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Mitsutake K, Shinya N, Seki M, Ohara T, Uemura K, Fukunaga M, Sakai J, Nagao M, Sata M, Hamada Y, Kawasuji H, Yamamoto Y, Nakamatsu M, Koizumi Y, Mikamo H, Ukimura A, Aoyagi T, Sawai T, Tanaka T, Izumikawa K, Takayama Y, Nakamura K, Kanemitsu K, Tokimatsu I, Nakajima K, Akine D. Clinical characteristics and analysis of prognostic factors in methicillin-resistant Staphylococcus aureus endocarditis: A retrospective multicenter study in Japan. J Infect Chemother 2024:S1341-321X(24)00157-0. [PMID: 38876203 DOI: 10.1016/j.jiac.2024.06.002] [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: 12/14/2023] [Revised: 05/16/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Infective endocarditis (IE) caused by MRSA (methicillin-resistant Staphylococcus aureus) is associated with a high mortality rate. This study aimed to elucidate the characteristics of patients with MRSA-IE in Japan and identify the factors associated with prognosis. METHODS This retrospective study included patients with a confirmed diagnosis of IE caused by MRSA, between January 2015 and April 2019. RESULTS A total of 65 patients from 19 centers were included, with a mean age of 67 years and 26% were female. Fifty percent of the patients with IE were had nosocomial infections and 25% had prosthetic valve involvement. The most common comorbidities were hemodialysis (20%) and diabetes (20%). Congestive heart failure was present in 86% of patients (NYHA class I, II: 48%; III, IV: 38%). The 30-day and in-hospital mortality rates were 29% and 46%, respectively. Multi-organ failure was the primary cause of death, accounting for 43% of all causes of death. Prognostic factors for in-hospital mortality were age, disseminated intravascular coagulation, daptomycin and/or linezolid as initial antibiotic therapy, and surgery. Surgical treatment was associated with a lower mortality rate (odds ratio [OR], 0.026; 95% confidence interval [CI], 0.002-0.382; p=0.008 for 30-day mortality and OR, 0.130; 95% CI; 0.029-0.584; p=0.008 for in-hospital mortality). CONCLUSION Mortality due to MRSA-IE remains high. Surgical treatment is a significant prognostic predictor of MRSA-IE.
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Affiliation(s)
- Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan.
| | - Natsuki Shinya
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan
| | - Masafumi Seki
- Department of Infectious Diseases and Infection Control, Saitama International Medical Center, Saitama Medical University, 397-1, Hidaka, Saitama, 350-1298, Japan; Department of Infectious Diseases, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku,Sendai, Miyagi 983-8536, Japan
| | - Takahiro Ohara
- Division of Geriatric and Community Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, Miyagi 983-8536, Japan
| | - Kohei Uemura
- Department of Biostatistics and Bioinformatics, Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Masato Fukunaga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita, Kitakyushu, Fukuoka 802-8555, Japan
| | - Jun Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University Hospital, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto City, Kyoto 606-8507, Japan
| | - Makoto Sata
- National Cerebral and Cardiovascular Center Division of Pulmonology and Infection Control, 6-1, Kishibe Shinmachi, Suita, Osaka 564-8565, Japan
| | - Yohei Hamada
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, 5-1-1 Nabeshima, Saga, 849-0937, Japan
| | - Hitoshi Kawasuji
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Masashi Nakamatsu
- Department of Infection control, University of the Ryukyus Hospital, 207 Aza-Uehara, Nishihara, Nakagami-gun, Okinawa, 903-0215, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Iwasaku, Ganmata, Nagakute, Aichi 480-1195, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1 Iwasaku, Ganmata, Nagakute, Aichi 480-1195, Japan
| | - Akira Ukimura
- Infection Control Center, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-cho, Takatsuki, Osaka 569-0801, Japan
| | - Tetsuji Aoyagi
- Department of Clinical Microbiology and Infection, Tohoku University Graduate School of Medicine, Department of Comprehensive Infectious Diseases, 2-1 Seiryo-cho, Aoba-ku, Sendai 980-8575, Japan
| | - Toyomitsu Sawai
- Nagasaki Harbor Medical Center, Department of Respiratory Medicine, 6-39 Shinchi-cho, Nagasaki City, Nagasaki 850-0842, Japan
| | - Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, 1 Chome-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1 Chome-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yoko Takayama
- Department of Infection Control and Infectious Diseases Research and Development Center for New Medical Frontiers Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Kiwamu Nakamura
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Keiji Kanemitsu
- Department of Infection Control, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Issei Tokimatsu
- Department of Medicine, Division of Clinical Infectious Diseases, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| | - Kazuhiko Nakajima
- Department of Infection Prevention and Control, Hyogo medical University, 1-1, Mukogawa, Nishinomiya, Hyogo 663-850, Japan
| | - Dai Akine
- Division of Clinical infectious diseases, School of Medicine, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan
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Jiang F, Cai C, Wang X, Han S. A dual biomarker-targeting probe enables signal-on surface labeling of Staphylococcus aureus. Bioorg Med Chem Lett 2023; 93:129428. [PMID: 37541632 DOI: 10.1016/j.bmcl.2023.129428] [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: 05/12/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023]
Abstract
Imaging or killing of a specific pathogen is of significance for precise therapy. Staphylococcus aureus (S. aureus) is an infectious gram-positive bacteria relying on Sortase A (SrtA) to anchor cell surface protein on peptidoglycan. We herein report signal-on labeling of S. aureus with self-quenched optical probes featuring vancomycin-conjugated SrtA substrate that is flanked by a dabcyl moiety paired with either fluorescein or eosine photosensizer (PS). SrtA-mediated cleavage of the substrate motif releases the dabcyl quencher, leading to covalent labeling of peptidoglycan with fluorescein or PS of restored photophysical property. The dual biomarked-enabled peptidoglycan labeling enables signal-on imaging and effective photodynamic destruction of S. aureus, suggesting a protheranostic approch activatable to SrtA-positive bacteria engaged in myriad diseases.
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Affiliation(s)
- Feng Jiang
- Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory for Physical Chemistry of Solid Surfaces, Xiamen University, Xiamen 361005, China
| | - Chengteng Cai
- Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory for Physical Chemistry of Solid Surfaces, Xiamen University, Xiamen 361005, China
| | - Xiumin Wang
- School of Pharmaceutical Sciences, Fujian Provincial Key Laboratory of Innovative Drug Target Research, Xiamen University, Xiamen 361102, China.
| | - Shoufa Han
- Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, State Key Laboratory for Physical Chemistry of Solid Surfaces, Xiamen University, Xiamen 361005, China.
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3
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Fries F, Kany AM, Rasheed S, Hirsch AKH, Müller R, Herrmann J. Impact of Drug Administration Routes on the In Vivo Efficacy of the Natural Product Sorangicin a Using a Staphylococcus aureus Infection Model in Zebrafish Embryos. Int J Mol Sci 2023; 24:12791. [PMID: 37628971 PMCID: PMC10454396 DOI: 10.3390/ijms241612791] [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: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Staphylococcus aureus causes a wide range of infections, and it is one of the leading pathogens responsible for deaths associated with antimicrobial resistance, the rapid spread of which among S. aureus urges the discovery of new antibiotics. The evaluation of in vivo efficacy of novel drug candidates is usually performed using animal models. Recently, zebrafish (Danio rerio) embryos have become increasingly attractive in early drug discovery. Herein, we established a zebrafish embryo model of S. aureus infection for evaluation of in vivo efficacy of novel potential antimicrobials. A local infection was induced by microinjecting mCherry-expressing S. aureus Newman followed by treatment with reference antibiotics via microinjection into different injection sites as well as via waterborne exposure to study the impact of the administration route on efficacy. We successfully used the developed model to evaluate the in vivo activity of the natural product sorangicin A, for which common mouse models were not successful due to fast degradation in plasma. In conclusion, we present a novel screening platform for assessing in vivo activity at the antibiotic discovery stage. Furthermore, this work provides consideration for the choice of an appropriate administration route based on the physicochemical properties of tested drugs.
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Affiliation(s)
- Franziska Fries
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
- Department of Pharmacy, Saarland University, 66123 Saarbrücken, Germany
| | - Andreas M. Kany
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
| | - Sari Rasheed
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
| | - Anna K. H. Hirsch
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
- Department of Pharmacy, Saarland University, 66123 Saarbrücken, Germany
| | - Rolf Müller
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
- Department of Pharmacy, Saarland University, 66123 Saarbrücken, Germany
| | - Jennifer Herrmann
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University, Campus E8 1, 66123 Saarbrücken, Germany; (F.F.); (A.M.K.); (S.R.); (A.K.H.H.); (R.M.)
- German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
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Manoharadas S, Ahmad N, Altaf M, Alrefaei AF, Al-Rayes BF. An Enzybiotic Cocktail Effectively Disrupts Preformed Dual Biofilm of Staphylococcus aureus and Enterococcus faecalis. Pharmaceuticals (Basel) 2023; 16:ph16040564. [PMID: 37111322 PMCID: PMC10145859 DOI: 10.3390/ph16040564] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Multidrug-resistant bacterial infections are on the rise around the world. Chronic infections caused by these pathogens through biofilm mediation often complicate the situation. In natural settings, biofilms are often formed with different species of bacteria existing synergistically or antagonistically. Biofilms on diabetic foot ulcers are formed predominantly by two opportunistic pathogens, Staphylococcus aureus and Enterococcus faecalis. Bacteriophages and phage-based proteins, including endolysins, have been found to be active against biofilms. In this study, we evaluated the activity of two engineered enzybiotics either by themselves or as a combination against a dual biofilm formed by S. aureus and E. faecalis in an inert glass surface. An additive effect in rapidly disrupting the preformed dual biofilm was observed with the cocktail of proteins, in comparison with mono treatment. The cocktail-treated biofilms were dispersed by more than 90% within 3 h of treatment. Apart from biofilm disruption, bacterial cells embedded in the biofilm matrix were also effectively reduced by more than 90% within 3 h of treatment. This is the first instance where a cocktail of engineered enzybiotics has been effectively used to impede the structural integrity of a dual biofilm.
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Affiliation(s)
- Salim Manoharadas
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
- Central Laboratory RM 63AA, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Naushad Ahmad
- Central Laboratory RM 63AA, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Mohammad Altaf
- Central Laboratory RM 63AA, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Abdulwahed Fahad Alrefaei
- Department of Zoology, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Basel F Al-Rayes
- Central Laboratory RM 63AA, College of Science, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
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5
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The Assessment of Antimicrobial Resistance in Gram-Negative and Gram-Positive Infective Endocarditis: A Multicentric Retrospective Analysis. Medicina (B Aires) 2023; 59:medicina59030457. [PMID: 36984458 PMCID: PMC10054718 DOI: 10.3390/medicina59030457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/03/2023] Open
Abstract
Background and Objectives: Multidrug-resistant microorganisms have made treating bacterial infections challenging. Resistance to antibiotics is expected to overcome efforts to produce new, effective antibacterial medication that is lifesaving in many situations. Infective endocarditis (IE) is a life-threatening infection that affects 5–15 per 100,000 patients annually and requires rapid antibiotic therapy to prevent morbidity and mortality. Materials and Methods: The present research assessed IE cases over five years, from a multicentric database, with the main objective of determining the degree of antibiotic resistance in these patients, stratified by Gram-positive and Gram-negative bacteria. Results: Bad oral hygiene was present in 58.6% of patients from the Gram-negative group (vs. 38.7% in the Gram-positive group). Non-valvular heart disease was identified in approximately 40% of all patients, and valvopathies in approximately 20%. It was observed that 37.9% of Gram-negative IE bacteria were resistant to three or more antibiotics, whereas 20.7% were susceptible. Among Gram-positive infections, S. aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics. Patients with Gram-negative IE were 4.2 times more likely to die. The mortality risk was 4 times higher when bacteria resistant to two or more antibiotics was involved and 5.7 times higher with resistance patterns to three or more antibiotics than the reference group with no antibiotic resistance. Peripheral catheters were the most common cause of multi-resistant IE, followed by heart surgery, dental procedures, and ENT interventions. Conclusions: Even though Gram-positive infections were the most frequent (83.0% of all cases), Gram-negative IE infections are substantially more deadly than Gram-positive IE infections. However, it was also observed that patients with Gram-negative infections were more likely to have underlying comorbidities, be institutionalized, and be underweight. Although the Gram-negative infections were more severe, their resistance patterns were similar to Gram-positive bacteria. As resistance patterns increase, more efforts should be made to prevent a healthcare catastrophe. At the same time, careful prophylaxis should be considered in patients at risk, including those with central catheters, undergoing dental procedures, and with poor oral hygiene.
