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Imazio M. The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:718-726. [PMID: 38916201 PMCID: PMC11365601 DOI: 10.2459/jcm.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis update the previous 2015 guidelines with main novelties in five areas: (1) antibiotic prevention for high-risk patients, and prevention measures for intermediate-risk and high-risk patients; (2) diagnosis with emphasis on multimodality imaging to assess cardiac lesions of infective endocarditis' (3) antibiotic therapy allowing an outpatient antibiotic treatment for stabilized, uncomplicated cases; (4) cardiac surgery with an emphasis on early intervention without delay for complicated cases; and (5) shared management decision by the endocarditis team. Most evidence came from observational studies and expert opinions. The guidelines strongly support a patient-centred approach with a shared decision process by a multidisciplinary team that should be implemented either in tertiary referral centres, becoming heart valve centres, and referral centres. A continuous sharing of data is warranted in the hospitals' network between heart valve centres, which are used for referrals for complicated cases of infective endocarditis, and referral centres, which should be able to manage uncomplicated cases of infective endocarditis.
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Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy
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Lai CKC, Leung E, He Y, Ching-Chun C, Oliver MOY, Qinze Y, Li TCM, Lee ALH, Li Y, Lui GCY. A Machine Learning-Based Risk Score for Prediction of Infective Endocarditis Among Patients With Staphylococcus aureus Bacteremia-The SABIER Score. J Infect Dis 2024; 230:606-613. [PMID: 38420871 DOI: 10.1093/infdis/jiae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Early risk assessment is needed to stratify Staphylococcus aureus infective endocarditis (SA-IE) risk among patients with S. aureus bacteremia (SAB) to guide clinical management. The objective of the current study was to develop a novel risk score that is independent of subjective clinical judgment and can be used early, at the time of blood culture positivity. METHODS We conducted a retrospective big data analysis from territory-wide electronic data and included hospitalized patients with SAB between 2009 and 2019. We applied a random forest risk scoring model to select variables from an array of parameters, according to the statistical importance in predicting SA-IE outcome. The data were divided into derivation and validation cohorts. The areas under the curve of the receiver operating characteristic (AUCROCs) were determined. RESULTS We identified 15 741 SAB patients, among them 658 (4.18%) had SA-IE. The AUCROC was 0.74 (95%CI 0.70-0.76), with a negative predictive value of 0.980 (95%CI 0.977-0.983). The four most discriminatory features were age, history of infective endocarditis, valvular heart disease, and community onset. CONCLUSIONS We developed a novel risk score with performance comparable with existing scores, which can be used at the time of SAB and prior to subjective clinical judgment.
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Affiliation(s)
- Christopher Koon-Chi Lai
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- S.H. Ho Research Centre for Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eman Leung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yinan He
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheung Ching-Chun
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mui Oi Yat Oliver
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Qinze
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alfred Lok-Hang Lee
- Department of Microbiology, Prince of Wales Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Yu Li
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Briol S, Gheysens O, Jamar F, Yildiz H, De Greef J, Cyr Yombi J, Verroken A, Belkhir L. Impact of [ 18F] FDG PET/CT on outcomes in patients with Staphylococcus aureus bacteremia: A retrospective single-center experience. Infect Dis Now 2024; 54:104977. [PMID: 39276874 DOI: 10.1016/j.idnow.2024.104977] [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: 05/04/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE Staphylococcus aureus bacteremia (SAB) is a leading cause of community and hospital-acquired bacteremia with significant morbidity and mortality. Effective management depends on accurate diagnosis, source control and assessment of metastatic infections. [18F] FDG PET/CT has been shown to reduce mortality in high-risk SAB patients. This study aims to evaluate the impact of [18F] FDG PET/CT on outcomes in patients with SAB. METHODS Single-center, retrospective, real-life setting study including all consecutive SAB cases from 2017 to 2019. Medical records were analyzed to collect information. RESULTS Out of the 315 included patients, 132 underwent [18F] FDG PET/CT. In those patients, a clear focus of infection was more frequently identified, leading to better adapted treatments and extended hospital stays. Overall mortality rates at 30 days, 90 days and one year were 25.1 %, 36.8 % and 44.8 % respectively. Mortality was significantly lower in the [18F] FDG PET/CT group (p < 0.0001) and persisted (p < 0.05) after adjusting for imbalances between groups regarding oncologic patients and deaths within 7 days. The difference in mortality remained significant irrespective of prolonged bacteremia but was not significant with regard to hospital-acquired SAB. Supplementary analysis using the Cox proportional hazards model confirmed that [18F] FDG PET/CT was significantly associated with reduced mortality (p < 0.05). CONCLUSION In this real-life cohort, patients with SAB having undergone [18F] FDG PET/CT experienced lower mortality rates, highlighting the additional value of [18F] FDG PET/CT in SAB management. Further research is needed to identify the subpopulations that would benefit most from the integration of [18F] FDG PET/CT in their work-up.
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Affiliation(s)
- Sébastien Briol
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium.
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - Halil Yildiz
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium
| | - Julien De Greef
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Jean Cyr Yombi
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Alexia Verroken
- Department of Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Leïla Belkhir
- Department of Internal Medicine and Infectious Diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 av Hippocrate, 1200 Brussels, Belgium; Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
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Sykora D, Crowley PD, Abu Saleh OM. 79-Year-Old Man With Dysuria, Fever, and Back Pain. Mayo Clin Proc 2024; 99:1482-1487. [PMID: 38912992 DOI: 10.1016/j.mayocp.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 06/25/2024]
Affiliation(s)
- Daniel Sykora
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Patrick D Crowley
- Fellow in Infectious Diseases, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Omar M Abu Saleh
- Advisor to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN.
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La Canna G, Torracca L, Barbone A, Scarfò I. Unexpected Infective Endocarditis: Towards a New Alert for Clinicians. J Clin Med 2024; 13:5058. [PMID: 39274271 PMCID: PMC11396651 DOI: 10.3390/jcm13175058] [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: 06/30/2024] [Revised: 08/17/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.
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Affiliation(s)
- Giovanni La Canna
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Lucia Torracca
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Alessandro Barbone
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Iside Scarfò
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
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Bergenman O, Nilson B, Rasmussen M. Risk of infective endocarditis and complicated infection in Staphylococcus aureus bacteremia - a retrospective cohort study on the role of bacteriuria. Eur J Clin Microbiol Infect Dis 2024; 43:1419-1426. [PMID: 38771404 PMCID: PMC11271437 DOI: 10.1007/s10096-024-04850-7] [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: 03/22/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE S. aureus bacteremia (SAB) is a common and severe infection with high mortality and morbidity. The clinical relevance of the finding of concurrent S. aureus bacteriuria (SABU) is debated. The goal of this study was to analyze whether a concurrent SABU is associated with complicated SAB, infective endocarditis (IE) and mortality. METHODS We conducted a retrospective cohort study, reviewing medical charts of all episodes of SAB in patients > 18 years in the region of Skåne, Sweden, between 1st of January and 31st of June 2020. Episodes where a concurrent urine culture was performed were included for analysis. An episode was considered as complicated SAB if there was either attributable mortality, recurrent infection, embolic stroke, or occurrence of a complicated focus of infection. RESULTS During the study period, there were 279 episodes of SAB. 154 episodes met the eligibility criteria, of whom 37 (24%) had concurrent SABU. In 78 episodes (51%), the patients had a complicated SAB. There was a significantly lower proportion of complicated SAB for episodes with concurrent SABU (32%), compared to episodes without concurrent SABU (56%), p-value 0.014. Moreover, in the cohort there were 11 episodes (7.1%) of IE and a 30 days mortality rate of 16%, with no difference between the groups with or without SABU. CONCLUSIONS There is an association between concurrent SABU and a decreased risk for complicated SAB among patients with SAB. This study found no significant association between SABU and neither IE nor mortality for patients with SAB.
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Affiliation(s)
- Oskar Bergenman
- Kalmar Regional Hospital, Kalmar, Sweden.
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14 SE-221 84, Lund, Sweden.
| | - Bo Nilson
- Clinical Microbiology, Office for Medical Services, Infection Prevention and Control, Region Skåne, Lund, Sweden
- Division of Medical Microbiology, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, BMC B14 SE-221 84, Lund, Sweden.
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden.
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Scolarici MJ, Berman LR, Callander N, Smith J, Saddler C. Infective endocarditis is rare in patients with hematologic malignancy and neutropenia. Transpl Infect Dis 2024; 26:e14302. [PMID: 38761053 DOI: 10.1111/tid.14302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Infective endocarditis (IE) is a serious complication of bloodstream infections (BSIs) that occurs at variable rates depending on the pathogen and clinical setting. There is a paucity of data describing the risk of IE in patients with hematologic malignancy who develop bacteremia while neutropenic. METHODS Adult patients on the hematology ward from January 2018 to December 2020 with hematologic malignancy and bacteremia were evaluated retrospectively for endocarditis by applying the 2023 Duke-ISCVID criteria. Charts of possible cases were evaluated 90 days after the initial BSI for new infectious complications that could indicate missed IE. Descriptive statistics compared patients admitted for hematopoietic stem cell transplantation (HSCT) to those admitted for alternative reasons (non-HSCT). RESULTS Among the 1005 positive blood cultures initially identified, there were 66 episodes in 65 patients with hematologic malignancy and at least grade 3 neutropenia for a mean duration of 11.4 days during their admission. Transthoracic echocardiography (TTE) was performed in 34.8% of BSIs, and transesophageal echocardiography (TEE) in 6.1%. There were no new infectious complications in possible cases 90 days after their initial BSI. No cases of endocarditis were identified. CONCLUSIONS Endocarditis is rare amongst patients with hematologic malignancy, bacteremia, and neutropenia, and no cases were identified in this cohort. The use of routine TTE in this setting seems unwarranted, and the addition of TEE is unlikely to improve patient-centered outcomes.
