1
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Kok W. Is It Useful to Repeat Blood Cultures in Endocarditis Patients? A Critical Appraisal. Diagnostics (Basel) 2024; 14:1578. [PMID: 39061715 PMCID: PMC11276044 DOI: 10.3390/diagnostics14141578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Previous guidelines for endocarditis have suggested repeating blood cultures until they become negative, with limited evidence. METHODS Literature reviews were conducted (1) on the incidence of persistent bacteremia and association with outcome and (2) on timing of valve culture negativization to examine the claim for prolongation of antibiotic therapy starting from negative blood cultures. RESULTS Persistent bacteremia and fever may be present in the first 3 days of endocarditis, despite treatment, and are more common in Staphylococcus (especially MRSA) and Enterococcus species. Persistent bacteremia (48-72 h), persistent infection (day 7), and new onset septic shock are related and predict in-hospital mortality. It is, however, persistent infection at day 7 and septic shock that primarily determine the infectious course of endocarditis, and not persistent bacteremia. Valve cultures at surgery become negative in most cases (>85-90%) after 14-21 days of antibiotic therapy, with no calculated benefit for prolonging therapy after 21 days. CONCLUSIONS Persistent infection at 7 days after appropriate antibiotic therapy is a better key event for prognosis then positive or negative blood cultures at 48-72 h. Therapy prolongation from the day of negative blood cultures is not reasonable. There is no need to survey blood cultures in endocarditis patients after starting therapy.
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Affiliation(s)
- Wouter Kok
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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2
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Rogers R, Rice LB. State-of-the-Art Review: Persistent Enterococcal Bacteremia. Clin Infect Dis 2024; 78:e1-e11. [PMID: 38018162 DOI: 10.1093/cid/ciad612] [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: 05/02/2023] [Indexed: 11/30/2023] Open
Abstract
Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss factors specific to Enterococcus species that may contribute to persistent infections, and describe a measured approach to diagnostic and therapeutic strategies for patients with these frequently complicated infections. The diagnosis of persistent enterococcal bacteremia is typically clinically evident in the setting of repeatedly positive blood culture results; instead, the challenge is to determine in an accurate, cost-effective, and minimally invasive manner whether any underlying nidus of infection (eg, endocarditis or undrained abscess) is present and contributing to the persistent bacteremia. Clinical outcomes for patients with persistent enterococcal bacteremia remain suboptimal. Beyond addressing host immune status if relevant and pursuing source control for all patients, management decisions primarily involve the selection of the proper antimicrobial agent(s). Options for antimicrobial therapy are often limited in the setting of intrinsic and acquired antimicrobial resistance among enterococcal clinical isolates. The synergistic benefit of combination antimicrobial therapy has been demonstrated for enterococcal endocarditis, but it is not clear at present whether a similar approach will provide any clinical benefit to some or all patients with persistent enterococcal bacteremia.
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Affiliation(s)
- Ralph Rogers
- Division of Infectious Diseases and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Louis B Rice
- Division of Infectious Diseases and Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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3
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Herrera-Hidalgo L, Fernández-Rubio B, Luque-Márquez R, López-Cortés LE, Gil-Navarro MV, de Alarcón A. Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge. Antibiotics (Basel) 2023; 12:antibiotics12040704. [PMID: 37107066 PMCID: PMC10135260 DOI: 10.3390/antibiotics12040704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/01/2023] [Indexed: 04/07/2023] Open
Abstract
Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of Enterococcus faecium is a matter of considerable concern due to its probable spread to E. faecalis and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6–8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed.