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Alnabelsi TS, Sinner G, Al-Abdouh A, Marji M, Viquez K, Abusnina W, Kotter J, Smith MD, El-Dalati S, Leung SW. The Evolving Trends in Infective Endocarditis and Determinants of Mortality: a 10-year Experience From a Tertiary Care Epicenter. Curr Probl Cardiol 2023; 48:101673. [PMID: 36828048 DOI: 10.1016/j.cpcardiol.2023.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
The epidemiology of infective endocarditis (IE) continues to evolve in areas affected by the opioid epidemic. Understanding the demographics of the disease allows us to better tailor therapy towards this at-risk population. This was an observational study of adults (age ≥ 18) admitted to the University of Kentucky hospital with IE between January 2009 and December 2018. 1,255 patients were included in the final analysis. The mean age was 42 years, 45% were female and injection drug use was seen in 66% of patients. On multivariable analysis, higher Charlson comorbidity indices, left sided, and multivalve involvement were associated with increased mortality, whereas surgical intervention demonstrated a trend towards lower mortality. Our results highlight the alarming increase in injection drug use related IE and the high mortality rates despite therapeutic advances. Patients with left sided IE, multivalve involvement and a higher Charlson comorbidity index had decreased survival.
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Affiliation(s)
- Talal S Alnabelsi
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY; Department of Cardiology, Cardiovascular Imaging Institute, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
| | - Gregory Sinner
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Meera Marji
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY
| | - Karolina Viquez
- Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Waiel Abusnina
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY
| | - John Kotter
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY
| | - Mikel D Smith
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY
| | - Sami El-Dalati
- Division of Infectious Disease, Department of Internal Medicine, University of Kentucky, Lexington, KY
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, KY
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Welcome MO, Dogo D, Nikos E Mastorakis. Cellular mechanisms and molecular pathways linking bitter taste receptor signalling to cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction in heart diseases. Inflammopharmacology 2023; 31:89-117. [PMID: 36471190 PMCID: PMC9734786 DOI: 10.1007/s10787-022-01086-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
Heart diseases and related complications constitute a leading cause of death and socioeconomic threat worldwide. Despite intense efforts and research on the pathogenetic mechanisms of these diseases, the underlying cellular and molecular mechanisms are yet to be completely understood. Several lines of evidence indicate a critical role of inflammatory and oxidative stress responses in the development and progression of heart diseases. Nevertheless, the molecular machinery that drives cardiac inflammation and oxidative stress is not completely known. Recent data suggest an important role of cardiac bitter taste receptors (TAS2Rs) in the pathogenetic mechanism of heart diseases. Independent groups of researchers have demonstrated a central role of TAS2Rs in mediating inflammatory, oxidative stress responses, autophagy, impulse generation/propagation and contractile activities in the heart, suggesting that dysfunctional TAS2R signalling may predispose to cardiac inflammatory and oxidative stress disorders, characterised by contractile dysfunction and arrhythmia. Moreover, cardiac TAS2Rs act as gateway surveillance units that monitor and detect toxigenic or pathogenic molecules, including microbial components, and initiate responses that ultimately culminate in protection of the host against the aggression. Unfortunately, however, the molecular mechanisms that link TAS2R sensing of the cardiac milieu to inflammatory and oxidative stress responses are not clearly known. Therefore, we sought to review the possible role of TAS2R signalling in the pathophysiology of cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction in heart diseases. Potential therapeutic significance of targeting TAS2R or its downstream signalling molecules in cardiac inflammation, oxidative stress, arrhythmia and contractile dysfunction is also discussed.
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Affiliation(s)
- Menizibeya O Welcome
- Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Plot 681 Cadastral Zone, C-00 Research and Institution Area, Jabi Airport Road Bypass, FCT, Abuja, Nigeria.
| | - Dilli Dogo
- Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, Nile University of Nigeria, Abuja, Nigeria
| | - Nikos E Mastorakis
- Technical University of Sofia, Klement Ohridksi 8, Sofia, 1000, Bulgaria
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Bergadà-Pijuan J, Frank M, Boroumand S, Hovaguimian F, Mestres CA, Bauernschmitt R, Carrel T, Stadlinger B, Ruschitzka F, Zinkernagel AS, Kouyos RD, Hasse B. Antibiotic prophylaxis before dental procedures to prevent infective endocarditis: a systematic review. Infection 2023; 51:47-59. [PMID: 35972680 PMCID: PMC9879842 DOI: 10.1007/s15010-022-01900-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE. METHODS We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol. RESULTS The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered. CONCLUSIONS Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.
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Affiliation(s)
- Judith Bergadà-Pijuan
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Boroumand
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frédérique Hovaguimian
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Carlos A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Bauernschmitt
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Roger D. Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Lefèvre B, Legoff A, Boutrou M, Goehringer F, Ngueyon-Sime W, Chirouze C, Revest M, Vernet Garnier V, Duval X, Delahaye F, Le Moing V, Selton-Suty C, Filippetti L, Hoen B, Agrinier N. Staphylococcus aureus endocarditis: Identifying prognostic factors using a method derived from morbidity and mortality conferences. Front Med (Lausanne) 2022; 9:1053278. [PMID: 36561723 PMCID: PMC9763316 DOI: 10.3389/fmed.2022.1053278] [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: 09/25/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Objectives Lethality of Staphylococcus aureus (Sa) infective endocarditis (IE) is high and might be due to yet unidentified prognostic factors. The aim of this study was to search for new potential prognostic factors and assess their prognostic value in SaIE. Materials and methods We used a two-step exploratory approach. First, using a qualitative approach derived from mortality and morbidity conferences, we conducted a review of the medical records of 30 patients with SaIE (15 deceased and 15 survivors), randomly extracted from an IE cohort database (NCT03295045), to detect new factors of possible prognostic interest. Second, we collected quantitative data for these factors in the entire set of SaIE patients and used multivariate Cox models to estimate their prognostic value. Results A total of 134 patients with modified Duke definite SaIE were included, 64 of whom died during follow-up. Of the 56 candidate prognostic factors identified at the first step, 3 had a significant prognostic value in multivariate analysis: the prior use of non-steroidal anti-inflammatory drugs [aHR 3.60, 95% CI (1.59-8.15), p = 0.002]; the non-performance of valve surgery when indicated [aHR 1.85, 95% CI (1.01-3.39), p = 0.046]; and the decrease of vegetation size on antibiotic treatment [aHR 0.34, 95% CI (0.12-0.97), p = 0.044]. Conclusion We identified three potential SaIE prognostic factors. These results, if externally validated, might eventually help improve the management of patients with SaIE.
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Affiliation(s)
- Benjamin Lefèvre
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France,Université de Lorraine, APEMAC, Nancy, France,*Correspondence: Benjamin Lefèvre,
| | - Antoine Legoff
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France
| | - Mathilde Boutrou
- CH Andrée Rosemon, Unité de Maladies Infectieuses et Tropicales, Cayenne, France
| | | | - Willy Ngueyon-Sime
- CHRU-Nancy, Institut National de la Sante et de la Recherche Medicale (INSERM), Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Catherine Chirouze
- UMR 6249 CNRS-UFC Chrono-environnement, Service de Maladies Infectieuses, CHRU Besançon, Besançon, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France,CIC-Institut National de la Sante et de la Recherche Medicale (INSERM) 1414, Pontchaillou University Hospital, Rennes, France,University of Rennes, Institut National de la Sante et de la Recherche Medicale (INSERM), Bacterial Regulatory RNAs and Medicine, UMR 1230, Rennes, France
| | | | - Xavier Duval
- Institut National de la Sante et de la Recherche Medicale (INSERM) CIC 1425, Bichat–Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Institut National de la Sante et de la Recherche Medicale (INSERM), UMR-1137, IAME, Paris University, Paris, France,Université de Paris, IAME, Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France,Centre for Clinical Investigation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard University Hospital, Paris, France
| | | | - Vincent Le Moing
- Montpellier University Hospital, Department of Infectious and Tropical Diseases, Montpellier, France
| | | | | | - Bruno Hoen
- Université de Lorraine, CHRU-Nancy, Service des Maladies Infectieuses et Tropicales, Nancy, France,Université de Lorraine, APEMAC, Nancy, France
| | - Nelly Agrinier
- Université de Lorraine, APEMAC, Nancy, France,CHRU-Nancy, Institut National de la Sante et de la Recherche Medicale (INSERM), Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
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10
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Ch'ng JH, Muthu M, Chong KKL, Wong JJ, Tan CAZ, Koh ZJS, Lopez D, Matysik A, Nair ZJ, Barkham T, Wang Y, Kline KA. Heme cross-feeding can augment Staphylococcus aureus and Enterococcus faecalis dual species biofilms. THE ISME JOURNAL 2022; 16:2015-2026. [PMID: 35589966 PMCID: PMC9296619 DOI: 10.1038/s41396-022-01248-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 12/17/2022]
Abstract
The contribution of biofilms to virulence and as a barrier to treatment is well-established for Staphylococcus aureus and Enterococcus faecalis, both nosocomial pathogens frequently isolated from biofilm-associated infections. Despite frequent co-isolation, their interactions in biofilms have not been well-characterized. We report that in combination, these two species can give rise to augmented biofilms biomass that is dependent on the activation of E. faecalis aerobic respiration. In E. faecalis, respiration requires both exogenous heme to activate the cydAB-encoded heme-dependent cytochrome bd, and the availability of O2. We determined that the ABC transporter encoded by cydDC contributes to heme import. In dual species biofilms, S. aureus provides the heme to activate E. faecalis respiration. S. aureus mutants deficient in heme biosynthesis were unable to augment biofilms whereas heme alone is sufficient to augment E. faecalis mono-species biofilms. Our results demonstrate that S. aureus-derived heme, likely in the form of released hemoproteins, promotes E. faecalis biofilm formation, and that E. faecalis gelatinase activity facilitates heme extraction from hemoproteins. This interspecies interaction and metabolic cross-feeding may explain the frequent co-occurrence of these microbes in biofilm-associated infections.
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Affiliation(s)
- Jun-Hong Ch'ng
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore. .,Department of Surgery Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Infectious Disease Translational Research Program, National University Health System, Singapore, Singapore. .,Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore.
| | - Mugil Muthu
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore.,Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kelvin K L Chong
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore.,Nanyang Technological University Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
| | - Jun Jie Wong
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore.,Singapore Centre for Environmental Life Sciences Engineering, Interdisciplinary Graduate Program, Nanyang Technological University, Singapore, Singapore
| | - Casandra A Z Tan
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore.,Singapore Centre for Environmental Life Sciences Engineering, Interdisciplinary Graduate Program, Nanyang Technological University, Singapore, Singapore
| | - Zachary J S Koh
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore
| | - Daniel Lopez
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Artur Matysik
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Zeus J Nair
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Timothy Barkham
- Department of Microbiology and Immunology, National University of Singapore, Singapore, Singapore.,Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yulan Wang
- Singapore Phenome Center, Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Kimberly A Kline
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore. .,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore.