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Affiliation(s)
- Michael J Scolarici
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Leigh R Berman
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Natalie Callander
- Department of Medicine, Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, Wisconsin, USA
| | - Jeannina Smith
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
| | - Christopher Saddler
- Department of Medicine, Division of Infectious Diseases, University of Wisconsin, Madison, Wisconsin, USA
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Teixeira Antunes A, Monney P, Tzimas G, Tozzi P, Kirsch M, Guery B, Papadimitriou-Olivgeris M. Association of persistent positive blood cultures and infective endocarditis: A cohort study among patients with suspected infective endocarditis. Int J Infect Dis 2024; 143:107022. [PMID: 38561042 DOI: 10.1016/j.ijid.2024.107022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES To ascertain whether infective endocarditis (IE) was associated with persistent bacteraemia/candidaemia among patients with suspected IE. METHODS This study included bacteraemic/candidaemic adult patients with echocardiography and follow-up blood cultures. Persistent bacteraemia/candidaemia was defined as continued positive blood cultures with the same microorganism for 48 h or more after antibiotic treatment initiation. Each case was classified for IE by the Endocarditis Team. RESULTS Among 1962 episodes of suspected IE, IE (605; 31%) was the most prevalent infection type. Persistent bacteraemia/candidaemia was observed in 426 (22%) episodes. Persistent bacteraemia was more common among episodes with Staphylococcus aureus bacteraemia compared to episodes with positive blood cultures for other pathogens (32%, 298/933 vs 12%, 128/1029; P < 0.001). Multivariable analysis demonstrated that cardiac predisposing factors (aOR 1.84, 95% CI 1.31-2.60), community or non-nosocomial healthcare-associated (2.85, 2.10-3.88), bacteraemia by high-risk bacteria, such as S. aureus, streptococci, enterococci or HACEK (1.84, 1.31-2.60), two or more positive sets of index blood cultures (6.99, 4.60-10.63), persistent bacteraemia/candidaemia for 48 h from antimicrobial treatment initiation (1.43, 1.05-1.93), embolic events within 48h from antimicrobial treatment initiation (12.81, 9.43-17.41), and immunological phenomena (3.87, 1.09-1.78) were associated with infective endocarditis. CONCLUSIONS IE was associated with persistent bacteraemia/candidaemia, along with other commonly associated factors.
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Affiliation(s)
- André Teixeira Antunes
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthaios Papadimitriou-Olivgeris
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, Cantonal Hospital of Sion and Institut Central des Hôpitaux (ICH), Sion, Switzerland.
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Ngiam JN, Koh MCY, Archuleta S, Fisher D, Chai LYA, Sia CH, Kong WKF, Tambyah PA. Performance of Risk Scores in Predicting Infective Endocarditis in Patients with Staphylococcus aureus Bacteraemia in a Prospective Asian Cohort. J Clin Med 2024; 13:2947. [PMID: 38792488 PMCID: PMC11122131 DOI: 10.3390/jcm13102947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Several risk scores have been derived to predict the risk of infective endocarditis (IE) amongst patients with Staphylococcus aureus bacteraemia (SAB), which helps to guide clinical management. Methods: We prospectively studied 634 patients admitted with SAB. The cohort was stratified into those with or without IE, and the PREDICT Day 1, Day 5 and VIRSTA scores were tabulated. Area under the receiver operating characteristic (AUC) curves were constructed to compare the performance of each score. Results: Of the 634 patients examined, 36 (5.7%) had IE. These patients were younger (51.6 ± 20.1 vs. 59.2 ± 18.0 years, p = 0.015), tended to have community acquisition of bacteraemia (41.7% vs. 17.9%, p < 0.001), and had persistent bacteraemia beyond 72 h (19.4% vs. 6.0%, p = 0.002). The VIRSTA score had the best performance in predicting IE (AUC 0.76, 95%CI 0.66-0.86) compared with PREDICT Day 1 and Day 5. A VIRSTA score of <3 had the best negative predictive value (97.5%), compared with PREDICT Day 1 (<4) and Day 5 (<2) (94.3% and 96.6%, respectively). Conclusions: Overall, the risk scores performed well in our Asian cohort. If applied, 23.5% of the cohort with a VIRSTA ≥ 3 would require TEE, and a score of <3 had an excellent negative predictive value.
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Affiliation(s)
- Jinghao Nicholas Ngiam
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
| | - Matthew Chung Yi Koh
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
| | - Sophia Archuleta
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Dale Fisher
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Louis Yi-Ann Chai
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228, Singapore
| | - William K. F. Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228, Singapore
| | - Paul Anantharajah Tambyah
- Division of Infectious Diseases, National University Hospital, National University Health System, 1E Kent Ridge Rd, NUHS Tower Block, Level 10, Singapore 119228, Singapore; (M.C.Y.K.)
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Berge A, Lundin J, Bläckberg A, Sunnerhagen T, Rasmussen M. Non-betahemolytic streptococcal bacteremia, cardiac implantable electronic device, endocarditis, extraction, and outcome; a population-based retrospective cohort study. Infection 2024:10.1007/s15010-024-02221-0. [PMID: 38634990 DOI: 10.1007/s15010-024-02221-0] [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: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Patients with non-beta-hemolytic streptococcal bacteremia (NBHSB) are at risk of infective endocarditis (IE). Patients with cardiac implantable electronic device (CIED) have been described to have an increased risk of IE. The aim of the study was to describe a population-based cohort of patients with NBHSB and CIED and variables associated with IE and recurrent NBHSB. METHODS All episodes with NBHSB in blood culture from 2015 to 2018 in a population of 1.3 million inhabitants were collected from the Clinical Microbiology Laboratory, Lund, Sweden. Through medical records, patients with CIED during NBHSB were identified and clinical data were collected. Patients were followed 365 days after NBHSB. RESULTS Eighty-five episodes in 79 patients with CIED and NBHSB constituted the cohort. Eight patients (10%) were diagnosed with definite IE during the first episode, five of whom also had heart valve prosthesis (HVP). In 39 patients (49%) transesophageal echocardiography (TEE) was performed of which six indicated IE. Four patients had the CIED extracted. Twenty-four patients did not survive (30%) the study period. Four patients had a recurrent infection with NBHSB with the same species, three of whom had HVP and had been evaluated with TEE with a negative result during the first episode and diagnosed with IE during the recurrency. CONCLUSION The study did not find a high risk of IE in patients with NBHSB and CIED. Most cases of IE were in conjunction with a simultaneous HVP. A management algorithm is suggested.
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Affiliation(s)
- Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, 171 76, Stockholm, Sweden.
- Department of Infectious Diseases, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Johannes Lundin
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, 221 00, Lund, Sweden
| | - Anna Bläckberg
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, 221 00, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, 221 00, Lund, Sweden
| | - Torgny Sunnerhagen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, 221 00, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, 221 85, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, 221 00, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, 221 00, Lund, Sweden
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Lindberg H, Berge A, Jovanovic-Stjernqvist M, Hagstrand Aldman M, Krus D, Öberg J, Kahn F, Bläckberg A, Sunnerhagen T, Rasmussen M. Performance of the 2023 Duke-International Society of Cardiovascular Infectious Diseases Diagnostic Criteria for Infective Endocarditis in Relation to the Modified Duke Criteria and to Clinical Management-Reanalysis of Retrospective Bacteremia Cohorts. Clin Infect Dis 2024; 78:956-963. [PMID: 38330240 PMCID: PMC11006102 DOI: 10.1093/cid/ciae040] [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: 06/01/2023] [Revised: 08/06/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Revised diagnostic criteria for infective endocarditis (IE), the 2023 Duke-ISCVID criteria, were recently presented and need validation. Here, we compare the 2000 modified Duke criteria for IE with Duke-ISCVID among patients with bacteremia and relate the diagnostic classification to IE treatment. METHODS We reanalyzed patient cohorts with Staphylococcus aureus, Staphylococcus lugdunensis, non-β-hemolytic streptococci, Streptococcus-like bacteria, Streptococcus dysgalactiae, Enterococcus faecalis, and HACEK (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) bacteremia. Episodes were classified as definite, possible, or rejected IE with the modified Duke and Duke-ISCVID criteria. Reclassification included the microbiology criteria, positron emission tomography-computed tomography, and cardiac implanted electronic devices. To calculate sensitivity, patients treated for IE were considered as having IE. RESULTS In 4050 episodes of bacteremia, the modified Duke criteria assigned 307 episodes (7.6%) as definite IE, 1190 (29%) as possible IE, and 2553 (63%) as rejected IE. Using the Duke-ISCVID criteria, 13 episodes (0.3%) were reclassified from possible to definite IE, and 475 episodes (12%) were reclassified from rejected to possible IE. With the modified Duke criteria, 79 episodes that were treated as IE were classified as possible IE, and 11 of these episodes were reclassified to definite IE with Duke-ISCVID. Applying the decision to treat for IE as a reference standard, the sensitivity of the Duke-ISCVID criteria was 80%. None of the 475 episodes reclassified to possible IE were treated as IE. CONCLUSIONS The Duke-ISCVID criteria reclassified a small proportion of episodes to definite IE at the expense of more episodes of possible IE. Future criteria should minimize the possible IE group while keeping or improving sensitivity.
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Affiliation(s)
- Helena Lindberg
- Department of Infectious Diseases, Hospital of Halland, Halmstad, Sweden
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital Stockholm, Sweden
| | | | - Malin Hagstrand Aldman
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
| | - David Krus
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
| | - Jonas Öberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Fredrik Kahn
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
| | - Anna Bläckberg
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Microbiology and Infection Control, Region Skåne Office for Medical Services, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
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Rasmussen M, Gilje P, Fagman E, Berge A. Bacteraemia with gram-positive bacteria-when and how do I need to look for endocarditis? Clin Microbiol Infect 2024; 30:306-311. [PMID: 37659693 DOI: 10.1016/j.cmi.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients with bacteraemia caused by gram-positive bacteria are at risk for infective endocarditis (IE). Because IE needs long antibiotic treatment and sometimes heart valve surgery, it is very important to identify patients with IE. OBJECTIVES In this narrative review we present and discuss how to determine which investigations to detect IE that are needed in individual patients with gram-positive bacteraemia. SOURCES Published original studies and previous reviews in English, within the relevant field are used. CONTENT First, the different qualities of the bacteraemia in relation to IE risk are discussed. The risk for IE in bacteraemia is related to the species of the bacterium but also to monomicrobial bacteraemia and the number of positive cultures. Second, patient-related factors for IE risk in bacteraemia are presented. Next, the risk stratification systems to determine the risk for IE in gram-positive bacteraemia caused by Staphylococcus aureus, viridans streptococci, and Enterococcus faecalis are presented and their use is discussed. In the last part of the review, an account for the different modalities of IE-investigations is given. The main focus is on echocardiography, which is the cornerstone of IE-investigations. Furthermore, 18F-fluorodesoxyglucose positron emission tomography/computed tomography and cardiac computed tomography are presented and their use is also discussed. A brief account for investigations used to identify embolic phenomena in IE is also given. Finally, we present a flowchart suggesting which investigations to perform in relation to IE in patients with gram-positive bacteraemia. IMPLICATIONS For the individual patient as well as the healthcare system, it is important both to diagnose IE and to decide when to stop looking for IE. This review might be helpful in finding that balance.
