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Othman R, Mallat HH, Osman R, Ayoubi A. Unsolved Controversies in Management of Infective Endocarditis. Cureus 2024; 16:e58095. [PMID: 38737997 PMCID: PMC11088747 DOI: 10.7759/cureus.58095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Infective endocarditis (IE) is defined as an infection in the cardiac endothelium. It is triggered by both bacteremia and endothelial dysfunction and poses many risks to the health of the patient. Many organisms can cause IE with Staphylococcus aureus being the major cause. Signs and symptoms may vary according to age and agent but almost all cases are presented with fever, fatigue, and a maculopapular rash. Although pediatric IE is very rare, risk factors such as congenital heart defects have been identified, with some of the cases remaining a mystery. We present a case of a 19-year-old patient, previously healthy and developing subacute IE with sepsis and septic embolic showers in multiple organs. IE cannot be taken for granted as mortality is high, hence a multidisciplinary approach is prompt and necessary for the survival of the patient.
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Affiliation(s)
- Rima Othman
- General Medicine, Faculty of Medicine at University of Balamand, Beirut, LBN
| | - Hassan H Mallat
- Infectious Diseases, Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, LBN
| | - Raed Osman
- Interventional Cardiology, Nini Hospital, Tripoli, LBN
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2
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Alqahtani FS, Al-Asadi H, Alsenani AI, Alanazi WS, Alanazi AG. Infective Endocarditis Caused By Streptococcus pluranimalium: A Case Report. Cureus 2023; 15:e49219. [PMID: 38143616 PMCID: PMC10739377 DOI: 10.7759/cureus.49219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Infective endocarditis (IE) refers to an infection of the endocardium that can be caused by bacteria, viruses, or fungi. It can manifest either acutely or sub-acutely. Which can be complicated to stroke and congestive heart failure. We report a case of IE caused by Streptococcus (S.) pluranimalium. It is a rare organism that was discovered in 1999 in infections affecting domestic animals. It can cause serious complications, such as brain abscesses, and IE in both humans and animals. Our patient was diagnosed with IE caused by S. pluranimalium based on modified Duke's criteria. After the diagnosis was made, the patient started on intravenous antibiotics according to the blood cultures. Then, the patient significantly improved. We are reporting this case because only a few cases were documented for infective endocarditis caused by S. pluranimalium.
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Affiliation(s)
| | - Hiba Al-Asadi
- Infectious Disease, Specialized Medical Center Hospital, Riyadh, SAU
| | | | - Wejdan S Alanazi
- Internal Medicine, Specialized Medical Center Hospital, Riyadh, SAU
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3
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McDonald EG, Aggrey G, Tarik Aslan A, Casias M, Cortes-Penfield N, Dong MQD, Egbert S, Footer B, Isler B, King M, Maximos M, Wuerz TC, Azim AA, Alza-Arcila J, Bai AD, Blyth M, Boyles T, Caceres J, Clark D, Davar K, Denholm JT, Forrest G, Ghanem B, Hagel S, Hanretty A, Hamilton F, Jent P, Kang M, Kludjian G, Lahey T, Lapin J, Lee R, Li T, Mehta D, Moore J, Mowrer C, Ouellet G, Reece R, Ryder JH, Sanctuaire A, Sanders JM, Stoner BJ, So JM, Tessier JF, Tirupathi R, Tong SYC, Wald-Dickler N, Yassin A, Yen C, Spellberg B, Lee TC. Guidelines for Diagnosis and Management of Infective Endocarditis in Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open 2023; 6:e2326366. [PMID: 37523190 DOI: 10.1001/jamanetworkopen.2023.26366] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Practice guidelines often provide recommendations in which the strength of the recommendation is dissociated from the quality of the evidence. Objective To create a clinical guideline for the diagnosis and management of adult bacterial infective endocarditis (IE) that addresses the gap between the evidence and recommendation strength. Evidence Review This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In April 2022 a call to new and existing members was released electronically (social media and email) for the next WikiGuidelines topic, and subsequently, topics and questions related to the diagnosis and management of adult bacterial IE were crowdsourced and prioritized by vote. For each topic, PubMed literature searches were conducted including all years and languages. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were crafted discussing the risks and benefits of different approaches. Findings A total of 51 members from 10 countries reviewed 587 articles and submitted information relevant to 4 sections: establishing the diagnosis of IE (9 questions); multidisciplinary IE teams (1 question); prophylaxis (2 questions); and treatment (5 questions). Of 17 unique questions, a clear recommendation could only be provided for 1 question: 3 randomized clinical trials have established that oral transitional therapy is at least as effective as intravenous (IV)-only therapy for the treatment of IE. Clinical reviews were generated for the remaining questions. Conclusions and Relevance In this consensus statement that applied the WikiGuideline method for clinical guideline development, oral transitional therapy was at least as effective as IV-only therapy for the treatment of IE. Several randomized clinical trials are underway to inform other areas of practice, and further research is needed.
