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Uçkay I, Holy D, Betz M, Sauer R, Huber T, Burkhard J. Osteoarticular infections: a specific program for older patients? Aging Clin Exp Res 2021; 33:703-710. [PMID: 31494913 DOI: 10.1007/s40520-019-01329-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the increasing number of elderly patients, arthroplasties, fractures and diabetic foot infections, the worldwide number of osteoarticular infections (OAI) among the elderly is concomitantly expected to rise. AIMS We explore existing scientific knowledge about OAI in the frail elderly population. METHODS We performed a literature search linking OAIs to geriatric patients and comparing elderly patients (> 65 years) with average adults (range 18-65 years). RESULTS In this literature, financial aspects, comparison of diverse therapies on quality of life, reimbursement policies, or specific guidelines or nursing recommendations are missing. Age itself was not an independent factor related to particular pathogens, prevention of OAI, nursing care, and outcomes of OAI. However, geriatric patients were significantly more exposed to adverse events of therapy. They had more co-morbidities and more conservative surgery for OAI. CONCLUSION Available literature regarding OAI management among elderly patients is sparse. In recent evaluations, age itself does not seem an independent factor related to particular epidemiology, pathogens, prevention, nursing care, rehabilitation and therapeutic outcomes of OAI. Future clinical research will concern more conservative surgical indications, but certainly reduce inappropriate antibiotic use.
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Affiliation(s)
- Ilker Uçkay
- Infectiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
- Infection Control, Balgrist University Hospital, Zurich, Switzerland.
| | - Dominique Holy
- Internal Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Michael Betz
- Orthopaedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Regina Sauer
- Nursing Care, Balgrist University Hospital, Zurich, Switzerland
| | - Tanja Huber
- Pharmacy, Balgrist University Hospital, Zurich, Switzerland
| | - Jan Burkhard
- Infection Control, Balgrist University Hospital, Zurich, Switzerland
- Internal Medicine, Balgrist University Hospital, Zurich, Switzerland
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Asumang J, Heard KL, Troise O, Fahmy S, Mughal N, Moore LSP, Hughes S. Evaluation of a thrice weekly administration of teicoplanin in the outpatient setting: a retrospective observational multicentre study. JAC Antimicrob Resist 2021; 3:dlab012. [PMID: 34223089 PMCID: PMC8210249 DOI: 10.1093/jacamr/dlab012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/19/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction The glycopeptide teicoplanin is commonly utilized to facilitate outpatient parenteral antimicrobial therapy (OPAT). Licensed for once daily maintenance dosing, teicoplanin’s long half-life allows for less frequent dosing (e.g. thrice weekly) following successful loading. This service evaluation reviews the safety and effectiveness of a novel thrice weekly teicoplanin dosing regimen. Methods A retrospective, observational study was conducted at Chelsea and Westminster Hospital (March 2018 to July 2020), evaluating trough serum teicoplanin concentrations for patients receiving >5 days of teicoplanin in the OPAT setting. Teicoplanin dosing and administration (once daily versus thrice weekly), clinical outcomes and therapeutic levels were analysed for all patients. The project was registered with clinical governance locally. Results A total of 82 patients treated with teicoplanin in the OPAT service were included; 53/82 receiving thrice weekly and 29/82 receiving once daily dosing. Mean teicoplanin trough levels were similar in both groups (26.2 mg/L and 25.8 mg/L in once daily and thrice weekly groups, P = 0.8895). High clinical success rates were recorded in both groups (25/29 [86.2%] versus 50/53 [94.3%]). No correlation with clinical outcomes and initial teicoplanin serum levels was identified. Normal renal function (>90 mL/min) was associated with lower teicoplanin serum concentrations (mean [±SD] 21.4 mg/L [±10.1] versus 29.7 mg/L [±14], P = 0.0178) in the thrice weekly dosed group but not with the once daily dosed group (mean [±SD] 28.2 mg/L [±9.4] versus 23.7 mg/L [±9.9], P = 0.2201). Conclusions This study supports thrice weekly teicoplanin as a convenient and effective OPAT for administration in the OPAT setting. Therapeutic drug monitoring is advised to adjust for intra-patient variability.
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Affiliation(s)
- John Asumang
- School of Medicine, Imperial College, London, SW7 2DD, UK
| | - Katie L Heard
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Oliver Troise
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Sandra Fahmy
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Nabeela Mughal
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Luke S P Moore
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Stephen Hughes
- Chelsea and Westminster NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
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3
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Subcutaneous teicoplanin in staphylococcal bone and joint infections. Med Mal Infect 2020; 50:83-86. [DOI: 10.1016/j.medmal.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/18/2019] [Accepted: 10/01/2019] [Indexed: 12/28/2022]
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4
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Concia E, Viscoli C, Del Bono V, Giannella M, Bassetti M, De Rosa GF, Durante Mangoni E, Esposito S, Giusti M, Grossi P, Menichetti F, Pea F, Petrosillo N, Tumbarello M, Stefani S, Venditti M, Viale P. The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts. J Chemother 2018; 30:157-171. [PMID: 29380676 DOI: 10.1080/1120009x.2017.1420610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.