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Affiliation(s)
- Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden; Department for Infectious Diseases, Skåne University Hospital, Lund, Sweden.
| | - Patrik Gilje
- Department of Cardiology, Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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13
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Dingen H, Urheim S, Jordal S, Saeed S. Echocardiographic assessment in infective endocarditis: Transthoracic or transesophageal echocardiography, or both?: Echocardiography in endocarditis. Curr Probl Cardiol 2024; 49:102151. [PMID: 37866416 DOI: 10.1016/j.cpcardiol.2023.102151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Affiliation(s)
- Håvard Dingen
- Department of Internal Medicine, Stord Hospital, Stord, Norway
| | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stina Jordal
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
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14
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Tabaja H, Baddour LM, Chesdachai S, DeMartino RR, Lahr BD, DeSimone DC. Incidence and Outcomes of Bloodstream Infection After Arterial Aneurysm Repair: Findings From a Population-Based Study. Open Forum Infect Dis 2023; 10:ofad521. [PMID: 38023557 PMCID: PMC10644795 DOI: 10.1093/ofid/ofad521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Limited research has focused on bloodstream infection (BSI) in patients with arterial grafts. This study aims to describe the incidence and outcomes of BSI after arterial aneurysm repair in a population-based cohort. Methods The expanded Rochester Epidemiology Project (e-REP) was used to analyze aneurysm repairs in adults (aged ≥18 years) residing in 8 counties in southern Minnesota from January 2010 to December 2020. Electronic records were reviewed for the first episode of BSI following aneurysm repair. BSI patients were assessed for vascular graft infection (VGI) and followed for all-cause mortality. Results During the study, 643 patients had 706 aneurysm repairs: 416 endovascular repairs (EVARs) and 290 open surgical repairs (OSRs). Forty-two patients developed BSI during follow-up. The 5-year cumulative incidence of BSI was 4.7% (95% confidence interval [CI], 3.0%-6.4%), with rates of 4.0% (95% CI, 1.8%-6.2%) in the EVAR group and 5.8% (95% CI, 2.9%-8.6%) in the OSR group (P = .052). Thirty-nine (92.9%) BSI cases were monomicrobial, 33 of which were evaluated for VGI. VGI was diagnosed in 30.3% (10/33), accounting for 50.0% (8/16) of gram-positive BSI cases compared to 11.8% (2/17) of gram-negative BSI cases (P = .017). The 1-, 3-, and 5-year cumulative post-BSI all-cause mortality rates were 22.2% (95% CI, 8.3%-34.0%), 55.8% (95% CI, 32.1%-71.2%), and 76.8% (95% CI, 44.3%-90.3%), respectively. Conclusions The incidence of BSI following aneurysm repair was overall low. VGI was more common with gram-positive compared to gram-negative BSI. All-cause mortality following BSI was high, which may be attributed to advanced age and significant comorbidities in our cohort.
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Affiliation(s)
- Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian D Lahr
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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15
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 268] [Impact Index Per Article: 268.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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16
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Barbieri A, Cecchi E, Bursi F, Mantovani F. Is Infectious Endocarditis Evolving into a Time-Dependent Diagnosis in the Contemporary Epidemiological Era? Emphasis on the Role of Echocardiography as a First-Line Diagnostic Approach. Rev Cardiovasc Med 2023; 24:283. [PMID: 39077575 PMCID: PMC11273157 DOI: 10.31083/j.rcm2410283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 07/31/2024] Open
Abstract
Despite significant advances in understanding and outcomes in various domains of cardiology, the prognosis of infective endocarditis (IE) remains dismal. One of the main reasons may rely on an even more intricate diagnosis since epidemiology has shifted towards an aggressive infection, typically in older patients with the involvement of prosthetic valves and cardiovascular implantable electronic devices with earlier clinical presentation. In this novel setting, it is critical to avoid a delay in diagnosis that may delay subsequent adequate treatment, further complications, and ultimately poor clinical outcomes. Accordingly, based on the available data, we will examine the proper use of first-line echocardiography representing the first-line imaging method in patients with clinical suspicion of IE. We will focus on the following three crucial questions: (1) What is the threshold to start the echocardiographic diagnostic workup in stable patients? (2) Has infective endocarditis become a time-dependent diagnosis, even in stable patients? (3) What is the appropriate use of echocardiography in unstable patients? Finally, we propose a new mindset to improve the echocardiographic diagnostic workflow.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, 41122 Modena, Italy
| | - Enrico Cecchi
- Department of Cardiology, Humanitas Cellini, 10100 Turin, Italy
| | - Francesca Bursi
- Division of Cardiology, Dipartimento di Scienze della salute, San Paolo Hospital, ASST Santi Paolo and Carlo, University of Milan, 20142 Milano, Italy
| | - Francesca Mantovani
- Cardiology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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17
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Ramos-Martínez A, González-Merino P, Suanzes-Martín E, la Fuente MMD, Escudero-López G, Andrés-Eisenhofer A, Expósito-Palomo E, Gutierrez-Villanueva A, Diego-Yagüe I, Múñez E, Fernandez-Cruz A, Calderón-Parra J. Risk of endocarditis among patients with coagulase-negative Staphylococcus bacteremia. Sci Rep 2023; 13:15613. [PMID: 37730691 PMCID: PMC10511700 DOI: 10.1038/s41598-023-41888-7] [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: 03/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Coagulase-negative staphylococci (CoNS) are currently considered typical microorganisms causing infective endocarditis (IE) in patients with prosthetic valves. The objective was to determine variables associated with IE in patients with CoNS bacteremia. We performed an analysis of the clinical characteristics of patients with CoNS bacteremia admitted to a university hospital in Madrid (Spain) from 2021 to December 2022 according to the occurrence of IE. This study is an evaluation of a bacteremia registry. During the study period, 106 patients with CoNS bacteremia were detected. In 85 patients an echocardiogram was performed during hospital admission to rule out IE. Among them, 12 episodes were detected that met IE criteria (14.2%). Of the 6 patients with heart valve prostheses, 5 patients (83.3%) had IE (p < 0.001). Patients with IE more frequently had positive blood cultures more than 12 h after the first draw (58.3% versus 13.4%; p < 0.001). There was a tendency to associate community-acquired bacteremia and to that all blood culture bottles obtained were positive with an increased risk of IE (p = 0.091 and p = 0,057, respectively). Attributable mortality to infection was higher in patients with IE relative to all other patients (16.7% vs. 0%; p = 0.033). The multivariable analysis included having valve prosthesis and persistent bacteremia for more than 12 h. Both were independently associated with IE: valve prosthesis OR 38.6 (95% CI 5.8-258; p < 0.001) and persistent bacteremia OR 2.6 (95% CI 1.1-6.8; p = 0.046). In conclusion, a high percentage of cases of CoNS bacteremia may be due to IE. Some of the variables related to a higher risk of IE, such as having a valvular prosthesis or presenting positive blood cultures for more than 12 h, should lead to rule out or confirm the presence of IE by performing echocardiography.
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Affiliation(s)
- Antonio Ramos-Martínez
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain.
| | | | - Elena Suanzes-Martín
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Gabriela Escudero-López
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ane Andrés-Eisenhofer
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Esther Expósito-Palomo
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Itziar Diego-Yagüe
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Elena Múñez
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ana Fernandez-Cruz
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain
| | - Jorge Calderón-Parra
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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18
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Covino M, De Vita A, d'Aiello A, Ravenna SE, Ruggio A, Genuardi L, Simeoni B, Piccioni A, De Matteis G, Murri R, Leone AM, Flex A, Gasbarrini A, Liuzzo G, Massetti M, Franceschi F. A New Clinical Prediction Rule for Infective Endocarditis in Emergency Department Patients With Fever: Definition and First Validation of the CREED Score. J Am Heart Assoc 2023; 12:e027650. [PMID: 37119081 PMCID: PMC10227214 DOI: 10.1161/jaha.122.027650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/23/2023] [Indexed: 04/30/2023]
Abstract
Background Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy-to-use clinical prediction score for the diagnosis of IE in the ED. Methods and Results We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56-81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849-0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848-0.913) in the validation cohort, not significantly different from the one calculated in the retrospective cohort (P=0.578). Conclusions In this study, we propose and prospectively validate the CREED score, a clinical prediction rule for the diagnosis of IE in patients with fever admitted to the ED. Our data reflect the difficulty of creating a meaningful tool able to identify patients with IE among this general and heterogeneous population because of the complexity of the disease and its low prevalence in the ED setting.
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Affiliation(s)
- Marcello Covino
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
| | - Antonio De Vita
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Alessia d'Aiello
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | | | - Aureliano Ruggio
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Lorenzo Genuardi
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Benedetta Simeoni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Piccioni
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giuseppe De Matteis
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Rita Murri
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Infectious DiseaseFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Maria Leone
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Andrea Flex
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Antonio Gasbarrini
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Internal MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Giovanna Liuzzo
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Massimo Massetti
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
- Department of Cardiovascular SciencesFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
| | - Francesco Franceschi
- Emergency MedicineFondazione Policlinico Universitario A, Gemelli, IRCCSRomeItaly
- Università Cattolica del Cattolica del Sacro CuoreRomeItaly
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Hess KA, Kooda K, Shulha JA, Mara K, Go JR, Fida M, DeSimone DC, Stevens RW. Retrospective Evaluation of the Association of Oxacillin MIC on Acute Treatment Outcomes with Cefazolin and Antistaphylococcal Penicillins in Methicillin-Susceptible Staphylococcus aureus Bacteremia. J Clin Microbiol 2023; 61:e0003923. [PMID: 36988505 PMCID: PMC10117114 DOI: 10.1128/jcm.00039-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
Antistaphylococcal penicillins (ASP) and cefazolin are first-line treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Borderline oxacillin resistance (i.e., oxacillin MICs 1-8 μg/mL) is observed in strains hyperproducing beta-lactamases. This mechanism is also behind the proposed inoculum effect. Minimal data exists on the comparative efficacy of cefazolin or ASP in qualitatively susceptible strains that demonstrate MICs of oxacillin of 1 to 2 μg/mL compared to strains with MIC of oxacillin < 1 μg/mL. We performed a retrospective cohort study of acute treatment outcomes in adult patients with community-acquired MSSA bacteremia treated with cefazolin or ASP, stratified by oxacillin MIC. The primary outcome was a composite of all-cause mortality during the index inpatient admission, failure to clear blood cultures within 72 h after initiating definitive therapy, and change in therapy due to perceived lack of efficacy. A total of 402 patients were included in this study, including 226 isolates with an oxacillin MIC ≥ 1 μg/mL and 176 isolates with an MIC < 1 μg/mL. There were no differences in the rate of the primary outcome occurrence between patients with an oxacillin MIC ≥ 1 μg/mL and an MIC < 1 μg/mL (16.4% versus 15.9%, P = 0.90). There was no difference in the primary outcome between high versus low oxacillin MIC groups among those who received ASP (22.9% versus 24.1%, P = 0.86) or cefazolin (10.3% versus 11.9%, P = 0.86). In our cohort of patients with MSSA bacteremia, oxacillin MIC (i.e., ≥ 1 versus < 1 μg/mL) was not associated with acute treatment outcomes, regardless of the beta-lactam selected as definitive therapy.