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11
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Kinney KJ, Tang SS, Wu XJ, Tran PM, Bharadwaj NS, Gibson-Corley KN, Forsythe AN, Kulhankova K, Gumperz JE, Salgado-Pabón W. SEC is an antiangiogenic virulence factor that promotes Staphylococcus aureus endocarditis independent of superantigen activity. SCIENCE ADVANCES 2022; 8:eabo1072. [PMID: 35544579 PMCID: PMC9094652 DOI: 10.1126/sciadv.abo1072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/24/2022] [Indexed: 06/15/2023]
Abstract
The superantigen staphylococcal enterotoxin C (SEC) is critical for Staphylococcus aureus infective endocarditis (SAIE) in rabbits. Superantigenicity, its hallmark function, was proposed to be a major underlying mechanism driving SAIE but was not directly tested. With the use of S. aureus MW2 expressing SEC toxoids, we show that superantigenicity does not sufficiently account for vegetation growth, myocardial inflammation, and acute kidney injury in the rabbit model of native valve SAIE. These results highlight the critical contribution of an alternative function of superantigens to SAIE. In support of this, we provide evidence that SEC exerts antiangiogenic effects by inhibiting branching microvessel formation in an ex vivo rabbit aortic ring model and by inhibiting endothelial cell expression of one of the most potent mediators of angiogenesis, VEGF-A. SEC's ability to interfere with tissue revascularization and remodeling after injury serves as a mechanism to promote SAIE and its life-threatening systemic pathologies.
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Affiliation(s)
- Kyle J. Kinney
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | - Sharon S. Tang
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Xiao-Jun Wu
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Phuong M. Tran
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Nikhila S. Bharadwaj
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, USA
| | - Katherine N. Gibson-Corley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ana N. Forsythe
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
| | | | - Jenny E. Gumperz
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI, USA
| | - Wilmara Salgado-Pabón
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
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12
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Grando K, Nicastro LK, Tursi SA, De Anda J, Lee EY, Wong GCL, Tükel Ç. Phenol-Soluble Modulins From Staphylococcus aureus Biofilms Form Complexes With DNA to Drive Autoimmunity. Front Cell Infect Microbiol 2022; 12:884065. [PMID: 35646719 PMCID: PMC9131096 DOI: 10.3389/fcimb.2022.884065] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
The bacterial amyloid curli, produced by Enterobacteriales including Salmonella species and Escherichia coli, is implicated in the pathogenesis of several complex autoimmune diseases. Curli binds to extracellular DNA, and these complexes drive autoimmunity via production of anti-double-stranded DNA autoantibodies. Here, we investigated immune activation by phenol-soluble modulins (PSMs), the amyloid proteins expressed by Staphylococcus species. We confirmed the amyloid nature of PSMs expressed by S. aureus using a novel specific amyloid stain, (E,E)-1-fluoro-2,5-bis(3-hydroxycarbonyl-4-hydroxy) styrylbenzene (FSB). Direct interaction of one of the S. aureus PSMs, PSMα3, with oligonucleotides promotes fibrillization of PSM amyloids and complex formation with bacterial DNA. Finally, utilizing a mouse model with an implanted mesh-associated S. aureus biofilm, we demonstrated that exposure to S. aureus biofilms for six weeks caused anti-double-stranded DNA autoantibody production in a PSM-dependent manner. Taken together, these results highlight how the presence of PSM-DNA complexes in S. aureus biofilms can induce autoimmune responses, and suggest an explanation for how bacterial infections trigger autoimmunity.
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Affiliation(s)
- Kaitlyn Grando
- Center for Microbiology and Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Lauren K. Nicastro
- Center for Microbiology and Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Sarah A. Tursi
- Center for Microbiology and Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Jaime De Anda
- Department of Bioengineering, Department of Chemistry and Biochemistry, California Nano Systems Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ernest Y. Lee
- Department of Bioengineering, Department of Chemistry and Biochemistry, California Nano Systems Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Gerard C. L. Wong
- Department of Bioengineering, Department of Chemistry and Biochemistry, California Nano Systems Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Çağla Tükel
- Center for Microbiology and Immunology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
- *Correspondence: Çağla Tükel,
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13
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Meidrops K, Burkhardt FJ, Osipovs JD, Petrosina E, Groma V, Stradins P. Etiology, Risk Factors and Clinical Outcomes in Infective Endocarditis Patients Requiring Cardiac Surgery. J Clin Med 2022; 11:jcm11071957. [PMID: 35407565 PMCID: PMC9000117 DOI: 10.3390/jcm11071957] [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: 02/08/2022] [Revised: 03/26/2022] [Accepted: 03/30/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Infective endocarditis, which may be caused by various microbial agents, severely affects the innermost layer of the heart and often leads to poor clinical outcomes. The purpose of this study was to investigate the etiology, risk factors and short and long-term outcomes of infective endocarditis caused by various bacterial agents in patients requiring cardiac surgery. Methods: One hundred and forty-four patients aged 18 years or above with indications for cardiac surgery due to S. aureus, Streptococcus spp., E. faecalis or coagulase-negative staphylococci caused infective endocarditis were included in this study. Results: S. aureus, Streptococcus spp., E. faecalis and coagulase-negative staphylococci were the causative agents of infective endocarditis in 44 (30.6%), 35 (24.3%), 33 (22.9%) and 32 (22.2%) patients, respectively. The presence of bicuspid aortic valve was the most common predisposing factor confirmed in 19 (23.5%), whereas intravenous drug usage was the most common in 17 (11.8%) patients. No significant differences in intrahospital mortality due to infective endocarditis caused by various bacterial agents were found, however, the worsening of long-term prognosis of endocarditis caused by S. aureus when compared to E. faecalis was confirmed (p = 0.03). The presence of S. aureus was associated with significantly higher rates of embolic complications (p = 0.003). The presence of coagulase-negative staphylococci was associated with prosthetic valve endocarditis (p = 0.015) and perivalvular complications (p = 0.024). Conclusions: In contrast to E. faecalis, the presence of S. aureus determines the worsening of the long-term mortality from infective endocarditis. Perivalvular complications are associated with the presence of coagulase-negative staphylococci.
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Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
- Correspondence: ; Tel.: +371-22318008
| | | | - Janis Davis Osipovs
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Eva Petrosina
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Valerija Groma
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
| | - Peteris Stradins
- Riga Stradins University, LV-1007 Riga, Latvia; (F.J.B.); (J.D.O.); (E.P.); (V.G.); (P.S.)
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia
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14
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Stagg NJ, Katavolos P, Achilles Poon K, Zhong S, Ljumanovic N, Kamath A, Cai H, Carrasco-Triguero M, Halpern W. Nonclinical toxicology development of a novel antibody antibiotic conjugate for treating invasive Staphylococcus Aureus infections. Toxicol Appl Pharmacol 2021; 435:115811. [PMID: 34896194 DOI: 10.1016/j.taap.2021.115811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/30/2022]
Abstract
Invasive Staphylococcus aureus (S. aureus) infections are a leading cause of death and not effectively treated with prolonged standard of care antibiotics. A novel THIOMAB™ antibody antibiotic conjugate (TAC) was developed that uses a bacterial-wall specific antibody to deliver the antibiotic (dmDNA31, a rifamycin analogue) to bacteria to minimize toxicities typically seen with prolonged use of traditional antibiotics. The TAC nonclinical toxicology package included repeat dose rat and cynomolgus monkey toxicology studies for 8 weekly intravenous (IV) doses, a 7-day daily repeat dose IV toxicology study of dmDNA31 and an assessment of genotoxicity, cardiovascular toxicity, neurotoxicity and sperm parameters. TAC and dmDNA31 were well tolerated in rats and monkeys, and there was no evidence of genotoxicity, cardiovascular toxicity or neurotoxicity. Non-adverse findings were observed and included blue discoloration in skin, blood, etc. due to the blue color of dmDNA31, increased globulin due to the high doses of antibodies, and abnormal sperm morphology of small heads in male rats with no histopathology correlate in testis. This is an example of antibody-mediated delivery of an antibiotic that has the potential to offer a more effective way of eradicating infection while providing a better safety profile compared to traditional antibiotics.
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Affiliation(s)
- Nicola J Stagg
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
| | - Paula Katavolos
- Nonclinical Safety, Bristol Myers Squibb, New Brunswick, NJ 08901, USA
| | - Kirsten Achilles Poon
- Department of Pharmacology and Toxicology, Ultragenyx Pharmaceutical, Inc., Novato, CA 94949, USA
| | - Shelly Zhong
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nina Ljumanovic
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Amrita Kamath
- Department of Preclinical & Translational Pharmacokinetics & Pharmacodynamics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Hao Cai
- Department of Preclinical & Translational Pharmacokinetics & Pharmacodynamics, Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | | | - Wendy Halpern
- Safety Assessment, Genentech Inc., 1 DNA Way, South San Francisco, CA 94080, USA.
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15
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Jiang F, Shi Y, Zou X, Han J, Han S. In cellulo synthesis of dendrimeric sensors for fluorescence-on imaging of bacterial phagocytosis. J Mater Chem B 2021; 10:4800-4809. [PMID: 34761795 DOI: 10.1039/d1tb02012a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Methods for optical tracking of pathogen-host interactions are of biomedical significance. We herein have reported a high molecular weight pH sensor (Den-pH) that is assembled in bacteria and then stably trapped in bacteria irrespective of bacterial membrane potentials. Endowed with acidity-triggered red fluorescence, Den-pH allows signal-on tracking of S. aureus in phagocytosis by macrophages. Intra-bacterial formation of multifunctional optical probes, which offers the advantage of overcoming the liability of conventional potential-sensitive dyes to dissipate from stressed bacteria, offers a new tool to study stressed pathogens.
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Affiliation(s)
- Feng Jiang
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
| | - Yilong Shi
- State key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signalling Network, School of Life Sciences, Xiamen University, Xiamen 361005, China
| | - Xiaoxue Zou
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
| | - Jiahuai Han
- State key Laboratory of Cellular Stress Biology, Innovation Center for Cell Signalling Network, School of Life Sciences, Xiamen University, Xiamen 361005, China
| | - Shoufa Han
- State Key Laboratory for Physical Chemistry of Solid Surfaces, Department of Chemical Biology, College of Chemistry and Chemical Engineering, the Key Laboratory for Chemical Biology of Fujian Province, The MOE Key Laboratory of Spectrochemical Analysis & Instrumentation, and Innovation Center for Cell Signaling Network, Xiamen University, Xiamen 361005, China.