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Affiliation(s)
- Ercole Concia
- a Università degli Studi di Verona, Italy - Dipartimento Diagnostica e Sanità Pubblica - Sezione Malattie Infettive
| | - Claudio Viscoli
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Valerio Del Bono
- b A.O.U. IRCCS San Martino/Università degli Studi, Genova, Italy - Clinica delle Malattie Infettive
| | - Maddalena Giannella
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
| | - Matteo Bassetti
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | | | | | - Silvano Esposito
- g Università degli Studi di Salerno, Italy, Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana"
| | - Massimo Giusti
- h A.O. San Giovanni Bosco, Torino, Italy - Reparto di Medicina Interna A
| | - Paolo Grossi
- i Università degli Studi dell'Insubria, Varese, Italy - Dipartimento di Medicina Interna - Malattie infettive e tropicali
| | - Francesco Menichetti
- j A.O.U. Pisana, Pisa, Italy - Direttore di Unità Operativa - U.O. Malattie Infettive
| | - Federico Pea
- d A.O.U. Santa Maria della Misericordia, Udine, Italy - Clinica di Malattie Infettive (Bassetti), Istituto di Farmacologia Clinica (Pea)
| | - Nicola Petrosillo
- k Istituto Nazionale Malattie Infettive "Lazzaro Spallanzani", Roma, Italy - U.O.C. Infezioni Sistemiche e dell'Immunodepresso
| | - Mario Tumbarello
- l Università Cattolica del Sacro Cuore, Roma, Italy - Facoltà di Medicina e Chirurgia, Clinica delle Malattie Infettive
| | - Stefania Stefani
- m Università degli Studi di Catania, Italy - Dipartimento di Scienze Biomediche e Biotecnologiche
| | - Mario Venditti
- n Università "La Sapienza"/A.O. Policlinico Umberto I, Roma, Italy - Dipartimento di Sanità Pubblica e Malattie Infettive
| | - Pierluigi Viale
- c Università degli Studi di Bologna/Ospedale Sant'Orsola-Malpighi, Bologna, Italy - Dipartimento di Scienze Mediche e Chirurgiche, Settore Malattie Infettive
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Abstract
BACKGROUND Chronic osteomyelitis is generally treated with antibiotics and surgical debridement but can persist intermittently for years with frequent therapeutic failure or relapse. Despite advances in both antibiotic and surgical treatment, the long-term recurrence rate remains around 20%. This is an update of a Cochrane review first published in 2009. OBJECTIVES To determine the effects of different systemic antibiotic treatment regimens for treating chronic osteomyelitis in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (October 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 9), MEDLINE (January 1948 to September Week 4 2012), EMBASE (January 1980 to 2012 Week 40), LILACS (October 2012), the WHO International Clinical Trials Registry Platform (June 2012) and reference lists of relevant articles. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs addressing the effects of different antibiotic treatments given after surgical debridement for chronic osteomyelitis in adults. DATA COLLECTION AND ANALYSIS Two review authors independently screened papers for inclusion, extracted data and appraised risk of bias in the included trials. Where appropriate, we pooled data using the fixed-effect model. MAIN RESULTS We included eight small trials involving a total of 282 participants with chronic osteomyelitis. Data were available from 248 participants. Most participants were male with post-traumatic osteomyelitis, usually affecting the tibia and femur, where recorded. The antibiotic regimens, duration of treatment and follow-up varied between trials. All trials mentioned surgical debridement before starting on antibiotic therapy as part of treatment, but it was unclear in four trials whether all participants underwent surgical debridement.We found that study quality and reporting were often inadequate. In particular, we judged almost all trials to be at moderate to high risk of bias due to failure to conceal allocation and inadequate follow-up.Four trials compared oral versus parenteral route for administration of antibiotics. There was no statistically significant difference between the two groups in the remission at the end of treatment (70/80 versus 58/70; risk ratio (RR) 1.04, 95% confidence interval (CI) 0.92 to 1.18; four trials, 150 participants). There was no statistically significant difference between the two groups in the remission rate 12 or more months after treatment (49/64 versus 44/54; RR 0.94, 95% CI 0.78 to 1.13; three trials, 118 participants). There was also no significant difference between the two groups in the occurrence of mild adverse events (11/64 versus 8/54; RR 1.08, 95% CI 0.49 to 2.42; three trials, 118 participants) or moderate and severe adverse events (3/49 versus 4/42; RR 0.69, 95% CI 0.19 to 2.57; three trials, 91 participants). Superinfection occurred in participants of both groups (5/66 in the oral group versus 4/58 in the parenteral group; RR 1.08, 95% CI 0.33 to 3.60; three trials, 124 participants).Single trials with few participants found no statistical significant differences for remission or adverse events for the following four comparisons: oral only versus parenteral plus oral administration; parenteral plus oral versus parenteral only administration; two different parenteral antibiotic regimens; and two different oral antibiotic regimens. No trials compared different durations of antibiotic treatment for chronic osteomyelitis, or adjusted the remission rate for bacteria species or severity of disease. AUTHORS' CONCLUSIONS Limited and low quality evidence suggests that the route of antibiotic administration (oral versus parenteral) does not affect the rate of disease remission if the bacteria are susceptible to the antibiotic used. However, this and the lack of statistically significant differences in adverse effects need confirmation. No or insufficient evidence exists for other aspects of antibiotic therapy for chronic osteomyelitis.The majority of the included trials were conducted over 20 years ago and currently we are faced with a far higher prevalence of bacteria that are resistant to many of the available antibiotics used for healthcare. This continuously evolving bacterial resistance represents another challenge in the choice of antibiotics for treating chronic osteomyelitis.