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Affiliation(s)
- Laura Herrera-Hidalgo
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Beatriz Fernández-Rubio
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Rafael Luque-Márquez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Luis E. López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen Macarena/SCIC/Universidad de Sevilla, 41009 Seville, Spain
| | - Maria V. Gil-Navarro
- Unidad de Gestión Clínica de Farmacia, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | - Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP) Grupo de Resistencias Bacterianas y Antimicrobianos (CIBERINFEC), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
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4
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Danneels P, Hamel JF, Picard L, Rezig S, Martinet P, Lorleac’h A, Talarmin JP, Buzelé R, Guimard T, Le Moal G, Brochard-Libois J, Beaudron A, Letheulle J, Codde C, Chenouard R, Boutoille D, Lemaignen A, Bernard L, Cattoir V, Dubée V. Impact of Enterococcus faecalis Endocarditis Treatment on Risk of Relapse. Clin Infect Dis 2022; 76:281-290. [PMID: 36124844 PMCID: PMC9839190 DOI: 10.1093/cid/ciac777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Enterococcus faecalis infective endocarditis (EFIE) is characterized by a higher frequency of relapses than other infective endocarditis. The role of the treatment on its occurrence remains poorly understood. The aim of this study was to investigate whether the antibiotic regimen could impact the risk of relapse in EFIE. MATERIALS This was a multicenter retrospective study of patients diagnosed with definite EFIE between 2015 and 2019 in 14 French hospitals. The primary endpoint was the occurrence of relapses within the year following endocarditis diagnosis. As death was a competing risk for relapse, Fine and Gray models were used for studying risk factors and impact of treatment. RESULTS Of the 279 patients included, 83 (29.7%) received the amoxicillin-gentamicin (A-G) combination, 114 (40.9%) amoxicillin-ceftriaxone (A-C), 63 (22.6%) A-G and A-C (A-G/A-C) sequentially, 9 (3.2%) amoxicillin (A), and 10 received other treatments. One-year-relapse rate was 9.3% (26 patients). Relapse occurred after a median delay of 107 days from EFIE diagnosis; 6 occurred after 6 months, and 6 were diagnosed by blood cultures in asymptomatic patients. In multivariate analysis, surgery during treatment was a protective factor against one-year relapse and death.The cumulative incidence of relapse 1 year after endocarditis was 46.2% for patients treated with amoxicillin, 13.4% with A-G, 14.7% with A-C, and 4.3% with A-G/A-C (P≥.05 in multivariate analysis). CONCLUSIONS Relapses after treatment of EFIE are frequent, frequently asymptomatic, and may occur more than 6 months after the initial episode.
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Affiliation(s)
- Pierre Danneels
- Infectious Diseases and Tropical Medicine, Angers University Hospital, Angers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | | | - Léa Picard
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Schéhérazade Rezig
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Pauline Martinet
- Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Aurélien Lorleac’h
- Infectious Diseases and Tropical Medicine, Groupe Hospitalier Bretagne Sud, Lorient, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Jean-Philippe Talarmin
- Infectious Diseases and Tropical Medicine, Cornouaille Hospital, Quimper, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Rodolphe Buzelé
- Infectious Diseases and Tropical Medicine, Saint-Brieuc General Hospital, Saint-Brieuc, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Thomas Guimard
- Infectious Diseases and Tropical Medicine, Vendée Departmental Hospital, La Roche Sur Yon, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Gwenaël Le Moal
- Infectious Diseases and Tropical Medicine, Poitiers University Hospital, Poitiers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Julia Brochard-Libois
- Infectious Diseases and Tropical Medicine, Saint Nazaire General Hospital, St-Nazaire, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Aurélie Beaudron
- Department of Bacteriology, Le Mans General Hospital, Le Mans, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Julien Letheulle
- Service de médecine polyvalente, Centre Hospitalier de Laval, Laval, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Cyrielle Codde
- Infectious Diseases and Tropical Medicine, Limoges University Hospital, Limoges, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Rachel Chenouard
- Department of Bacteriology, Angers University Hospital, Angers, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - David Boutoille
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, CIC-UIC 1413 INSERM, Centre Hospitalier Universitaire de Nantes, Nantes, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Adrien Lemaignen
- Infectious Diseases and Tropical Medicine, Tours University Hospital, Tours, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Louis Bernard
- Infectious Diseases and Tropical Medicine, Tours University Hospital, Tours, France,Groupe d’Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l’Ouest (GERICCO), France
| | - Vincent Cattoir
- Department of Bacteriology, Pontchaillou University Hospital, Rennes, France,National Reference Center for Enterococci, Pontchaillou University Hospital, Rennes, France,INSERM unit U1230, University of Rennes 1, Rennes, France
| | - Vincent Dubée
- Correspondence: V. Dubée, Infectious Diseases and Tropical Medicine, University Hospital. 4, Rue Larrey, 49100 Angers, France ()
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5
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Vigneswaran N, McKew G. A retrospective study of Enterococcus faecalis infective endocarditis: comparison of clinical characteristics and outcomes associated with treatment. JAC Antimicrob Resist 2022; 4:dlac096. [PMID: 36196445 PMCID: PMC9524564 DOI: 10.1093/jacamr/dlac096] [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: 05/23/2022] [Accepted: 08/19/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
A synergistic antibiotic combination of a penicillin and gentamicin (AG) or ceftriaxone (AC) is used in the management of Enterococcus faecalis infective endocarditis (EFIE). We compare the treatment outcomes between AG and AC, including low and high dose ceftriaxone (1 and 2 g 12 hourly).