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16
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Val DD, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Vendramin I, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Corriea de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:102-112. [PMID: 34688853 DOI: 10.1016/j.cjca.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S aureus) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on S aureus IE after transcatheter aortic valve replacement (TAVR). METHODS Data was obtained from the Infectious Endocarditis after TAVR International Registry including patients with definite IE following TAVR from 59 centers in 11 countries. Patients were divided into two groups according to microbiological etiology (non-S aureus-IE, non-SA-IE vs. S aureus-IE, SA-IE). RESULTS SA-IE was identified in 141 out of 573 (24.6%) patients, methicillin-sensitive S aureus in most cases (115/141, 81.6%). SEV were more common than BEV in patients with early SA-IE. Major bleeding and sepsis complicating TAVR, neurological symptoms or systemic embolism at admission and IE with cardiac device involvement other than the TAVR prosthesis were associated with SA-IE (p<0.05 for all). Among IE post-TAVR patients, the likelihood of SA-IE increased from 19% in the absence of those risk factors to 84.6% if ≥3 risk factors were present. In-hospital (47.8% vs. 26.9%, p<0.001) and 2-year mortality (71.5% vs. 49.6%, p<0.001) rates were higher among SA-IE (vs. non-SA-IE) patients. Surgery at the time of index SA-IE was associated with a lower mortality rate at follow-up (HRadj: 0.46, 95% CI: 0.22-0.96, p=0.038). CONCLUSIONS SA-IE represented ∼ 25% of IE cases after TAVR and was associated with a very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA-IE and could help to orientate early antibiotic regimen selection. Surgery at index SA-IE was associated with improved outcomes, and its role should be evaluated in future studies.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA; Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes-Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Evolution of epidemiological characteristics of infective endocarditis in Greece. Int J Infect Dis 2021; 106:213-220. [PMID: 33711517 DOI: 10.1016/j.ijid.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The clinical profile, management and outcome of infective endocarditis (IE) may be influenced by socioeconomic issues. METHODS A nationwide prospective study evaluated IE during the era of deep economic crisis in Greece. Epidemiological data and factors associated with 60-day mortality were analyzed through descriptive statistics, logistic and Cox-regression models. RESULTS Among 224 patients (male 72.3%, mean age 62.4 years), Staphylococcus aureus (n = 62; methicillin-resistant S. aureus (MRSA) 33.8%) predominated in the young without impact on mortality (p = 0.593), whilst Enterococci (n = 36) predominated in the elderly. Complications of IE were associated with mortality: heart failure [OR 2.415 (95% CI: 1.159-5.029), p = 0.019], stroke [OR 3.206 (95% CI: 1.190-8.632), p = 0.018] and acute kidney injury [OR 2.283 (95% CI: 1.085-4.805), p = 0.029]. A 60-day survival benefit was solely related to cardiac surgery for IE during hospitalization [HR 0.386 (95% CI: 0.165-0.903), p = 0.028] and compliance with antimicrobial treatment guidelines [HR 0.487 (95% CI: 0.259-0.916), p = 0.026]. Compared with a previous country cohort study, history of rheumatic fever and native valve predisposition had declined, whilst underlying renal disease and right-sided IE had increased (p < 0.0001); HIV infection had emerged (p = 0.002). No difference in rates of surgery and outcome was assessed. CONCLUSIONS A country-wide survey of IE highlighted emergence of HIV, right-sided IE and predominance of MRSA in the youth during a severe socioeconomic crisis. Compliance with treatment guidelines promoted survival.
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Liang M, Xiong M, Zhang Y, Chen J, Feng K, Huang S, Wu Z. Increased glucose variability is associated with major adverse events in patients with infective endocarditis undergo surgical treatment. J Thorac Dis 2021; 13:653-663. [PMID: 33717538 PMCID: PMC7947509 DOI: 10.21037/jtd-20-2692] [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] [Indexed: 12/04/2022]
Abstract
Background This study aimed to investigate the prognostic value of glucose variability (GV) in predicting postoperative major adverse events (MAEs) in patients with infective endocarditis (IE) who underwent surgical treatment. Methods This retrospective observational study included a total of 381 consecutive patients who underwent surgical treatment in our institution from October 2007 to August 2019. The MAEs included all-cause death, stroke, myocardial infarction, acute heart failure, IE recurrence, acute renal failure and sepsis. Postoperative GV in the first 24 hours was measured by the mean 24-hour glucose, standard deviation, coefficient of variation (CV) and mean amplitude of glycemic excursions. Univariate and multivariate logistic regression analyses were performed to identify the independent association of GV with MAEs. Results Of the 381 patients, 79 (20.7%) developed MAEs. The 30-day mortality of the overall study cohort was 5.23%. The multivariate logistic regression analysis indicated that 24-hour GV, measured as the CV [odds ratio (OR) =1.49, 95% CI, 1.23–3.57, P=0.012], was significantly associated with MAEs in IE patients. For every 10% increase in 24‐hour CV, there was a 49% increase in the risk of MAEs. Furthermore, compared to patients in the low tertile of GV, patients in the top tertile of 24-hour GV had a higher 30-day mortality and an increased incidence of heart failure and hemodialysis as well as longer ventilation support. Conclusions The results of this retrospective investigation demonstrated that increased GV measured by CV is an independent predictor of postoperative MAEs in patients undergoing surgical treatment for IE.
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Affiliation(s)
- Mengya Liang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mai Xiong
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi Zhang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiantao Chen
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kangni Feng
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Suiqing Huang
- Assisted Circulatory Laboratory of Health Ministry, Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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19
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Endocarditis due to Staphylococcus lugdunensis-a retrospective national registry-based study. Eur J Clin Microbiol Infect Dis 2020; 40:1103-1106. [PMID: 33378000 PMCID: PMC8084830 DOI: 10.1007/s10096-020-04134-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
We present characteristics of infective endocarditis (IE) caused by Staphylococcus lugdunensis and compare with IE caused by Staphylococcus aureus and other CoNS, in the National Swedish Registry of IE (2008–2018). Thirty episodes of S. lugdunensis IE were registered, of which 21 cases affected native valves, and 7 patients were subjected to surgery. The mortality rate at 30 days was significantly higher for S. lugdunensis IE (20%, n = 6), than for IE caused by other CoNS (7%) or S. aureus (9%) p = 0.016. Septic embolisation was only reported in two cases (7%). The most common treatment was isoxazolyl penicillin (n = 18).
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Pivatto Júnior F, Bellagamba CCDA, Pianca EG, Fernandes FS, Butzke M, Busato SB, Gus M. Analysis of Risk Scores to Predict Mortality in Patients Undergoing Cardiac Surgery for Endocarditis. Arq Bras Cardiol 2020; 114:518-524. [PMID: 32267324 PMCID: PMC7792725 DOI: 10.36660/abc.20190050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 06/03/2019] [Indexed: 01/03/2023] Open
Abstract
Fundamento Escores de risco estão disponíveis para uso na prática clínica diária, mas saber qual deles escolher é ainda incerto. Objetivos Avaliar o EuroSCORE logístico, o EuroSCORE II e os escores específicos para endocardite infecciosa STS-IE, PALSUSE, AEPEI, EndoSCORE e RISK-E na predição de mortalidade hospitalar de pacientes submetidos à cirurgia cardíaca por endocardite ativa em um hospital terciário de ensino do sul do Brasil. Métodos Estudo de coorte retrospectivo incluindo todos os pacientes com idade ≥ 18 anos submetidos à cirurgia cardíaca por endocardite ativa no centro do estudo entre 2007 e 2016. Foram realizadas análises de calibração (razão de mortalidade observada/esperada, O/E) e de discriminação (área sob a curva ROC, ASC), sendo a comparação das ASC realizada pelo teste de DeLong. P < 0,05 foi considerado estatisticamente significativo Resultados Foram incluídos 107 pacientes, sendo a mortalidade hospitalar de 29,0% (IC95%: 20.4-37.6%). A melhor razão de mortalidade O/E foi obtida pelo escore PALSUSE (1,01, IC95%: 0,70-1,42), seguido pelo EuroSCORE logístico (1,3, IC95%: 0,92-1,87). O EuroSCORE logístico apresentou o maior poder discriminatório (ASC 0,77), significativamente superior ao EuroSCORE II (p = 0,03), STS-IE (p = 0,03), PALSUSE (p = 0,03), AEPEI (p = 0,03) e RISK-E (p = 0,02). Conclusões Apesar da disponibilidade dos recentes escores específicos, o EuroSCORE logístico foi o melhor preditor de mortalidade em nossa coorte, considerando-se análise de calibração (mortalidade O/E: 1,3) e de discriminação (ASC 0,77). A validação local dos escores específicos é necessária para uma melhor avaliação do risco cirúrgico. (Arq Bras Cardiol. 2020; 114(3):518-524)
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Affiliation(s)
| | | | | | | | - Maurício Butzke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
| | | | - Miguel Gus
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
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Abdulrehman T, Qadri S, Skariah S, Sultan A, Mansour S, Azzi J, Haik Y. Boron doped silver-copper alloy nanoparticle targeting intracellular S. aureus in bone cells. PLoS One 2020; 15:e0231276. [PMID: 32275737 PMCID: PMC7147743 DOI: 10.1371/journal.pone.0231276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES Alloyed metallic nanoparticles of silver and copper are effective against intracellular infection. However, systemic toxicity may arise due to the non-specific delivery of the nanoparticles. In addressing the issue, this study deals with the targeting of silver-copper-boron (ACB) nanoparticles to infected osteoblasts, which could decrease systemic toxicity and form the basis of targeting specific markers expressed in bone infections. METHODS ACB nanoparticles were synthesized and conjugated to the Cadherin-11 antibody (OBAb). The effect of targeting nanoparticles against extracellular and intracellular S. aureus was determined by enumeration of bacterial growth. The binding of the targeting nanoparticles to infected osteoblasts as well as the visualization of live/dead bacteria due to treatment was carried out using fluorescence microscopy. MTT assay was used to determine the viability of osteoblasts with different concentrations of the nanoparticles. RESULTS The ACB nanoparticles conjugated to OBAb (ACB-OBAb) were effective against extracellular S. aureus. The ACB-OBAb nanoparticles showed a 1.32 log reduction of intracellular S. aureus at a concentration of 1mg/L. The ACB-OBAb nanoparticles were able to bind to the infected osteoblast and showed toxicity to osteoblasts at levels ≥20mg/L. Also, the percentage of silver, copper, and boron in the nanoparticles determined the effectiveness of their antibacterial activity. CONCLUSION The ACB-OBAb nanoparticles were able to target the osteoblasts and demonstrated significant antibacterial activity against intracellular S. aureus. Targeting shows promise as a strategy to target specific markers expressed on infected osteoblasts for efficient nanoparticle delivery, and further animal studies are recommended to test its efficacy in vivo.
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Affiliation(s)
- Tahir Abdulrehman
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Shahnaz Qadri
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
| | - Sini Skariah
- Weil Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Ali Sultan
- Weil Cornell Medicine-Qatar, Education City, Doha, Qatar
| | - Said Mansour
- Qatar Environment and Energy Research Institute (QEERI), Hamad Bin Khalifa University, Doha, Qatar
| | - Jamil Azzi
- Brigham and Women’s Hospital, Harvard Medical School, Boston, United States of America
| | - Yousef Haik
- College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
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Farshadfar C, Mollica A, Rafii F, Noorbakhsh A, Nikzad M, Seyedi SH, Abdi F, Verki SA, Mirzaie S. Novel potential inhibitor discovery against tyrosyl-tRNA synthetase from Staphylococcus aureus by virtual screening, molecular dynamics, MMPBSA and QMMM simulations. MOLECULAR SIMULATION 2020. [DOI: 10.1080/08927022.2020.1726911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Chiako Farshadfar
- Department of Biochemistry, Science and Research Branch, Islamic Azad University, Sanandaj, Iran
| | - Adriano Mollica
- Dipartimento di Farmacia, Università di Chieti-Pescara “G. d’Annunzio”, Chieti, Italy
| | - Fatemeh Rafii
- Division of Microbiology, National Center for Toxicological Research Jefferson, Jefferson, AR, USA
| | - Akbar Noorbakhsh
- Department of Biochemistry, Science and Research Branch, Islamic Azad University, Sanandaj, Iran
| | - Mozhgan Nikzad
- Department of Biochemistry, Science and Research Branch, Islamic Azad University, Sanandaj, Iran
| | - Seyed Hamid Seyedi
- Department of Biochemistry, Science and Research Branch, Islamic Azad University, Sanandaj, Iran
| | - Fatemeh Abdi
- Department of Medicine and Paramedical, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | | | - Sako Mirzaie
- Department of Biochemistry, Sanandaj Branch, Islamic Azad University, Sanandaj, Iran
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Reza A, Sutton JM, Rahman KM. Effectiveness of Efflux Pump Inhibitors as Biofilm Disruptors and Resistance Breakers in Gram-Negative (ESKAPEE) Bacteria. Antibiotics (Basel) 2019; 8:antibiotics8040229. [PMID: 31752382 PMCID: PMC6963839 DOI: 10.3390/antibiotics8040229] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/21/2022] Open
Abstract
Antibiotic resistance represents a significant threat to the modern healthcare provision. The ESKAPEE pathogens (Enterococcus faecium., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), in particular, have proven to be especially challenging to treat, due to their intrinsic and acquired ability to rapidly develop resistance mechanisms in response to environmental threats. The development of biofilm has been characterised as an essential contributing factor towards antimicrobial-resistance and tolerance. Several studies have implicated the involvement of efflux pumps in antibiotic resistance, both directly, via drug extrusion and indirectly, through the formation of biofilm. As a result, the underlying mechanism of these pumps has attracted considerable interest due to the potential of targeting these protein structures and developing novel adjunct therapies. Subsequent investigations have revealed the ability of efflux pump-inhibitors (EPIs) to block drug-extrusion and disrupt biofilm formation, thereby, potentiating antibiotics and reversing resistance of pathogen towards them. This review will discuss the potential of EPIs as a possible solution to antimicrobial resistance, examining different challenges to the design of these compounds, with an emphasis on Gram-negative ESKAPEE pathogens.
