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Singh A, Bhatt KS, Nguyen HC, Frisbee JC, Singh KK. Endothelial-to-Mesenchymal Transition in Cardiovascular Pathophysiology. Int J Mol Sci 2024; 25:6180. [PMID: 38892367 PMCID: PMC11173124 DOI: 10.3390/ijms25116180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Under different pathophysiological conditions, endothelial cells lose endothelial phenotype and gain mesenchymal cell-like phenotype via a process known as endothelial-to-mesenchymal transition (EndMT). At the molecular level, endothelial cells lose the expression of endothelial cell-specific markers such as CD31/platelet-endothelial cell adhesion molecule, von Willebrand factor, and vascular-endothelial cadherin and gain the expression of mesenchymal cell markers such as α-smooth muscle actin, N-cadherin, vimentin, fibroblast specific protein-1, and collagens. EndMT is induced by numerous different pathways triggered and modulated by multiple different and often redundant mechanisms in a context-dependent manner depending on the pathophysiological status of the cell. EndMT plays an essential role in embryonic development, particularly in atrioventricular valve development; however, EndMT is also implicated in the pathogenesis of several genetically determined and acquired diseases, including malignant, cardiovascular, inflammatory, and fibrotic disorders. Among cardiovascular diseases, aberrant EndMT is reported in atherosclerosis, pulmonary hypertension, valvular disease, fibroelastosis, and cardiac fibrosis. Accordingly, understanding the mechanisms behind the cause and/or effect of EndMT to eventually target EndMT appears to be a promising strategy for treating aberrant EndMT-associated diseases. However, this approach is limited by a lack of precise functional and molecular pathways, causes and/or effects, and a lack of robust animal models and human data about EndMT in different diseases. Here, we review different mechanisms in EndMT and the role of EndMT in various cardiovascular diseases.
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Affiliation(s)
- Aman Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (A.S.); (K.S.B.); (H.C.N.); (J.C.F.)
| | - Kriti S. Bhatt
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (A.S.); (K.S.B.); (H.C.N.); (J.C.F.)
| | - Hien C. Nguyen
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (A.S.); (K.S.B.); (H.C.N.); (J.C.F.)
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
| | - Jefferson C. Frisbee
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (A.S.); (K.S.B.); (H.C.N.); (J.C.F.)
| | - Krishna K. Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (A.S.); (K.S.B.); (H.C.N.); (J.C.F.)
- Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
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2
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Zhou MX, Viozzi CF, Heneberk O, Lee SK, Klarich KW, Salinas TJ. Oral Health Clearance Outcomes for Cardiovascular Surgery. Mayo Clin Proc Innov Qual Outcomes 2024; 8:121-130. [PMID: 38384717 PMCID: PMC10879629 DOI: 10.1016/j.mayocpiqo.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Objective To determine the risk of morbidity and mortality in patients receiving dental extractions before planned cardiovascular surgery (CVS) and examine factors that may affect the chance of oral health clearance. Patients and Methods A retrospective medical record review was performed of patients who underwent dental screening before CVS from January 1, 2015, to December 31, 2021, at a major medical institution. A total of 496 patients met the inclusion criteria and were divided into 2 groups. Group 1 patients were cleared to advance to planned CVS (n=390). Group 2 patients were not cleared for surgery and subsequently underwent dental extractions before planned CVS (n=106). Results Six patients (5.7%) experienced postoperative complications after dental extraction that resulted in an emergency room visit. No deaths occurred after dental extraction before CVS. However, 4 patients died within 30 days of CVS, 3 from Group 1 (0.77%) and 1 from Group 2 (0.94%). Dental extraction before planned CVS showed a borderline significant association with death based on unadjusted (P=.06) and age-adjusted analysis (P=.05). Patients who reported seeing a dentist routinely had a significantly higher chance of oral health clearance (P <.001). No differences were noted between the 2 groups with regard to age, sex, or 30-day hospital readmission rate. Conclusion Patients who had dental extractions completed before planned CVS may be at an increased risk of mortality. Further studies are needed to examine this relationship. Emphasis should be on prioritization of routine dental visits before planned CVS.
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Affiliation(s)
- Miao Xian Zhou
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | | | - Ondřej Heneberk
- Department of Dentistry, University Hospital, Hradec Kralove, Czech Republic
| | - Sarah K. Lee
- Department of Dental Specialties, Mayo Clinic, Rochester, MN
| | - Kyle W. Klarich
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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3
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Sane VD, Ranade A, Nair VS, Sane RV, Kadam P, Bhosale N. Role of Prophylactic Dose of Oral Amoxicillin Trihydrate in Prevention of Bacteremia Post Surgical Removal of Impacted Mandibular Third Molar: A Clinical Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2907-2912. [PMID: 37974866 PMCID: PMC10645961 DOI: 10.1007/s12070-023-03883-2] [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: 08/13/2022] [Accepted: 05/08/2023] [Indexed: 11/19/2023] Open
Abstract
The current study is designed to evaluate the efficacy of pre-operative prophylactic antibiotic for prevention of bacteremia after surgical removal of impacted mandibular third molar SRIMTM. The study was carried out as an open clinical trial. Fifty patients who fulfilled the criteria were included. Twenty five randomly selected patients (study group) were administered two grams oral dose of amoxicillin trihydrate, one hour prior to the procedure. Twenty five patients (control group) were not administered any antibiotic prior to the procedure. All patients underwent surgical removal of impacted mandibular third molar through intraoral approach under local anesthesia. Blood culture for detection of aerobic and anaerobic micro-organisms was done for all 50 patients. Eleven out of the twenty five patients (44%) in the control group showed positive growth, including mixed growth (aerobic and anaerobic). Seven patients showed purely anaerobic, 2 patients purely aerobic and two mixed growth. In the study (antibiotic) group, 7 out of the 25 patients (28%) showed positive growth, including mixed growth. Three patients showed purely anaerobic, 2 patients purely aerobic and 2 mixed type of growth. The study suggests that the judicious use of antibiotic prophylaxis, in conjunction with optimal oral health care serves to minimize the adverse effects of antibiotic therapy; and at the same time reduce the significant morbidity and mortality associated with systemic infections that might occur due to bacteremia resulting from surgical procedures of the oral cavity.
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Affiliation(s)
- Vikrant Dilip Sane
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to Be University) Dental College and Hospital, Katraj, Pune, 411043 India
| | | | - Vivek Sunil Nair
- Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth (Deemed to Be University) Dental College and Hospital, Katraj, Pune, 411043 India
| | - Rashmi Vikrant Sane
- Department of Oral Medicine and Radiology, Bharati Vidyapeeth (Deemed to Be University) Dental College and Hospital, Pune, India
| | - Pankaj Kadam
- Department of Prosthodontics, Crown and Bridge, Bharati Vidyapeeth (Deemed to Be University) Dental College and Hospital, Pune, India
| | - Nishita Bhosale
- Department of Periodontology and Implantology, Bharati Vidyapeeth (Deemed to Be University) Dental College and Hospital, Pune, India
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Brookes Z, McGrath C, McCullough M. Antimicrobial Mouthwashes: An Overview of Mechanisms-What Do We Still Need to Know? Int Dent J 2023; 73 Suppl 2:S64-S68. [PMID: 37867063 PMCID: PMC10690552 DOI: 10.1016/j.identj.2023.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/24/2023] Open
Abstract
This narrative literature review is the first in a 6-section supplement on the role of mouthwashes in oral care. This introduction briefly summarises current knowledge on antimicrobial mechanisms, relating to some of the most common over-the-counter mouthwash products available worldwide: chlorhexidine, hydrogen peroxide, cetylpyridinium chloride, povidone iodine, and essential oils. The aim of this first article is to describe how mouthwashes "kill" pathogenic microbes when used adjunctively and thus provide a basis for their widespread use to manage key oral diseases, namely caries, gingivitis, and periodontal disease. This article therefore sets the scene for subsequent, more detailed exploration of mouthwashes regarding their clinical effectiveness, impact on the oral microbiome, and possible effects on systemic health as well as natural alternatives and future directions. Other than the clinical effectiveness (for certain agents) of mouthwashes, on many topics there remains insufficient evidence for systematic review or formulation of robust national guidelines. The supplement, therefore, compiled by an international task team, is aimed at general dental practitioners across the globe, as an easy-to-read guide for helping to advise patients on mouthwash use based on the current best available evidence.