Methods
A retrospective cohort study of patients treated for EFIE at single tertiary centre (2012–2019). Outcome measures examined were 90- and 180-day mortality, treatment associated adverse events and relapse of bacteraemia (within 1 year).
Results
39 patients were enrolled [61.6% given (AC) (n = 24), 24% received ACL (n = 10) and 34% received ACN (n = 14)], 38.4% received AG (n = 15). We noted a difference in the mortality outcomes at 90 and 180 days between those treated with AG and AC overall (6.7% and 33.3%, respectively) although this did not reach statistical significance (P = 0.114, P = 0.061). No significant difference was noted between these groups in incidence of relapsed bacteraemia with two cases noted in the AC cohort (8.3%, 2/24) and none observed (0/15) in the AG cohort (P = 0.662, P = 0.414). A greater number of adverse events was observed in the AG group (11/15, 73.3%) compared to the overall AC group (6/24, 25.0%) (P = 0.009), with no difference between the high and low dose ceftriaxone groups (P = 0.05).
Conclusion
Combination treatment of EFIE with AC is associated with a reduced number of adverse events in comparison to AG groups. Although increased mortality was observed in the AC group, this did not reach statistical significance, and reflects the greater comorbidities and reduced capacity for surgical source control in this cohort.
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Affiliation(s)
- N Vigneswaran
- Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital , Sydney , Australia
| | - G McKew
- Department of Infectious Diseases and Microbiology, Concord Repatriation General Hospital , Sydney , Australia
- University of Sydney , Sydney , Australia
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6
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Cuervo G, Hernández-Meneses M, Falces C, Quintana E, Vidal B, Marco F, Perissinotti A, Carratalà J, Miro JM. Infective Endocarditis: New Challenges in a Classic Disease. Semin Respir Crit Care Med 2022; 43:150-172. [PMID: 35172365 DOI: 10.1055/s-0042-1742482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infective endocarditis is a relatively rare, but deadly infection, with an overall mortality of around 20% in most series. Clinical manifestations have evolved in response to significant epidemiological shifts in industrialized nations, with a move toward a nosocomial or health-care-related pattern, in older patients, with more episodes associated with prostheses and/or intravascular electronic devices and a predominance of staphylococcal and enterococcal etiology.Diagnosis is often challenging and is based on the conjunction of clinical, microbiological, and imaging information, with notable progress in recent years in the accuracy of echocardiographic data, coupled with the recent emergence of other useful imaging techniques such as cardiac computed tomography (CT) and nuclear medicine tools, particularly 18F-fluorodeoxyglucose positron emission/CT.The choice of an appropriate treatment for each specific case is complex, both in terms of the selection of the appropriate agent and doses and durations of therapy as well as the possibility of using combined bactericidal antibiotic regimens in the initial phase and finalizing treatment at home in patients with good evolution with outpatient oral or parenteral antimicrobial therapies programs. A relevant proportion of patients will also require valve surgery during the active phase of treatment, the timing of which is extremely difficult to define. For all the above, the management of infective endocarditis requires a close collaboration of multidisciplinary endocarditis teams.
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Affiliation(s)
- Guillermo Cuervo
- Infectious Diseases Service, Hospital Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Hernández-Meneses
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Falces
- Cardiology Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Cardiovascular Surgery Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Bárbara Vidal
- Cardiology Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Microbiology Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Andrés Perissinotti
- Department of Nuclear Medicine, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.,Biomedical Research Networking Centre of Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Jordi Carratalà
- Infectious Diseases Service, Hospital Bellvitge - IDIBELL, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose M Miro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.,Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
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7
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Marino A, Munafò A, Zagami A, Ceccarelli M, Campanella E, Cosentino F, Moscatt V, Cantarella G, Di Mauro R, Bernardini R, Nunnari G, Cacopardo B. Ampicillin plus ceftriaxone therapy against Enterococcus faecalis endocarditis: A case report, guidelines considerations, and literature review. IDCases 2022; 28:e01462. [PMID: 35265458 PMCID: PMC8899221 DOI: 10.1016/j.idcr.2022.e01462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Enterococcus faecalis infective endocarditis (EFIE) continues to be a very serious disease, showing considerable morbidity and mortality rates which are influenced by the spread of multi-drug resistant strains occurred in the last decades. Although aminoglycosides were considered the treatment of choice of EIFE, in recent years several studies have investigated alternative therapeutic approaches, including combinations of beta-lactams, mainly because of the aminoglycoside-renowned nephrotoxicity and the widespread development of high-level aminoglycosides resistance (HLAR). In this scenario, we reported a case involving a prosthetic valve infective endocarditis caused by an aminoglycoside-resistant E. faecalis strain which was successfully treated with ampicillin plus ceftriaxone despite the presence of artificial heart valve and the patient’s severe clinical conditions.