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Affiliation(s)
- Akif Reza
- Institute of Pharmaceutical Science, King’s College London, London, SE1 9NH, UK;
| | - J. Mark Sutton
- National Infections Service, Public Health England, Porton Down, Salisbury, Wiltshire SP4 0JG, UK;
| | - Khondaker Miraz Rahman
- Institute of Pharmaceutical Science, King’s College London, London, SE1 9NH, UK;
- Correspondence: ; Tel.: +44-(0)207-848-1891
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Herdendorf TJ, Geisbrecht BV. Staphylococcus aureus evasion proteins EapH1 and EapH2: Residue-level investigation of an alternative binding motif for human neutrophil elastase. Arch Biochem Biophys 2019; 676:108140. [PMID: 31622584 DOI: 10.1016/j.abb.2019.108140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/20/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022]
Abstract
The Staphylococcus aureusExtracellular Adherence Protein (Eap) and its homologs, EapH1 and EapH2, are a family of secreted proteins that potently inhibit the neutrophil serine proteases Neutrophil Elastase (hNE), Cathepsin G, and Proteinase 3. Similarly to EapH1, inhibition of hNE by EapH2 is characterized by a rapid association rate (2.9 × 105 M-1s-1) coupled with a very slow dissociation rate (5.9 × 10-4 s-1), yielding an apparent inhibition constant of 2.11 nM. As with EapH1, inhibition of hNE by EapH2 is also time-dependent in character. A phenylalanine in EapH2 replaces the leucine in EapH1 that sits over the hNE catalytic serine and creates a potential steric clash. Indeed, the EapH1 L59F mutant is severely decreased in its ability to inhibit hNE (~9500-fold). When compared to the EapH1:hNE co-crystal structure, a model of the EapH2:hNE complex predicts an alternative binding motif comprised of EapH2 residues 120-127. These putative interfacing residues were individually mutated and kinetically interrogated. The EapH2 N127A mutant resulted in the largest decrease in hNE inhibition (~200-fold) and loss of the time-dependent characteristic. Surprisingly, the time-dependent characteristic was still abolished in the EapH2 T125A mutant, even though it was less perturbed in hNE inhibition (~25-fold). T125 forms an intra-molecular hydrogen bond to the carbonyl oxygen of N127 in the EapH2 crystal structure. Given these observations, we conclude (i) that EapH2 has an altogether distinct hNE binding motif than EapH1, (ii) that N127 is the main functional determinant in EapH2, and (iii) that T125 serves an ancillary role aiding in the optimal orientation of N127.
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Affiliation(s)
- Timothy J Herdendorf
- Department of Biochemistry & Molecular Biophysics, Kansas State University, Manhattan, KS, 66506, USA
| | - Brian V Geisbrecht
- Department of Biochemistry & Molecular Biophysics, Kansas State University, Manhattan, KS, 66506, USA.
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25
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Weber C, Gassa A, Eghbalzadeh K, Merkle J, Djordjevic I, Maier J, Sabashnikov A, Deppe AC, Kuhn EW, Rahmanian PB, Liakopoulos OJ, Wahlers T. Characteristics and outcomes of patients with right-sided endocarditis undergoing cardiac surgery. Ann Cardiothorac Surg 2019; 8:645-653. [PMID: 31832354 DOI: 10.21037/acs.2019.08.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There has been an increasing incidence of right-sided infective endocarditis (RSIE) due to the global rise of intravenous drug use (IVDU) and an increasing number of implantable cardiac electronic devices and central venous catheters. Our aim was to investigate differences in the clinical presentation, microbiological findings and prognosis of patients undergoing surgery for RSIE compared to left-sided infective endocarditis (LSIE). Methods Relevant clinical data of all 432 consecutive patients undergoing valve surgery for infective endocarditis (IE) at our institution between January 2009 and December 2018 were retrospectively analyzed. Acquired data included patients' demographic and preoperative comorbidities, manifestation of IE according to the recently modified Duke Criteria, perioperative data and relevant clinical outcomes. Results A total of 403 patients (93.3%) underwent surgery for LSIE and twenty-nine patients (6.7%) for RSIE. Eleven patients with RSIE (37.9%) showed a concomitant left-sided infection. Compared to LSIE, RSIE patients were significantly younger [47.5 (40.4-69.3) vs. 65.1 (53.7-74.6); P=0.008] and presented with less comorbidities such as hypertension (41.4% vs. 65.3%; P=0.010) and coronary artery disease (6.9% vs. 29.0%; P=0.010). Rates of IVDU (34.5% vs. 4.5%; P<0.001), human immunodeficiency virus (HIV) (10.3% vs. 1.7%; P=0.023) and hepatitis C virus (HCV) infection (24.1% vs. 5.2%; P=0.001) were greater in RSIE. The proportion of Staphylococcus aureus IE was significantly higher in RSIE compared to LSIE (37.9% vs. 21.1%; P=0.035). 30-day mortality was 6.9% after surgery for RSIE compared to 14.6% after operation for LSIE (P=0.372). Conclusions Patients undergoing surgery for RSIE compared to LSIE presented with a higher rate of pulmonary septic emboli, more Staphylococcus aureus infections and larger vegetations. Larger multicenter prospective trials are needed to provide more reliable data on the clinical profile of these patients, in order to determine optimal surgical management.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Asmae Gassa
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Julia Merkle
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Johanna Maier
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Elmar W Kuhn
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
| | | | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany
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26
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Sapi E, Kasliwala RS, Ismail H, Torres JP, Oldakowski M, Markland S, Gaur G, Melillo A, Eisendle K, Liegner KB, Libien J, Goldman JE. The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease. Antibiotics (Basel) 2019; 8:antibiotics8040183. [PMID: 31614557 PMCID: PMC6963883 DOI: 10.3390/antibiotics8040183] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 01/29/2023] Open
Abstract
Whether Borrelia burgdorferi, the causative agent of Lyme disease, can persist for long periods in the human body has been a controversial question. The objective of this study was to see if we could find B. burgdorferi in a Lyme disease patient after a long clinical course and after long-term antibiotic treatment. Therefore, we investigated the potential presence of B. burgdorferi antigens and DNA in human autopsy tissues from a well-documented serum-, PCR-, and culture-positive Lyme disease patient, a 53-year-old female from northern Westchester County in the lower Hudson Valley Region of New York State, who had received extensive antibiotic treatments during extensive antibiotic treatments over the course of her 16-year-long illness. We also asked what form the organism might take, with special interest in the recently found antibiotic-resistant aggregate form, biofilm. We also examined the host tissues for the presence of inflammatory markers such as CD3+ T lymphocytes. Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics. We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy. The aggregates contained a well-established biofilm marker, alginate, on their surfaces, suggesting they are true biofilm. We found B. burgdorferi DNA by FISH, polymerase chain reaction (PCR), and an independent verification by WGS/metagenomics, which resulted in the detection of B. burgdorferi sensu stricto specific DNA sequences. IHC analyses showed significant numbers of infiltrating CD3+ T lymphocytes present next to B. burgdorferi biofilms. In summary, we provide several lines of evidence that suggest that B. burgdorferi can persist in the human body, not only in the spirochetal but also in the antibiotic-resistant biofilm form, even after long-term antibiotic treatment. The presence of infiltrating lymphocytes in the vicinity of B. burgdorferi biofilms suggests that the organism in biofilm form might trigger chronic inflammation.
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Affiliation(s)
- Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Rumanah S Kasliwala
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Hebo Ismail
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Jason P Torres
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Michael Oldakowski
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Sarah Markland
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Gauri Gaur
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Anthony Melillo
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT 06516, USA.
| | - Klaus Eisendle
- Central Teaching Hospital Bolzano L Böhlerstr, 539100 Bolzano, Italy.
| | - Kenneth B Liegner
- Private practice, 592 Route 22, Suite 1B, Pawling, NY 12564, USA.
- Northwell System, Northern Westchester Hospital, Mount Kisco, NY 10549, USA.
- Health Quest System, Sharon Hospital, Sharon, CT 06069, USA.
| | - Jenny Libien
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - James E Goldman
- Department of Pathology and Cell Biology, Columbia University, New York, NY 10031, USA.
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Chakravarty S, Massé E. RNA-Dependent Regulation of Virulence in Pathogenic Bacteria. Front Cell Infect Microbiol 2019; 9:337. [PMID: 31649894 PMCID: PMC6794450 DOI: 10.3389/fcimb.2019.00337] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022] Open
Abstract
During infection, bacterial pathogens successfully sense, respond and adapt to a myriad of harsh environments presented by the mammalian host. This exquisite level of adaptation requires a robust modulation of their physiological and metabolic features. Additionally, virulence determinants, which include host invasion, colonization and survival despite the host's immune responses and antimicrobial therapy, must be optimally orchestrated by the pathogen at all times during infection. This can only be achieved by tight coordination of gene expression. A large body of evidence implicate the prolific roles played by bacterial regulatory RNAs in mediating gene expression both at the transcriptional and post-transcriptional levels. This review describes mechanistic and regulatory aspects of bacterial regulatory RNAs and highlights how these molecules increase virulence efficiency in human pathogens. As illustrative examples, Staphylococcus aureus, Listeria monocytogenes, the uropathogenic strain of Escherichia coli, Helicobacter pylori, and Pseudomonas aeruginosa have been selected.
