, Saint-Laurent-du-Var, France
| | | | - Anaïs Mothes
- Médecine Interne et Polyvalente, Centre Hospitalier de la Dracénie, Draguignan, France
| | - Cédric Foucault
- Médecine Polyvalente et Infectiologie, Centre Hospitalier d'Hyères, Hyères, France
| | - Laurence Maulin
- Infectiologie, Centre Hospitalier du Pays d'Aix, Aix-en-Provence, France
| | | | - Pierre-Marie Roger
- Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, 151 Route de Saint Antoine, 06200, Nice, France
| | - Elisa Demonchy
- Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, 151 Route de Saint Antoine, 06200, Nice, France
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Diallo K, Thilly N, Luc A, Beraud G, Ergonul Ö, Giannella M, Kofteridis D, Kostyanev T, Paňo-Pardo JR, Retamar P, Kern W, Pulcini C. Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey. Int J Antimicrob Agents 2018; 51:794-798. [PMID: 29309899 DOI: 10.1016/j.ijantimicag.2017.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/19/2017] [Accepted: 12/16/2017] [Indexed: 12/17/2022]
Abstract
Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate. Their practices were evaluated using six clinical vignettes presenting uncomplicated BSI cases. A total of 616 professionals from 56 countries participated [333/616 (54%) infectious diseases specialists, 188/616 (31%) clinical microbiologists], of whom 76% (468/616) were members of an antimicrobial stewardship team. Large variations in practice were noted, in particular for the Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa vignettes. Echocardiography was considered standard of care by 81% (373/459) of participants for MRSA, 78% (400/510) for methicillin-susceptible S. aureus and 60% (236/395) for Candida albicans. Antimicrobial combination therapy was recommended by 2% (8/360) of respondents for C. albicans, 11% (43/378) for E. coli, 27% (114/420) for MRSA and 39% (155/393) for E. faecalis. Intravenous-to-oral switch was considered in 68% (285/418) for MRSA, 79% (306/388) for E. faecalis, 72% (264/366) for P. aeruginosa and 75% (270/362) for C. albicans. In multivariable analysis, IDSA guideline-compliant practice was more frequent among participants belonging to an antimicrobial stewardship team (aOR = 1.7, P = 0.018 for the MRSA vignette; and aOR = 2.0, P = 0.008 for the candidaemia vignette). This survey showed large variations in practice among infection specialists. International guidelines on management of BSI are urgently needed.
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Affiliation(s)
- Kévin Diallo
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, F-54000 Nancy, France; Université de Lorraine, CHRU-Nancy, Plateforme d'Aide à la Recherche Clinique, F-54000 Nancy, France
| | - Amandine Luc
- Université de Lorraine, CHRU-Nancy, Plateforme d'Aide à la Recherche Clinique, F-54000 Nancy, France
| | - Guillaume Beraud
- Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, Chemin Sainte-Foy (Québec), Canada; CHU de Poitiers, Médecine Interne et Maladies Infectieuses, Poitiers, France; Hasselt University, CenStat, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt, Belgium
| | - Önder Ergonul
- Koç University, School of Medicine, Department of Infectious Diseases, Istanbul, Turkey
| | - Maddalena Giannella
- Sant'Orsola-Malpighi Hospital, University of Bologna, Department of Medical and Surgical Sciences, Infectious Disease Unit, Bologna, Italy
| | - Diamantis Kofteridis
- University Hospital of Heraklion and University of Crete, Faculty of Medicine, Department of Internal Medicine, Heraklion, Crete, Greece
| | - Tomislav Kostyanev
- University of Antwerp, Vaccine & Infectious Disease Institute, Department of Medical Microbiology, Wilrijk, Belgium
| | | | - Pilar Retamar
- Hospital Virgen Macarena-IBiS, Clinical Microbiology and Infectious Diseases Unit, Seville, Spain
| | - Winfried Kern
- University of Freiburg, Faculty of Medicine and Medical Center, Division of Infectious Diseases, Department of Medicine II, Freiburg, Germany
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
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Klompas M, Kalil AC. Colouring outside the guidelines. Clin Microbiol Infect 2017; 23:691-692. [PMID: 28528192 DOI: 10.1016/j.cmi.2017.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 11/15/2022]
Affiliation(s)
- M Klompas
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - A C Kalil
- Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
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Tissot-Dupont H, Casalta JP, Gouriet F, Hubert S, Salaun E, Habib G, Fernandez-Gerlinger MP, Mainardi JL, Tattevin P, Revest M, Lucht F, Botelho-Nevers E, Gagneux-Brunon A, Snygg-Martin U, Chan KL, Bishara J, Vilacosta I, Olmos C, San Román JA, López J, Tornos P, Fernández-Hidalgo N, Durante-Mangoni E, Utili R, Paul M, Baddour LM, DeSimone DC, Sohail MR, Steckelberg JM, Wilson WR, Raoult D. International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines. Clin Microbiol Infect 2017; 23:736-739. [PMID: 28323194 DOI: 10.1016/j.cmi.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. METHODS Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. RESULTS The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. CONCLUSION Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics.
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Affiliation(s)
- H Tissot-Dupont
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - J P Casalta
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - F Gouriet
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - S Hubert
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - E Salaun
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - G Habib
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - M P Fernandez-Gerlinger
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - J L Mainardi
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - P Tattevin
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - M Revest
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - F Lucht
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - E Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - A Gagneux-Brunon
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - U Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K L Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - J Bishara
- Infectious Disease Unit Rabin Medical Centre, Beilinson Hospital Sackler Faculty of Medicine, Tel-Aviv University, Jabotinsky 39, Petah-Tiqva, Israel
| | - I Vilacosta
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - C Olmos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - J A San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - J López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - P Tornos
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - E Durante-Mangoni
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - R Utili
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - M Paul
- Ramban Health Care Campus, Haifa, Israel
| | - L M Baddour
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D C DeSimone
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Sohail
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J M Steckelberg
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Raoult
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
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