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Affiliation(s)
- Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Correspondence to: ARNAS Garibaldi Hospital, Via Palermo, 636, 95122 Catania, Italy.
| | - Antonio Munafò
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Aldo Zagami
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
| | - Edoardo Campanella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, Catania, Italy
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8
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Marino A, Munafò A, Zagami A, Ceccarelli M, Di Mauro R, Cantarella G, Bernardini R, Nunnari G, Cacopardo B. Ampicillin Plus Ceftriaxone Regimen against Enterococcus faecalis Endocarditis: A Literature Review. J Clin Med 2021; 10:jcm10194594. [PMID: 34640612 PMCID: PMC8509562 DOI: 10.3390/jcm10194594] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/28/2021] [Accepted: 10/01/2021] [Indexed: 12/19/2022] Open
Abstract
Enterococcus faecalis infective endocarditis (EFIE) continues to represent a potentially fatal infectious disease characterized by elevated morbidity and mortality. Despite advances in antimicrobial therapy, changing demographics and the reduced availability of useful antibiotics combined with the dissemination of multi-drug resistant strains, the mortality rate remained unchanged in the last decades. Nowadays, optimizing the antibiotic regimen is still of paramount importance. Historically, aminoglycosides were considered as a cornerstone for treatment even though their use is associated with a high risk of kidney failure. It is against this background that, in recent years, several studies have been carried in order to assess the validity of alternative therapeutic approaches, including combinations of beta-lactams, that, acting synergistically, have yielded useful results in different clinical settings. In this scenario, we searched and critically report clinical studies assessing the efficacy and safety of double beta-lactam therapy in treating EFIE.
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Affiliation(s)
- Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (A.Z.); (M.C.); (B.C.)
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Antonio Munafò
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy; (A.M.); (R.D.M.); (G.C.)
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Aldo Zagami
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (A.Z.); (M.C.); (B.C.)
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (A.Z.); (M.C.); (B.C.)
| | - Rosaria Di Mauro
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy; (A.M.); (R.D.M.); (G.C.)
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Giuseppina Cantarella
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy; (A.M.); (R.D.M.); (G.C.)
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
| | - Renato Bernardini
- Department of Biomedical and Biotechnological Science, School of Medicine, University of Catania, 95123 Catania, Italy; (A.M.); (R.D.M.); (G.C.)
- Unit of Clinical Toxicology, Policlinico G. Rodolico, School of Medicine, University of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-095-478-1190
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, 95123 Catania, Italy; (A.M.); (A.Z.); (M.C.); (B.C.)
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Cuervo G, Escrihuela-Vidal F, Gudiol C, Carratalà J. Current Challenges in the Management of Infective Endocarditis. Front Med (Lausanne) 2021; 8:641243. [PMID: 33693021 PMCID: PMC7937698 DOI: 10.3389/fmed.2021.641243] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/01/2021] [Indexed: 12/17/2022] Open
Abstract
Infective endocarditis is a relatively rare, but deadly cause of sepsis, with an overall mortality ranging from 20 to 25% in most series. Although the classic clinical classification into syndromes of acute or subacute endocarditis have not completely lost their usefulness, current clinical forms have changed according to the profound epidemiological changes observed in developed countries. In this review, we aim to address the changing epidemiology of endocarditis, several recent advances in the understanding of the pathophysiology of endocarditis and endocarditis-triggered sepsis, new useful diagnostic tools as well as current concepts in the medical and surgical management of this disease. Given its complexity, the management of infective endocarditis requires the close collaboration of multidisciplinary endocarditis teams that must decide on the diagnostic approach; the appropriate initial treatment in the critical phase; the detection of patients needing surgery and the timing of this intervention; and finally the accurate selection of patients for out-of-hospital treatment, either at home hospitalization or with oral antibiotic treatment.