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Affiliation(s)
- Zoë Brookes
- Peninsula Dental School, Plymouth University, Plymouth, UK.
| | - Colman McGrath
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Michael McCullough
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
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Predictors of mortality of Staphylococcus aureus bacteremia among patients hospitalized in a Swiss University Hospital and the role of early source control; a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:347-357. [PMID: 36729318 PMCID: PMC9892677 DOI: 10.1007/s10096-023-04557-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
S. aureus bacteremia is associated with high mortality. The aim was to identify predictors of mortality among patients with S. aureus bacteremia and evaluate the role of early source control. This retrospective study was conducted at the Lausanne University Hospital, Switzerland. All episodes of S. aureus bacteremia among adult patients from 2015 to 2021 were included. During the study period, 839 episodes of S. aureus bacteremia were included, of which 7.9% were due to methicillin-resistant isolates. Bacteremias were related to bone or joint infections (268; 31.9%), followed by bacteremia of unknown origin (158; 18.8%), proven endocarditis (118; 14.1%) and lower-respiratory tract infections (79; 9.4%). Overall 28-day mortality was 14.5%. Cox multivariate regression model showed that Charlson comorbidity index > 5 (P < 0.001), nosocomial bacteremia (P 0.019), time to blood culture positivity ≤ 13 h (P 0.004), persistent bacteremia for ≥ 48 h (P 0.004), sepsis (P < 0.001), bacteremia of unknown origin (P 0.036) and lower respiratory tract infection (P < 0.001) were associated with 28-day mortality, while infectious diseases consultation within 48 h from infection onset (P < 0.001) was associated with better survival. Source control was warranted in 575 episodes and performed in 345 episodes (60.0%) within 48 h from infection onset. Results from a second multivariate analysis confirmed that early source control (P < 0.001) was associated with better survival. Mortality among patients with S. aureus bacteremia was high and early source control was a key determinant of outcome. Infectious diseases consultation within 48 h played an important role in reducing mortality.
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van der Vaart TW, Heerschop LL, Bouma BJ, Freudenburg W, Bonten MJM, Prins JM, van der Meer JTM. Value of diagnosing immunological phenomena in patients with suspected endocarditis. Infection 2022; 51:705-713. [DOI: 10.1007/s15010-022-01954-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Purpose
Immunological phenomena are a minor criteria in the modified Duke Criteria for endocarditis. Given the changes in epidemiology and diagnostics, the added value of determining these phenomena in today’s patients with suspected endocarditis is unknown.
Methods
In a retrospective cohort study of all patients with suspected endocarditis admitted to our hospital and discussed in our endocarditis team, we determined the proportion of patients classified as definite endocarditis because of either positive IgM rheumatoid factor (IgM RF), haematuria, or Roth’s spots on ophthalmology consultation. We also determined diagnostic accuracy of each of these immunological phenomena separately and combined.
Results
Of 285 patients included, 138 (48%) had definite endocarditis and at least one immunological test was performed in 222 patients (78%). Elevated IgM RF was found in 22 of 126 patients tested (17%), haematuria in 78 of 196 tested (40%) and Roth’s spots in six of 120 tested (5%). Eighteen of 138 patients with definite IE (13%) were classified as such because of a positive IgM RF, haematuria or Roth’s spots. Haematuria had the highest sensitivity: 50.5% (95% CI 40.4–60.6) and Roth’s spots the highest specificity: 98.3% (95% CI 90.8–99.9). The diagnostic accuracy results were robust in a sensitivity analysis aimed at avoiding incorporation bias.
Conclusion
Among patients with a clinical suspicion of endocarditis, recommended systematic testing for immunological phenomena helped classify more patients as definite IE and is useful to confirm the diagnosis of endocarditis.
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Dreyfuss I, Ramnot A, Jean-Pierre PH, French F, Hernandez L, Nouri K. Review of the Current Antibiotic Guidelines used in Dermatologic Surgery. Dermatol Ther 2022; 35:e15557. [PMID: 35524368 DOI: 10.1111/dth.15557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
Antibiotics have been used as a prophylaxis for dermatologic procedures. We will review the various procedures that specific antibiotics with dosages are used for, depending on the procedure, diagnosis, and circumstance of the patient. We will examine the current and updated guidelines used in dermatologic surgery and the overlapping guidelines across other fields. Physicians must consider the side effects of antibiotics and the resistance that may occur as a result before using the class or level of prophylaxis. Initial evaluation for alcohol, chlorhexidine or iodine should be measured as well. Updated guidelines aim to address the contraindications of antibiotics, yet further research is needed to avoid antibiotic resistance and to explore alternative methods of antibiotic application, such as intranasal and intravenous. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Isabella Dreyfuss
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
| | - Amanda Ramnot
- Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine
| | - Philippe H Jean-Pierre
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Fabio French
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine
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8
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Lindberg H, Löfström E, Rasmussen M. Risk stratification score screening for infective endocarditis in patients with Gram-positive bacteraemia. Infect Dis (Lond) 2022; 54:488-496. [DOI: 10.1080/23744235.2022.2049360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Helena Lindberg
- Department of Infectious Diseases, Hospital of Halland, Halmstad, Sweden
| | - Emma Löfström
- Department of Clinical Microbiology, Hospital of Halland, Halmstad, Sweden
| | - Magnus Rasmussen
- Division of Infection, Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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9
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Papadimitriou-Olivgeris M, Monney P, Mueller L, Senn L, Guery B. The LAUsanne STAPHylococcus aureus ENdocarditis (LAUSTAPHEN) score: A prediction score to estimate initial risk for infective endocarditis in patients with S. aureus bacteremia. Front Cardiovasc Med 2022; 9:961579. [PMID: 36568565 PMCID: PMC9780492 DOI: 10.3389/fcvm.2022.961579] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Infective endocarditis (IE) is a common complication of Staphylococcus aureus bacteremia (SAB). The study aimed to develop and validate a prediction score to determine IE risk among SAB. Methods This retrospective study included adults with SAB (2015-2021) and divided them into derivation and validation cohorts. Using the modified 2015 European Society of Cardiology modified Duke Criteria for definite IE, the LAUSTAPHEN score was compared to previous scores. Results Among 821 SAB episodes, 419 and 402 were divided into derivation and validation cohorts, respectively. Transthoracic and transoesophageal echocardiography (TOE) were performed in 77.5 and 42.1% of episodes, respectively. Definite IE was diagnosed in 118 episodes (14.4%). Derivation cohort established that cardiac predisposing factors, such as cardiac implantable electronic devices, prolonged bacteremia ≥48 h, and vascular phenomena were independently associated with IE. In addition to those parameters, native bone and joint infections were used to constitute the LAUSTAPHEN score. LAUSTAPHEN and VIRSTA scores misclassified <4% of IE cases as low risk. Misclassification using POSITIVE and PREDICT scores was >10%. The number of TOEs required to safely exclude IE were 66.9 and 51.6% with VIRSTA and LAUSTAPHEN, respectively. Discussion LAUSTAPHEN and VIRSTA scores exhibited the lowest misclassification rate of IE cases to the low-risk group. However, the number of patients requiring TOE was higher for VIRSTA than for LAUSTAPHEN.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- *Correspondence: Matthaios Papadimitriou-Olivgeris
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Linda Mueller
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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van der Vaart TW, Prins JM, Soetekouw R, van Twillert G, Veenstra J, Herpers BL, Rozemeijer W, Jansen RR, Bonten MJM, van der Meer JTM. Prediction rules for ruling out endocarditis in patients with Staphylococcus aureus bacteremia. Clin Infect Dis 2021; 74:1442-1449. [PMID: 34272564 PMCID: PMC9049276 DOI: 10.1093/cid/ciab632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background Staphylococcus aureus bacteremia (SAB) is in 10% to 20% of cases complicated by infective endocarditis. Clinical prediction scores may select patients with SAB at highest risk for endocarditis, improving the diagnostic process of endocarditis. We compared the accuracy of the Prediction Of Staphylococcus aureus Infective endocarditiseTime to positivity, Iv drug use, Vascular phenomena, preExisting heart condition (POSITIVE), Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT), and VIRSTA scores for classifying the likelihood of endocarditis in patients with SAB. Methods Between August 2017 and September 2019, we enrolled consecutive adult patients with SAB in a prospective cohort study in 7 hospitals in the Netherlands. Using the modified Duke Criteria for definite endocarditis as reference standard, sensitivity, specificity, negative predictive (NPV), and positive predictive values were determined for the POSITIVE, PREDICT, and VIRSTA scores. An NPV of at least 98% was considered safe for excluding endocarditis. Results Of 477 SAB patients enrolled, 33% had community-acquired SAB, 8% had a prosthetic valve, and 11% a cardiac implantable electronic device. Echocardiography was performed in 87% of patients, and 42% received transesophageal echocardiography (TEE). Eighty-seven (18.2%) had definite endocarditis. Sensitivity was 77.6% (65.8%–86.9%), 85.1% (75.8%–91.8%), and 98.9% (95.7%–100%) for the POSITIVE (n = 362), PREDICT, and VIRSTA scores, respectively. NPVs were 92.5% (87.9%–95.8%), 94.5% (90.7%–97.0%), and 99.3% (94.9%–100%). For the POSITIVE, PREDICT, and VIRSTA scores, 44.5%, 50.7%, and 70.9% of patients with SAB, respectively, were classified as at high risk for endocarditis. Conclusions Only the VIRSTA score had an NPV of at least 98%, but at the expense of a high number of patients classified as high risk and thus requiring TEE. Clinical Trials Registration Netherlands Trial Register code 6669.
