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Comments on the 2023 ESC guidelines for the management of endocarditis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:191-195. [PMID: 38007152 DOI: 10.1016/j.rec.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023]
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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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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Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, Tattevin P, Olaison L, Freiberger T, Hurley J, Hannan MM, Chu V, Hoen B, Moreno A, Cuervo G, Llopis J, Miró JM. Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12:1083-1101. [PMID: 36922460 PMCID: PMC10147876 DOI: 10.1007/s40121-023-00763-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. METHODS The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. RESULTS IE cases from 13 European countries were included. Two periods were considered: 2000-2006 and 2008-2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern-Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49-74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p < 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. CONCLUSIONS Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Freiberger
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - John Hurley
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Margaret M Hannan
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Vivian Chu
- Duke University School of Medicine, Durham, NC, USA
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, University of Lorraine Medical Center at Nancy, EA 4364 APEMAC, University of Lorraine, Nancy, France
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Jaume Llopis
- Biostatistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
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Kobalava ZD, Kotova EO. [Global and national trends in the evolution of infective endocarditis]. KARDIOLOGIIA 2023; 63:3-11. [PMID: 36749195 DOI: 10.18087/cardio.2023.1.n2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023]
Abstract
For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.
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Affiliation(s)
- Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - E O Kotova
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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Kong WKF, Salsano A, Giacobbe DR, Popescu BA, Laroche C, Duval X, Schueler R, Moreo A, Colonna P, Piper C, Calvo-Iglesias F, Badano LP, Srdanovic I, Boutoille D, Huttin O, Stöhr E, Timóteo AT, Vaskelyte JJ, Sadeghpour A, Tornos P, Abid L, Poh KK, Habib G, Lancellotti P. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry. Eur Heart J 2022; 43:2770-2780. [PMID: 35695691 PMCID: PMC9459867 DOI: 10.1093/eurheartj/ehac307] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/21/2022] [Accepted: 05/25/2022] [Indexed: 12/13/2022] Open
Abstract
AIM Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.
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Affiliation(s)
- William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino—IRCCS, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, Genoa, Italy
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy ‘Carol Davila’ Euroecolab, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’, Bucharest, Romania
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | - Xavier Duval
- INSERM Clinical Investigation Center 1425, Université Paris Diderot, Sorbonne Paris-Cité, IAME 1138, Paris, France
- AEPEI Service de Maladies Infectieuses et Tropicales, APHP, Hôpital Bichat, Paris, France
| | | | - Antonella Moreo
- Dipartimento CardioToracoVascolare ‘De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Luigi P Badano
- University of Milano-Bicocca, Milano, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences; Istituto Auxologico Italiano, IRCCS—San Luca Hospital, Milano, Italy
| | - Ilija Srdanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, Nantes, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Nancy, France
- CIC-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, CIC-IT, U1433, CHRU de Nancy, France
- INSERM U1254, IADI, Université de Lorraine, Nancy, France
| | | | - Ana Teresa Timóteo
- Secretária-Geral Sociedade Portuguesa Cardiologia, Lisbon, Portugal
- Assistente Hospitalar Graduada Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisbon Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Anita Sadeghpour
- Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
- Duke Cardiovascular MR Center, Durham, NC, USA
| | - Pilar Tornos
- Cardiology Service, Hospital Quiron, Barcelona, Spain
| | | | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
- University Hospital of Liege (CHU), Liege, Belgium