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Affiliation(s)
- Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Abdullah Tarik Aslan
- The University of Queensland, Faculty of Medicine, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Michael Casias
- Jersey Shore University Medical Center, Neptune, New Jersey
| | | | | | - Susan Egbert
- Department of Chemistry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Footer
- Providence Portland Medical Center, Portland, Oregon
| | - Burcu Isler
- University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | | | - Mira Maximos
- Women's College Hospital, Toronto, Ontario, Canada
| | - Terence C Wuerz
- Departments of Internal Medicine & Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed Abdul Azim
- Division of Infectious Diseases, Allergy and Immunology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tom Boyles
- Right to Care, NPC, Centurion, South Africa and London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juan Caceres
- Division of Internal Medicine, Michigan Medicine, Ann Arbor
| | - Devin Clark
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Kusha Davar
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Justin T Denholm
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Fergus Hamilton
- Infection Science, North Bristol NHS Trust, Bristol, United Kingdom
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Minji Kang
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas
| | | | - Tim Lahey
- University of Vermont Medical Center, Burlington
| | | | | | - Timothy Li
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Dhara Mehta
- Bellevue Hospital Center, New York, New York
| | | | - Clayton Mowrer
- University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha
| | | | - Rebecca Reece
- Section of Infectious Diseases, West Virginia University, Morgantown
| | - Jonathan H Ryder
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha
| | - Alexandre Sanctuaire
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, Canada
| | | | | | - Jessica M So
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | | | | | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Noah Wald-Dickler
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Arsheena Yassin
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Christina Yen
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern, Dallas
| | - Brad Spellberg
- Los Angeles County and University of Southern California Medical Center, Los Angeles
| | - Todd C Lee
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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Schmidt T, Malik A, Pislaru S, Sinak L. Don't Tear My Heart: Sternal Wire Pericardial Injury After Aortic Valve Replacement. CASE (PHILADELPHIA, PA.) 2023; 7:278-282. [PMID: 37546360 PMCID: PMC10403635 DOI: 10.1016/j.case.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
•TTE is a valuable cardiac imaging tool given its availability. •TTE can be used for the evaluation of cardiothoracic surgical complications. •Imaging modalities aid in supplementing information in postoperative patients. •Sternal wire fracture may cause a cardiac laceration.
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Affiliation(s)
- Tyler Schmidt
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Awais Malik
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Sorin Pislaru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Lawrence Sinak
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
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5
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Henriquez E, Fatima N, Sayabugari R, Nasim MH, Noorayingarath H, Bai K, Garcia A, Habib A, Patel TP, Shaikh F, Razzaq W, Abdin ZU, Gupta I. Transesophageal Echocardiography vs. Transthoracic Echocardiography for Methicillin-Sensitive Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Endocarditis. Cureus 2023; 15:e39996. [PMID: 37416006 PMCID: PMC10321677 DOI: 10.7759/cureus.39996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Infective endocarditis is an infection of the inner layers of the heart, seen often in intravenous drug users and patients with valvular lesions or prosthetic heart valves. This entity has high mortality and morbidity. The most common causative microorganism is Staphylococcus aureus. In this comprehensive literature review, we focused on both Staphylococcus aureus infections, i.e., methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) endocarditis, demographics, use of transthoracic echocardiogram and/or transesophageal echocardiogram for diagnostics, and treatments. Although clinical criteria are relevant, transesophageal echocardiogram plays a vital role in establishing and identifying the presence of infective endocarditis and its local complications, with higher sensitivity in patients with prosthetic valves. The antibiotic selection posed a great challenge for clinicians due to antibiotic resistance and the aggressive nature of Staphylococcus aureus. Early diagnosis of infective endocarditis, when suspected, and effective management by a multispecialty team can improve the outcome for the patients.
