Archive for January 6, 2018

Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: Nationwide population based cohort and a case crossover study

BMJ September 7, 2017 V.358 

Sarah Tubiana, epidemiologist12, Pierre-Olivier Blotière, statistician2, Bruno Hoen, professor3, Philippe Lesclous, professor4, Sarah Millot, associate professor5, Jérémie Rudant, epidemiologist2 , Alain Weill, epidemiologist2, Joel Coste, professor2, François Alla, professor2, Xavier Duval, professor1

1INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; INSERM CIC-1425, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France

2Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France

3Service de Maladies Infectieuses et Tropicales et Inserm-CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre, Guadeloupe, France

4INSERM, U 1229, RMeS, Nantes, France, UFR d’Odontologie, Université de Nantes, Nantes, France, CHU Hôtel Dieu, Nantes, France

5Department of Odontology, CHRU Université de Montpellier, France; UMR 1149 INSERM, CRI. Université Paris Diderot, France

Abstract

Objective

To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves.

Design

Nationwide population based cohort and a case crossover study.

Setting

French national health insurance administrative data linked with the national hospital discharge database.

Participants

All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014.

Main outcome measures

Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods.

Results

The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% v 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03).

Conclusion

Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves.

FULL TEXT

http://www.bmj.com/content/358/bmj.j3776

PDF

http://www.bmj.com/content/bmj/358/bmj.j3776.full.pdf

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January 6, 2018 at 12:11 pm

Clindamycin affects group A streptococcus virulence factors and improves clinical outcome.

J Infect Dis 2017 Jan 15; 215:269.

Federica Andreoni  Claudia Zürcher  Andrea Tarnutzer  Katrin Schilcher  Andrina Neff Nadia Keller  Ewerton Marques Maggio  Claire Poyart  Reto A. Schuepbach Annelies S. Zinkernagel

Abstract

Group A Streptococcus (GAS) has acquired an arsenal of virulence factors, promoting life-threatening invasive infections such as necrotizing fasciitis. Current therapeutic regimens for necrotizing fasciitis include surgical debridement and treatment with cell wall–active antibiotics. Addition of clindamycin (CLI) is recommended, although clinical evidence is lacking. Reflecting the current clinical dilemma, an observational study showed that only 63% of the patients with severe invasive GAS infection received CLI. This work thus aimed to address whether CLI improves necrotizing fasciitis outcome by modulating virulence factors of CLI-susceptible and CLI-resistant GAS in vitro and in vivo. Treatment with CLI reduced extracellular DNase Sda1 and streptolysin O (SLO) activity in vivo, whereas subinhibitory CLI concentrations induced expression and activity of SLO, DNase, and Streptococcus pyogenes cell envelope protease in vitro. Our in vivo results suggest that CLI should be administered as soon as possible to patients with necrotizing fasciitis, while our in vitro studies emphasize that a high dosage of CLI is essential.

FULL TEXT

https://academic.oup.com/jid/article/215/2/269/2742472

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January 6, 2018 at 12:09 pm

EDITORIAL – Simultaneous emergence of multidrug-resistant Candida auris on 3 continents confirmed by whole-genome sequencing and epidemiological analyses

Clin Infect Dis  Jan 15, 2018 V.64 N.134.

Shawn R. Lockhart  Kizee A. Etienne  Snigdha Vallabhaneni  Joveria Farooqi Anuradha Chowdhary  Nelesh P. Govender  Arnaldo Lopes Colombo  Belinda Calvo Christina A. Cuomo  Christopher A. Desjardins

Background.

Candida auris, a multidrug-resistant yeast that causes invasive infections, was first described in 2009 in Japan and has since been reported from several countries.

Methods.

To understand the global emergence and epidemiology of C. auris, we obtained isolates from 54 patients with C. auris infection from Pakistan, India, South Africa, and Venezuela during 2012–2015 and the type specimen from Japan. Patient information was available for 41 of the isolates. We conducted antifungal susceptibility testing and whole-genome sequencing (WGS).

Results.

Available clinical information revealed that 41% of patients had diabetes mellitus, 51% had undergone recent surgery, 73% had a central venous catheter, and 41% were receiving systemic antifungal therapy when C. auris was isolated. The median time from admission to infection was 19 days (interquartile range, 9–36 days), 61% of patients had bloodstream infection, and 59% died. Using stringent break points, 93% of isolates were resistant to fluconazole, 35% to amphotericin B, and 7% to echinocandins; 41% were resistant to 2 antifungal classes and 4% were resistant to 3 classes. WGS demonstrated that isolates were grouped into unique clades by geographic region. Clades were separated by thousands of single-nucleotide polymorphisms, but within each clade isolates were clonal. Different mutations in ERG11 were associated with azole resistance in each geographic clade.

Conclusions.

  1. auris is an emerging healthcare-associated pathogen associated with high mortality. Treatment options are limited, due to antifungal resistance. WGS analysis suggests nearly simultaneous, and recent, independent emergence of different clonal populations on 3 continents. Risk factors and transmission mechanisms need to be elucidated to guide control measures.

FULL TEXT

https://academic.oup.com/cid/article/64/2/134/2706620

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January 6, 2018 at 12:07 pm


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