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Affiliation(s)
- Kyle A. Hess
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirstin Kooda
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - John R. Go
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Madiha Fida
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C. DeSimone
- Division of Public Health, Infectious Disease, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan W. Stevens
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
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20
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Berge A, Carlsén C, Petropoulos A, Gadler F, Rasmussen M. Staphylococcus aureus bacteraemia, cardiac implantable electronic device, and the risk of endocarditis: a retrospective population-based cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:583-591. [PMID: 36920628 PMCID: PMC10105663 DOI: 10.1007/s10096-023-04585-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023]
Abstract
Patients with cardiac implantable electronic device (CIED) and Staphylococcus aureus bacteraemia (SAB) are at risk of having infective endocarditis (IE). The objectives were to describe a Swedish population-based cohort of patients with CIED and SAB, to identify risk factors, and to construct a predictive score for IE. Patients over 18 years old in the Stockholm Region identified to have SAB in the Karolinska Laboratory database from January 2015 through December 2019 were matched to the Swedish Pacemaker and Implantable Cardioverter-Defibrillator ICD Registry to identify the study cohort. Data were collected from study of medical records. A cohort of 274 patients with CIED and SAB was identified and in 38 episodes (14%) IE were diagnosed, 19 with changes on the CIED, and 35 with changes on the left side of the heart. The risk factors predisposition for IE, community acquisition, embolization, time to positivity of blood cultures, and growth in blood culture after start of therapy in blood cultures were independently associated to IE. A score to identify patients with IE was constructed, the CTEPP score, and the chosen cut-off generated a sensitivity of 97%, specificity of 25%, and a negative predictive value of 98%. The score was externally validated in a population-based cohort of patients with CIED and SAB from another Swedish region. We found that 14% of patients with CIED and SAB had definite IE diagnosed. The CTEPP-score can be used to predict the risk of IE and, when negative, the risk is negligible.
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Affiliation(s)
- Andreas Berge
- Unit of Infectious Diseases, Department of Medicine, SolnaKarolinska Institutet, 17176, Stockholm, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Casper Carlsén
- Unit of Infectious Diseases, Department of Medicine, SolnaKarolinska Institutet, 17176, Stockholm, Sweden
| | - Alexandros Petropoulos
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Unit of Cardiology, Department of Medicine, SolnaKarolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden.,Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden
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21
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Bastien S, Meyers S, Salgado-Pabón W, Giulieri SG, Rasigade JP, Liesenborghs L, Kinney KJ, Couzon F, Martins-Simoes P, Moing VL, Duval X, Holmes NE, Bruun NE, Skov R, Howden BP, Fowler VG, Verhamme P, Andersen PS, Bouchiat C, Moreau K, Vandenesch F. All Staphylococcus aureus bacteraemia-inducing strains can cause infective endocarditis: Results of GWAS and experimental animal studies. J Infect 2023; 86:123-133. [PMID: 36603774 PMCID: PMC10399548 DOI: 10.1016/j.jinf.2022.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/21/2022] [Accepted: 12/24/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We aimed at determining whether specific S. aureus strains cause infective endocarditis (IE) in the course of Staphylococcus aureus bacteraemia (SAB). METHODS A genome-wide association study (GWAS) including 924 S. aureus genomes from IE (274) and non-IE (650) SAB patients from international cohorts was conducted, and a subset of strains was tested with two experimental animal models of IE, one investigating the early step of bacterial adhesion to inflamed mice valves, the second evaluating the local and systemic developmental process of IE on mechanically-damaged rabbit valves. RESULTS The genetic profile of S. aureus IE and non-IE SAB strains did not differ when considering single nucleotide polymorphisms, coding sequences, and k-mers analysed in GWAS. In the murine inflammation-induced IE model, no difference was observed between IE and non-IE SAB strains both in terms of adhesion to the cardiac valves and in the propensity to cause IE; in the mechanical IE-induced rabbit model, there was no difference between IE and non-IE SAB strains regarding the vegetation size and CFU. CONCLUSION All strains of S. aureus isolated from SAB patients must be considered as capable of causing this common and lethal infection once they have accessed the bloodstream.
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Affiliation(s)
- Sylvère Bastien
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Severien Meyers
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Wilmara Salgado-Pabón
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
| | - Stefano G Giulieri
- Department of Microbiology and Immunology and Department of Infectious Diseases, The University of Melbourne at the Doherty Institute for Infection and Immunity; Victorian Infectious Disease Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Jean-Phillipe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Kyle J Kinney
- Department of Microbiology and Immunology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Florence Couzon
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - Patricia Martins-Simoes
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | | | - Xavier Duval
- Hôpital Bichat Claude Bernard, AP-HP, Paris, France; Inserm CIC 1425, Inserm UMR-1137 IAME, Cité Paris University, UFR de Médecine-Bichat, Paris, France
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Niels Eske Bruun
- Clinical Institute, Copenhagen and Aalborg University, Aalborg, Denmark; Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark
| | - Robert Skov
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Benjamin P Howden
- Department of Microbiology and Immunology and Department of Infectious Diseases, The University of Melbourne at the Doherty Institute for Infection and Immunity; Victorian Infectious Disease Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, Austin Health, Heidelberg, Australia
| | - Vance G Fowler
- Duke University Medical Center, Durham, NC USA; Duke Clinical Research Institute, Durham, NC USA
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium
| | - Paal Skytt Andersen
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Coralie Bouchiat
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France
| | - Karen Moreau
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France
| | - François Vandenesch
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, F-69007, Lyon, France; Centre National de Référence des Staphylocoques, Institut des Agents Infectieux, Hospices Civils de Lyon, F-69004, Lyon, France.
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22
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Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, Dahl A, Chamat-Hedemand S, Petersen JK, Jensen AD, Christensen JJ, Rosenvinge FS, Jarløv JO, Moser C, Andersen CØ, Coia J, Marmolin ES, Søgaard KK, Lemming L, Køber L, Fosbøl EL. Prevalence and Mortality of Infective Endocarditis in Community-Acquired and Healthcare-Associated Staphylococcus aureus Bacteremia: A Danish Nationwide Registry-Based Cohort Study. Open Forum Infect Dis 2022; 9:ofac647. [PMID: 36540385 PMCID: PMC9757695 DOI: 10.1093/ofid/ofac647] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes. METHODS First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30 days) or healthcare-associated (SAB >48 hours of hospital admission, hospitalization within 30 days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis. RESULTS We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86-2.41]). No difference in mortality was observed with 0-40 days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83-1.37]), while with 41-365 days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53-.95]). CONCLUSIONS Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40 days of survival, community-acquired SAIE was associated with a lower mortality.
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Affiliation(s)
- Lauge Østergaard
- Correspondence: Lauge Østergaard, MD, PhD, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark ()
| | | | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,Clinical Institutes, Copenhagen and Aalborg University, Aalborg, Denmark
| | - Henning Bundgaard
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Regionshospital Nord, Hjørring, Denmark
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Chamat-Hedemand
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jens Jørgen Christensen
- Regional Department of Clinical Microbiology, Zealand University Hospital, Køge and Institute of Clinical Medicine, University of Copenhagen, Køge, Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Denmark and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - John Coia
- Department of Clinical Microbiology, Hospital of South-west Jutland and Institute for Regional Health Research University of South Denmark, Esbjerg, Denmark
| | | | - Kirstine K Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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23
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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. All-Cause and Infection-Related Mortality in Staphylococcus aureus Bacteremia, a Multicenter Prospective Cohort Study. Open Forum Infect Dis 2022; 9:ofac653. [PMID: 36589483 PMCID: PMC9792080 DOI: 10.1093/ofid/ofac653] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Staphylococcus aureus bacteremia (SAB) is a heterogeneous disease with changing epidemiology due to changing demographics and evolving clinical management. SAB is associated with high mortality, but the current fraction of infection-related mortality is less well quantified. Methods In a multicenter prospective cohort study of consecutive patients with SAB, we determined clinical features of SAB and determined 90-day mortality and risk factors of all-cause and infection-related mortality. Infection-related mortality was based on an adjudication committee evaluation. Results Four hundred ninety patients with SAB were included, with community-acquired (n = 166), health care-associated (n = 163), and hospital-acquired SAB (n = 161). Endocarditis (n = 90, 18.3%), peripheral intravenous catheter infection (n = 80, 16.3%), and septic arthritis (n = 58, 11.8%) were the most frequent diagnoses, but proportions differed for community, health care, and hospital acquisition. One hundred ninety-two patients (39%) had permanent implanted prosthetic material (eg, prosthetic joint, heart valve, pacemaker). Day 90 all-cause mortality was 33% (n = 161), with 60% adjudicated as infection-related, and 90% of infection-related deaths occurring in the first 30 days post-SAB. Infection-related deaths after 30 days were rare and mainly related to endocarditis. Determinants associated with day 90 infection-related mortality were age (odds ratio [OR], 1.09; 95% CI, 1.06-1.11), Charlson comorbidity index (OR, 1.13; 95% CI, 1.01-1.26), septic shock (OR, 9.78; 95% CI, 4.56-20.95), endocarditis (OR, 3.4; 95% CI, 1.75-6.61), and persistent SAB at 48 hours (OR, 2.36; 95% CI, 1.27-4.37). Conclusions Mortality due to S. aureus infection remains high and mainly occurs in the first 30 days, which could guide end points in future studies.
