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Beaumont AL, Mestre F, Decaux S, Bertin C, Duval X, Iung B, Rouzet F, Grall N, Para M, Thy M, Deconinck L. Long-term Oral Suppressive Antimicrobial Therapy in Infective Endocarditis (SATIE Study): An Observational Study. Open Forum Infect Dis 2024; 11:ofae194. [PMID: 38737431 PMCID: PMC11083633 DOI: 10.1093/ofid/ofae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
Background The role of suppressive antimicrobial therapy (SAT) in infective endocarditis (IE) management has yet to be defined. The objective of this study was to describe the use of SAT in an IE referral center and the patients' outcomes. Methods We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included. Results Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%). Conclusions SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.
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Affiliation(s)
- Anne-Lise Beaumont
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Femke Mestre
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Sixtine Decaux
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Chloé Bertin
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- Center of Clinical Investigations, Inserm, CIC 1425, Bichat Hospital, AP-HP, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Nathalie Grall
- Bacteriology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, IAME, INSERM, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Michael Thy
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
| | - Laurène Deconinck
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
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Diaz‐Arocutipa C, Moreno G, Vicent L. Impact of valvular surgery according to frailty risk in patients with infective endocarditis. Clin Cardiol 2024; 47:e24268. [PMID: 38741388 PMCID: PMC11091451 DOI: 10.1002/clc.24268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. METHODS We performed a retrospective study using the 2016-2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. RESULTS A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34-68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. CONCLUSIONS Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
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Affiliation(s)
- Carlos Diaz‐Arocutipa
- Unidad de Revisiones Sistemáticas y Meta‐análisis (URSIGET), Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
| | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de OctubreMadridSpain
- Facultad de Enfermería, Fisioterapia y PodologíaUniversidad Complutense de Madrid (UCM)MadridSpain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de OctubreMadridSpain
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Gaifer Z, Samman BS, Albluwi NA. Infective Endocarditis Caused by Corynebacterium striatum: Navigating Challenges and Treatment Strategies in an Emerging Threat. Cureus 2023; 15:e49526. [PMID: 38156191 PMCID: PMC10753037 DOI: 10.7759/cureus.49526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Corynebacterium striatum is a type of bacteria normally found in the environment and is considered a benign microbe on the human body surface. However, it can induce severe medical conditions, including bacteremia, infective endocarditis, osteomyelitis, and infections, in other organs. This case study focuses on a 56-year-old male patient with multiple comorbidities who presented with an ischemic stroke. Several days after the insertion of a right internal jugular line, the patient developed fever and tachycardia. Blood cultures revealed the presence of Corynebacterium striatum, a Gram-positive bacilli. Transesophageal echocardiography confirmed the diagnosis of complicated infective endocarditis (IE) with mitral valve vegetation and moderate mitral regurgitation. Prompt treatment with appropriate antibiotics, including linezolid and later vancomycin, led to the patient's improvement and eventual discharge in good condition. This case highlights the importance of early recognition, aggressive management, and accurate diagnosis in cases of IE caused by Corynebacterium striatum. Proper antibiotic selection is crucial, considering the emerging antibiotic resistance patterns associated with this pathogen. By addressing these aspects, patient outcomes can be improved, and potential complications such as IE can be prevented.
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Affiliation(s)
- Zied Gaifer
- Internal Medicine, Ministry of National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | - Basim S Samman
- Internal Medicine, Ministry of National Guard - Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | - Nouf A Albluwi
- Internal Medicine, Sulaiman Al-Rajhi University, Medina , SAU
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