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Affiliation(s)
- Elvis Henriquez
- Internal Medicine, University of Medical Sciences, Las Tunas, CUB
| | - Neha Fatima
- Internal Medicine, Lisie Hospital, Kochi, IND
| | | | | | | | - Karoona Bai
- Internal Medicine, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK
| | | | - Ayesha Habib
- Internal Medicine, Punjab Medical College, Faisalabad, PAK
| | | | - Fouziya Shaikh
- Internal Medicine, Krishna Institute of Medical Sciences, Karad, IND
| | - Waleed Razzaq
- Internal Medicine, Services Hospital Lahore, Lahore, PAK
| | - Zain U Abdin
- Medicine, District Head Quarters Hospital, Faisalabad, PAK
| | - Ishita Gupta
- Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, IND
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6
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Onofrei VA, Adam CA, Marcu DTM, Crisan Dabija R, Ceasovschih A, Constantin M, Grigorescu ED, Petroaie AD, Mitu F. Infective Endocarditis during Pregnancy-Keep It Safe and Simple! MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050939. [PMID: 37241171 DOI: 10.3390/medicina59050939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.
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Affiliation(s)
- Viviana Aursulesei Onofrei
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Cristina Andreea Adam
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Radu Crisan Dabija
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, Doctor Iosif Cihac Street No. 30, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Mihai Constantin
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- "St. Spiridon" Clinical Emergency Hospital, Independence Boulevard No. 1, 700111 Iasi, Romania
| | - Elena-Daniela Grigorescu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Antoneta Dacia Petroaie
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I, II, III and Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, University Street No. 16, 700115 Iasi, Romania
- Cardiovascular Rehabilitation Clinic, Clinical Rehabilitation Hospital, Pantelimon Halipa Street No. 14, 700661 Iasi, Romania
- Academy of Medical Sciences, Ion C. Brătianu Boulevard No. 1, 030167 Bucharest, Romania
- Academy of Romanian Scientists, Professor Dr. Doc. Dimitrie Mangeron Boulevard No. 433, 700050 Iasi, Romania
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7
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Adema JL, Ahiskali A, Fida M, Mediwala Hornback K, Stevens RW, Rivera CG. Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis. Pathogens 2023; 12:703. [PMID: 37242373 PMCID: PMC10223386 DOI: 10.3390/pathogens12050703] [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: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Infective endocarditis (IE) is a rare but increasingly prevalent disease with high morbidity and mortality, requiring antimicrobials and at times surgical intervention. Through the decades of healthcare professionals' experience with managing IE, certain dogmas and uncertainties have arisen around its pharmacotherapy. The introduction of new antimicrobials and novel combinations are exciting developments but also further complicate IE treatment choices. In this review, we provide and evaluate the relevant evidence focused around contemporary debates in IE treatment pharmacotherapy, including beta-lactam choice in MSSA IE, combination therapies (aminoglycosides, ceftaroline), the use of oral antimicrobials, the role of rifamycins, and long-acting lipoglycopeptides.
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Affiliation(s)
- Jennifer L. Adema
- Department of Pharmacy, East Carolina University Health, Greenville, NC 27834, USA
| | - Aileen Ahiskali
- Department of Pharmacy, Hennepin Healthcare, Minneapolis, MN 55415, USA
| | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Krutika Mediwala Hornback
- Department of Pharmacy, Medical University of South Carolina (MUSC) Health, Charleston, SC 29425, USA
| | - Ryan W. Stevens
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55902, USA
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Rajaratnam D, Rajaratnam R. Outpatient Parenteral Antimicrobial Therapy for Infective Endocarditis-Model of Care. Antibiotics (Basel) 2023; 12:antibiotics12020355. [PMID: 36830266 PMCID: PMC9952299 DOI: 10.3390/antibiotics12020355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Infective endocarditis (IE) is a serious infectious disease with significant mortality and morbidity placing a burden on healthcare systems. Outpatient antimicrobial therapy in selected patients has been shown to be safe and beneficial to both patients and the healthcare system. In this article, we review the literature on the model of care for outpatient parenteral antimicrobial therapy in infective endocarditis and propose that systems of care be developed based on local resources and all patients admitted with infective endocarditis be screened appropriately for outpatient antimicrobial therapy.
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Affiliation(s)
| | - Rohan Rajaratnam
- Liverpool Hospital, Sydney, NSW 2170, Australia
- School of Medicine, Western Sydney University, Campbelltown Campus, Sydney, NSW 2560, Australia
- School of Medicine, Southwest Clinical School, The University of New South Wales, Sydney, NSW 2170, Australia
- Correspondence:
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Castillo-Fernández N, Pérez-Crespo PMM, Salamanca-Rivera E, Herrera-Hidalgo L, de Alarcón A, Navarro-Amuedo MD, Marrodán Ciordia T, Pérez-Rodríguez MT, Sevilla-Blanco J, Jover-Saenz A, Fernández-Suárez J, Armiñanzas-Castillo C, Reguera-Iglesias JM, Natera Kindelán C, Boix-Palop L, León Jiménez E, Galán-Sánchez F, del Arco Jiménez A, Bahamonde-Carrasco A, Vinuesa García D, Smithson Amat A, Cuquet Pedragosa J, Reche Molina IM, Pérez Camacho I, Merino de Lucas E, Gutiérrez-Gutiérrez B, Rodríguez Baño J, López Cortés LE. Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort. Antibiotics (Basel) 2023; 12:antibiotics12010129. [PMID: 36671330 PMCID: PMC9854520 DOI: 10.3390/antibiotics12010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/01/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p < 0.001; OR 0.275, 95%CI 0.129−0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324−1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease.