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De Ciancio G, Erpelding ML, Filippetti L, Goehringer F, Blangy H, Huttin O, Agrinier N, Juillière Y, Sadoul N, Selton-Suty C. Adherence to diagnostic and therapeutic practice guidelines for suspected cardiac implantable electronic device infections. Arch Cardiovasc Dis 2021; 114:634-646. [PMID: 34742672 DOI: 10.1016/j.acvd.2021.06.010] [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: 12/21/2020] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite guidelines describing the optimal diagnostic and therapeutic procedures for patients with suspected cardiac implantable electronic device (CIED) infections, their management is often challenging. AIMS To describe our diagnostic and therapeutic practices for suspected CIED infection, and to compare them with European Heart Rhythm Association (EHRA) guidelines. METHODS Patients hospitalized in the tertiary care Nancy University Hospital for suspected CIED infection from 2014 to 2019 were included retrospectively. We applied the EHRA classification of CIED infection, and compared diagnostic and therapeutic management with the EHRA guidelines. RESULTS Among 184 patients (mean age 72.3±12.4 years), 137 had a proven infection of the lead (by transthoracic echocardiography/transoesophageal echocardiography, 18F-fluorodesoxyglucose positron emission tomography/computed tomography or positive culture of the lead) or an isolated pocket infection without proof of lead infection, and 47 had no proof of CIED infection. According to the EHRA classification, CIED infection was considered as definite in 145 patients and possible in 31 and was excluded in eight patients. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, transthoracic echocardiography in 97.8%, transoesophageal echocardiography in 85.9%, 18F-fluorodesoxyglucose positron emission tomography/computed tomography in 50.5% and imaging for embolisms in 78.3% of the patients. Compared with therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%) and antibiotic therapy was prescribed in 130 (89.7%), with a duration equal to or longer than that recommended in 105 (72.4%) of the patients. CONCLUSION This study underlines the difficulties in following theoretical guidelines in daily practice, where both technical and human considerations interfere with their strict appliance.
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Affiliation(s)
| | - Marie-Line Erpelding
- Inserm, CIC, Faculty of Medicine, Épidémiologie Clinique, University of Lorraine, CHRU Nancy, 54505 Vandœuvre-lès-Nancy, France
| | - Laura Filippetti
- Department of Cardiology, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France.
| | - François Goehringer
- Department of Infectious Diseases, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Department of Cardiology, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France
| | - Olivier Huttin
- Department of Cardiology, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France; Faculty of Medicine, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Nelly Agrinier
- Inserm, CIC, Faculty of Medicine, Épidémiologie Clinique, University of Lorraine, CHRU Nancy, 54505 Vandœuvre-lès-Nancy, France; Faculty of Medicine, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Yves Juillière
- Department of Cardiology, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France; Faculty of Medicine, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Nicolas Sadoul
- Department of Cardiology, CHRU NANCY, 54511 Vandœuvre-lès-Nancy, France; Faculty of Medicine, University of Lorraine, 54505 Vandœuvre-lès-Nancy, France
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Evolution of epidemiological characteristics of infective endocarditis in Greece. Int J Infect Dis 2021; 106:213-220. [PMID: 33711517 DOI: 10.1016/j.ijid.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. METHODS A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. RESULTS Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. CONCLUSIONS A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.
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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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10
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Huang G, Gupta S, Davis KA, Barnes EW, Beekmann SE, Polgreen PM, Peacock JE. Infective Endocarditis Guidelines: The Challenges of Adherence-A Survey of Infectious Diseases Clinicians. Open Forum Infect Dis 2020; 7:ofaa342. [PMID: 32964063 PMCID: PMC7489528 DOI: 10.1093/ofid/ofaa342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background Guidelines exist to aid clinicians in managing patients with infective endocarditis (IE), but the degree of adherence with guidelines by Infectious Disease (ID) physicians is largely unknown. Methods An electronic survey assessing adherence with selected IE guidelines was emailed to 1409 adult ID physician members of the Infectious Diseases Society of America’s Emerging Infections Network. Results Five hundred fifty-seven physicians who managed IE responded. Twenty percent indicated that ID was not consulted on every case of IE at their hospitals, and 13% did not recommend transthoracic echocardiography (TTE) for all IE cases. The duration of antimicrobial therapy was timed from the first day of negative blood cultures by 91% of respondents. Thirty-four percent of clinicians did not utilize an aminoglycoside for staphylococcal prosthetic valve IE (PVE). Double β-lactam therapy was “usually” or “almost always” employed by 83% of respondents for enterococcal IE. For patients with active IE who underwent valve replacement and manifested positive surgical cultures, 6 weeks of postoperative antibiotics was recommended by 86% of clinicians. Conclusions The finding that adherence was <90% with core guideline recommendations that all patients with suspected IE be seen by ID and that all patients undergo TTE is noteworthy. Aminoglycoside therapy of IE appears to be declining, with double β-lactam regimens emerging as the preferred treatment for enterococcal IE. The duration of postoperative antimicrobial therapy for patients undergoing valve replacement during acute IE is poorly defined and represents an area for which additional evidence is needed.