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Affiliation(s)
- Thomas W van der Vaart
- Correspondence: Thomas van der Vaart, MD, Amsterdam University Medical Centers, Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands ()
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, 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
- Regional Public Health Laboratory Kennemerland, 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
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24
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Khan UA, Zaidi SH, Majeed H, Lopez E, Tofighi D, Andre P, Schevchuck A, Garcia ME, Sheikh AB, Raizada V, Sheikhar R, Sagheer S. Clinical Risk Factors for Infective Endocarditis Patients with Staphylococcus Aureus Bacteremia and the Diagnostic Utility of Transesophageal Echocardiogram. Curr Probl Cardiol 2022; 47:101331. [PMID: 35870547 DOI: 10.1016/j.cpcardiol.2022.101331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Umair Aslam Khan
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Syeda Humna Zaidi
- Division of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Harris Majeed
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Erick Lopez
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Davood Tofighi
- Department of Biostatistics, Epidemiology, and Research Design Support, University of New Mexico Health Sciences Center, NM, USA
| | - Paul Andre
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Alex Schevchuck
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Mark E Garcia
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Abu Baker Sheikh
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Veena Raizada
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Rahul Sheikhar
- Division of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Shazib Sagheer
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
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25
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Aldred B, Drekonja DM. Timing of Patient Management Decisions Relative to Echocardiography in Staphylococcus aureus Bacteremia; A Single-Center Retrospective Analysis. Open Forum Infect Dis 2022; 9:ofac290. [PMID: 35873286 PMCID: PMC9297306 DOI: 10.1093/ofid/ofac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with Staphylococcus aureus bacteremia (SAB), endocarditis evaluation includes transthoracic echocardiography (TTE) and, in patients at increased risk of endocarditis, subsequent transesophageal echocardiography (TEE). In patients deemed to warrant TEE, it has not been well-studied whether performing TTE prior to TEE influences clinicians’ decision-making.
Methods
This retrospective case series studied clinician behavior at a large Veterans Affairs medical center regarding the care of adult patients diagnosed with SAB who completed both TTE and TEE (n = 206 episodes of SAB). The timing of key patient management decisions were compared to the timing of the patient’s TTE and TEE. It was inferred whether each management decision could have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included: documentation of antibiotic treatment duration, initiation of synergistic antibiotics, consultation of relevant specialists, ordering of relevant imaging studies, and performance of valve surgery or cardiac device explanation.
Results
The primary outcome (any of the above five management decisions taking place) occurred after completion of TTE but prior to TEE in 13 SAB episodes (6.3%). The primary outcome occurred after completion of both TTE and TEE in 178 SAB episodes (86.4%). Documentation of antibiotic treatment duration accounted for the large majority of observed management decisions.
Conclusion
Among patients with SAB who are deemed to warrant TEE for endocarditis evaluation, TTE results alone rarely prompt clinical management decisions.
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Affiliation(s)
- Bruce Aldred
- Infectious Diseases Fellow Department of Infectious Diseases and International Medicine University of Minnesota Minneapolis , MN , USA
| | - Dimitri Maximilian Drekonja
- Chief, Infectious Disease Section , Minneapolis VA Health Care System Minneapolis VA Health Care System Minneapolis, MN , USA
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26
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Enterococcus faecalis bacteremia, cardiac implantable electronic device, extraction, and the risk of recurrence. Infection 2022; 50:1517-1523. [PMID: 35538390 PMCID: PMC9705423 DOI: 10.1007/s15010-022-01838-3] [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: 02/23/2022] [Accepted: 04/15/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE In all patients with cardiac implantable electronic devices (CIED) and Enterococcus faecalis bacteremia (EfsB), endocarditis (IE) and CIED infection should be suspected. Guidelines recommend extraction of the CIED when CIED infection or IE is diagnosed. Whether extraction of the CIED should be done in other situations with EfsB is not known. We aimed to describe the management and outcome of patients with CIED and monomicrobial EfsB, in relation to extraction and recurrent EfsB. METHODS A population-based cohort of patients with monomicrobial EfsB from January 2014 to November 2020 was identified through microbiology registers in the Region Skåne, Sweden. Data on CIED and other clinical features were collected from medical records. RESULTS Among 1087 episodes of EfsB, 72 patients with CIED and monomicrobial EfsB were identified. Five of these patients were diagnosed with IE (7%), three of whom had echocardiographic changes on the CIED. Four CIED were extracted (6%). Recurrences were found in seven of 68 patients (10%) not subjected to extraction and in none of the extracted. In the group of patients without extraction, community acquisition and predisposition for IE were significantly associated with recurrent infection in univariate analyses. No infections involving the CIED were diagnosed during the recurrences. CONCLUSIONS In patient with monomicrobial EfsB, it seems safe to omit extraction if no structural changes are found on the CIED.
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27
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Simos PA, Holland DJ, Stewart A, Isler B, Hughes I, Price N, Henderson A, Alcorn K. Clinical prediction scores and the utility of time to blood culture positivity in stratifying the risk of infective endocarditis in Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2022; 77:2003-2010. [DOI: 10.1093/jac/dkac129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/31/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) complicates up to a quarter of Staphylococcus aureus bacteraemia (SAB) cases. Risk scores predict IE complicating SAB but have undergone limited external validation, especially in community-acquired infections and those who use IV drugs. Addition of the time to positive culture (TTP) may provide incremental risk prognostication.
Objectives
To externally validate risk scores for predicting IE in SAB and assess the incremental value of TTP.
Methods
The modified Duke score was calculated for adults hospitalized with SAB at a major tertiary institution. All patients underwent echocardiography. Sensitivity and specificity of the risk scores for predicting IE were calculated, and the incremental value of TTP was assessed.
Results
One hundred and six cases were analysed and 18 (17%) met definite IE criteria. The optimal TTP to predict IE was 11.5 h (sensitivity 88.9%; specificity 71.6%). The sensitivity of VIRSTA and PREDICT (Predicting risk of endocarditis using a clinical tool) were similar (94.4% for both) and higher than POSITIVE (Prediction Of Staphylococcus aureus Infective endocarditis Time to positivity, IV drug use, Vascular phenomena, pre-Existing heart condition; 77.8%). The receiver-operator characteristic AUCs were VIRSTA 0.83, PREDICT 0.75, POSITIVE 0.89 and TTP 0.85. Adding TTP to VIRSTA (i.e. VIRSTA+) resulted in the highest AUC (0.90), sensitivity (100%) and negative predictive value (100%), albeit with a low specificity (33%).
Conclusions
The VIRSTA and POSITIVE scores were the strongest predictors for IE complicating SAB. The addition of TTP to VIRSTA (VIRSTA+) significantly improved discriminatory value and may be safely used to rationalize echocardiography strategies.
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Affiliation(s)
- Peter A. Simos
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Infectious Disease Department, Gold Coast University Hospital, Southport, Queensland, Australia
| | - David J. Holland
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
- School of Human Movement and Nutrition Studies, The University of Queensland, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - Adam Stewart
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
- Department of Infectious Diseases, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Burcu Isler
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane and Women’s Hospital Campus, Brisbane, Australia
| | - Ian Hughes
- Office for Research Governance and Development, Gold Coast Health, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nathan Price
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Henderson
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kylie Alcorn
- Infectious Disease Department, Gold Coast University Hospital, Southport, Queensland, Australia
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28
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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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29
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Calderón-Parra J, Diego-Yagüe I, Santamarina-Alcantud B, Mingo-Santos S, Mora-Vargas A, Vázquez-Comendador JM, Fernández-Cruz A, Muñez-Rubio E, Gutiérrez-Villanueva A, Sánchez-Romero I, Ramos-Martínez A. Unreliability of Clinical Prediction Rules to Exclude without Echocardiography Infective Endocarditis in Staphylococcus aureus Bacteremia. J Clin Med 2022; 11:jcm11061502. [PMID: 35329827 PMCID: PMC8955153 DOI: 10.3390/jcm11061502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is unclear whether the use of clinical prediction rules is sufficient to rule out infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB) without an echocardiogram evaluation, either transthoracic (TTE) and/or transesophageal (TEE). Our primary purpose was to test the usefulness of PREDICT, POSITIVE, and VIRSTA scores to rule out IE without echocardiography. Our secondary purpose was to evaluate whether not performing an echocardiogram evaluation is associated with higher mortality. METHODS We conducted a unicentric retrospective cohort including all patients with a first SAB episode from January 2015 to December 2020. IE was defined according to modified Duke criteria. We predefined threshold cutoff points to consider that IE was ruled out by means of the mentioned scores. To assess 30-day mortality, we used a multivariable regression model considering performing an echocardiogram as covariate. RESULTS Out of 404 patients, IE was diagnosed in 50 (12.4%). Prevalence of IE within patients with negative PREDICT, POSITIVE, and VIRSTA scores was: 3.6% (95% CI 0.1-6.9%), 4.9% (95% CI 2.2-7.7%), and 2.2% (95% CI 0.2-4.3%), respectively. Patients with negative VIRSTA and negative TTE had an IE prevalence of 0.9% (95% CI 0-2.8%). Performing an echocardiogram was independently associated with lower 30-day mortality (OR 0.24 95% CI 0.10-0.54, p = 0.001). CONCLUSION PREDICT and POSITIVE scores were not sufficient to rule out IE without TEE. In patients with negative VIRSTA score, it was doubtful if IE could be discarded with a negative TTE. Not performing an echocardiogram was associated with worse outcomes, which might be related to presence of occult IE. Further studies are needed to assess the usefulness of clinical prediction rules in avoiding echocardiographic evaluation in SAB patients.
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Affiliation(s)
- Jorge Calderón-Parra
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
- Correspondence:
| | - Itziar Diego-Yagüe
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | | | - Susana Mingo-Santos
- Cardiology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain;
| | - Alberto Mora-Vargas
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - José Manuel Vázquez-Comendador
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - Ana Fernández-Cruz
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
| | - Elena Muñez-Rubio
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
| | - Andrea Gutiérrez-Villanueva
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
| | - Isabel Sánchez-Romero
- Microbiology Service, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (B.S.-A.); (I.S.-R.)
| | - Antonio Ramos-Martínez
- Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain; (I.D.-Y.); (A.M.-V.); (J.M.V.-C.); (A.F.-C.); (E.M.-R.); (A.G.-V.); (A.R.-M.)
