Archive for April, 2017

ESCMID guideline for the diagnosis and treatment of biofilm infections 2014.

Clinical Microbiology and Infection May 2015 V.21 Suppl 1:S1-25.

Høiby N1, Bjarnsholt T2, Moser C3, Bassi GL4, Coenye T5, Donelli G6, Hall-Stoodley L7, Holá V8, Imbert C9, Kirketerp-Møller K10, Lebeaux D11, Oliver A12, Ullmann AJ13, Williams C14; ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli.

Author information

1 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. Electronic address: hoiby@hoibyniels.dk

2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.

3 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.

4 Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona; Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona; and University of Barcelona, Barcelona, Spain.

5 Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.

6 Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.

7 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, Ohio State University, Columbus, OH, USA.

8 Institute for Microbiology, Masaryk University and St Anne’s University Hospital, Brno, Czech Republic.

9 Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, Poitiers, France.

10 Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark.

11 Institut Pasteur, Unité de Génétique des Biofilms, Paris; Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker Enfants Malades, Centre d’Infectiologie Necker-Pasteur; and Institut Imagine, Paris, France.

12 Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.

13 Department of Internal Medicine II, Julius-Maximilians-University, Würzburg, Germany.

14 Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK.

Abstract

Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient’s history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)00090-1/pdf

April 22, 2017 at 9:00 am

Antimicrobial susceptibility testintg in biofilm-growing bacteria

Clinical Microbiology and Infection October 2014 V.20 N.10 P.981-990

M.D. Macia, E. Rojo-Molinero, A. Oliver

Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces. The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied. The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria. Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies. Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms. Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria. Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing. Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65364-7/pdf

April 22, 2017 at 8:59 am

Using antibiotics responsibly: right drug, right time, right dose, right duration.

J Antimicrob Chemother. November 2011 V.66 N.11 P.2441-3.

Dryden M1, Johnson AP, Ashiru-Oredope D, Sharland M.

Author information

1 Department of Microbiology and Communicable Disease, Royal Hampshire County Hospital, Winchester SO22 5DG, UK. matthew.dryden@wehct.nhs.uk

Abstract

Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. The objective should be to provide optimal patient care while at the same time seeking to minimize selective pressure that may result in the emergence and spread of antibiotic resistance. To this end, in 2008 the European Centre for Disease Control initiated the annual European Antibiotic Awareness Day (EAAD) to take place on 18 November, when Europe-wide activities are undertaken to highlight the critical importance of prudent antibiotic prescribing. This year activities in England will focus on the optimal management of infections in secondary care, and will have two inter-related aims. The first is to improve the quality of the initial decision to prescribe an antibiotic (including making an informed choice of empirical drug and dose) in particular ensuring rapid prescribing and administration in presumed sepsis. This is deliberately combined with a second focus on the critical importance of formally reviewing antibiotic therapy at 48 h, based on the patient’s clinical response and the availability of microbiology test results. This should lead to a clear decision to stop, switch to oral, switch to outpatient antibiotic therapy (OPAT) or change antibiotic, if possible to a narrower spectrum. The EAAD campaign in England will highlight the need to ‘Start Smart-Then Focus’. The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jac/66/11/10.1093/jac/dkr370/2/dkr370.pdf?Expires=1493207512&Signature=Btcx3-Rb8L4bMN66ikHP9iC-S~YdhBW~QnRCXpuCp21Uw5EFaQNx5oSZaigPCyPBTxN8XxtrfeNIkfDzEUxLnbwV0Yf2z4IcprL5CP1z6GqPtvMfbMjvwQCnsMl3i7Ogv5J9grdkoHPikcDo6KKT80sBtAOEHhUjTXh19YJJm1xaTdK3TtJvgrA2r2q-gDHTJLJKpbB1GK4HUCOv8j-ifcq9PJ7k1seGg4mvvg8dGlDiiam7w8cGsR17SelreyCH7lkSRV~gO5lTaYGauaeXK~EmdZrgDnUZ0Vh7gtXmlzfUI3Yh4eif086C9UXj-u5C3lWPsfMD3ktwRM2G4~xLcw__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

April 22, 2017 at 8:58 am

Bartonella henselae Infective Endocarditis Detected by a Prolonged Blood Culture.

Intern Med. 2016;55(20):3065-3067. Epub 2016 Oct 15.

Mito T1, Hirota Y, Suzuki S, Noda K, Uehara T, Ohira Y, Ikusaka M.

Author information

1 Department of General Medicine, Chiba University Hospital, Japan.

Abstract

A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient’s history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109581/pdf/1349-7235-55-3065.pdf

April 20, 2017 at 4:02 pm

Synergistic Interaction Between Phage Therapy and Antibiotics Clears Pseudomonas aeruginosa Infection in Endocarditis and Reduces Virulence

Journal of Infectious Diseases March 1, 2017

Frank Oechslin,1 Philippe Piccardi,1 Stefano Mancini,1 Jérôme Gabard,3 Philippe Moreillon,1 José M. Entenza,1 Gregory Resch,1 and Yok-Ai Que2 1 Department of Fundamental Microbiology, University of Lausanne, and  2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland; and  3 Pherecydes Pharma, Romainville, France

Background.