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Affiliation(s)
- Glen Huang
- Infectious Diseases, Department of Internal Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Siddhi Gupta
- Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Kyle A Davis
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Erin W Barnes
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Susan E Beekmann
- Emerging Infections Network, University of Iowa, Iowa City, Iowa, USA
| | - Philip M Polgreen
- Emerging Infections Network, University of Iowa, Iowa City, Iowa, USA
| | - James E Peacock
- Section on Infectious Diseases, Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Martí-Carvajal AJ, Dayer M, Conterno LO, Gonzalez Garay AG, Martí-Amarista CE. A comparison of different antibiotic regimens for the treatment of infective endocarditis. Cochrane Database Syst Rev 2020; 5:CD009880. [PMID: 32407558 PMCID: PMC7527143 DOI: 10.1002/14651858.cd009880.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but due to the differences in presentation, populations affected, and the wide variety of micro-organisms that can be responsible, their use is not standardised. This is an update of a review previously published in 2016. OBJECTIVES To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference Proceedings Citation Index - Science on 6 January 2020. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) assessing the effects of antibiotic regimens for treating definitive infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates, and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment, and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of the evidence. We described the included studies narratively. MAIN RESULTS Six small RCTs involving 1143 allocated/632 analysed participants met the inclusion criteria of this first update. The included trials had a high risk of bias. Three trials were sponsored by drug companies. Due to heterogeneity in outcome definitions and different antibiotics used data could not be pooled. The included trials compared miscellaneous antibiotic schedules having uncertain effects for all of the prespecified outcomes in this review. Evidence was either low or very low quality due to high risk of bias and very low number of events and small sample size. The results for all-cause mortality were as follows: one trial compared quinolone (levofloxacin) plus standard treatment (antistaphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin), and rifampicin) versus standard treatment alone and reported 8/31 (26%) with levofloxacin plus standard treatment versus 9/39 (23%) with standard treatment alone; risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49 to 2.56. One trial compared fosfomycin plus imipenem 3/4 (75%) versus vancomycin 0/4 (0%) (RR 7.00, 95% CI 0.47 to 103.27), and one trial compared partial oral treatment 7/201 (3.5%) versus conventional intravenous treatment 13/199 (6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The results for rates of cure with or without surgery were as follows: one trial compared daptomycin versus low-dose gentamicin plus an antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or vancomycin and reported 9/28 (32.1%) with daptomycin versus 9/25 (36%) with low-dose gentamicin plus antistaphylococcal penicillin or vancomycin; RR 0.89, 95% CI 0.42 to 1.89. One trial compared glycopeptide (vancomycin or teicoplanin) plus gentamicin with cloxacillin plus gentamicin (13/23 (56%) versus 11/11 (100%); RR 0.59, 95% CI 0.40 to 0.85). One trial compared ceftriaxone plus gentamicin versus ceftriaxone alone (15/34 (44%) versus 21/33 (64%); RR 0.69, 95% CI 0.44 to 1.10), and one trial compared fosfomycin plus imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR 0.50, 95% CI 0.07 to 3.55). The included trials reported adverse events, the need for cardiac surgical interventions, and rates of uncontrolled infection, congestive heart failure, relapse of endocarditis, and septic emboli, and found no conclusive differences between groups (very low-quality evidence). No trials assessed quality of life. AUTHORS' CONCLUSIONS This first update confirms the findings of the original version of the review. Limited and low to very low-quality evidence suggests that the comparative effects of different antibiotic regimens in terms of cure rates or other relevant clinical outcomes are uncertain. The conclusions of this updated Cochrane Review were based on few RCTs with a high risk of bias. Accordingly, current evidence does not support or reject any regimen of antibiotic therapy for the treatment of infective endocarditis.