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Affiliation(s)
- Shubham Chakravarty
- RNA Group, Department of Biochemistry, Faculty of Medicine and Health Sciences, CRCHUS, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Eric Massé
- RNA Group, Department of Biochemistry, Faculty of Medicine and Health Sciences, CRCHUS, University of Sherbrooke, Sherbrooke, QC, Canada
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Sáez C, Sarriá C, Vilacosta I, Olmos C, López J, García-Granja PE, Fernández C, de las Cuevas C, Reyes G, Domínguez L, San Román JA. "A contemporary description of staphylococcus aureus prosthetic valve endocarditis. Differences according to the time elapsed from surgery". Medicine (Baltimore) 2019; 98:e16903. [PMID: 31464922 PMCID: PMC6736462 DOI: 10.1097/md.0000000000016903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Staphylococcus aureus prosthetic valve endocarditis (SAPVE) has a poor prognosis. There are no large series that accurately describe this entity.This is a retrospective observational study on a prospective cohort from 3 Spanish reference hospitals for cardiac surgery, including 78 definitive episodes of left SAPVE between 1996 and 2016.Fifty percent had a Charlson Index score >5; 53% were health care-related. Twenty percent did not present fever. Complications at diagnosis included: severe heart failure (HF, 29%), septic shock (SS, 17.9%), central nervous system abnormalities (19%), septic metastasis (4%). Hemorrhagic stroke was not higher in anticoagulated patients. Twenty-seven percent were methicilin-resistant SA (MRSA). Fifteen of 31 had positive valve culture; it was related to surgery within first 24 hours. At diagnosis, 69% had vegetation (>10 mm in 75%), 21.8% perianular extension, and 20% prosthetic dehiscence. Forty-eight percent had persistent bacteremia, related to nonsurgical treatment. Perianular extension progressed in 18%. Surgery was performed in 35 episodes (12 with stroke). Eleven uncomplicated episodes were managed with medical therapy, 8 survived. In-hospital mortality was 55%, higher in episodes with hemorrhagic stroke (77.8% vs 52.2%, odds ratio 3.2 [0.62-16.55]). Early SAPVE was nosocomial (92%), presented as severe HF (54%), patients were diagnosed and operated on early, 38% died. In intermediate SAPVE (9 weeks-1 year) diagnosis was delayed (24%), patients presented with constitutional syndrome (18%), renal failure (41%), and underwent surgery >72 hours after indication; 53% died. Late SAPVE (>1 year) was related with health care, diagnosis delay, and 60% of deceases.Left SAPVE frequently affected patients with comorbidity and health care contact. Complications at diagnosis and absence of fever were frequent. Presence of MRSA was high. Positive valve culture was related to early surgery. Paravalvular extension was frequent; vegetations were large, but its absence at diagnosis was common. Some uncomplicated SAPVE episodes were safety treated with medical therapy. Surgery was feasible in patients with stroke. Mortality was high. There were differences in some clinical characteristics and in evolution according to the time elapsed from valve replacement. Prognosis was better in early SAPVE.
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Affiliation(s)
- Carmen Sáez
- Department of Medicine-Infectious diseases, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Cristina Sarriá
- Department of Medicine-Infectious diseases, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Javier López
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Pablo Elpidio García-Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Cristina Fernández
- Instituto Cardiovascular. Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carmen de las Cuevas
- Department of Microbiology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Guillermo Reyes
- Department of Cardiac Surgery, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Lourdes Domínguez
- Department of Cardiology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria, Universidad Autónoma de Madrid, Spain
| | - Jose Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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High-dose trimethoprim-sulfamethoxazole and clindamycin for Staphylococcus aureus endocarditis. Int J Antimicrob Agents 2019; 54:143-148. [PMID: 31181351 DOI: 10.1016/j.ijantimicag.2019.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The mortality rate for Staphylococcus aureus endocarditis remains as high as 20-30% despite improvements in medical and surgical treatment. This study evaluated the efficiency and tolerance of a combination of intravenous trimethoprim-sulfamethoxazole and clindamycin (T&C) +/- rifampicin and gentamicin, with a rapid switch to oral administration of T&C. METHODS This before-after intervention study compared the outcomes of 170 control patients before introduction of the T&C protocol (2001-2011) with the outcomes of 171 patients in the T&C group (2012-2016). All patients diagnosed with S. aureus infective endocarditis and referred to the study centre between 2001 and 2016 were included. Between 2001 and 2011, the patients received a standardized antibiotic treatment: oxacillin or vancomycin for 6 weeks, plus gentamicin for 5 days. Since February 2012, the antibiotic protocol has included a high dose of T&C (intravenous, switched to oral administration on day 7). Rifampicin and gentamicin are also given in cases of cardiac abscess or persistent bacteraemia. RESULTS The two groups were slightly different. On intention-to-treat analysis, global mortality (19% vs 30%, P=0.024), in-hospital mortality (10% vs 18%, P=0.03) and 30-day mortality (7% vs 14%, P=0.05) were lower in the T&C group. The mean duration of hospital stay was significantly shorter in the T&C group (30 vs 39 days; P=0.005). CONCLUSIONS The management of S. aureus infective endocarditis using a rapid shift to oral administration of T&C reduced the length of hospital stay and the mortality rate.
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Chan TY, Hsieh CC, Chen CL, Huang YY, Chuang CC. Case report: right-sided native endocarditis presenting with multiple abscess formations [care compliant]. Medicine (Baltimore) 2019; 98:e15961. [PMID: 31192934 PMCID: PMC6587655 DOI: 10.1097/md.0000000000015961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Right-sided native endocarditis is a difficult case with fewer cardiac symptoms and fewer classic signs of cutaneous vascular lesions compared with left-sided endocarditis. PATIENT CONCERNS A 68-year-old Taiwanese man with a history of gouty arthritis, hyperlipidemia, and adrenal insufficiency presented to our ED and complained dyspnea and low back pain for 1 month. DIAGNOSIS ASSESSMENT The PE showed bilateral crackles on chest auscultation and a palpable fluctuant mass over the anterior chest wall. The chest and abdominal CT scan showed multiple abscess formations involving pulmonary, sternal, and paraspinal areas. The TEE being performed and an oscillating mass over the anterior and septal leaflets of the tricuspid valve and moderate tricuspid regurgitation. INTERVENTIONS Only pharmacologic treatment without surgical interventions. OUTCOMES Deceased, patient expired on day 4 after ED visit. CONCLUSION This case arose as a sequela of staphylococcal endocarditis associated with persistent bacteremia and immunological dysregulation. The diagnosis of right-sided endocarditis is easily missing, multidisciplinary approach should be triggered as soon as possible, which might lead to a better outcome. Right-sided IE is still an important public health issue in southern Taiwan.
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Affiliation(s)
- Tsung-Yu Chan
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chih-Chia Hsieh
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | | | - Yao-Yi Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Chia-Chang Chuang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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A Phase 1, Randomized, Single-Ascending-Dose Study To Investigate the Safety, Tolerability, and Pharmacokinetics of DSTA4637S, an Anti- Staphylococcus aureus Thiomab Antibody-Antibiotic Conjugate, in Healthy Volunteers. Antimicrob Agents Chemother 2019; 63:AAC.02588-18. [PMID: 30910894 DOI: 10.1128/aac.02588-18] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/17/2019] [Indexed: 01/10/2023] Open
Abstract
Staphylococcus aureus causes serious bacterial infections with high morbidity and mortality, necessitating the discovery of new antibiotics. DSTA4637S is a novel antibody-antibiotic conjugate designed to target intracellular S. aureus that is not adequately eliminated by current standard-of-care antibiotics. DSTA4637S is composed of an anti-S. aureus Thiomab human immunoglobulin G1 (IgG1) monoclonal antibody linked to a novel rifamycin-class antibiotic (4-dimethylaminopiperidino-hydroxybenzoxazino rifamycin [dmDNA31]) via a protease-cleavable linker. Phagocytic cells ingest DSTA4637S-bound S. aureus, and intracellular cathepsins cleave the linker, releasing dmDNA31and killing intracellular S. aureus This first-in-human, randomized, double-blind, placebo-controlled, single-ascending-dose phase 1 trial analyzed the safety, pharmacokinetics, and immunogenicity of DSTA4637S in healthy volunteers. Thirty healthy male and female volunteers, 18-65 years old, were randomized into five cohorts receiving single intravenous (i.v.) doses of 5, 15, 50, 100, and 150 mg/kg of DSTA4637S or placebo (4 active:2 placebo). Subjects were followed for 85 days after dosing. No subject withdrew from the study, and no serious or severe adverse events occurred. One moderate infusion-related reaction (150 mg/kg DSTA4637S) occurred. No clinically meaningful or dose-related changes in laboratory parameters or vital signs occurred. Pharmacokinetics of plasma DSTA4637S conjugate and serum DSTA4637S total antibody were dose proportional. Systemic exposure of unconjugated dmDNA31 was low. No DSTA4637S-induced anti-drug antibody responses were observed. DSTA4637S was generally safe and well tolerated as a single i.v. dose in healthy volunteers. DSTA4637S has a favorable safety and pharmacokinetic profile that supports future development as a novel therapeutic for S. aureus infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02596399.).
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Lerche CJ, Christophersen LJ, Goetze JP, Nielsen PR, Thomsen K, Enevold C, Høiby N, Jensen PØ, Bundgaard H, Moser C. Adjunctive dabigatran therapy improves outcome of experimental left-sided Staphylococcus aureus endocarditis. PLoS One 2019; 14:e0215333. [PMID: 31002679 PMCID: PMC6474597 DOI: 10.1371/journal.pone.0215333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background Staphylococcus aureus is the most frequent and fatal cause of left-sided infective endocarditis (IE). New treatment strategies are needed to improve the outcome. S. aureus coagulase promotes clot and fibrin formation. We hypothesized that dabigatran, could reduce valve vegetations and inflammation in S. aureus IE. Methods We used a rat model of severe aortic valve S. aureus IE. All infected animals were randomized to receive adjunctive dabigatran (10 mg/kg b.i.d., n = 12) or saline (controls, n = 11) in combination with gentamicin. Valve vegetation size, bacterial load, cytokine, cell integrins expression and peripheral platelets and neutrophils were assessed 3 days post-infection. Results Adjunctive dabigatran treatment significantly reduced valve vegetation size compared to controls (p< 0.0001). A significant reduction of the bacterial load in aortic valves was seen in dabigatran group compared to controls (p = 0.02), as well as expression of key pro-inflammatory markers keratinocyte-derived chemokine, IL-6, ICAM-1, TIMP-1, L-selectin (p< 0.04). Moreover, the dabigatran group had a 2.5-fold increase of circulating platelets compared to controls and a higher expression of functional and activated platelets (CD62p+) unbound to neutrophils. Conclusion Adjunctive dabigatran reduced the vegetation size, bacterial load, and inflammation in experimental S. aureus IE.
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Affiliation(s)
- Christian J. Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Immunology and Microbiology, University of Copenhagen, Denmark
- * E-mail:
| | - Lars J. Christophersen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pia R. Nielsen
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - Kim Thomsen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Christian Enevold
- Institute for Inflammation Research, Department of Rheumatology and Spine Disease, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Immunology and Microbiology, University of Copenhagen, Denmark
| | - Peter Ø. Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Immunology and Microbiology, University of Copenhagen, Denmark
- Institute for Inflammation Research, Department of Rheumatology and Spine Disease, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Institute of Immunology and Microbiology, University of Copenhagen, Denmark
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Methicillin-Resistant Staphylococcus aureus Prosthetic Valve Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management. Clin Microbiol Rev 2019; 32:32/2/e00041-18. [PMID: 30760474 DOI: 10.1128/cmr.00041-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Staphylococcus aureus prosthetic valve endocarditis (PVE) remains among the most morbid bacterial infections, with mortality estimates ranging from 40% to 80%. The proportion of PVE cases due to methicillin-resistant Staphylococcus aureus (MRSA) has grown in recent decades, to account for more than 15% of cases of S. aureus PVE and 6% of all cases of PVE. Because no large studies or clinical trials for PVE have been published, most guidelines on the diagnosis and management of MRSA PVE rely upon expert opinion and data from animal models or related conditions (e.g., coagulase-negative Staphylococcus infection). We performed a review of the literature on MRSA PVE to summarize data on pathogenic mechanisms and updates in epidemiology and therapeutic management and to inform diagnostic strategies and priority areas where additional clinical and laboratory data will be particularly useful to guide therapy. Major updates discussed in this review include novel diagnostics, indications for surgical management, the utility of aminoglycosides in medical therapy, and a review of newer antistaphylococcal agents used for the management of MRSA PVE.