Increasing antibiotic resistance warrants therapeutic alternatives. Here we investigated the efficacy of bacteriophage-therapy (phage) alone or combined with antibiotics against experimental endocarditis (EE) due to Pseudomonas aeruginosa, an archetype of difficult-to-treat infection.

Methods.

In vitro fibrin clots and rats with aortic EE were treated with an antipseudomonas phage cocktail alone or combined with ciprofloxacin. Phage pharmacology, therapeutic efficacy, and resistance were determined.

Results.

In vitro, single-dose phage therapy killed 7 log colony-forming units (CFUs)/g of fibrin clots in 6 hours. Phage-resistant mutants regrew after 24 hours but were prevented by combination with ciprofloxacin (2.5 × minimum inhibitory concentration). In vivo, single-dose phage therapy killed 2.5 log CFUs/g of vegetations in 6 hours (P < .001 vs untreated controls) and was comparable with ciprofloxacin monotherapy. Moreover, phage/ciprofloxacin combinations were highly synergistic, killing >6 log CFUs/g of vegetations in 6 hours and successfully treating 64% (n = 7/11) of rats. Phage-resistant mutants emerged in vitro but not in vivo, most likely because resistant mutations affected bacterial surface determinants important for infectivity (eg, the pilT and galU genes involved in pilus motility and LPS formation).

Conclusions.

Single-dose phage therapy was active against P. aeruginosa EE and highly synergistic with ciprofloxacin. Phageresistant mutants had impaired infectivity. Phage-therapy alone or combined with antibiotics merits further clinical consideration.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/5/10.1093_infdis_jiw632/1/jiw632.pdf?Expires=1492519314&Signature=IX7VgknbY6WoG38D42jnp2D1bQJ42mOfQrwM6odCLBegLTrZ5Sr0Ae4~OQmtLaaLBIo4ZwREbkMQ3p4wTYaYKrvHv-oc3UwFqmXj2BVllcVyh0CkarlfbFie3u3A4l1V~OZRUEphJzLsToy2AEKtXKMr9sFbVDkwvaULGpMd75Okgsi9MprMryuVTBiRAaVkOI~-P0WFg~CTMXffzUK-DBaxKYk99VSObUKG6MPs99kAh02dM5tAK~HFGu080nIzj5c8vEibxAXHTN~L8O8rAAcWAcCXHTK1-seQVnDS3-6mcKKkAPf-Xle8TIghp4aSK5SXkIfpW4MyrfViOfhJ3A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

April 14, 2017 at 10:02 am

Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections

Clinical Microbiology & Infection April 2016 V.22 Suppl.2 S27-36

Russo, E. Concia, F. Cristini, F.G. De Rosa, S. Esposito, F. Menichetti, N. Petrosillo, M. Tumbarello, M. Venditti, P. Viale, C. Viscoli, M. Bassetti

In 2013 the US Food and Drug Administration (FDA) issued recommendations and guidance on developing drugs for treatment of skin infection using a new definition of acute bacterial skin and skin-structure infection (ABSSSI). The new classification includes cellulitis, erysipelas, major skin abscesses and wound infection with a considerable extension of skin involvement, clearly referring to a severe subset of skin infections. The main goal of the FDA was to better identify specific infections where the advantages of a new antibiotic could be precisely estimated through quantifiable parameters, such as improvement of the lesion size and of systemic signs of infection. Before the spread and diffusion of methicillin-resistant Staphylococcus aureus (MRSA) in skin infections, antibiotic therapy was relatively straightforward. Using an empiric approach, a β-lactam was the preferred therapy and cultures from patients were rarely obtained. With the emergence of MRSA in the community setting, initial ABSSSI management has been changed and readdressed. Dalbavancin, oritavancin and tedizolid are new drugs, approved or in development for ABSSSI treatment, that also proved to be efficient against MRSA. Dalbavancin and oritavancin have a long half-life and can be dosed less frequently. This in turn makes it possible to treat patients with ABSSSI in an outpatient setting, avoiding hospitalization or potentially allowing earlier discharge, without compromising efficacy. In conclusion, characteristics of long-acting antibiotics could represent an opportunity for the management of ABSSSI and could profoundly modify the management of these infections by reducing or in some cases eliminating both costs and risks of hospitalization.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30095-7/pdf

April 13, 2017 at 5:07 pm

ESCMID guideline: diagnosis and treatment of acute bacterial meningitis

Clinical Microbiology & Infection May 2016 V.22 Suppl 3 S37-62

van de Beek, C. Cabellos, O. Dzupova, S. Esposito, M. Klein, A.T. Kloek, S.L. Leib, B. Mourvillier, C. Ostergaard, P. Pagliano, H.W. Pfister, R.C. Read, O. Resat Sipahi, M.C. Brouwer for the ESCMID Study Group for Infections of the Brain (ESGIB)

Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. In the past decades the epidemiology and treatment strategies for community-acquired bacterial meningitis have significantly changed [[1], [2], [3]]. First, the introduction of conjugate vaccines in Europe resulted in the virtual disappearance of Haemophilus influenzae type b, while conjugate pneumococcal and meningococcal vaccines have substantially reduced the burden of bacterial meningitis [1]. As a result, community-acquired bacterial meningitis has become a disease that currently affects more adults than infants, with its specific complications and treatment options. A second important development is the increasing rate of reduced susceptibility to common antimicrobial agents among strains of Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus). Large differences in resistance rates in Europe exist, and empiric antibiotic treatment needs to be adjusted according to regional epidemiology. Finally, several adjunctive treatments have been tested in randomized controlled trials, often with conflicting results [3]. These developments leave the physician in need of a clear practical guideline, summarizing the available evidence for diagnostic methods, and antimicrobial and adjunctive treatment in bacterial meningitis. To this end the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) promotes guidelines development in the field of infectious diseases. This guideline project was initiated by the ESCMID Study Group for Infections of the Brain (ESGIB).

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http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/pdf

April 13, 2017 at 5:05 pm

European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection

Clinical Microbiology & Infection August 2016

M.J.T. Crobach, T. Planche, C. Eckert, F. Barbut, E.M. Terveer, O.M. Dekkers, M.H. Wilcox, E.J. Kuijper

In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched. Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests. The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing. This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed. Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests. Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence. Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30025-8/pdf

April 13, 2017 at 5:04 pm

Risk of serious infections associated with use of immunosuppressive agents in pregnant women with autoimmune inflammatory conditions: cohort study.

BMJ. 2017 Mar 6;356:j895.

Desai RJ1, Bateman BT2,3, Huybrechts KF2, Patorno E2, Hernandez-Diaz S4, Park Y4, Dejene SZ2, Cohen J4, Mogun H2, Kim SC2.

Author information

1 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, USA rdesai@bwh.harvard.edu.

2 Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, USA.

3 Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

4 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.

Abstract

Objective To compare the risk of serious infections associated with use of systemic steroids, non-biologic agents, or tumor necrosis factor α (TNF) inhibitors in pregnancy.

Design Observational cohort study.Setting Public (Medicaid, 2001-10) or private (Optum Clinformatics, 2004-15) health insurance programs in the US.Participants 4961 pregnant women treated with immunosuppressive drugs for rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, or inflammatory bowel disease.Exposure for observational studies Exposure was classified into steroid, non-biologic, or TNF inhibitors on first filled prescription during pregnancy. Because TNF inhibitors are not used to treat systemic lupus erythematosus, patients with this condition were excluded from comparisons involving TNF inhibitors.Main outcome measure The main outcome was occurrence of serious infections during pregnancy, defined by hospital admission for bacterial or opportunistic infections. Hazard ratios were derived using Cox proportional hazard regression models after adjustment for confounding with propensity score fine stratification. A logistic regression model was used to conduct a dose-response analysis among women filling at least one steroid prescription.

Results 71 out of 4961 pregnant women (0.2%) treated with immunosuppressive agents experienced serious infections. The crude incidence rates of serious infections per 100 person years among 2598 steroid users, 1587 non-biologic users, and 776 TNF inhibitors users included in this study were 3.4 (95% confidence interval 2.5 to 4.7), 2.3 (1.5 to 3.5), and 1.5 (0.7 to 3.0), respectively. No statistically significant differences in the risk of serious infections during pregnancy were observed among users of the three immunosuppressive drug classes: non-biologics v steroids, hazard ratio 0.81 (95% confidence interval 0.48 to 1.37), TNF inhibitors v steroids 0.91 (0.36 to 2.26), and TNF inhibitors v non-biologics 1.36 (0.47 to 3.93). In the dose-response analysis, higher steroid dose was associated with an increased risk of serious infections during pregnancy (coefficient for each unit increase in average prednisone equivalent mg daily dose=0.019, P=0.02).

Conclusions Risk of serious infections is similar among pregnant women with systemic inflammatory conditions using steroids, non-biologics, and TNF inhibitors. However, high dose steroid use is an independent risk factor of serious infections in pregnancy.

PDF

http://www.bmj.com/content/bmj/356/bmj.j895.full.pdf

April 13, 2017 at 8:37 am

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary

European Respiratory Journal March 2017 V.49 N.3

Claus F. Vogelmeier, Gerard J. Criner, Fernando J. Martinez, Antonio Anzueto, Peter J. Barnes, Jean Bourbeau, Bartolome R. Celli, Rongchang Chen, Marc Decramer, Leonardo M. Fabbri, Peter Frith, David M.G. Halpin, M. Victorina López Varela, Masaharu Nishimura, Nicolas Roche, Roberto Rodriguez-Roisin, Don D. Sin, Dave Singh, Robert Stockley, Jørgen Vestbo, Jadwiga A. Wedzicha, Alvar Agusti

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

PDF

http://erj.ersjournals.com/content/erj/49/3/1700214.full.pdf

April 12, 2017 at 8:13 am

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