Archive for September 6, 2014

Current antibiotic management of prosthetic joint infections in Italy: the ‘Udine strategy’

Journal of Antimicrobial Chemotherapy SEPT 2014 V.69 Suppl.1

Matteo Bassetti1,*, Barbara Cadeo1, Giovanni Villa1, Assunta Sartor2, Vanni Cainero3 and Araldo Causero3

1Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy

2Microbiology Unit, Santa Maria Misericordia University Hospital, Udine, Italy

3Orthopaedic Clinic, Santa Maria Misericordia University Hospital, Udine, Italy

*Corresponding author. Tel: +39-0432-559355; Fax: +39 0432-559360; E-mail: bassetti.matteo@aoud.sanita.fvg.it

The rate of prosthetic joint infections followed and cured at our institution is constantly increasing, in line with epidemiological data from the recent literature. This is probably related to the greater number of knee and hip prostheses implanted every year.

For intermediate and late infections, only the two-stage approach is applied, as this demonstrates the best outcome in our experience. Particular attention is paid to microbiological isolation of the pathogen: multiple samples of tissue are collected during the interventions, and kept in culture for a longer period of time than usual.

Sonication of prosthetic devices is used to enhance the sensitivity and specificity of the microbiological cultures. Histological examination influences surgical choices either towards implantation of a new prosthesis or replacement of the spacer.

An empirical antibiotic backbone of a glycopeptide/lipopeptide and rifampicin is chosen, due to the leading role of Gram-positive bacteria in this setting and the high incidence of methicillin resistance in our centre (>30%), followed by an antibiotic regimen containing linezolid. If specific risk factors are present, an anti-Gram-negative drug is added to the regimen.

Duration of therapy depends upon the approach that is chosen, usually being 6 weeks when the prosthesis is removed.

Despite at the moment being limited by its small sample size, data from our experience confirms that our empirical approach may represent a valid choice during the early phase of treatment, by keeping linezolid for a step-down therapy of shorter duration (4 weeks).

PDF

http://jac.oxfordjournals.org/content/69/suppl_1/i41.full.pdf+html

September 6, 2014 at 1:54 pm

Retrospective evaluation of possible renal toxicity associated with continuous infusion of vancomycin in critically ill patients.

Ann Intensive Care. 2011 Jul 19;1(1):26.

Spapen HD1, Janssen van Doorn K, Diltoer M, Verbrugghe W, Jacobs R, Dobbeleir N, Honoré PM, Jorens PG.

Author information

1Department of Intensive Care, University Hospital, Vrije Universiteit, Brussels, Brussels, Belgium. herbert.spapen@uzbrussel.be.

Abstract

BACKGROUND:

Continuous infusion of vancomycin is increasingly preferred as an alternative to intermittent administration in critically ill patients. Intermittent vancomycin treatment is associated with an increased occurrence of nephrotoxicity. This study was designed to determine the incidence and risk factors of acute kidney injury (AKI) during continuous infusion of vancomycin.

METHODS:

This was a retrospective, observational, two-center, cohort study in patients with microbiologically documented Gram-positive pneumonia and/or bacteremia and normal baseline renal function. Vancomycin dose was adjusted daily aiming at plateau concentrations of 15-25 μg/mL. AKI was defined as an increase in serum creatinine of 0.3 mg/dL or a 1.5 to 2 times increase from baseline on at least 2 consecutive days after the initiation of vancomycin. Primary data analysis compared patients with AKI with patients who did not develop AKI. A binary logistic regression analysis using the forward stepwise method was used to assess the risk factors associated with AKI.

RESULTS:

A total of 129 patients were studied of whom 38 (29.5%) developed AKI. Patients with AKI had higher body weight (77.3 ± 15 vs. 70.5 ± 15.2 kg; p = 0.02), more diabetes (79% vs. 54%; p = 0.01), and a higher vasopressor need (87% vs. 59%; p = 0.002). Serum vancomycin levels, body weight, and SAPS 3 score were identified as variables contributing to AKI. The incidence of AKI increased substantially when treatment duration was prolonged (14.9 ± 9.8 vs. 9.2 ± 4.9 days; p = 0.05) and plasma levels exceeded 30 μg/mL.