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Affiliation(s)
- Thomas W van der Vaart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Robin Soetekouw
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Gitte van Twillert
- Department of Internal Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Jan Veenstra
- Department of Internal Medicine, OLVG, Amsterdam, The Netherlands
| | - Bjorn L Herpers
- Department of Medical Microbiology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Wouter Rozemeijer
- Department of Medical Microbiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Rogier R Jansen
- Department of Medical Microbiology, OLVG, Amsterdam, The Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan T M van der Meer
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Hubers SA, DeSimone DC, Gersh BJ, Anavekar NS. Infective Endocarditis: A Contemporary Review. Mayo Clin Proc 2020; 95:982-997. [PMID: 32299668 DOI: 10.1016/j.mayocp.2019.12.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
Infective endocarditis (IE), initially described more than 350 years ago, involves infection of the endocardial surface of the heart. The clinical manifestations of IE can involve every organ system, and the cardiac manifestations can include valvular vegetation, abscess, periannular extension of infection, and myopericarditis. Echocardiography is crucial in the diagnosis of IE, but alternative imaging modalities are playing an increasing role in the diagnosis and management of IE. Multidisciplinary care is imperative to the management of IE, often requiring the expertise of cardiologists, cardiothoracic surgeons, infectious diseases specialists, radiologists, and neurologists. We performed a literature search of the PubMed database from January 1st, 2000, to September 30th, 2019, using the terms infective endocarditis, diagnosis, and management to find the most pertinent and highest-quality evidence. This review summarizes key aspects of IE, with a focus on emerging advances in diagnosis. We also highlight growing patient populations at risk for IE, including patients with intracardiac devices and congenital heart disease.
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Affiliation(s)
- Scott A Hubers
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN.
| | - Daniel C DeSimone
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN; Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Bernard J Gersh
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
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12
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Packyanathan JS, Rani Juneius CE, Vinoth M. Recent Antibiotics Used in Dental Disease Management. Microb Biotechnol 2018. [DOI: 10.1007/978-981-10-7140-9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Dayer M, Thornhill M. Is antibiotic prophylaxis to prevent infective endocarditis worthwhile? J Infect Chemother 2017; 24:18-24. [PMID: 29107651 DOI: 10.1016/j.jiac.2017.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 02/06/2023]
Abstract
Infective endocarditis (IE) is a rare condition which is associated with considerable morbidity and mortality. Almost 100 years ago, the links between endocarditis and procedures, particularly dental procedures, were postulated. Over 50 years ago the first guidelines recommending antibiotic prophylaxis (AP), with the aim of preventing IE developing after procedures, were proposed. However, there has only ever been circumstantial evidence in humans that AP prevents IE. The rarity of IE has made a randomised controlled clinical trial impractical to date. This article outlines the history of AP and reviews the evidence base for the use of AP to prevent IE.
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Affiliation(s)
- Mark Dayer
- Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton TA1 5DA, United Kingdom.
| | - Martin Thornhill
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield, School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TA, United Kingdom
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Rademacher WMH, Walenkamp GHIM, Moojen DJF, Hendriks JGE, Goedendorp TA, Rozema FR. Antibiotic prophylaxis is not indicated prior to dental procedures for prevention of periprosthetic joint infections. Acta Orthop 2017; 88. [PMID: 28639846 PMCID: PMC5560223 DOI: 10.1080/17453674.2017.1340041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - To minimize the risk of hematogenous periprosthetic joint infection (HPJI), international and Dutch guidelines recommended antibiotic prophylaxis prior to dental procedures. Unclear definitions and contradictory recommendations in these guidelines have led to unnecessary antibiotic prescriptions. To formulate new guidelines, a joint committee of the Dutch Orthopaedic and Dental Societies conducted a systematic literature review to answer the following question: can antibiotic prophylaxis be recommended for patients (with joint prostheses) undergoing dental procedures in order to prevent dental HPJI? Methods - The Medline, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs), reviews, and observational studies up to July 2015. Studies were included if they involved patients with joint implants undergoing dental procedures, and either considered HPJI as an outcome measure or described a correlation between HPJI and prophylactic antibiotics. A guideline was formulated using the GRADE method and AGREE II guidelines. Results - 9 studies were included in this systematic review. All were rated "very low quality of evidence". Additional literature was therefore consulted to address clinical questions that provide further insight into pathophysiology and risk factors. The 9 studies did not provide evidence that use of antibiotic prophylaxis reduces the incidence of dental HPJI, and the additional literature supported the conclusion that antibiotic prophylaxis should be discouraged in dental procedures. Interpretation - Prophylactic antibiotics in order to prevent dental HPJI should not be prescribed to patients with a normal or an impaired immune system function. Patients are recommended to maintain good oral hygiene and visit the dentist regularly.
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Affiliation(s)
- Willem M H Rademacher
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA);,Correspondence:
| | - Geert H I M Walenkamp
- Department of Orthopedic Surgery and Research Institute CAPHRI, Maastricht University Medical Centre, Maastricht
| | | | - Johannes G E Hendriks
- Department of Orthopaedics Greater Eindhoven, Máxima Medical Centre and Catharina Hospital, Eindhoven
| | | | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA)
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Nieman AE, Savelkoul PHM, Beishuizen A, Henrich B, Lamik B, MacKenzie CR, Kindgen-Milles D, Helmers A, Diaz C, Sakka SG, Schade RP. A prospective multicenter evaluation of direct molecular detection of blood stream infection from a clinical perspective. BMC Infect Dis 2016; 16:314. [PMID: 27364885 PMCID: PMC4928256 DOI: 10.1186/s12879-016-1646-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/10/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rapid diagnosis and appropriate antimicrobial therapy are of major importance to decrease morbidity and mortality in patients with blood stream infections (BSI). Blood culture, the current gold standard for detecting bacteria in blood, requires at least 24-48 hours and has limited sensitivity if obtained during antibiotic treatment of the patient. The aim of this prospective multicenter study was to clinically evaluate the application of a commercial universal 16S/18S rDNA PCR, SepsiTest™ (PCR-ST), directly on whole blood. METHODS In total 236 samples from 166 patients with suspected sepsis were included in the study. PCR-ST results were compared to blood culture, the current gold standard for detecting BSI. Because blood cultures can give false-negative results, we performed an additional analysis to interpret the likelihood of bloodstream infection by using an evaluation based on clinical diagnosis, other diagnostic tests and laboratory parameters. RESULTS Clinical interpretation of results defined the detected organism to be contaminants in 22 of 43 positive blood cultures (51.2 %) and 21 of 47 positive PCR-ST results (44.7 %). Excluding these contaminants resulted in an overall sensitivity and specificity of the PCR-ST of 66.7 and 94.4 % respectively. Of the 36 clinically relevant samples, 11 BSI were detected with both techniques, 15 BSI were detected with PCR-ST only and 10 with blood culture only. Therefore, in this study, SepsiTest™ detected an additional 71 % BSI compared to blood culture alone. CONCLUSIONS More clinically relevant BSI were diagnosed by molecular detection, which might influence patient treatment. An improved SepsiTest™ assay suited for routine use can have additional value to blood culture in diagnosing bacteremia in septic patients.