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Affiliation(s)
| | | | - Elena Salamanca-Rivera
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla/e Instituto de Biomedicina de Sevilla (IBiS)/CSIC, 41009 Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, 4103 Seville, Spain
| | - María Dolores Navarro-Amuedo
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, 4103 Seville, Spain
| | - Teresa Marrodán Ciordia
- Departamento de Microbiología Clínica, Complejo Asistencial Universitario de León (CAULE), 24071 León, Spain
| | | | - Juan Sevilla-Blanco
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Jerez de la Frontera, 11407 Cádiz, Spain
| | - Alfredo Jover-Saenz
- Unidad Funcional de Infecciones Nosocomiales, Hospital Arnau de Vilanova, 25198 Lérida, Spain
| | - Jonathan Fernández-Suárez
- Unidad de Microbiología, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Carlos Armiñanzas-Castillo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, 39008 Santander, Spain
| | | | - Clara Natera Kindelán
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
| | - Lucía Boix-Palop
- Unidad de Enfermedades Infecciosas, Hospital Universitari Mútua de Terrassa, 08221 Barcelona, Spain
| | - Eva León Jiménez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Nuestra Señora de Valme, 41014 Sevilla, Spain
| | - Fátima Galán-Sánchez
- Unidad de Gestión Clínica de Microbiología, Hospital Universitario Puerta del Mar, 11009 Cádiz, Spain
| | - Alfonso del Arco Jiménez
- Grupo Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Costa del Sol, 29603 Marbella, Spain
| | | | - David Vinuesa García
- Unidad Gestión Clínica Enfermedades Infecciosas, Hospital Universitario Clínico San Cecilio, 18016 Granada, Spain
| | - Alejandro Smithson Amat
- Unidad de Medicina Interna, Fundació Hospital de l’Esperit Sant, 08923 Santa Coloma de Gramenet, Spain
| | - Jordi Cuquet Pedragosa
- Departamento de Medicina Interna, Hospital Universitario de Granollers, 08402 Granollers, Spain
| | | | | | - Esperanza Merino de Lucas
- Unidad de Enfermedades Infecciosas, Hospital Universitario General de Alicante, 03010 Alicante, Spain
| | - Belén Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla/e Instituto de Biomedicina de Sevilla (IBiS)/CSIC, 41009 Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jesús Rodríguez Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla/e Instituto de Biomedicina de Sevilla (IBiS)/CSIC, 41009 Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Eduardo López Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena/Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla/e Instituto de Biomedicina de Sevilla (IBiS)/CSIC, 41009 Sevilla, Spain
- Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence:
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10
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Wolf S, Götz G, Wernly B, Wild C. Subcutaneous implantable cardioverter‐defibrillator: a systematic review of comparative effectiveness and safety. ESC Heart Fail 2022; 10:808-823. [PMID: 36444868 PMCID: PMC10053250 DOI: 10.1002/ehf2.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022] Open
Abstract
This systematic review evaluated the clinical effectiveness and safety of subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients at an increased risk of sudden cardiac death and with an ICD indication for primary or secondary prevention. A systematic literature search was conducted in four databases (Medline via Ovid, Embase, the Cochrane Library, and HTA-INAHTA). Randomized controlled trials (RCTs) and controlled observational studies with ≥100 S-ICD patients and a low to moderate risk of bias were eligible for inclusion. The studies' quality and the available evidence's strength were assessed using the Cochrane risk of bias tool, the ROBINS-I tool, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. One RCT, a post hoc analysis of the RCT (n = 849) and four controlled observational studies (n = 7149) were included. The quality of the available evidence was graded as low to very low, except for the primary composite endpoint of the RCT, which was rated as moderate quality. After 4 years, the RCT showed that S-ICD was non-inferior to TV-ICD regarding the composite endpoint of inappropriate shocks and device-related complications (68 [15.1%] vs. 68 [15.7%], hazard ratio [HR] 0.99, 95% confidence interval [CI] [0.71, 1.39], non-inferiority margin 1.45, P = 0.001). The RCT and two observational studies reported statistically significantly fewer lead complications in S-ICD patients (after 4 years: 1.4% vs. 6.6%, HR 0.24, 95% CI [0.10, 0.54]; after 3 years: 0.3% vs. 2.3%, P = 0.03; and after 5 years: 0.8% vs. 11.5%, P = 0.03). Identified evidence about appropriate and inappropriate shocks was inconclusive: The RCT detected statistically significantly more appropriate shocks in patients with S-ICD (83 [19.2%] vs. 57 [11.5%], HR 1.52, 95% CI [1.08, 2.12], P = 0.02), whereas one observational study showed a statistically significantly lower rate in the S-ICD group (9.9%, 95% CI [7.0, 13.9], vs. 13.9%, 95% CI [10.8, 17.8], P = 0.003). Regarding inappropriate shocks, one observational study reported statistically significantly higher rates in the S-ICD cohort (11.9% vs. 7.5%, P = 0.007), whereas the RCT and two other observational studies did not detect a statistically significant difference between the treatment groups (P > 0.05). None of the included studies showed a statistically significant difference in overall mortality and shock efficacy between patients with S-ICD and TV-ICD (P > 0.05). The available evidence is insufficient to show the superiority of S-ICD compared with TV-ICD, hindering the widespread use of the technology. Results of the recently completed ATLAS trial are to be awaited, and the anticipated role of the S-ICD needs to be clearly formulated.
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Affiliation(s)
- Sarah Wolf
- HTA Austria—Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for HTA) Vienna Austria
| | - Gregor Götz
- HTA Austria—Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for HTA) Vienna Austria
| | - Bernhard Wernly
- Department of Internal Medicine, General Hospital Oberndorf Teaching Hospital of the Paracelsus Medical University Salzburg Salzburg Austria
- Institute of general practice, family medicine and preventive medicine Paracelsus Medical University Salzburg Austria
| | - Claudia Wild
- HTA Austria—Austrian Institute for Health Technology Assessment GmbH (Former: Ludwig Boltzmann Institute for HTA) Vienna Austria
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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Barnes AMT, Frank KL, Dale JL, Manias DA, Powers JL, Dunny GM. Enterococcus faecalis colonizes and forms persistent biofilm microcolonies on undamaged endothelial surfaces in a rabbit endovascular infection model. FEMS MICROBES 2021; 2:xtab014. [PMID: 34734186 PMCID: PMC8557322 DOI: 10.1093/femsmc/xtab014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/23/2021] [Indexed: 01/03/2023] Open
Abstract
Infectious endocarditis (IE) is an uncommon disease with significant morbidity and mortality. The pathogenesis of IE has historically been described as a cascade of host-specific events beginning with endothelial damage and thrombus formation and followed by bacterial colonization of the nascent thrombus. Enterococcus faecalis is a Gram-positive commensal bacterial member of the gastrointestinal tract microbiota in most terrestrial animals and a leading cause of opportunistic biofilm-associated infections, including endocarditis. Here, we provide evidence that E. faecalis can colonize the endocardial surface without pre-existing damage and in the absence of thrombus formation in a rabbit endovascular infection model. Using previously described light and scanning electron microscopy techniques, we show that inoculation of a well-characterized E. faecalis lab strain in the marginal ear vein of New Zealand White rabbits resulted in rapid colonization of the endocardium throughout the heart within 4 days of administration. Unexpectedly, ultrastructural imaging revealed that the microcolonies were firmly attached directly to the endocardium in areas without morphological evidence of gross tissue damage. Further, the attached bacterial aggregates were not associated with significant cellular components of coagulation or host extracellular matrix damage repair (i.e. platelets). These results suggest that the canonical model of mechanical surface damage as a prerequisite for bacterial attachment to host sub-endothelial components is not required. Furthermore, these findings are consistent with a model of initial establishment of stable, endocarditis-associated E. faecalis biofilm microcolonies that may provide a reservoir for the eventual valvular infection characteristic of clinical endocarditis. The similarities between the E. faecalis colonization and biofilm morphologies seen in this rabbit endovascular infection model and our previously published murine gastrointestinal colonization model indicate that biofilm production and common host cell attachment factors are conserved in disparate mammalian hosts under both commensal and pathogenic contexts.
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Affiliation(s)
- Aaron M T Barnes
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Kristi L Frank
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Jennifer L Dale
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Dawn A Manias
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Jennifer L Powers
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
| | - Gary M Dunny
- Department of Microbiology and Immunology, University of Minnesota School of Medicine, Minneapolis, MN 55455, USA
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