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Schwiebert DR, Atanze DS, Iroegbu DU, Wilkins DM, Sandoe DJAT. Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation. Clin Med (Lond) 2024; 24:100213. [PMID: 38643831 PMCID: PMC11101910 DOI: 10.1016/j.clinme.2024.100213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Infective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. METHODS This is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. RESULTS We identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, six (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1,489 hospital bed days were saved. CONCLUSIONS In a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.
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Affiliation(s)
- Dr Ralph Schwiebert
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom.
| | - Dr Sokolayam Atanze
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | - Dr Uchechika Iroegbu
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
| | - Dr Molly Wilkins
- Department of Anaesthesia and Intensive Care Medicine, Countess of Chester Hospital, Chester, England, United Kingdom
| | - Dr Jonathan A T Sandoe
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom; Leeds Institute of Medical Research, University of Leeds, Leeds, England, United Kingdom
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Fernandez-Gerlinger MP, Arvieu R, Lebeaux D, Rouis K, Guigui P, Mainardi JL, Bouyer B. Successful 6-Week Antibiotic Treatment for Early Surgical-site Infections in Spinal Surgery. Clin Infect Dis 2020; 68:1856-1861. [PMID: 30247513 DOI: 10.1093/cid/ciy805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The incidence of spinal surgical site infections (SSIs) remains stable at less than 10%. Surgical reinterventions may be hampered by decubitus, treatment-related adverse events, and cost. In the context of emergence of bacterial resistance, a short duration of antimicrobial treatment is of critical importance. If the duration of treatment for SSI is currently 12 weeks, the aim of our study was to assess the efficacy of an antimicrobial treatment shortened to 6 weeks. METHODS This prospective study was carried out from November 2014 to July 2016 in an 827-bed teaching hospital. After surgical management of SSIs, patients received broad-spectrum antibiotics intravenously for 10 days and orally for the remainder, for a total of 6 weeks. Success was defined as absence of relapse, superinfection, or surgical failure at the end of treatment and at 1-year follow-up. RESULTS Eighty-five patients were included in this study. The median delay between initial surgery and diagnosis of SSI was 16 days. In 65 cases (76.4%), SSIs were monomicrobial; among these, Staphylococcus aureus was found in 30 cases (46%). Failure was observed in 7 cases (8.2%), with more than half caused by anaerobic bacteria. CONCLUSIONS Surgical management of SSI followed by a 6-week antibiotic treatment is associated with favorable outcome. Anaerobic bacteria seem to play a role in the occurrence of relapses. A 6-week reduction in antibiotic treatment leads to reduction in cost and, likely, also to reduction in the emergence and spread of resistant microorganisms.
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Affiliation(s)
- Marie-Paule Fernandez-Gerlinger
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Robin Arvieu
- Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - David Lebeaux
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Karama Rouis
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Pierre Guigui
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Jean-Luc Mainardi
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Benjamin Bouyer
- Faculté de Médecine, Université Paris Descartes, Paris, France.,Service d'Orthopédie et de Traumatologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
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Sandoe JAT, Barlow G, Chambers JB, Gammage M, Guleri A, Howard P, Olson E, Perry JD, Prendergast BD, Spry MJ, Steeds RP, Tayebjee MH, Watkin R. Guidelines for the diagnosis, prevention and management of implantable cardiac electronic device infection. Report of a joint Working Party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organization), British Heart Rhythm Society (BHRS), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). J Antimicrob Chemother 2014; 70:325-59. [PMID: 25355810 DOI: 10.1093/jac/dku383] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Infections related to implantable cardiac electronic devices (ICEDs), including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy devices, are increasing in incidence in the USA and are likely to increase in the UK, because more devices are being implanted. These devices have both intravascular and extravascular components and infection can involve the generator, device leads and native cardiac structures or various combinations. ICED infections can be life-threatening, particularly when associated with endocardial infection, and all-cause mortality of up to 35% has been reported. Like infective endocarditis, ICED infections can be difficult to diagnose and manage. This guideline aims to (i) improve the quality of care provided to patients with ICEDs, (ii) provide an educational resource for all relevant healthcare professionals, (iii) encourage a multidisciplinary approach to ICED infection management, (iv) promote a standardized approach to the diagnosis, management, surveillance and prevention of ICED infection through pragmatic evidence-rated recommendations, and (v) advise on future research projects/audit. The guideline is intended to assist in the clinical care of patients with suspected or confirmed ICED infection in the UK, to inform local infection prevention and treatment policies and guidelines and to be used in the development of educational and training material by the relevant professional societies. The questions covered by the guideline are presented at the beginning of each section.
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Affiliation(s)
| | - Gavin Barlow
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | | | | | - Philip Howard
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ewan Olson
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Michael J Spry
- Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Richard P Steeds
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Lima JK, Lima SR, de Lima Jr A, Agra CV, Valenti V, Gomes R, Rodrigues L, Correa J, Raimundo RD, de Abreu L. Double-lumen catheter in the right jugular vein induces two sub-endothelial abscesses in an unusual place, the transition between the superior vena cava and the right atrium: a case report. Int Arch Med 2014; 7:37. [PMID: 25110520 PMCID: PMC4125593 DOI: 10.1186/1755-7682-7-37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/12/2014] [Indexed: 11/10/2022] Open
Abstract
Endocarditis is a type of infection that is common in internal medicine wards and in haemodialysis clinics. The location that is most affected are the heart valves. Herein, we report a case of an uncommon abscess, a sub-endothelial abscess between the transition of the superior vena cava and the right atrium. There were several emboli to the lung and foot, and the agent was related to Staphylococcus aureus and a double-lumen catheter. Usually, this type of abscess is located in valves, either the tricuspid valve if related to catheters or injection drug use or the mitral valve if related to other causes. An exhaustive review was made, but we found no information about the location of this abscess and the rarity of the event motivating the report of infection.
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