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Affiliation(s)
- A. E. Nieman
- />Department of Medical Microbiology and Infection control, VU University Medical Center, Amsterdam, The Netherlands
- />Laboratory for Medical Microbiology, Immunology and Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - P. H. M. Savelkoul
- />Department of Medical Microbiology and Infection control, VU University Medical Center, Amsterdam, The Netherlands
- />Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A. Beishuizen
- />Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
- />Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - B. Henrich
- />Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - B. Lamik
- />Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - C. R. MacKenzie
- />Institute of Medical Microbiology and Hospital Hygiene, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - D. Kindgen-Milles
- />Department of Anesthesiology, University Clinic of Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - A. Helmers
- />Department of Microbiology, Merheim Zentrallabor, MVZ synlab Leverkusen GmbH, Leverkusen, Germany
| | - C. Diaz
- />Department of Microbiology, Merheim Zentrallabor, MVZ synlab Leverkusen GmbH, Leverkusen, Germany
| | - S. G. Sakka
- />Department of Anesthesiology and Intensive Care Medicine, Medical Center Cologne-Merheim, University Witten/Herdecke, Cologne, Germany
| | - R. P. Schade
- />Department of Medical Microbiology and Infection control, VU University Medical Center, Amsterdam, The Netherlands
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Dayer M, Thornhill M. Antibiotic Prophylaxis Guidelines and Infective Endocarditis. J Am Coll Cardiol 2015; 65:2077-8. [DOI: 10.1016/j.jacc.2015.03.535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
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Bacteremia after Endoscopic Submucosal Excavation for Treating the Gastric Muscular Layer Tumors. Gastroenterol Res Pract 2015; 2015:306938. [PMID: 26060492 PMCID: PMC4427819 DOI: 10.1155/2015/306938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/23/2015] [Indexed: 12/16/2022] Open
Abstract
Background. The bacteremia is reported as being infrequent and transient in gastric EMR and ESD for treating gastric mucosa lesions or superficial gastric neoplastic lesion. There was no report of it being investigated in ESD for treating gastric muscular layer tumors (endoscopic submucosal excavation, ESE). This study aimed to determine the frequency of bacteremia in gastric ESE. Patients and Methods. A prospective study, in 122 consecutive patients who underwent gastric ESE for treating gastric muscular layer tumors, investigated the frequency of bacteremia before and 15 minutes after the procedure. Results. The median time for the total ESE procedure was 29 min (range from 8 to 62 min). The mean size of the biggest diameter of each resected specimen was 10 ± 2.7 mm (range from 5 mm to 30 mm). Blood cultures obtained before ESE were positive in 0% (0/122) of cases. Blood cultures obtained 15 min after ESE were positive in 2.5% (3/122) of cases. Six blood samples contained Staphylococcus with coagulase negative, which was considered contaminant. No signs of sepsis were seen in all patients. Conclusions. The frequency of bacteremia after gastric ESE was low. ESE for treating gastric lesions is thought to have a low risk of infectious complications; therefore, prophylactic administration of antibiotics may not be warranted.
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Dental implants in patients at high risk for infective endocarditis: a preliminary study. Int J Oral Maxillofac Surg 2014; 43:1282-5. [DOI: 10.1016/j.ijom.2014.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/27/2014] [Accepted: 04/16/2014] [Indexed: 11/17/2022]
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TRENTO CL, MENEZES JÚNIOR LR, SIQUEIRA ADS, TAKESHITA WM. Avaliação do conhecimento de Cirurgiões-Dentistas e acadêmicos de Odontologia na cidade de Aracaju, Sergipe, a respeito da adequada prescrição de antimicrobianos. REVISTA DE ODONTOLOGIA DA UNESP 2014. [DOI: 10.1590/rou.2014.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: Os antimicrobianos são caracterizados como um dos mais notáveis exemplos do avanço da Medicina moderna. Contudo, a adaptabilidade dos microrganismos propicia resistência a determinados antimicrobianos.OBJETIVO: Apresentar, por meio de pesquisa realizada com alunos do curso de Odontologia e Cirurgiões-Dentistas na cidade de Aracaju-SE, um perfil do conhecimento destes sobre antibioticoterapia, propondo oferecer uma oportunidade de identificar e reconhecer os riscos relacionados à administração incorreta destes fármacos.MATERIAL E MÉTODO: Investigação observacional, transversal, com base em um questionário respondido por 80 alunos do curso de Odontologia e 50 Cirurgiões-Dentistas, escolhidos de forma aleatória, para verificar o conhecimento sobre o tema proposto.RESULTADO: Dentre os entrevistados, aproximadamente 40% eram profissionais e 60% acadêmicos de Odontologia; destes, cerca de 40% relataram que prescrevem utilizando como critério de seleção que o antimicrobiano seja seletivo e bactericida, enquanto que 90% dos entrevistados afirmam prescrever antibiótico somente quando necessário, como forma de evitar a resistência bacteriana.CONCLUSÃO: De acordo com a metodologia empregada, pode-se concluir que os dois grupos mostraram desconhecimento sobre a diferença entre antibioticoterapia, profilaxia antimicrobiana e terapêutica medicamentosa.
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Chidambaram R. Final thoughts on antibiotic use: wake up call for the oral health care professionals. Asian Pac J Trop Biomed 2014. [DOI: 10.12980/apjtb.4.2014apjtb-2014-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Chen A, Haddad F, Lachiewicz P, Bolognesi M, Cortes LE, Franceschini M, Gallo J, Glynn A, Gonzalez Della Valle A, Gahramanov A, Khatod M, Lazarinis S, Lob G, Nana A, Ochsner P, Tuncay I, Winkler T, Zeng Y. Prevention of late PJI. J Arthroplasty 2014; 29:119-28. [PMID: 24370487 DOI: 10.1016/j.arth.2013.09.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Young H, Hirsh J, Hammerberg EM, Price CS. Dental disease and periprosthetic joint infection. J Bone Joint Surg Am 2014; 96:162-8. [PMID: 24430417 DOI: 10.2106/jbjs.l.01379] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ The number of patients with end-stage osteoarthritis is increasing, and treatment with hip and knee arthroplasty is expected to increase over the next several decades. ➤ Dental disease has long been anecdotally associated with increased periprosthetic joint infections, although case-control studies do not support this relationship. ➤ While most recent guidelines for the prevention of endocarditis have favored treatment of fewer patients, the most recent recommendations for prevention of periprosthetic joint infection have increased the number of patients who would receive antibiotics before a dental procedure. ➤ Antibiotics given before a dental procedure decrease the risk of bacteremia from the oral cavity, but this is of uncertain clinical importance. ➤ The number of patients who would require antibiotics before dental procedures to prevent one periprosthetic joint infection greatly outnumbers the number of patients who would experience an adverse event associated with antibiotics given before a dental procedure.