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Affiliation(s)
- Guillermo Cuervo
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Escrihuela-Vidal
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain.,Insitut Català d'Oncologia, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Duran i Reynals, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Diseases Department, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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Calderón-Parra J, Kestler M, Ramos-Martínez A, Bouza E, Valerio M, de Alarcón A, Luque R, Goenaga MÁ, Echeverría T, Fariñas MC, Pericàs JM, Ojeda-Burgos G, Fernández-Cruz A, Plata A, Vinuesa D, Muñoz P. Clinical Factors Associated with Reinfection versus Relapse in Infective Endocarditis: Prospective Cohort Study. J Clin Med 2021; 10:jcm10040748. [PMID: 33668597 PMCID: PMC7918007 DOI: 10.3390/jcm10040748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/29/2022] Open
Abstract
We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008–2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37–5.29)), enterococci (OR: 3.01 (95% CI: 1.51–6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05–5.36)), and surgical treatment (OR: 0.23 (0.1–0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65–5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04–2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies.
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Affiliation(s)
- Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
| | - Martha Kestler
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
| | - Antonio Ramos-Martínez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
- Correspondence: ; Tel.: +34-638-211-120; Fax: +34-91191-6807
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
- Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Maricela Valerio
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena (IBIS), 41013 Sevilla, Spain; (A.d.A.); (R.L.)
| | - Rafael Luque
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena (IBIS), 41013 Sevilla, Spain; (A.d.A.); (R.L.)
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, 20010 San Sebastián, Spain;
| | - Tomás Echeverría
- Servicio de Cardiología, Hospital Donosti, 20010 San Sebastián, Spain;
| | - Mª Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, 39008 Santander, Spain;
| | - Juan M. Pericàs
- Infectious Disease Department, Hospital Clínic de Barcelona (IDIBAPS), 08036 Barcelona, Spain;
| | - Guillermo Ojeda-Burgos
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Ana Fernández-Cruz
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro- Majadahonda (IDIPHSA), 28222 Madrid, Spain; (J.C.-P.); (A.F.-C.)
| | - Antonio Plata
- Servicio de Enfermedades Infecciosas, Hospital Regional de Málaga, 29010 Málaga, Spain;
| | - David Vinuesa
- Servicio de Medicina Interna y Enfermedades Infecciosas, Hospital Clínico San Cecilio, 18016 Granada, Spain;
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain; (M.K.); (E.B.); (M.V.); (P.M.)
- Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
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How do I manage a patient with enterococcal bacteraemia? Clin Microbiol Infect 2020; 27:364-371. [PMID: 33152537 DOI: 10.1016/j.cmi.2020.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Enterococcal bacteraemia (EB) is common, particularly in the nosocomial setting, and its management poses a challenge for clinicians and microbiologists. OBJECTIVES The aim was to summarize the more relevant features of EB and to provide a practical state-of-the-art on the topics that more directly affect its management. SOURCES Pubmed articles from inception to 31 May 2020. CONTENT The following topics are covered: epidemiological, clinical and microbiological characteristics and factors associated with prognosis of EB; diagnosis and work-up, including the use of echocardiography to rule out endocarditis; antibiotic management with special focus on antimicrobial resistance and complicated EB; and the role of infectious disease consultation and the use of bundles in EB. In addition, three clinical vignettes are presented to illustrate the practical application of the guidance provided, and major gaps in the current evidence supporting EB management are discussed. IMPLICATIONS EB is associated with large burdens of morbidity and mortality, particularly among fragile and immunosuppressed patients presenting complicated bacteraemia due to multidrug-resistant enterococci. Most cases of EB are caused by Enterococcus faecalis, followed by E. faecium. EB often presents as polymicrobial bacteraemia. Rapidly identifying patients at risk of EB is crucial for timely application of diagnostic techniques and empiric therapy. Early alert systems and rapid diagnostic techniques, such as matrix-assisted desorption ionization-time of flight mass spectrometry, especially if used together with infectious disease consultation within bundles, appear to improve management and prognosis of EB. Echocardiography is also key in the work-up of EB and should probably be more extensively used, although its exact indications in EB are still debated. Multidisciplinary approaches are warranted due to the complexity and severity of EB.
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