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Affiliation(s)
- Lucieni O Conterno
- Marilia Medical SchoolDepartment of General Internal Medicine and Clinical Epidemiology UnitAvenida Monte Carmelo 800FragataMariliaSão PauloBrazil17519‐030
| | - Marilia D Turchi
- Federal University of GoiasDepartment of Public Health, Institute of Tropical Pathology and Public HealthRua Amorinopolis QdR2 Lt13 Residencial GoiasAlphaville FlamboyantGoianiaGoiasBrazil74884‐540
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Long-term, once-weekly outpatient teicoplanin use for suppression of chronic prosthetic joint infection. Int J Antimicrob Agents 2013. [DOI: 10.1016/j.ijantimicag.2012.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Antimicrobial resistance is a global medical problem, affecting most bacterial pathogens. The major challenges are currently posed by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Enterobacteriaceae producing extended-spectrum-beta-lactamases (ESBL) and carbapenemases, and multi-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii. Therapeutic options are very limited and, in some cases, virtually unavailable. This article provides an overview of the recent epidemiological trends exhibited by the most important multi-resistant pathogens, and of the treatment options that are currently available for these infections.
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Affiliation(s)
- Francesco Menichetti
- U.O.C. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
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8
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FDG PET/CT is useful for the interim evaluation of response to therapy in patients affected by haematogenous spondylodiscitis. Eur J Nucl Med Mol Imaging 2012; 39:1538-44. [DOI: 10.1007/s00259-012-2179-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/15/2012] [Indexed: 10/28/2022]
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9
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Gasbarrini A, Boriani L, Nanni C, Zamparini E, Rorato G, Ghermandi R, Salvadori C, Allegri V, Bandiera S, Barbanti-Brodano G, Colangeli S, Corghi A, Terzi S, Babbi L, Amendola L, Cristini F, Marinacci G, Tumietto F, Ciminari R, Malaguti M, Rimondi E, Difiore M, Bacchin R, Facchini F, Frugiuele J, Morigi A, Albisinni U, Bonarelli S, Fanti S, Viale P, Boriani S. Spinal Infection Multidisciplinary Management Project (SIMP): From Diagnosis to Treatment Guideline. Int J Immunopathol Pharmacol 2011; 24:95-100. [DOI: 10.1177/03946320110241s218] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Spine infections require a multidisciplinary approach to be treated and solved. A guide line to drive physicians in the deep complexity of such a disease is extremely helpful. SIMP suggests a flow-chart built up on clear concepts such as right and well managed antibiotic therapy, sound stability of the spine, correct and smart use of the standard and functional imaging techniques, such as f18 FDG PET/CT. In 16 months a total of 41 patients have been treated for spondylodiscitis, discitis and vertebral osteomyelitis by our team of physicians and 25 patients have been enrolled in a prospective study whose target is the assessment of the SIMP flow-chart and of every single aspect that characterize it.
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Affiliation(s)
| | | | - C. Nanni
- Nuclear Medicine Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - E. Zamparini
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - G. Rorato
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | | | - C. Salvadori
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - V. Allegri
- Nuclear Medicine Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | | | | | | | | | | | | | | | - F. Cristini
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - G. Marinacci
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - F. Tumietto
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - R. Ciminari
- Radiology and Diagnostic Imaging, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - M.C. Malaguti
- Radiology and Diagnostic Imaging, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - E. Rimondi
- Radiology and Diagnostic Imaging, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - M. Difiore
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - R. Bacchin
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - F. Facchini
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - J. Frugiuele
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - A. Morigi
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - U Albisinni
- Radiology and Diagnostic Imaging, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - S Bonarelli
- Anesthesia-Resuscitation and Intensive Care, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - S. Fanti
- Nuclear Medicine Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
| | - P Viale
- Infectious Diseases Unit, S. Orsola-Malpighi Universitary Hospital, Bologna, Italy
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