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Affiliation(s)
- Heather Young
- Divisions of Infectious Diseases (H.Y. and C.S.P.) and Rheumatology (J.H.), Denver Health Medical Center, 777 Bannock Street, MC 4000, Denver CO 80204. E-mail address for H. Young:
| | - Joel Hirsh
- Divisions of Infectious Diseases (H.Y. and C.S.P.) and Rheumatology (J.H.), Denver Health Medical Center, 777 Bannock Street, MC 4000, Denver CO 80204. E-mail address for H. Young:
| | - E Mark Hammerberg
- Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, MC 0188, Denver CO 80204
| | - Connie S Price
- Divisions of Infectious Diseases (H.Y. and C.S.P.) and Rheumatology (J.H.), Denver Health Medical Center, 777 Bannock Street, MC 4000, Denver CO 80204. E-mail address for H. Young:
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Hanson K, Alexander B. Strategies for the prevention of infection after solid organ transplantation. Expert Rev Anti Infect Ther 2014; 4:837-52. [PMID: 17140359 DOI: 10.1586/14787210.4.5.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Infection is a frequent complication of organ transplantation and is associated with significant morbidity and mortality. Preventative antimicrobial strategies are a key component of the care received by transplant patients. This review summarizes the evidence supporting anti-infective prophylaxis in this setting. Specific recommendations for the prevention of bacterial, fungal, viral and parasitic infection after transplant are made, with a focus on recent developments in the field of transplant infectious diseases.
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Affiliation(s)
- Kimberly Hanson
- Duke University Medical Center, Division of Infectious Diseases and International Health, Duke Clinical Microbiology Laboratory, NC 27710, USA.
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24
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Chen A, Haddad F, Lachiewicz P, Bolognesi M, Cortes LE, Franceschini M, Gallo J, Glynn A, Della Valle AG, Gahramanov A, Khatod M, Lazarinis S, Lob G, Nana A, Ochsner P, Tuncay I, Winkler T, Zeng Y. Prevention of late PJI. J Orthop Res 2014; 32 Suppl 1:S158-71. [PMID: 24464891 DOI: 10.1002/jor.22561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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25
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Protective effects of human lactoferrin during Aggregatibacter actinomycetemcomitans-induced bacteremia in lactoferrin-deficient mice. Antimicrob Agents Chemother 2013; 58:397-404. [PMID: 24189260 DOI: 10.1128/aac.00020-13] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Aggregatibacter actinomycetemcomitans, a periodontopathogen, has been associated with several systemic diseases. Herein, we report the protective effect of human lactoferrin (hLF) during A. actinomycetemcomitans bacteremia in lactoferrin knockout (LFKO(-/-)) mice. The prophylactic, concurrent, and therapeutic intravenous (i.v.) administrations of hLF significantly cleared the bacteria from blood and organs. Nevertheless, all modes of hLF administration significantly decreased the concentrations of serum proinflammatory cytokines, such as interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), IL-6, IL-10, and IL-12p70. Additionally, hLF administration significantly decreased hepatic and splenic proinflammatory cytokine expression levels compared to those in the non-hLF-treated group. Furthermore, administration of hLF decreased the serum C-reactive protein level, inducible nitric oxide synthase (iNOS) and myeloperoxidase (MPO) gene expression levels in liver and spleen. hLF treatment has also resulted in a 6-fold decrease in spleen weight with the migration of typical inflammatory cells in infected mice as a result of decreased inflammatory response. These results reveal that hLF protects against A. actinomycetemcomitans bacteremia, as indicated by rapid bacterial clearance and decreased host proinflammatory mediators.
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Ramu C, Padmanabhan TV. Indications of antibiotic prophylaxis in dental practice- review. Asian Pac J Trop Biomed 2012; 2:749-54. [PMID: 23570007 PMCID: PMC3609373 DOI: 10.1016/s2221-1691(12)60222-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 01/22/2012] [Accepted: 03/14/2012] [Indexed: 11/24/2022] Open
Abstract
Antibiotics are frequently used in dental practice. Clinical and bacteriological epidemiological factors determine the indications of antibiotics in dentistry. Antibiotics are used in addition to appropriate treatment to aid the host defences in the elimination of remaining bacteria. It is indicated when there is evidence of clinical sign involvement and spread of infection. Antibiotics are prescribed in dental practice for treating odontoge nic infections, non-odontogenic infections, as prophylaxis against focal and local infection. Special care needs to be addressed to patients with organ transplants, poorly controlled diabetes and pregnancy. Antibiotics should be used only as an adjunct to dental treatment and never alone as the first line of care. The present paper reviews the indications of antibiotics in dental practice.
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Affiliation(s)
- C Ramu
- *Corresponding author: Dr. C Ramu, MDS, Senior lecturer, Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra University,Porur, Chennai-600116, India. Tel: +919442322777 E-mail:
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Inchingolo F, Tatullo M, Abenavoli FM, Marrelli M, Inchingolo AD, Scacco S, Papa F, Inchingolo AM, Dipalma G. Odontostomatologic management of patients receiving oral anticoagulant therapy: a retrospective multicentric study. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2011; 5:5. [PMID: 21771331 PMCID: PMC3160425 DOI: 10.1186/1750-1164-5-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/19/2011] [Indexed: 11/12/2022]
Abstract
Introduction Today, we frequently find patients taking oral anticoagulant therapy (OAT), a prophylaxis against the occurrence of thromboembolic events. An oral surgeon needs to know how to better manage such patients, in order to avoid hemorrhagic and thromboembolic complications. Materials and methods A group of 193 patients (119 men aged between 46 and 82 and 74 women aged between 54 and 76) undergoing OAT for more than 5 years were managed with a standardized management protocol and a 2-months follow-up. The aim of the present study was to apply a protocol, which could provide a safe intra- and postoperative management of patients on OAT. Results Among the 193 patients, only 2 had postoperative complications. Conclusions We think that the protocol used in the present study can be used for complete safety in the treatment of this type of patients.
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Induction of experimental endocarditis by continuous low-grade bacteremia mimicking spontaneous bacteremia in humans. Infect Immun 2011; 79:2006-11. [PMID: 21321073 DOI: 10.1128/iai.01208-10] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Transient high-grade bacteremia following invasive procedures carries a risk of infective endocarditis (IE). This is supported by experimental endocarditis. On the other hand, case-control studies showed that IE could be caused by cumulative exposure to low-grade bacteremia occurring during daily activities. However, no experimental demonstration of this latter possibility exists. This study investigated the infectivity in animals of continuous low-grade bacteremia compared to that of brief high-grade bacteremia. Rats with aortic vegetations were inoculated with Streptococcus intermedius, Streptococcus gordonii or Staphylococcus aureus (strains Newman and P8). Animals were challenged with 10(3) to 10(6) CFU. Identical bacterial numbers were given by bolus (1 ml in 1 min) or continuous infusion (0.0017 ml/min over 10 h). Bacteremia was 50 to 1,000 times greater after bolus than during continuous inoculation. Streptococcal bolus inoculation of 10(5) CFU infected 63 to 100% vegetations compared to 30 to 71% infection after continuous infusion (P > 0.05). When increasing the inoculum to 10(6) CFU, bolus inoculation infected 100% vegetations and continuous infusion 70 to 100% (P > 0.05). S. aureus bolus injection of 10(3) CFU infected 46 to 57% valves. This was similar to the 53 to 57% infection rates produced by continuous infusion (P > 0.05). Inoculation of 10(4) CFU of S. aureus infected 80 to 100% vegetations after bolus and 60 to 75% after continuous infusion (P > 0.05). These results show that high-level bacteremia is not required to induce experimental endocarditis and support the hypothesis that cumulative exposure to low-grade bacteremia represents a genuine risk of IE in humans.