- Investigational Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), 28222 Majadahonda, Spain
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Creel JP, Triplett D, Nayyar M, Summers NA. Penile implant infection resulting in Staphylococcus aureus bacteraemia and infective endocarditis. Access Microbiol 2022; 3:000295. [PMID: 35024555 PMCID: PMC8749141 DOI: 10.1099/acmi.0.000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Penile implant infections are a possible surgical complication that has historically been most commonly associated with Gram-positive bacteria. Staphylococcus aureus is a Gram-positive bacteria and is the most common cause of endocarditis. Case Presentation A male patient in his 50s with a past medical history of hypertension, diabetes, end-stage renal disease (ESRD) on peritoneal dialysis (PD) and erectile dysfunction with a penile implant placed 6 years prior to the admission date presented with complaints of scrotal pain. The pump for his implant had eroded through his scrotum and was draining pus. Blood cultures returned positive for Gram-positive cocci in clusters in 4/4 bottles, which was eventually identified as methicillin-sensitive Staphylococcus aureus (MSSA). A transthoracic echocardiogram (TTE) was performed due to concern for infective endocarditis (IE) but did not show any valvular abnormalities. Due to high clinical suspicion, a transesophageal echocardiogram (TEE) was performed and revealed a vegetation on the native mitral valve. His penile implant was removed by urology and intraoperative cultures grew MSSA. Surgical valve replacement was not recommended, and the patient was sent home with IV antibiotics for 6 weeks. Discussion Post-operative site infections are a quite uncommon point of entry for infective endocarditis, with penile implant infections being an even rarer cause. While a TTE is often used initially to attempt to diagnose infective endocarditis, it has lower sensitivity than a TEE. If clinical suspicion for infective endocarditis remains high after negative imaging with TTE, then TEE should be performed for better visualization of the heart valves.
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Affiliation(s)
- Joseph P Creel
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Triplett
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mannu Nayyar
- Division of Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nathan A Summers
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
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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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Go JR, Challener D, Corsini Campioli C, Sohail MR, Palraj R, Baddour LM, Abu Saleh O. Clinical Significance of Staphylococcus aureus in a Single Positive Blood Culture Bottle. Open Forum Infect Dis 2021; 9:ofab642. [PMID: 35071685 PMCID: PMC8774077 DOI: 10.1093/ofid/ofab642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/15/2021] [Indexed: 12/28/2022] Open
Abstract
Abstract
Clinical significance of a single positive blood culture bottle (SPBCB) with Staphylococcus aureus is unclear. We aimed to assess the significance of an SPBCB by looking at the associated outcomes. We performed a retrospective, multicenter study of patients with an SPBCB with S aureus using data collected from both electronic health records and the clinical microbiology laboratory. Overall, 534 patients with S aureus bacteremia were identified and 118 (22.1%) had an SPBCB. Among cases with an SPBCB, 106 (89.8%) were classified as clinically significant whereas 12 (10.2%) were considered contaminated or of unclear significance. A majority (92.4%) of patients received antibiotic therapy, but patients with clinically significant bacteremia were treated with longer courses (25.9 vs 5.7 days, P < .001). Significant differences in both frequency of echocardiography (65.1% vs 84.6%, P < .001) and infective endocarditis diagnosis (3.8% vs 14.2%, P = .002) were seen in those with an SPBCB compared to those with multiple positive bottles. A longer hospital length of stay and higher 90-day, 6-month, and 1-year mortality rates were seen in patients with multiple positive blood culture bottles. An SPBCB with S aureus was common among our patients. While this syndrome has a more favorable prognosis as compared to those with multiple positive blood cultures, clinicians should remain concerned as it portends a risk of infective endocarditis and mortality.
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Affiliation(s)
- John Raymond Go
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Douglas Challener
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Cristina Corsini Campioli
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Raj Palraj
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Bloodstream Infection and Endocarditis Caused by Staphylococcus aureus in Patients with Cancer: A Multicenter Cohort Study. Infect Dis Ther 2021; 11:323-334. [PMID: 34855164 PMCID: PMC8847471 DOI: 10.1007/s40121-021-00575-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/24/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION In a large cohort of patients with Staphylococcus aureus bloodstream infection (SABSI), we aimed to analyze the incidence and risk factors for infective endocarditis (IE) among patients with active cancer (PAC) in comparison with those without cancer (PWC). METHODS Multicenter cohort study of patients with SABSI admitted to two tertiary care hospitals, from 2011 to 2019. PAC were defined as those with an active solid organ cancer or hematological malignancies. SABSI and S. aureus IE were compared between PAC and PWC. RESULTS Among 978 episodes of SABSI, 217 (22.2%) occurred in PAC. PAC were younger, had fewer comorbidities, carried cardiac devices less often, and had less community-acquired SABSI than PWC. Compared to PWC, PAC more frequently had catheter-related SABSI, less IE (2.8% vs 10.9%, p < 0.001) and osteoarticular infection (2.3% vs 14.3%, p < 0.001). Independent risk factors for IE were cardiopathy (aOR 4.392, 95% CI 2.719-7.094) and persistent bacteremia (aOR 3.545, 95% CI 2.159-5.820). Thirty-day mortality was high, and similar between groups (24.2% vs 25.5%, p = 0.282). CONCLUSIONS PAC with SABSI developed IE less frequently than PWC did. This finding seems related to the differences in baseline characteristics and may have significant clinical implications, such as transesophageal echocardiography in PAC without cardiopathy or persistent bacteremia.
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Yamashita S, Tago M, Motomura S, Oie S, Aihara H, Katsuki NE, Yamashita SI. Development of a Clinical Prediction Model for Infective Endocarditis Among Patients with Undiagnosed Fever: A Pilot Case-Control Study. Int J Gen Med 2021; 14:4443-4451. [PMID: 34413673 PMCID: PMC8370112 DOI: 10.2147/ijgm.s324166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/08/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose Infective endocarditis (IE) may be diagnosed as fever of unknown origin due to its delusively non-descriptive clinical features, especially in outpatient clinics. Our objective is to develop a prediction model to discriminate patients to be diagnosed as “definite” IE from “non-definite” by modified Duke criteria among patients with undiagnosed fever, using only history and results of physical examinations and common laboratory examinations. Patients and Methods The study was a single-center case–control study. Inpatients at Saga University Hospital diagnosed with IE from 2007 to 2017 and patients with undiagnosed fever from 2015 to 2017 were enrolled. Patients diagnosed with definite IE according to the modified Duke criteria, except those definitely diagnosed with other disorders responsible for fever, were allocated to the IE group. Patients without IE among those defined as non-definite according to the modified Duke criteria were allocated to the undiagnosed fever group. We developed a prediction model to pick up patients who would be “definite” by modified Duke criteria, which was subsequently assessed by area under the curve (AUC). Results A total of 144 adult patients were included. Of these, 59 patients comprised the IE group. We developed the prediction model using five indicators, including transfer by ambulance, cardiac murmur, pleural effusion, neutrophil count, and platelet count, with a sensitivity 84.7%, a specificity 84.7%, an AUC 0.893 (95% confidence interval 0.828–0.959), a shrinkage coefficient 0.635, and a stratum-specific likelihood ratio 0.2–50.4. Conclusion Our prediction model, which uses only indicators easy to gain, facilitates prediction of patients with IE. These indicators can be acquired even at common hospitals and clinics, without requiring advanced medical equipment or invasive examinations. Trial Registration Number UMIN000041344.
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Affiliation(s)
- Shun Yamashita
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - So Motomura
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Satsuki Oie
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Hidetoshi Aihara
- Department of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Department of General Medicine, Saga University Hospital, Saga, Japan
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Beaufrère M, Pressat-Laffouilhère T, Marcelli C, Michon J, Lequerré T, Prum-Delépine C, Fiaux E, Rasoldier V, Etienne M, Savouré A, Dormoy L, Dargère S, Verdon R, Vittecoq O, Avenel G. Valvular and infection-associated risk factors as criteria to guide the use of echocardiography in patients with native joint infections. Semin Arthritis Rheum 2021; 51:1274-1281. [PMID: 34465446 DOI: 10.1016/j.semarthrit.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Native joint and bone infections (NJBI) are associated with infective endocarditis (IE) in 15% of cases. There are no studies analyzing the use of cardiac imaging in cases of NJBI. The objective of this study was to identify factors associated with echocardiography suggestive of IE in patients with NJBI. METHODS This medical records review was conducted in patients hospitalized for NJBI between 2007 and 2017 in Rheumatology and Infectious Diseases departments of 2 university hospitals. Patients included had a microbiologically proven NJBI during their hospitalization. RESULTS In this cohort of 546 patients, median age 66 years, echocardiography was suggestive of IE in 66 (12%). In multivariate analysis, factors associated with echocardiography suggestive of IE were 2 or more positive blood cultures (OR 11.55 (CI95% 3.24-74.20)), cardiac conditions with a high risk of IE (OR 7.34 (CI95% 2.95-18.61)), unknown heart murmur (OR 4.59 (CI95% 1.79-11.74)), multifocal infection (OR 2.26 (CI95% 1.21-4.23)) and an infection due to S. bovis (OR 3.52 (CI95% 1.26-9.79)). The factor associated with the absence of an echocardiography evocative of IE was infection due to unconventional bacteria for IE (OR 0.13 (CI95% 0.01-0.76)). According to the factors associated with echocardiography evocative of IE, we propose the Normandy score based on three kinds of data: cardiac condition, bacterial strain and NJBI mechanism. Echocardiography should be realized when this score, whose negative predictive value is 100% CI95% (98-100%) for prescription of echocardiography, is more than zero. CONCLUSIONS A score based on valvular condition, bacterial strain and NJBI mechanism could guide clinicians in prescribing echocardiography during NJBI with an excellent negative predictive value.
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Affiliation(s)
- Marie Beaufrère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France.
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France
| | - Jocelyn Michon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Thierry Lequerré
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Camille Prum-Delépine
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Elise Fiaux
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Véro Rasoldier
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Manuel Etienne
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Arnaud Savouré
- CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Laurent Dormoy
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Cardiology, 14000 Caen, France
| | - Sylvie Dargère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Renaud Verdon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Olivier Vittecoq
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Gilles Avenel
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
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Kolben Y, Ishay Y, Azmanov H, Rokney A, Baum M, Amit S, Nir-Paz R. Right-sided endocarditis caused by polyclonal Staphylococcus aureus infection. Eur J Med Res 2021; 26:91. [PMID: 34380556 PMCID: PMC8356449 DOI: 10.1186/s40001-021-00549-z] [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: 05/17/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case of bacterial endocarditis with both methicillin-sensitive and methicillin-resistant Staphylococcus aureus, which based on typing, originated from two distinct clones. Such a case may be misinterpreted by microbiology lab automation to be a monoclonal multi-drug resistant Staphylococcus aureus, while simple microbiology techniques will instantly reveal distinct clonality.