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Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- School of Medicine, Universidad Francisco de Vitoria (Cochrane Madrid), Madrid, Spain
| | - Mark Dayer
- Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, UK
| | - Lucieni O Conterno
- Medical School, Department of Internal Medicine, Infectious Diseases Division, State University of Campinas (UNICAMP), Campinas, Brazil
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Ingram PR, Carrello TL, Jones AL, McCann MJ, Lan NSR, Judkins C, Larbalestier R, Manning LA, Dyer JR. Impact of adherence to surgical and non-surgical components of infective endocarditis guidelines and recommendations. J Infect Chemother 2020; 26:923-927. [PMID: 32354601 DOI: 10.1016/j.jiac.2020.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is associated with significant morbidity and mortality. Non-adherence to IE guidelines and recommendations is frequent, and may adversely impact patient outcomes. AIM To assess the impact of non-adherence to components of existing IE guidelines and recommendations on a composite outcome consisting of any of the following: mortality, unplanned cardiac surgery, embolic event or relapse of positive blood culture within six months of diagnosis. METHODS A single centre, retrospective cohort study. RESULTS Amongst 157 patients, there was inconsistent adherence to: initial diagnosis of an infective condition (87%), timely administration of antimicrobial therapy (82%), appropriateness of predominant antimicrobial regime (94%), appropriate management of the portal of entry (86%), multidisciplinary input (75%), end of antimicrobial therapy repeat echocardiography (60%) and adherence to indications for surgery (76%). Inpatient mortality was 12.1% (n = 19) and the composite adverse outcome occurred in 36 (22.9%) patients. In multivariate logistic regression analysis, infection of prosthetic device (adjusted odds ratio [95% confidence interval]; 2.43 [1.07-5.50]) and non-adherence to surgical guidelines (aOR 3.67 [1.60-8.47]) were significantly associated with an adverse outcome. CONCLUSIONS Our data suggests that adherence to differing components of IE management guidelines and recommendations varies and that non-adherence to surgical aspects of guidelines has the biggest impact in determining outcomes.
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Affiliation(s)
- Paul R Ingram
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia; Department of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia; Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, Australia
| | - Thomas L Carrello
- School of Medicine, University of Western Australia, Perth, Australia
| | - Aimee Lee Jones
- School of Medicine, University of Western Australia, Perth, Australia
| | | | - Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia.
| | | | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Laurens A Manning
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia; Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - John R Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Australia
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Lebeaux D, Fernández-Hidalgo N, Pilmis B, Tattevin P, Mainardi JL. Aminoglycosides for infective endocarditis: time to say goodbye? Clin Microbiol Infect 2019; 26:723-728. [PMID: 31669426 DOI: 10.1016/j.cmi.2019.10.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Based on experimental studies showing synergism with β-lactams and glycopeptides, aminoglycosides have long been considered essential in the treatment of infective endocarditis (IE). However, their use is associated with a high risk of renal failure, especially in elderly patients. AIMS The aim of this narrative review was to summarize the evidence to support reducing or even avoiding the use of aminoglycosides for the treatment of IE. We also analysed data supporting the use of aminoglycosides in specific subgroup of IE patients. SOURCES PubMed database was searched up to July 2019 to identify relevant studies. CONTENTS Recent European Guidelines reduced the use of aminoglycosides in IE, no longer recommended in Staphylococcus aureus native-valve IE, and shortened to 2 weeks for IE related to Enterococcus faecalis and streptococci with penicillin MIC >0.125 μg/mL. In addition, an alternative regimen without aminoglycosides (ampicillin or amoxicillin plus ceftriaxone) is proposed for E. faecalis. Observational studies suggested that gentamicin would not be necessary in the case of staphylococcal prosthetic valve IE as long as rifampicin is maintained. Recent clinical studies showed that for streptococcal IE, gentamicin could be restricted to isolates with penicillin MIC >0.5 μg/mL. For the empirical and definitive treatment of E. faecalis IE, amoxicillin or ampicillin plus ceftriaxone may be considered, irrespective of high-level of aminoglycoside resistance. IMPLICATIONS In a scenario of progressive increase in the age and frailty of IE patients, the use of aminoglycosides can be reduced or avoided in ~90% cases. This should result in reduced incidence of renal failure, an important prognostic factor in IE.