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Moalem J, Ruan DT, Farkas RL, Shen WT, Kebebew E, Duh QY, Clark OH. Patterns of Antibiotic Prophylaxis Use for Thyroidectomy and Parathyroidectomy: Results of an International Survey of Endocrine Surgeons. J Am Coll Surg 2010; 210:949-56. [DOI: 10.1016/j.jamcollsurg.2010.02.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/09/2010] [Accepted: 02/10/2010] [Indexed: 11/15/2022]
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Samson H, Berven L, Strand GV. Long-term effect of an oral healthcare programme on oral hygiene in a nursing home. Eur J Oral Sci 2009; 117:575-9. [PMID: 19758255 DOI: 10.1111/j.1600-0722.2009.00673.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This article reports on the long-term effect of an oral healthcare programme aimed at improving and maintaining the oral hygiene of elderly residents in a nursing home. The method was based on (i) motivation and oral-care training of the nursing staff, (ii) production of picture-based oral-care procedure cards, (iii) distribution of adequate oral-care equipment, (iv) practical implementation of new routines, and (v) assessment of results attained. The level of oral hygiene in the nursing home was assessed using the mucosal-plaque score (MPS) index. Overall evaluation was made before the start of the study, after 3 months, and eventually after 6 yr. Before implementation of the oral healthcare programme, 36% of the residents had an acceptable score. Six years later, the proportion was 70%. The evaluation showed that the introduction of such an oral healthcare programme significantly improved the oral hygiene of the residents on a long-term basis. However, 30% of the residents did not achieve an acceptable score because they were very ill or dying, aggressive or wanted to brush their teeth themselves.
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Affiliation(s)
- Heidi Samson
- Department of Clinical Dentistry - Gerodontology, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
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Al-Saeed MY, Babay N. The use of povidone-iodine and hydrogen peroxide mixture as an adjunct to non-surgical treatment of slight to moderate chronic periodontitis. Saudi Dent J 2009; 21:127-33. [PMID: 23960471 PMCID: PMC3723277 DOI: 10.1016/j.sdentj.2009.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 11/17/2008] [Accepted: 03/22/2009] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical effects of the adjunctive use of povidone-iodine with or without hydrogen peroxide as coolant and disinfectant during ultrasonic scaling and root planing in the treatment of chronic periodontitis. MATERIALS AND METHODS Sixteen patients initially participated in the study. Thirteen patients (8 males and 5 females) completed the 3-month follow-up period. Their mean (±SD) age was 42.92 ± 7.55 years. In each experimental subject, the mouth was split into four quadrants. A randomly selected quadrant was chosen to receive one of the three treatment group modalities which were: Group 1 - ultrasonic scaling and root planing plus irrigation with 1% povidone-iodine and 3.0% hydrogen peroxide mixture; Group 2 - ultrasonic scaling and root planing plus irrigation with 1% povidone-iodine; Group 3 - ultrasonic scaling and root planing plus irrigation with normal saline. The fourth quadrant served as a control group. RESULTS At the 3-month evaluation, there was no significant difference between the three treatment groups in terms of probing depth reduction, clinical attachment gain, gingival recession increase, reduction in the bleeding upon probing or plaque score reduction (P > 0.05). However, the three treatment groups had statistically significant higher mean reduction in the probing depth, gain in the clinical attachment level and reduction in the bleeding upon probing than the control group (P < 0.05). CONCLUSION There were no added benefits of using a mixture of povidone-iodine and hydrogen peroxide or povidone-iodine as disinfectants during ultrasonic scaling and root planing in the treatment of chronic periodontitis.
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Affiliation(s)
- Mohammed Y. Al-Saeed
- Dental Department, Qatif Central Hospital, P.O. Box 20052, Qatif 31911, Saudi Arabia
| | - Nadir Babay
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Gimeno García AZ, Parra Blanco A. [Gastrointestinal endoscopy. Is antibiotic prophylaxis indicated in patients with a metallic heart prosthesis scheduled to undergo therapeutic endoscopy?]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:466-7. [PMID: 18783696 DOI: 10.1157/13125597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Antonio Z Gimeno García
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Tenerife, España
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Mittnacht AJC, Fanshawe M, Konstadt S. Anesthetic Considerations in the Patient With Valvular Heart Disease Undergoing Noncardiac Surgery. Semin Cardiothorac Vasc Anesth 2008; 12:33-59. [DOI: 10.1177/1089253208316442] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Valvular heart disease can be an important finding in patients presenting for noncardiac surgery. Valvular heart disease and resulting comorbidity, such as heart failure or atrial fibrillation, significantly increase the risk for perioperative adverse events. Appropriate preoperative assessment, adequate perioperative monitoring, and early intervention, should hemodynamic disturbances occur, may help prevent adverse events and improve patient outcome. This review article aims to guide the practitioner in the various aspects of anesthetic management in the perioperative care of patients with valvular heart disease. The pharmacological approach to optimization of patient outcome with drugs, such as βblockers and lipid-lowering medications (statins), is an evolving field, and recent developments are discussed in this article.
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Affiliation(s)
| | | | - Steven Konstadt
- Department of Anesthesiology, Maimonides Medical Center, Brooklyn New York
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Poh KK, Yang H, Omar AR, Yip JWL, Chan YH, Ling LH. Clinically Compressed Digital Echocardiography: A Patient-safe Alternative to Videotape Review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2007. [DOI: 10.47102/annals-acadmedsg.v36n8p662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Introduction: Digital storage of echocardiographic data offers logistical advantages over videotape archival. However, limited information is available on the accuracy of clinically compressed digitised examinations, an important consideration for patient safety.
Materials and Methods: Transthoracic echocardiograms of 520 consecutive patients were prospectively acquired digitally and on videotape. Two echocardiologists, in consensus, reported studies in both formats sequentially. Using the videotape as a reference, the significance of any reported differences was graded from both imaging and clinical standpoints, and the reasons for these differences identified.
Results: From an imaging perspective, differences between digital and videotaped studies were absent or minor in 459 cases (88%), fairly significant in 55 (11%) and very significant in 6 (1%). The main reasons for the observed differences were inadequate acquisition of optimal views (59%), an insufficient number of acquired cardiac cycles (25%) and suboptimal image quality (9%). These differences were considered to be of possible or definite clinical importance in 21 (4%) and 8 (2%) cases, respectively. In multinominal logistic regression models, the only independent predictor of significant difference between digitised and videotaped images was study complexity. Regardless of case complexity, most diagnostic errors arising from digital review were attributable to technical failure rather than observer error.
Conclusions: The potential for important errors arising from exclusive reporting of clinically compressed digital echocardiograms is small. Digital echocardiography, as practiced in a routine clinical setting, offers a patient-safe alternative to videotape review.
Key words: Clinical implications, Digital echocardiography, Patient safety, Videotape
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Affiliation(s)
| | - Hong Yang
- National University of Singapore, Singapore
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Vasanthan A, Dallal N. Periodontal treatment considerations for cell transplant and organ transplant patients. Periodontol 2000 2007; 44:82-102. [PMID: 17474927 DOI: 10.1111/j.1600-0757.2006.00198.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Asvin Vasanthan
- Department of Periodontics, School of Dentistry, University of Missouri-Kansas City, USA
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Ferrieri GB, Castiglioni S, Carmagnola D, Cargnel M, Strohmenger L, Abati S. Oral Surgery in Patients on Anticoagulant Treatment Without Therapy Interruption. J Oral Maxillofac Surg 2007; 65:1149-54. [PMID: 17517299 DOI: 10.1016/j.joms.2006.11.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Revised: 09/08/2006] [Accepted: 11/15/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE Conflicting opinions exist in literature concerning the management of oral surgery in patients on oral anticoagulants because no consensus on perioperative protocols is available, including precise guidelines regarding the need for therapy modification or withdrawal. The aim of this study was to evaluate bleeding complications associated with oral surgery performed on patients on oral anticoagulants without therapy modification or withdrawal but following a standardized comprehensive perioperative management protocol. PATIENTS AND METHODS Patients on oral anticoagulant therapy with warfarin and in need of oral surgery underwent a thorough general and oral clinical evaluation to assess thromboembolic and bleeding risk; 255 subjects who, on the morning of surgery, had INR values <or=5.5 were included in the study. An atraumatic surgical technique was carried out and all patients received postoperative careful instructions. RESULTS Five cases (1.96%) of bleeding complication were observed in patients with moderate to high thromboembolic and bleeding risk. CONCLUSION The findings from this study suggest that a comprehensive perioperative management protocol for oral surgery in patients on oral anticoagulants including 1) thromboembolic and bleeding risk assessment, 2) an atraumatic surgical technique, and 3) postoperative careful instructions, can lead to safe and successful results with minimal complications.