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Affiliation(s)
- Yotam Kolben
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Yuval Ishay
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Henny Azmanov
- Department of Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Assaf Rokney
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Moti Baum
- Government Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Sharon Amit
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ran Nir-Paz
- Department of Microbiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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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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Enterococcus faecalis in blood cultures-a prospective study on the role of persistent bacteremia. Diagn Microbiol Infect Dis 2021; 101:115433. [PMID: 34139401 DOI: 10.1016/j.diagmicrobio.2021.115433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 12/21/2022]
Abstract
Enterococcus faecalis can cause infective endocarditis and other complicated infections. We prospectively investigate the incidence of persistent bacteremia with E. faecalis. Of 50 episodes with monomicrobial E. faecalis bacteremia the control blood culture after 48 to 72 hours was positive in 5 episodes (10%) of which 4 had a complicated focal infection.
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39
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Zervou FN, Zacharioudakis IM. The Utility of Scoring Systems in Determining the Need for Echocardiography in Patients with Staphylococcus aureus Bacteremia. Clin Infect Dis 2021; 74:165-166. [PMID: 33972992 DOI: 10.1093/cid/ciab420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Fainareti N Zervou
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Ioannis M Zacharioudakis
- Division of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, New York, NY, USA
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40
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Rasmussen M, Lindberg H, Kahn F. One scoring system does not fit all health care settings. Clin Infect Dis 2021; 74:166-167. [PMID: 33972993 PMCID: PMC8752244 DOI: 10.1093/cid/ciab422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Magnus Rasmussen
- Skåne University Hospital, Lund, Sweden.,Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Fredrik Kahn
- Skåne University Hospital, Lund, Sweden.,Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.,The hospital of Halland, Halmstad, Sweden
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Mun SJ, Kim SH, Huh K, Cho SY, Kang CI, Chung DR, Peck KR. Role of echocardiography in uncomplicated Staphylococcus aureus catheter-related bloodstream infections. Medicine (Baltimore) 2021; 100:e25679. [PMID: 33950948 PMCID: PMC8104220 DOI: 10.1097/md.0000000000025679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/06/2021] [Indexed: 01/04/2023] Open
Abstract
Uncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan-Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography (P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13-43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05-805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.
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Affiliation(s)
- Seok Jun Mun
- Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan
| | - Si-Ho Kim
- Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon
| | - Kyungmin Huh
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Young Cho
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Shah S, Gupta T, White CJ, Jain S, Ramee E, Qamruddin S, Kemmerly SA. Optimizing cardiovascular imaging in Staphylococcus aureus endocarditis. Echocardiography 2021; 38:574-581. [PMID: 33704836 DOI: 10.1111/echo.15022] [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: 10/22/2020] [Revised: 01/13/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The shift toward value-based health care drives physicians to examine opportunities to optimize use of healthcare resources. There is discordance between providers' use of cardiovascular imaging (CVI) in assessing patients for infective endocarditis (IE) with Staphylococcus aureus bacteremia (SAB). An evidence-based algorithm was created to minimize variation of CVI use. The primary objective was to ensure sensitivity of the algorithm to recommend CVI in patients suspected of IE. METHODS A retrospective review evaluated patients at Ochsner Medical Center who developed SAB between 1/1/13 and 12/31/14. Predefined patient demographics, use of CVI, outcomes, and 12-week follow-up for readmission after first positive blood culture were collected from chart review. The created algorithm was applied retrospectively to determine its sensitivity and specificity in recommending the right CVI test. RESULTS 181 patients admitted were admitted with SAB, of which 114 (63%) were male. There were 115 TTEs and 55 TEEs performed. Out of 15 patients diagnosed with IE, 3 were found on TTE and 12 were found on TEE. The algorithm would have recommended a TEE in all 15 patients who had high-risk features for IE and a true diagnosis of IE, suggesting a sensitivity of 100% and specificity of 74.7% for the algorithm to have recommended a highly sensitive CVI modality. CONCLUSION This algorithm optimizes CVI for diagnosing IE in patients with SAB. As healthcare adapts to a value-based system, use of best-practice algorithms will promote consistency in practice among providers and help optimize patient outcomes and use of resources.
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Affiliation(s)
- Sangeeta Shah
- Department of Cardiology, Pauley Heart Center, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
| | - Tripti Gupta
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.,University of Queensland Ochsner School of Medicine, Brisbane, Australia
| | - Christopher J White
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.,University of Queensland Ochsner School of Medicine, Brisbane, Australia
| | - Surma Jain
- University of Queensland Ochsner School of Medicine, Brisbane, Australia.,Department of Pulmonary and Critical Care, Ochsner Clinical Foundation, New Orleans, LA, USA
| | - Emily Ramee
- University of Queensland Ochsner School of Medicine, Brisbane, Australia.,Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA, USA.,University of Queensland Ochsner School of Medicine, Brisbane, Australia
| | - Sandra A Kemmerly
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, LA, USA
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Kimmig A, Hagel S, Weis S, Bahrs C, Löffler B, Pletz MW. Management of Staphylococcus aureus Bloodstream Infections. Front Med (Lausanne) 2021; 7:616524. [PMID: 33748151 PMCID: PMC7973019 DOI: 10.3389/fmed.2020.616524] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.
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Affiliation(s)
- Aurelia Kimmig
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
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Validation of VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) Scores to Determine the Priority of Echocardiography in Patients With Staphylococcus aureus Bacteremia. Clin Infect Dis 2021; 73:e1151-e1157. [DOI: 10.1093/cid/ciaa1844] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) secondary to Staphylococcus aureus bacteremia (SAB) has high morbidity and mortality. The systematic use of echocardiography in SAB is controversial. We aimed to validate VIRSTA and Predicting Risk of Endocarditis Using a Clinical Tool (PREDICT) scores for predicting the risk of IE in Colombian patients with SAB and, consequently, to determine the need for echocardiography.
Methods
Cohort of patients hospitalized with SAB in 2 high complexity institutions in Medellin, Colombia, between 2012 and 2018. The diagnosis of IE was established based on the modified Duke criteria. The VIRSTA and PREDICT scores were calculated from the clinical records, and their operational performance was calculated.
Results
The final analysis included 922 patients, 62 (6.7%) of whom were diagnosed with IE. The frequency of IE in patients with a negative VIRSTA scale was 0.44% (2/454). The frequency of IE in patients with a negative PREDICT scale on day 5 was 4.8% (30/622). The sensitivity and negative predictive value (NPV) of the VIRSTA scale was 96.7% and 99.5%, respectively. For the PREDICT scale on day 5, the sensitivity and NPV were 51.6% and 95.1%, respectively. The discrimination, given by the area under the receiver operating characteristic curve, was 0.86 for VIRSTA and 0.64 for PREDICT.
Conclusions
In patients with negative VIRSTA, screening echocardiography may be unnecessary because of the low frequency of IE. In PREDICT-negative patients, despite the low frequency of IE, it is not safe to omit echocardiography.
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Kahn F, Resman F, Bergmark S, Filiptsev P, Nilson B, Gilje P, Rasmussen M. Time to blood culture positivity in Staphylococcus aureus bacteraemia to determine risk of infective endocarditis. Clin Microbiol Infect 2020; 27:1345.e7-1345.e12. [PMID: 33197608 DOI: 10.1016/j.cmi.2020.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Patients with Staphylococcus aureus bacteraemia (SAB) at risk for infective endocarditis (IE) need to be identified because they should undergo echocardiography. We validated previous scoring systems for IE risk determination and evaluated whether time to blood culture positivity (TTP) could improve scoring systems. METHODS This retrospective population-based study included adults with SAB in 2016 in a derivation cohort and those from 2017 in a validation cohort. TTP was compared between patients with and without IE. A new score including TTP was constructed using a least absolute shrinkage selection operator. The new POSITIVE score was compared to the previously described PREDICT and VIRSTA scores. RESULTS A total of 465 episodes with SAB were included in the derivation cohort, of which 38 (8.2%) represented IE. Median (interquartile range) TTP was significantly shorter in episodes with IE, at 8.7 (7.7-10.6) hours compared to those without, at 13.3 (10.5-16.5) hours. When using a cutoff at 13 hours, TTP had a sensitivity of 100% (95% confidence interval (CI), 91-100) and specificity of 52% (95% CI, 47-57) for IE. The POSITIVE score included TTP, intravenous drug use, embolizations and presence of preexisting heart conditions. It had a sensitivity of 93% (95% CI, 76-99) and a specificity of 70% (95% CI, 66-74) in the validation cohort. The performance of POSITIVE was superior to PREDICT, and the specificity was higher than that of VIRSTA. CONCLUSIONS TTP, either by itself or as part of the POSITIVE score, can be used to identify patients with SAB at low risk for IE. Further validation is needed because TTP is sensitive to several external factors.
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Affiliation(s)
- Fredrik Kahn
- Skåne University Hospital, Sweden; Division of Infection Medicine, Department of Clinical Sciences Lund, Sweden
| | - Fredrik Resman
- Skåne University Hospital, Sweden; Division of Infectious Diseases, Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | | | - Bo Nilson
- Clinical Microbiology, Labmedicine, Region Skåne, Lund, Sweden; Division of Medical Microbiology, Department of Laboratory Medicine, Sweden
| | - Patrik Gilje
- Skåne University Hospital, Sweden; Division of Cardiology, Department of Clinical Sciences, Lund University, Sweden
| | - Magnus Rasmussen
- Skåne University Hospital, Sweden; Division of Infection Medicine, Department of Clinical Sciences Lund, Sweden.
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46
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Lambregts MMC, Molendijk EBD, Meziyerh S, Schippers EF, Delfos NM, Leendertse M, Bernards AT, Visser LG, Dekkers OM, de Boer MGJ. Early differentiation between uncomplicated and complicated Staphylococcus aureus bacteraemia: Potential value and limitations of a clinical risk score. Int J Clin Pract 2020; 74:e13601. [PMID: 32603544 PMCID: PMC7685114 DOI: 10.1111/ijcp.13601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/25/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE A cornerstone in the management of Staphylococcus aureus bacteraemia (SAB) is the differentiation between a complicated and an uncomplicated SAB course. The ability to early and accurately identify patients with - and without - complicated bacteraemia may optimise the utility of diagnostics and prevent unnecessary prolonged antibiotic therapy. METHODS Development and validation of a prediction score in SAB using demographic, clinical, and laboratory data from two independent Dutch cohorts; estimating the risk of complicated disease at the time of the first positive blood culture. Models were developed using logistic regression and evaluated by c-statistics, ie area under the ROC-curve, and negative predictive values (NPV). RESULTS The development- and validation cohorts included 150 and 183 patients, respectively. The most optimal prediction model included: mean arterial pressure, signs of metastatic infection on physical examination, leucocyte count, urea level and time to positivity of blood cultures (c-statistic 0.82, 95% CI 0.74-0.89). In the validation cohort, the c-statistic of the prediction score was 0,77 (95% CI 0.69-0.84). The NPV for complicated disease for patients with a score of ≤2 was 0.83 (95% CI 0.68-0.92), with a negative likelihood ratio of 0.14 (95% CI 0.06-0.31). CONCLUSION The early SAB risk score helps to identify patients with high probability of uncomplicated SAB. However, the risk score's lacked absolute discriminative power to guide decisions on the management of all patients with SAB on its own. The heterogenicity of the disease and inconsistency in definitions of complicated SAB are important challenges in the development of clinical rules to guide the management of SAB.