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Affiliation(s)
- D Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Centre Université de Paris, Université de Paris, Paris, France.
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. Barcelona, Spain; Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - B Pilmis
- Service de Microbiologie et Plateforme de dosage des Anti-infectieux, Equipe Mobile de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - J-L Mainardi
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Centre Université de Paris, Université de Paris, Paris, France
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14
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Affiliation(s)
- Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
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Tascini C, Attanasio V, Ripa M, Carozza A, Pallotto C, Bernardo M, Francisci D, Oltolini C, Palmiero G, Scarpellini P. Ceftobiprole for the treatment of infective endocarditis: A case series. J Glob Antimicrob Resist 2019; 20:56-59. [PMID: 31351247 DOI: 10.1016/j.jgar.2019.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Ceftobiprole is a relatively new cephalosporin with broad-spectrum activity and good tolerability. Despite its promising characteristics, to our knowledge, only two case reports, previously published also by some of us, is available concerning its administration for the treatment of infective endocarditis. Hereby we report our experience in this field. METHODS All the patients with infective endocarditis treated with ceftobiprole were enrolled. RESULTS 12 cases of endocarditis were treated with ceftobiprole, 11/12 in combination with daptomycin and 1/12 as monotherapy. Gram-positive bacteria were isolated in 12/12 patients; 3 cases were polymicrobial. Cure rate was 83% (10/12 patients). In 9/12 (75%) cases, patients were switched to ceftobiprole following failure of previous antimicrobial regimen. In 3/3 patients in which ceftobiprole was administered because of persistently positive blood culture, bacteraemia clearance was rapidly achieved. CONCLUSIONS Ceftobiprole, especially in combination, could be a promising alternative treatment for infective endocarditis.
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Affiliation(s)
- Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Marco Ripa
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
| | - Antonio Carozza
- UOSD Advanced Techniques in Cardiosurgery, Monaldi Hospital, AORN dei Colli, via Bianchi, snc, Naples, Italy.
| | - Carlo Pallotto
- Section of Infectious Diseases, Department of Medicine, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy; UOC Infectious Diseases, San Donato Hospital, Azienda USL Toscana Sud Est, via Nenni, 22, Arezzo, Italy.
| | - Mariano Bernardo
- Microbiology and Virology Unit, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Daniela Francisci
- Section of Infectious Diseases, Department of Medicine, University of Perugia, Piazzale Gambuli, 1, Perugia, Italy.
| | - Chiara Oltolini
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
| | - Giulia Palmiero
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, via Bianchi snc, Naples, Italy.
| | - Paolo Scarpellini
- Department of Infectious Disease, San Raffaele Hospital, via Stamira d'Ancona, Milan, Italy.
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16
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Friedman J, Leibovici L. CMI: how did we do in 2018? Clin Microbiol Infect 2019; 25:1057-1059. [PMID: 31266677 DOI: 10.1016/j.cmi.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 11/16/2022]
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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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Brouqui P, Raoult D. Should evidence-based medicine be considered as a truth in clinical microbiology? Int J Antimicrob Agents 2018; 51:278-279. [DOI: 10.1016/j.ijantimicag.2017.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/23/2017] [Indexed: 11/26/2022]
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Fernández-Hidalgo N, Almirante B. Current status of infectious endocarditis: New populations at risk, new diagnostic and therapeutic challenges. Enferm Infecc Microbiol Clin 2018; 36:69-71. [PMID: 29325999 DOI: 10.1016/j.eimc.2017.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, España
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20
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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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21
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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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