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Levy MJ, Norton ID, Clain JE, Enders FB, Gleeson F, Limburg PJ, Nelson H, Rajan E, Topazian MD, Wang KK, Wiersema MJ, Wilson WR. Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions. Clin Gastroenterol Hepatol 2007; 5:684-9. [PMID: 17544995 DOI: 10.1016/j.cgh.2007.02.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Recent studies showed that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a low-risk procedure for causing bacteremia and infectious complications when sampling solid lesions of the upper gastrointestinal (GI) tract. As a result, antibiotics are not recommended for prophylaxis against endocarditis. Our aim was to prospectively evaluate the risk of bacteremia and other infectious complications in patients undergoing EUS FNA of lower GI tract lesions. METHODS Patients referred for EUS FNA of lower GI tract lesions were considered for enrollment. Patients were excluded if there was an indication for preprocedure antibiotic administration based on American Society for Gastrointestinal Endoscopy guidelines, had taken antibiotics within the prior 7 days, or if they had a cystic lesion. Blood cultures were obtained immediately before the procedure, after flexible sigmoidoscopy/radial EUS, and 15 minutes after EUS FNA. RESULTS One hundred patients underwent a total of 471 FNAs (mean, 4.7 FNAs/patient; range, 1-10 FNAs/patient). Blood cultures were positive in 6 patients. Cultures from 4 patients (4.0%, 95% confidence interval, 1.6%-9.8%) grew coagulase-negative Staphylococcus (n = 2), Peptostreptococcus stomatis (n = 1), or Moraxella (n = 1), which were considered contaminants. Two patients (2.0%, 95% confidence interval, 0.6%-7%) developed bacteremia: Bacteroides fragilis (n = 1) and Gemella morbillorum (n = 1). No signs or symptoms of infection developed in any patient. CONCLUSIONS EUS FNA of solid lesions in the lower GI tract should be considered a low-risk procedure for infectious complications that does not warrant prophylactic administration of antibiotics for the prevention of bacterial endocarditis.
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic Foundation, Rochester, Minnesota 55905, USA.
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40
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Vazirani S, Paige NM, Nouvong A, Aungst D. Evaluating and minimizing cardiac risk in surgical patients. Clin Podiatr Med Surg 2007; 24:261-83. [PMID: 17430770 DOI: 10.1016/j.cpm.2006.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular complications are a major cause of postoperative morbidity and mortality. Proper assessment of risk and subsequent interventions can help diminish these complications. Assessing the patient's risk is based on the type of surgery performed and on individual patient characteristics. The latter can be established with a thorough history and physical, laboratory testing, risk indices, and cardiology studies.
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Affiliation(s)
- Sondra Vazirani
- Department of Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine-UCLA, 11301 Wilshire Boulevard, 10H1/111, Los Angeles, CA 90073, USA.
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41
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Rustemeyer J, Bremerich A. Necessity of surgical dental foci treatment prior to organ transplantation and heart valve replacement. Clin Oral Investig 2007; 11:171-4. [PMID: 17431693 DOI: 10.1007/s00784-007-0101-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2006] [Accepted: 01/15/2007] [Indexed: 10/23/2022]
Abstract
Diagnosis and surgical treatment of septic foci (e.g., apical or marginal and profound periodontitis, cysts, unrestorable teeth, or abscesses) in patients awaiting organ transplants and heart valve replacement (HVR) have become a recommended, yet controversial standard procedure. This study aims to evaluate the numerical extent of the required oral surgical procedures removing septic foci in these patients. Data of 204 patients (115 males/89 females) of the Department of Oral- and Maxillofacial Surgery with an average age of 58 years were evaluated in terms of necessary oral surgical procedures before HVR or kidney (K), heart (H), or liver (L) transplant (T) and were compared with data from patients not undergoing transplantation or HVR, who were referred for other reasons such as oral surgery. The number of tooth extractions or apicoectomies per patient averaged two to five for each of the four patient groups (KT, 0-7 affected teeth; HT, 0-5; LT, 1-5; and HVR, 1-10). Treatment of periodontitis was necessary in 64% of patients. A total of 70% of patients required oral surgical procedures before HT, LT, and HVR, while 84% needed before KT. Removal of oral septic foci is necessary to avoid jeopardizing the success of transplantations. With regard to the surprisingly high need for surgical treatment in this patient population, assessment of these patients by the appropriate specialist and continuation with a follow-up program is still highly recommended.
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Affiliation(s)
- Jan Rustemeyer
- Department of Cranio-Maxillofacial Surgery, Klinikum Bremen Mitte, 28177 Bremen, Germany.
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42
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Moreillon P, Wilson WR, Leclercq R, Entenza JM. Single-dose oral amoxicillin or linezolid for prophylaxis of experimental endocarditis due to vancomycin-susceptible and vancomycin-resistant Enterococcus faecalis. Antimicrob Agents Chemother 2007; 51:1661-5. [PMID: 17353251 PMCID: PMC1855552 DOI: 10.1128/aac.00744-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Endocarditis prophylaxis following genitourinary or gastrointestinal procedures targets Enterococcus faecalis. Prophylaxis recommendations advocate oral amoxicillin (2 g in the United States and 3 g in the United Kingdom) in moderate-risk patients and intravenous amoxicillin (2 g) or vancomycin (1 g) plus gentamicin in high-risk patients. While ampicillin-resistant (or amoxicillin-resistant) E. faecalis is still rare, there is a concern that these regimens might fail against vancomycin-resistant and/or aminoglycoside-resistant isolates. The present study tested oral linezolid as an alternative. Rats with catheter-induced aortic vegetations were given prophylaxis simulating human pharmacokinetics of oral amoxicillin (2- to 3-g single dose), oral linezolid (600 mg, single or multiple oral doses every 12 h), or intravenous vancomycin (1-g single dose). Rats were then inoculated with the minimum inoculum infecting 90% of the animals (90% infective dose [ID(90)]) or with 10 times the ID(90) of the vancomycin-susceptible E. faecalis strain JH2-2 or the vancomycin-resistant (VanA phenotype) E. faecalis strain UCN41. Amoxicillin was also tested with two additional vancomycin-susceptible E. faecalis strains, 309 and 1209. Animals were sacrificed 3 days later. All the tested bacteria were susceptible to amoxicillin and gentamicin. Single-dose amoxicillin provided 100% protection against all four isolates at both the ID(90) and 10 times the ID(90). In contrast, linezolid required up to four consecutive doses to provide full protection against the vancomycin-resistant isolate. Vancomycin protected only against the vancomycin-susceptible strain. The high efficacy of single-dose oral amoxicillin suggests that this regimen could be used for prophylaxis in both moderate-risk and high-risk patients without additional aminoglycosides. Linezolid appears to be less reliable, at least against the vancomycin-resistant strain.
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Affiliation(s)
- Philippe Moreillon
- Department of Fundamental Microbiology, Biophore Building, University of Lausanne, CH-1015 Lausanne, Switzerland
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43
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Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal Disease: A Comprehensive Review. J Am Coll Surg 2007; 204:102-17. [PMID: 17189119 DOI: 10.1016/j.jamcollsurg.2006.08.022] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 08/24/2006] [Accepted: 08/25/2006] [Indexed: 12/11/2022]
Affiliation(s)
- Orit Kaidar-Person
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA
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Jayawardena S, Eisdorfer J, Indulkar S, Zarkaria M. Infective endocarditis of native valve after anterior nasal packing. Am J Ther 2006; 13:460-2. [PMID: 16988543 DOI: 10.1097/01.mjt.0000209683.99205.4f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case report of a patient who was previously treated for spontaneous epistaxis with a petroleum jelly gauze (0.5 in x 72 in) anterior nasal packing filled with an antibiotic ointment, along with prophylactic oral clindamycin. The patient presented with fever and hypotension 3 days after the nasal packing. Her blood cultures grew methicillin-resistant Staphylococcus aureus and the transesophageal echocardiography showed vegetation on the atrial surface of the posterior mitral valve leaflet, confirming the diagnosis of bacterial endocarditis attributable to nasal packing. Several case reports discuss toxic shock syndrome after nasal packing, but none describe endocarditis of the native heart valves subsequent to anterior nasal packing. Current guidelines on endocarditis prophylaxis produced by the American Heart Association, European Cardiac Society, and British Cardiac Society together with published evidence do not recommend endocarditis prophylaxis for patients with native heart valves undergoing anterior nasal packing.