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Hilbig A, Cheng A. Infective Endocarditis in the Intravenous Drug Use Population at a Tertiary Hospital in Melbourne, Australia. Heart Lung Circ 2019; 29:246-253. [PMID: 30962062 DOI: 10.1016/j.hlc.2018.12.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/30/2018] [Accepted: 12/21/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Infective endocarditis has been associated with underlying cardiac pathology and streptococci infections. Intravenous drug use (IVDU) is increasingly implicated as a contributing factor, resulting in a shift to a younger patient demographic, tricuspid valve involvement, severe staphylococcal infection, and unique management challenges. The objective of this study was to describe the clinical features, management and outcomes of patients with IVDU-associated infective endocarditis in the Australian context. METHODS A retrospective review of all episodes of IVDU-associated infective endocarditis at a tertiary hospital in Melbourne, Australia, from 2008 to 2015, was conducted. Included cases met Duke Criteria for 'definite' or 'possible' infective endocarditis, and had a history of IVDU within 3 months of presentation. Demographic data, substance use history, clinical features, surgical intervention, follow-up, and mortality data was collected. We explored factors associated with surgical intervention, recurrence and mortality. RESULTS Fifty-five (55) episodes of IVDU-associated infective endocarditis were identified in 46 patients; the median age was 40 years and 58% were male. The tricuspid valve was most commonly affected (38%), and left heart pathology was documented in 53% of cases. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (67%). Thirty-six (36%) per cent of patients underwent surgical intervention, and all patients received antibiotics as a component of treatment, with a median duration of 42 days (IQR 21, 42 days). Heart failure and a vegetation larger than 1 cm were significantly associated with surgical intervention. Total mortality was 14.5%; surgical mortality was 10%. Opioid replacement therapy and the absence of psychiatric co-morbidities were protective factors for surgical intervention and disease recurrence. CONCLUSIONS In contrast to common perception, left-sided endocarditis was more common than tricuspid valve endocarditis. Left heart pathology is typically a more severe clinical entity, however, our study determined mortality rates remained similar when compared to right heart pathology. Further research is required to assess rates of left sided disease in the IVDU population, and elucidate the relationship between IVDU and left heart pathology.
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Affiliation(s)
| | - Allen Cheng
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Vic, Australia
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Joshi SS, Henderson N, Griffith DJ, Henriksen PA, Denvir MA, Macsween KF, Mackintosh CL, Inverarity D. Staphylococcus Aureus Endocarditis associated with Injecting New Psychoactive Substances. J R Coll Physicians Edinb 2018; 48:304-310. [DOI: 10.4997/jrcpe.2018.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Staphylococcus aureus infective endocarditis (IE) associated with injection of new psychoactive substances (NPS) in Edinburgh from 2014 to 2016 was observed. We compared these infections with a series of S. aureus IE cases in a non-injecting population within Edinburgh. Methods NPS-associated S. aureus IE diagnosed between 1 January 2014 and 31 May 2016 in persons who inject drugs (PWID) were compared with a series of S. aureus IE cases from non-PWID. Results There was a fourfold increase in the annual incidence of S. aureus IE, mainly due to NPS use in PWID. A larger vegetation diameter was seen on echocardiogram in PWID vs non-PWID (median 1.7 cm vs 0.65 cm; p = 0.009) with more embolic complications in PWID (15 PWID vs 1 non-PWID; p = 2.1 x 10-7) but no difference in 90-day mortality (2 PWID vs 4 non-PWID; p = 0.39). Conclusions NPS-associated S. aureus IE correlated with complications, such as deep organ embolic abscesses, that were different from non-PWID S. aureus IE. The alarming increase in incidence resolved with targeted public health and legislative measures.
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Affiliation(s)
- SS Joshi
- Cardiology Registrar, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - N Henderson
- Microbiology Registrar, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - DJ Griffith
- Consultant Microbiologist, Victoria Hospital, Kirkcaldy, UK
| | - PA Henriksen
- Consultant Cardiologist, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - MA Denvir
- Consultant Cardiologist, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - KF Macsween
- Consultant Microbiologist, St John's Hospital, Livingston, UK
| | - CL Mackintosh
- Consultant in Infectious Diseases, Western General Hospital, Edinburgh, UK
| | - D Inverarity
- Consultant Microbiologist, Royal Infirmary of Edinburgh, Edinburgh, UK
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Drissa M, Amani F, Drissa H. Staphylococcus aureus infective endocarditis at a tertiary Tunisian hospital. A changing profile? Egypt Heart J 2018; 70:365-368. [PMID: 30591756 PMCID: PMC6303375 DOI: 10.1016/j.ehj.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/02/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- Meriem Drissa
- Cardiology Department of La Rabta Hospital, Tunis, Tunisia
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Ramos-Martínez A, Muñoz Serrano A, de Alarcón González A, Muñoz P, Fernández-Cruz A, Valerio M, Fariñas MC, Gutiérrez-Cuadra M, Miró JM, Ruiz-Morales J, Sousa-Regueiro D, Montejo JM, Gálvez-Acebal J, HidalgoTenorio C, Domínguez F. Gentamicin may have no effect on mortality of staphylococcal prosthetic valve endocarditis. J Infect Chemother 2018; 24:555-562. [PMID: 29628387 DOI: 10.1016/j.jiac.2018.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/23/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Alejandro Muñoz Serrano
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Arístides de Alarcón González
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Grupo de Investigación sobre Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla / CSIC / Universidad Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Ana Fernández-Cruz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - María Carmen Fariñas
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - Manuel Gutiérrez-Cuadra
- Unidad de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José Ma Miró
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS. Universidad de Barcelona, Barcelona, Spain.
| | - Josefa Ruiz-Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
| | | | - José Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS. Universidad de Sevilla, Sevilla, Spain.
| | - Carmen HidalgoTenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Complejo Hospitalario de Granada, Granada, Spain.
| | - Fernando Domínguez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Cunha BA, Jimada I, Chawla K. Intracranial complications of acute bacterial endocarditis. Surg Neurol Int 2018; 9:107. [PMID: 29930873 PMCID: PMC5991278 DOI: 10.4103/sni.sni_67_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Infectious endocarditis (IE) clinically manifests as either subacute bacterial endocarditis (SBE) or acute bacterial endocarditis (ABE). Neurologic manifestations are markedly different for these two entities. ABE is caused by invasive, highly virulent pathogens (e.g., Staphylococcus aureus), whereas SBE is attributed to relatively avirulent, non-invasive organisms (e.g., viridans streptococci). Methods: Here, we reviewed the clinical and radiographic presentations of a patient with cranial complications attributed to ABE. Such patients typically develop central nervous system (CNS) septic emboli resulting in stroke (with/without intracranial hemorrhage (ICH)) and/or mycotic aneurysms resulting in ICH bleeds. Results: With ABE, cerebrospinal fluid (CSF) seeding may result in acute bacterial meningitis (ABM), documented by positive Gram stain and/or culture for S. aureus, decreased glucose, highly elevated lactose acid levels, or ICH. Alternatively, in SBE, the CSF profile reflects an aseptic (viral) meningitis (i.e., Gram stain and culture negative, a normal glucose, and lymphocytic pleocytosis), while septic microemboli to the vasa vasorum contribute to an inflammatory reaction in the adventitia/muscle layer that weakens the vessel wall and results in mycotic aneurysms that may leak but often do not rupture causing ICH. Conclusion: Here, we reviewed the literature for intracranial pathology accompanying ABE versus SBE. ABE typically results in acute ischemia, septic emboli, stroke/hemorrhagic infarcts, or ICH. SBE more classically produces septic microemboli and mycotic aneurysms that may leak, but rarely producing ICH. We also presented a patient with ABE attributed to S. aureus whose septic emboli/stroke was accompanied by a mycotic aneurysm; the ruptured resulting in a large right occipital ICH.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA.,State University of New York, School of Medicine, Stony Brook, New York, USA
| | - Ismail Jimada
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA.,State University of New York, School of Medicine, Stony Brook, New York, USA
| | - Karishma Chawla
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA.,State University of New York, School of Medicine, Stony Brook, New York, USA
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39
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Murphy GR, Dunstan RH, Macdonald MM, Gottfries J, Roberts TK. Alterations in amino acid metabolism during growth by Staphylococcus aureus following exposure to H 2O 2 - A multifactorial approach. Heliyon 2018; 4:e00620. [PMID: 29756075 PMCID: PMC5944418 DOI: 10.1016/j.heliyon.2018.e00620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/20/2018] [Accepted: 04/27/2018] [Indexed: 01/02/2023] Open
Abstract
Temperature and pH are known to vary in a wound site due to the immune response and subsequent healing processes. This study used a multifactorial design to examine the cellular responses of Staphylococcus aureus to hydrogen peroxide (0–100 mM) when bacteria were grown in temperatures of 37 ± 2 °C and pH 7 ± 1, conditions potentially encountered in wound sites. A centroid sample was included in the design which represented the mid-point values of all three environmental parameters (37 °C, pH 7, 50 mM H2O2). Cytoplasmic extracts and corresponding medium supernatants were analysed for amino acid composition by gas chromatography. Exposures of S. aureus to H2O2 during the inoculation process resulted in extended lag phases lasting well after the peroxide had been neutralised by the bacterium's antioxidant systems, after which the bacteria eventually resumed growth at equivalent rates to the controls. Even though the subsequent growth rates appeared normal, the cells exhibited a variant metabolic regime at the mid-exponential phase of growth as a result of the initial exposure to peroxide. The alterations in metabolism were reflected by the differential amino acid profiles measured in the cytoplasmic extracts (P < 0.0001). The data indicated that the metabolic responses to H2O2 challenge were uniquely different depending on the variations of temperature and pH. The uptake patterns of amino acids from the media also altered depending on prevailing environmental conditions. From these results, it was proposed that a specific reproducible homeostasis could be induced under a specific set of defined environmental conditions. It was also evident that early toxic insults on the bacterial culture could have lasting impacts on cellular homeostasis after successive generations, even after the offending chemical had been removed and initial cell integrity restored. It was concluded that metabolic homeostasis would be continually adjusting and responding to changing environmental conditions to deploy defensive proteins as well as optimising processes for survival. The powerful ability to continually and rapidly adapt to the environment may represent the key feature supporting the virulence of S. aureus as an opportunistic pathogen invading the wound site.