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Affiliation(s)
- Merel M. C. Lambregts
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Eva B. D. Molendijk
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal MedicineAlrijne HospitalLeiderdorpThe Netherlands
| | - Soufian Meziyerh
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal MedicineHaga Teaching HospitalDen HaagThe Netherlands
| | - Emile F. Schippers
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
- Department of Internal MedicineHaga Teaching HospitalDen HaagThe Netherlands
| | - Nathalie M. Delfos
- Department of Internal MedicineAlrijne HospitalLeiderdorpThe Netherlands
| | - Masja Leendertse
- Department of Medical MicrobiologyAlrijne HospitalLeiderdorpThe Netherlands
| | - Alexandra T. Bernards
- Department of Medical MicrobiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Leo G. Visser
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Olaf M. Dekkers
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Mark G. J. de Boer
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
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Epidemiology, bacteriology, and clinical characteristics of HACEK bacteremia and endocarditis: a population-based retrospective study. Eur J Clin Microbiol Infect Dis 2020; 40:525-534. [PMID: 32944895 PMCID: PMC7892745 DOI: 10.1007/s10096-020-04035-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/10/2020] [Indexed: 12/16/2022]
Abstract
The objective was to describe the epidemiology, bacteriology, clinical presentation, risk factors for endocarditis (IE), diagnostic workup, and outcome of patients with bacteremia caused by the non-influenzae Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella genera (HACEK). A retrospective population-based cohort of patients with bacteremia collected from 2012 to 2017 was identified. Clinical data from identified patients were collected from medical records to classify patients, calculate incidences, analyze risk factors of IE, and describe the management and outcome of the cohort. A total of 118 episodes of HACEK bacteremia were identified, of which 27 were definite IE. The incidence of HACEK bacteremia was 5.2 and of HACEK IE 1.2 episodes per 1,000,000 inhabitants per year. Other focal infections were identified in 55 of 118 of the episodes, most commonly within the abdomen (26 episodes). The propensity to cause IE ranged from 62 in Aggregatibacter actinomycetemcomitans to 6% in Eikenella. Risk factors for IE were cardiac implantable electronical device, predisposing cardiac conditions, community acquisition, long duration of symptoms, multiple positive blood cultures, fever, heart murmur, embolization, and unknown origin of infection. The scoring system DENOVA developed to predict IE in bacteremia with Enterococcus faecalis also had a high sensitivity and specificity for predicting IE in HACEK bacteremia. The 30-day mortality was 4% in IE and 15% in non-IE bacteremia, and only one case of relapse was found. IE is common in bacteremia with Aggregatibacter, Cardiobacterium, and Kingella but relatively rare in Haemophilus and Eikenella. Treatment failures are very rare, and DENOVA can be used to evaluate the need for transesophageal echocardiography.
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48
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Abraham L, Bamberger DM. Staphylococcus aureus Bacteremia: Contemporary Management. MISSOURI MEDICINE 2020; 117:341-345. [PMID: 32848271 PMCID: PMC7431060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Staphylococcus aureus bacteremia (SAB) is a serious cause of bloodstream infection associated with significant morbidity and mortality. Complications include deep-seated foci of infection including infective endocarditis, device-associated infection, osteoarticular metastases, pleuropulmonary involvement, and recurrent infection. With the 30-day all-cause mortality being around 20%, a collaborative effort of early Infectious Diseases (ID) consultation and Antimicrobial Stewardship Program (ASP) involvement will show improved SAB outcomes and therapy optimization.1.
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Affiliation(s)
- Leny Abraham
- Infectious Diseases Fellow, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri
| | - David M Bamberger
- Chief, Infectious Diseases, Truman Medical Center, Medical Director, Sexual Health Clinic, Kansas City Health Department, and Professor of Medicine, University of Missouri - Kansas City School of Medicine, Kansas City, Missouri
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Chamat-Hedemand S, Dahl A, Østergaard L, Arpi M, Fosbøl E, Boel J, Oestergaard LB, Lauridsen TK, Gislason G, Torp-Pedersen C, Bruun NE. Prevalence of Infective Endocarditis in Streptococcal Bloodstream Infections Is Dependent on Streptococcal Species. Circulation 2020; 142:720-730. [PMID: 32580572 DOI: 10.1161/circulationaha.120.046723] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Streptococci frequently cause infective endocarditis (IE), yet the prevalence of IE in patients with bloodstream infections (BSIs) caused by different streptococcal species is unknown. We aimed to investigate the prevalence of IE at species level in patients with streptococcal BSIs. METHODS We investigated all patients with streptococcal BSIs, from 2008 to 2017, in the Capital Region of Denmark. Data were crosslinked with Danish nationwide registries for identification of concomitant hospitalization with IE. In a multivariable logistic regression analysis, we investigated the risk of IE according to streptococcal species adjusted for age, sex, ≥3 positive blood culture bottles, native valve disease, prosthetic valve, previous IE, and cardiac device. RESULTS Among 6506 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men) the IE prevalence was 7.1% (95% CI, 6.5-7.8). The lowest IE prevalence was found with Streptococcus pneumoniae (S pneumoniae) 1.2% (0.8-1.6) and Spyogenes 1.9% (0.9-3.3). An intermediary IE prevalence was found with Sanginosus 4.8% (3.0-7.3), Ssalivarius 5.8% (2.9-10.1), and Sagalactiae 9.1% (6.6-12.1). The highest IE prevalence was found with Smitis/oralis 19.4% (15.6-23.5), Sgallolyticus (formerly Sbovis) 30.2% (24.3-36.7), Ssanguinis 34.6% (26.6-43.3), Sgordonii 44.2% (34.0-54.8), and Smutans 47.9% (33.3-62.8). In multivariable analysis using S pneumoniae as reference, all species except S pyogenes were associated with significantly higher IE risk, with the highest risk found with S gallolyticus odds ratio (OR) 31.0 (18.8-51.1), S mitis/oralis OR 31.6 (19.8-50.5), S sanguinis OR 59.1 (32.6-107), S gordonii OR 80.8 (43.9-149), and S mutans OR 81.3 (37.6-176). CONCLUSIONS The prevalence of IE in streptococcal BSIs is species dependent with S mutans, S gordonii, S sanguinis, S gallolyticus, and S mitis/oralis having the highest IE prevalence and the highest associated IE risk after adjusting for IE risk factors.
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Affiliation(s)
- Sandra Chamat-Hedemand
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (S.C.-H., N.E.B.)
| | - Anders Dahl
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (S.C.-H., A.D., L.B.O., T.K.L., G.G.)
| | - Lauge Østergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark (L.Ø., E.F.)
| | - Magnus Arpi
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.A., J.B.)
| | - Emil Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark (L.Ø., E.F.)
| | - Jonas Boel
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev-Gentofte, Denmark (M.A., J.B.)
| | - Louise Bruun Oestergaard
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (S.C.-H., A.D., L.B.O., T.K.L., G.G.)
| | - Trine K Lauridsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (S.C.-H., A.D., L.B.O., T.K.L., G.G.)
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark (S.C.-H., A.D., L.B.O., T.K.L., G.G.)
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark (C.T.-P.).,Department of Cardiology, Aalborg University Hospital, Denmark (C.T.-P.)
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (S.C.-H., N.E.B.).,Institute of Clinical Medicine, Copenhagen University, Denmark (N.E.B.).,Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
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50
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Pérez-Rodríguez MT, Sousa A, López-Cortés LE, Martínez-Lamas L, Val N, Baroja A, Nodar A, Vasallo F, Álvarez-Fernández M, Crespo M, Rodríguez-Baño J. Moving beyond unsolicited consultation: additional impact of a structured intervention on mortality in Staphylococcus aureus bacteraemia. J Antimicrob Chemother 2020; 74:1101-1107. [PMID: 30689894 DOI: 10.1093/jac/dky556] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Some evidence-based bundles have tried to standardize the management of Staphylococcus aureus bacteraemia (SAB) to improve the outcome. The aim of our study was to analyse the additional impact on mortality of a structured intervention in patients with SAB. METHODS Compliance with the bundle was evaluated in an ambispective cohort of patients with SAB, which included a retrospective cohort [including patients treated before and after the implementation of a bacteraemia programme (no-BP and BP, respectively)] and a prospective cohort (i-BP), in which an additional specific intervention for bundle application was implemented. Multivariate logistic regression was used to measure the influence of the independent variables including compliance with the bundle on 14 and 30 day crude mortality. RESULTS A total of 271 adult patients with SAB were included. Mortality was significantly different among the three groups (no-BP, BP and i-BP): mortality at 14 days was 18% versus 7% versus 2%, respectively, P = 0.002; and mortality at 30 days was 20% versus 12% versus 5%, respectively, P = 0.011. The factors associated with 14 and 30 day mortality in multivariable analysis were heart failure (OR = 7.63 and OR = 2.27, respectively), MRSA infection (OR = 4.02 and OR = 4.37, respectively) and persistent bacteraemia (OR = 11.01 and OR = 7.83, respectively); protective factors were catheter-related bacteraemia (OR = 0.16 and OR = 0.19, respectively) and >75% bundle compliance (OR = 0.15 and OR = 0.199, respectively). Time required to perform the intervention and the follow-up was 50 min (IQR 40-55 min) per patient. CONCLUSIONS High-level compliance with a standardized bundle of intervention for management of SAB that requires little time was associated with lower mortality at 14 and 30 days.
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Affiliation(s)
- María Teresa Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Adrián Sousa
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lucía Martínez-Lamas
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Nuria Val
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Aida Baroja
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Andrés Nodar
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Francisco Vasallo
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Maximiliano Álvarez-Fernández
- Microbiology Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Manuel Crespo
- Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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