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Affiliation(s)
- Suriya Jayawardena
- Department of Medicine, Coney Island Hospital, Maimonides Medical Center, Brooklyn, NY 11235, USA.
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Al-Haroni M, Skaug N. Knowledge of prescribing antimicrobials among Yemeni general dentists. Acta Odontol Scand 2006; 64:274-80. [PMID: 16945892 DOI: 10.1080/00016350600672829] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Overuse of antimicrobial agents is closely related to an increase in bacterial resistance. A sound knowledge of appropriate prescribing of antimicrobials among health professionals is thus critical in combating the resistance. The objectives of this study were to assess the rationale for and patterns of antimicrobial prescriptions by general dental practitioners in Yemen. MATERIAL AND METHODS A questionnaire containing 65 closed questions was used for this cross-sectional study and distributed to 280 dentists in the three major governorates in Yemen. The anonymously completed questionnaires sought answers to demographic questions and to questions on the therapeutic and prophylactic use of antimicrobial agents in dentistry. Correct and incorrect answers were defined according to information available in the current authoritative literature. Each correct answer was given a score of 1 while an incorrect answer scored 0. Thus, the total score had an attainable range from 0 to 65. Frequencies, means, and associations were assessed statistically. RESULTS Out of 181 collected forms (response rate 64.6%), 150 were appropriately completed and used for data analyses. Penicillins were the most frequently prescribed drugs (72%), followed by spiramycin (10%). It was found that up to 84% of practitioners were likely to prescribe an antimicrobial agent when there was no clinical indication for such a medication. Many respondents (70%) would consider antibiotics for at least one of the given non-clinical factors. CONCLUSIONS The results suggest that dental practitioners in Yemen lack uniformity in the rationale for appropriate prescribing of antimicrobials to their patients. Consequently, to reduce overuse, there is an urgent need for the dental community in the country to be informed about evidence-based guidelines and the appropriate use of antimicrobial agents in clinical dental practice.
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Affiliation(s)
- Mohammed Al-Haroni
- Department of Oral Sciences-Oral Microbiology, Faculty of Dentistry, University of Bergen, Norway.
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Martin SR, Foley MR. Intensive care in obstetrics: an evidence-based review. Am J Obstet Gynecol 2006; 195:673-89. [PMID: 16949397 DOI: 10.1016/j.ajog.2006.05.042] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Revised: 03/05/2006] [Accepted: 05/30/2006] [Indexed: 11/26/2022]
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Haldar SM, O'Gara PT. Infective endocarditis: diagnosis and management. ACTA ACUST UNITED AC 2006; 3:310-7. [PMID: 16729009 DOI: 10.1038/ncpcardio0535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 01/04/2006] [Indexed: 01/24/2023]
Abstract
Despite advances in antimicrobial therapy, diagnostic imaging and cardiac surgery, infective endocarditis (IE) remains challenging clinically and is associated with high morbidity and mortality. Diagnosis relies on several factors: initial clinical suspicion, microbiological data and echocardiographic findings. The use of an integrated diagnostic schema, such as the modified Duke criteria, is useful. Transthoracic or transesophageal echocardiography should be performed promptly for all suspected IE cases. Although the choice of investigation might be influenced by availability, the approach to imaging should be tailored to the individual's clinical situation. Promptly administered intravenous antimicrobial therapy is essential, while the use of antiplatelet or antithrombin therapy to prevent embolic complications is not supported by clinical data. Deciding whether to undertake cardiac surgery for the treatment of IE can be extremely difficult. The principal indications are the development of heart failure from acute, severe aortic or mitral regurgitation, or perivalvular extension of infection. The timing of surgery following central nervous system embolization is problematic because of the risk of hemorrhagic transformation. Prophylactic surgery to prevent embolization is currently advocated only for the management of large, mobile vegetations, when undertaken at centers performing high volumes of heart valve surgery. In this review, we describe diagnostic approaches for IE, particularly echocardiography, and provide recommendations for treatment, paying particular attention to surgery in the acute setting.
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Affiliation(s)
- Saptarsi M Haldar
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA
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Athanassopoulos G, Pefanis A, Sakka V, Iliopoulos D, Perrea D, Giamarellou H. Linezolid in prophylaxis against experimental aortic valve endocarditis due to Streptococcus oralis or Enterococcus faecalis. Antimicrob Agents Chemother 2006; 50:654-7. [PMID: 16436723 PMCID: PMC1366895 DOI: 10.1128/aac.50.2.654-657.2006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There are no experimental studies regarding the prophylactic efficacy of linezolid against infective endocarditis. Nonbacterial thrombotic endocarditis of the aortic valve was induced in rabbits by the insertion of a polyethylene catheter. Twenty-four hours later, animals were randomly assigned to a control group, and groups receiving either ampicillin (two doses of 40 mg/kg of body weight each, given intravenously, 2 h apart) or linezolid (a single per os dose of 75 mg/kg). The first dose of ampicillin and the single dose of linezolid were administered 0.5 and 1 h, respectively, prior to the intravenous inoculation of approximately 10(7) CFU of Streptococcus oralis or Enterococcus faecalis. Linezolid peak levels in rabbit serum were similar to the peak serum levels in humans following a 600-mg oral dose of linezolid. Linezolid prevented endocarditis in 87% of S. oralis-challenged rabbits (P < 0.001 versus controls; P = 0.026 versus ampicillin). In rabbits challenged with E. faecalis, linezolid prevented endocarditis in 73% (P = 0.003 versus controls; P = 0.049 versus ampicillin). Ampicillin prevented endocarditis due to S. oralis or due to E. faecalis in 47% (P = 0.005 versus controls) and in 30% (P = not significant versus controls) of the challenged animals, respectively. In conclusion, linezolid was effective as prophylaxis against endocarditis caused by a strain of S. oralis and to a lesser degree against that caused by a strain of E. faecalis. Its prophylactic efficacy was superior to that of ampicillin.
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Affiliation(s)
- George Athanassopoulos
- Fourth Department of Internal Medicine, General Hospital Attikon, Athens University School of Medicine, Athens, Greece
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Affleck AG, Birnie AJ, Gee TM, Gee BC. Antibiotics in cutaneous surgery: why aren't we following the guidelines? Reply from authors. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.2006.02070.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Walsh MA, Bialkowski J, Szkutnik M, Pawelec-Wojtalik M, Bobkowski W, Walsh KP. Atrioventricular block after transcatheter closure of perimembranous ventricular septal defects. Heart 2006; 92:1295-7. [PMID: 16449504 PMCID: PMC1861195 DOI: 10.1136/hrt.2005.084988] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To look at the presentation, treatment and outcome of patients who developed atrioventricular block after transcatheter closure of a perimembranous ventricular septal defect (PMVSD) with the Amplatzer PMVSD device. SETTING Three tertiary referral centres for paediatric cardiology in two countries. RESULTS All three patients presented within 10 days of the procedure. All three patients were treated with intravenous steroids. A permanent pacemaker was inserted in all patients but no pacemaker required activation after two months. CONCLUSION Complete atrioventricular block occurring in the weeks after device occlusion of a PMVSD appears to resolve quickly. Continued involvement in multicentre device databases is required to monitor safety.
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Affiliation(s)
- M A Walsh
- Cardiac Department, Our Lady's Hospital for Sick Children, Crumlin, Dublin 8, Ireland
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