Archive for January 25, 2018

Quantifying infective endocarditis risk in patients with predisposing cardiac conditions.

Eur Heart J. 2017 Nov 17.

Thornhill MH1,2, Jones S3,4, Prendergast B5, Baddour LM6, Chambers JB5, Lockhart PB2, Dayer MJ7.

Author information

1 Unit of Oral and Maxillofacial Medicine, Pathology and Surgery, University of Sheffield School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TA, UK.

2 Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.

3 Department of Population Health, NYU School of Medicine, NYU Translational Research Building, 227 East 30th Street, New York, NY 10016, USA.

4 Department of Clinical and Experimental Medicine, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK.

5 Department of Cardiology, St Thomas’ Hospital, Westminster bridge Road, London SE1 7EH, UK.

6 Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

7 Department of Cardiology, Taunton and Somerset NHS Trust, Musgrove Park, Taunton, Somerset TA1 5DA, UK.

Abstract

AIMS:

There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions.

METHODS AND RESULTS:

English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions-even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices.

CONCLUSION:

These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

abstract (CLIC en PDF)

https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehx655/4638266

PDF FREE (CLIC en PDF)

January 25, 2018 at 8:32 am

Reduced Chlorhexidine and Daptomycin Susceptibility in Vancomycin-Resistant Enterococcus faecium after Serial Chlorhexidine Exposure.

Antimicrob Agents Chemother. 2017 Dec 21;62(1). pii: e01235-17.

Bhardwaj P1, Hans A1, Ruikar K1, Guan Z2, Palmer KL3.

Author information

1 Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA.

2 Department of Biochemistry, Duke University Medical Center, Durham, North Carolina, USA.

3 Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA kelli.palmer@utdallas.edu

Abstract

Vancomycin-resistant Enterococcus faecium strains (VREfm) are critical public health concerns because they are among the leading causes of hospital-acquired bloodstream infections. Chlorhexidine (CHX) is a bisbiguanide cationic antiseptic that is routinely used for patient bathing and other infection control practices. VREfm are likely frequently exposed to CHX; however, the long-term effects of CHX exposure have not been studied in enterococci. In this study, we serially exposed VREfm to increasing concentrations of CHX for a period of 21 days in two independent experimental evolution trials. Reduced CHX susceptibility emerged (4-fold shift in CHX MIC). Subpopulations with reduced daptomycin (DAP) susceptibility were detected, which were further analyzed by genome sequencing and lipidomic analysis. Across the trials, we identified adaptive changes in genes with predicted or experimentally confirmed roles in chlorhexidine susceptibility (efrE), global nutritional stress response (relA), nucleotide metabolism (cmk), phosphate acquisition (phoU), and glycolipid biosynthesis (bgsB), among others. Moreover, significant alterations in membrane phospholipids were identified for some populations with reduced DAP susceptibility. Our results are clinically significant because they identify a link between serial subinhibitory CHX exposure and reduced DAP susceptibility. In addition, the CHX-induced genetic and lipidomic changes described in this study offer new insights into the mechanisms underlying the emergence of antibiotic resistance in VREfm.

PDF

http://aac.asm.org/content/62/1/e01235-17.full.pdf+html

January 25, 2018 at 8:31 am

Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections – United States, 2014.

MMWR Morb Mortal Wkly Rep. 12 Ene 2018;67(1):18-22.

Ailes EC, Summers AD, Tran EL, Gilboa SM, y cols.

Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1).

Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2).

Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance.

Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4).

To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs.

Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy.

Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole.

Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women’s health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age…..

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a4-H.pdf

January 25, 2018 at 7:50 am


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