CONCLUSIONS:

AKI is frequently observed during continuous vancomycin infusion, particularly when conditions that cause acute (shock) or chronic (diabetes) renal dysfunction are present and vancomycin levels above target range are achieved. Although this study challenges the concept that continuous vancomycin infusion might alleviate the risk of nephrotoxicity in critically ill patients, a direct relationship between vancomycin and nephrotoxicity remains to be proven.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224465/pdf/2110-5820-1-26.pdf

September 6, 2014 at 1:50 pm

Oritavancin: a new opportunity for outpatient therapy of serious infections.

Clin Infect Dis. 2012 Apr;54 Suppl 3:S239-43.

Tice A.

Author information

Infections Limited Hawaii, Honolulu, Hawaii 96814, USA. alantice@idlinks.com

Abstract

Oritavancin is a new antibiotic for the treatment of serious infections with Gram-positive bacteria. It has been shown to be effective against methicillin-susceptible and -resistant Staphylococcus aureus as well as enterococci.

With a terminal half-life of 393 hours, oritavancin lends itself to a convenient and potentially cost-effective single-dose regimen. The single-dose regimen is currently being evaluated in pivotal phase 3 studies.

This unique property provides an opportunity to assure consistent, effective, and safe treatment for serious infections while reducing the costs of care through the elimination of multiple infusions, reduced medical care staff, shorter hospital stays, and avoidance of hospital-acquired infections.

These features seem ideal for the use of oritavancin in the outpatient management of serious infections. The impact that oritavancin will have on outpatient therapy is unclear. Current models will need to change with only a single infusion. Physician monitoring of the infection and underlying diseases may not be as frequent despite the need for close follow-up and frequent evaluations.

There will be less need for a team of outpatient infusion specialists. Outpatient therapy will be compensated less without multiple infusions. With the possibility of fewer physician and other medical visits, there will be more responsibility for the patient and family and a reliance on patients to care for themselves.

Although oritavancin offers tremendous theoretical advantages in the outpatient treatment of serious infections, care should be taken to assure the quality of care through changes in reimbursement, patient education, and development of systems to monitor care and outcomes.

PDF

http://cid.oxfordjournals.org/content/54/suppl_3/S239.full.pdf+html

September 6, 2014 at 1:48 pm

Activity of oritavancin against methicillin-resistant staphylococci, vancomycin-resistant enterococci and β-haemolytic streptococci collected from western European countries in 2011.

J Antimicrob Chemother. 2013 Jan;68(1):164-7.

Morrissey I1, Seifert H, Canton R, Nordmann P, Stefani S, Macgowan A, Janes R, Knight D; Oritavancin Study Group.

Collaborators (39)

Author information

1Quotient Bioresearch Ltd, Fordham, UK. imorrissey@ihmainc.com

Abstract

OBJECTIVES:

To determine the activity of oritavancin against methicillin-resistant staphylococci, vancomycin-resistant enterococci (VRE) and β-haemolytic streptococci recently isolated from acute bacterial skin and skin structure infections or bacteraemia in western Europe.

METHODS:

Forty-one centres in Spain (8), Italy (9), Germany (8), France (8) and the UK (8) submitted 866 isolates [204 methicillin-resistant Staphylococcus aureus (MRSA), 177 methicillin-resistant coagulase-negative staphylococci (MRCoNS), 101 VRE, 193 Streptococcus agalactiae and 191 Streptococcus pyogenes] that were collected during the first 6 months of 2011. These were re-identified and susceptibilities to oritavancin and comparators were determined.

RESULTS:

Oritavancin was very active against MRSA (MIC(50)/MIC(90) 0.03/0.06 mg/L), MRCoNS (0.06/0.12 mg/L), VRE (0.03/0.06 mg/L), S. agalactiae (0.03/0.06 mg/L) and S. pyogenes (0.06/0.25 mg/L). The highest oritavancin MIC observed was 0.25 mg/L (species were S. aureus, Staphylococcus epidermidis, Staphylococcus hominis, S. agalactiae, S. pyogenes and Enterococcus faecalis).

CONCLUSIONS:

These data from recently collected Gram-positive bacteria in western Europe confirm the potent in vitro activity of oritavancin against a wide range of resistant MRSA, MRCoNS and VRE isolates, including ones resistant to newer agents.

PDF

http://jac.oxfordjournals.org/content/68/1/164.full.pdf+html

September 6, 2014 at 1:44 pm


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