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Affiliation(s)
- Grace R Murphy
- Metabolic Research Group, Faculty of Science and Information Technology, School of Environmental and Life Sciences, Department of Biology, University Drive, Callaghan, 2308, NSW, Australia
| | - R Hugh Dunstan
- Metabolic Research Group, Faculty of Science and Information Technology, School of Environmental and Life Sciences, Department of Biology, University Drive, Callaghan, 2308, NSW, Australia
| | - Margaret M Macdonald
- Metabolic Research Group, Faculty of Science and Information Technology, School of Environmental and Life Sciences, Department of Biology, University Drive, Callaghan, 2308, NSW, Australia
| | | | - Tim K Roberts
- Metabolic Research Group, Faculty of Science and Information Technology, School of Environmental and Life Sciences, Department of Biology, University Drive, Callaghan, 2308, NSW, Australia
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40
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Pfirman KS, Haile R. Intracardiac Abscess and Pacemaker Lead Infection Secondary to Hematogenous Dissemination of Methicillin-Sensitive Staphylococcus Aureus from a Prior Diabetic Foot Ulcer and Osteomyelitis. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:224-228. [PMID: 29491344 PMCID: PMC5842747 DOI: 10.12659/ajcr.906227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 77 Final Diagnosis: MSSA intracardiac abscess and pacemaker lead infection Symptoms: Syncope • fever • dyspnea • lethargy • rigors • chills • malaise Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Kristopher S Pfirman
- Department of Medical Education, Camden Clark Medical Center, Parkersburg, WV, USA
| | - Robel Haile
- Department of Critical Care and Pulmonology, Camden Clark Medical Center, Parkersburg, WV, USA
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41
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Georges H, Leroy O, Airapetian N, Lamblin N, Zogheib E, Devos P, Preau S. Outcome and prognostic factors of patients with right-sided infective endocarditis requiring intensive care unit admission. BMC Infect Dis 2018; 18:85. [PMID: 29466956 PMCID: PMC5822595 DOI: 10.1186/s12879-018-2989-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background Right-sided infective endocarditis (RSIE) is an uncommon diagnosis accounting for less than 10% of cases of infective endocarditis. Optimal management for severely ill patients with RSIE remains challenging because few studies reported on management and outcome. The goal of our study was to determine outcome and associated prognostic factors in a population of ICU patients with a diagnosis of definite, active and severe RSIE. Methods We performed a retrospective study in 10 French ICUs between January 2002 and December 2012. Main outcome was mortality at 30 days after ICU admission. Significant variables associated with 30-days mortality in the bivariate analysis were included in a logistic regression analysis. Results A total of 37 patients were studied. Mean age was 47.9 ± 18.4 years. Mean SAPS II, SOFA score and Charlson comorbidity index were 32.4 ± 17.4, 6.3 ± 4.4 and 3.1 ± 3.4, respectively. Causative pathogens, identified in 34 patients, were mainly staphylococci (n = 29). The source of endocarditis was a catheter related infection in 10 patients, intravenous drug abuse in 8 patients, cutaneous in 7 patients, urinary tract related in one patient and has an unknown origin in 7 patients. Vegetation size was higher than 20 mm for 14 patients. Valve tricuspid regurgitation was classified as severe in 11 patients. All patients received initial appropriate antimicrobial therapy. Aminoglycosides were delivered in combination with β-lactam antibiotics or vancomycin in 22 patients. Surgical procedure was performed in 14 patients. Eight patients (21.6%) died within 30 days following ICU admission. One independent prognostic factor was identified: use of aminoglycosides was associated with improved outcome (OR = 0.1; 95%CI = 0.0017–0.650; p = 0.007). Conclusion Mortality of patients with RSIE needing ICU admission is high. Aminoglycosides used in combination with β-lactam or vancomycin could reduce 30 days mortality.
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Affiliation(s)
- Hugues Georges
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président, 59200, Tourcoing, France.
| | - Olivier Leroy
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président, 59200, Tourcoing, France
| | | | - Nicolas Lamblin
- Pôle de cardiologie, Hôpital cardio-thoracique, CHU Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France
| | - Elie Zogheib
- Réanimation polyvalente, CHU Amiens Picardie, Amiens, France
| | - Patrick Devos
- Université LILLE. EA 2694 - Santé publique : Epidémiologie et qualité des soins, CHU de Lille, 59000, Lille, France
| | - Sebastien Preau
- Pôle de réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59000, Lille Cedex, France
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42
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Hu YN, Wan S. Repair of infected mitral valves: what have we learned? Surg Today 2018; 48:899-908. [DOI: 10.1007/s00595-018-1637-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/18/2018] [Indexed: 01/10/2023]
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43
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Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteraemia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond) 2017; 50:175-192. [PMID: 29105519 DOI: 10.1080/23744235.2017.1392039] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To review the epidemiology of Staphylococcus aureus bacteraemia (SAB) and endocarditis (SAE), and discuss the short- and long-term outcome. Materials and methods: A literature review of the epidemiology of SAB and SAE. RESULTS The reported incidence of SAB in Western countries is 16-41/100,000 person-years. Increasing incidence has been observed in many regions, in Iceland by 27% during 1995-2008. The increase is believed to depend on changes in population risk factors and possibly better and more frequent utilization of diagnostic procedures. S. aureus is now the leading causes of infective endocarditis (IE) in many regions of the world. It accounts for 15-40% of all IE cases, and the majority of cases in people who inject drugs (PWID). Recently, the incidence of SAE in PWID in Stockholm, Sweden, was found to be 2.5/1000 person-years, with an in-hospital mortality of 2.5% in PWID as compared to 15% in non-drug users. The 30-day mortality associated with SAB amounts to 15-25% among adults in Western countries, but is lower in children (0-9%). Mortality associated with SAE is high (generally 20-30% in-hospital mortality), and symptomatic cerebral embolizations are common (12-35%). The 1-year mortality reported after SAB and SAE is 19-62% and reflects deaths from underlying diseases and complications caused by the infection. In a subset of SAE cases, valvular heart surgery is needed (15-45%), but active intravenous drug use seems to be a reason to refrain from surgery. Despite its importance, there are insufficient data on the optimal management of SAB and SAE, especially on the required duration of antibiotic therapy. Conclusions: The epidemiology of SAB and SAE has been changing in the past decades. They still carry a substantial morbidity and mortality. Intensified studies on treatment are warranted for improving patient outcome.
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Affiliation(s)
- Hilmir Asgeirsson
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Anders Thalme
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Ola Weiland
- a Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,b Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
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44
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Hyperbaric oxygen therapy augments tobramycin efficacy in experimental Staphylococcus aureus endocarditis. Int J Antimicrob Agents 2017; 50:406-412. [DOI: 10.1016/j.ijantimicag.2017.04.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/24/2017] [Accepted: 04/05/2017] [Indexed: 12/14/2022]
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45
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Gragnano F, Crisci M, Bigazzi MC, Bianchi R, Sperlongano S, Natale F, Fimiani F, Concilio C, Cesaro A, Pariggiano I, Diana V, Limongelli G, Cirillo P, Russo M, Golia E, Calabrò P. Von Willebrand Factor as a Novel Player in Valvular Heart Disease: From Bench to Valve Replacement. Angiology 2017; 69:103-112. [PMID: 28481153 DOI: 10.1177/0003319717708070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
von Willebrand Factor (vWF) is a well-known mediator of hemostasis and vascular inflammation. Its dynamic modulation in the bloodstream, according to hemodynamic conditions, makes it an appealing biomarker in patients with valvular heart disease (VHD). Recent studies highlight the close connection between vWF and VHD, with possible implications in the pathogenesis of VHD, promoting valve aging and calcification or favoring the development of infective endocarditis. Moreover, vWF has been recently proposed as a new diagnostic and prognostic tool in patients with valve stenosis or regurgitation, showing a strict correlation with severity of valve disease, outcome, and bleeding (Heyde syndrome). A novel role for vWF is also emerging in patients undergoing percutaneous or surgical valve repair/replacement to select and stratify patients, evaluate periprocedural bleeding risk, and detect procedural complications. We also report our single-center experience, suggesting, for the first time, possible clinical implications for vWF in percutaneous mitral valve repair (MitraClip). This review summarizes recent advances in the role of vWF in VHD with an updated overview going from bench to operating room.
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Affiliation(s)
- Felice Gragnano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Crisci
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Cappelli Bigazzi
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Renatomaria Bianchi
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Sperlongano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Natale
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Fimiani
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Claudia Concilio
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Arturo Cesaro
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ivana Pariggiano
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Diana
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Limongelli
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Plinio Cirillo
- 2 Department of Advanced Biological Sciences, Federico II University, Naples, Italy
| | - Mariagiovanna Russo
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Enrica Golia
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- 1 Division of Cardiology, Department of Cardio-thoracic and Respiratory Sciences, A.O. dei Colli Monaldi Hospital, University of Campania "Luigi Vanvitelli", Naples, Italy
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47
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Moser C, Pedersen HT, Lerche CJ, Kolpen M, Line L, Thomsen K, Høiby N, Jensen PØ. Biofilms and host response - helpful or harmful. APMIS 2017; 125:320-338. [PMID: 28407429 DOI: 10.1111/apm.12674] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 01/14/2017] [Indexed: 01/09/2023]
Abstract
Biofilm infections are one of the modern medical world's greatest challenges. Probably, all non-obligate intracellular bacteria and fungi can establish biofilms. In addition, there are numerous biofilm-related infections, both foreign body-related and non-foreign body-related. Although biofilm infections can present in numerous ways, one common feature is involvement of the host response with significant impact on the course. A special characteristic is the synergy of the innate and the acquired immune responses for the induced pathology. Here, we review the impact of the host response for the course of biofilm infections, with special focus on cystic fibrosis, chronic wounds and infective endocarditis.
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Affiliation(s)
- Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hannah Trøstrup Pedersen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Johann Lerche
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mette Kolpen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Costerton Biofilm Center, Institute of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Laura Line
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kim Thomsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Høiby
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Costerton Biofilm Center, Institute of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Peter Østrup Jensen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Costerton Biofilm Center, Institute of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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Abstract
Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis.
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49
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Sneha S, Venishetty S, Seshadri S, Rao MS, Mukhopadhyay C. An Unusual Occurrence of Methicillin Resistant Staphylococcal Endocarditis with Vancomycin Creep Phenomenon - A Therapeutic Challenge. J Clin Diagn Res 2017; 10:OD12-OD14. [PMID: 28208915 DOI: 10.7860/jcdr/2016/21709.9085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/26/2016] [Indexed: 11/24/2022]
Abstract
Infective endocarditis by Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia is a common association and carries a high mortality. However, rising Minimum Inhibitory Concentrations (MICs) for vancomycin amongst MRSA strains is an emerging threat which carries poor prognosis and higher mortality. Here, we report a case of 41-year-old young non-addict gentleman presenting with fever of 3 days duration following recovery from an acute kidney injury necessitating haemodialysis. Systemic examination revealed signs of mitral regurgitation and left sided cerebellar signs. Laboratory investigations revealed anaemia, MRSA bacteraemia and transthoracic echocardiogram showed a mitral valve vegetation. He was diagnosed with MRSA mitral valve endocarditis with acute left cerebellar infarct. He was initially treated with intravenous vancomycin based on MIC at the dose of one gram every twelfth hourly. As the MRSA strain was shown to demonstrate a vancomycin creep phenomemon along with worsening clinical condition of the patient, treatment was changed to intravenous daptomycin at dose of 9mg/kg as per blood culture and sensitivity pattern which was administered for 6 weeks. Following initiation of daptomycin patient became afebrile and vegetations reduced in size and finally disappeared.
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Affiliation(s)
- S Sneha
- Assistant Professor, Department of Internal Medicine, Kasturba Medical College , Manipal, Karnataka, India
| | - Shanthan Venishetty
- Junior Resident, Department of Internal Medicine, Kasturba Medical College , Manipal, Karnataka, India
| | - Shubha Seshadri
- Professor, Department of Internal Medicine, Kasturba Medical College , Manipal, Karnataka, India
| | - M Sudhakar Rao
- Registrar, Department of Cardiology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Professor, Department of Microbiology, Kasturba Medical College, Manipal University , Manipal, Karnataka, India
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50
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Aonuma K, Shiga T, Atarashi H, Doki K, Echizen H, Hagiwara N, Hasegawa J, Hayashi H, Hirao K, Ichida F, Ikeda T, Maeda Y, Matsumoto N, Sakaeda T, Shimizu W, Sugawara M, Totsuka K, Tsuchishita Y, Ueno K, Watanabe E, Hashiguchi M, Hirata S, Kasai H, Matsumoto Y, Nogami A, Sekiguchi Y, Shinohara T, Sugiyama A, Sumitomo N, Suzuki A, Takahashi N, Yukawa E, Homma M, Horie M, Inoue H, Ito H, Miura T, Ohe T, Shinozaki K, Tanaka K. Guidelines for Therapeutic Drug Monitoring of Cardiovascular Drugs Clinical Use of Blood Drug Concentration Monitoring (JCS 2015) ― Digest Version ―. Circ J 2017; 81:581-612. [DOI: 10.1253/circj.cj-66-0138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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