Posts filed under ‘F.O.D’

Epidemiology, Microbiological Diagnosis, and Clinical Outcomes in Pyogenic Vertebral Osteomyelitis: A 10-year Retrospective Cohort Study

Open Forum Infectious Diseases, March 2018 V.5 N.3

EDITOR’S CHOICE

Brian S W Chong; Christopher J Brereton; Alexander Gordon; Joshua S Davis

Background

Pyogenic vertebral osteomyelitis (PVO) is rising in incidence, but optimal methods of investigation and duration of antibiotic therapy remain controversial.

Methods

We conducted a single-center retrospective cohort study of PVO at an Australian teaching hospital. We included all adults with a first episode of PVO between 2006 and 2015. PVO was defined based on the presence of prespecified clinical and radiological criteria. The main exposures of interest were investigation strategy and antibiotic treatment. The main outcome measures were duration of hospital admission, mortality during index admission, symptom resolution during index admission, and attributable readmission within 2 years.

Results

Of 129 included patients, 101 (78%) had a causative organism identified. Patients with an identified pathogen were more likely to be febrile (75% compared with 29%, P < .001) and had a higher mean admission C-reactive protein (207 vs 54, P < .001) compared with patients without an identified pathogen. However, they were less likely to experience an adverse outcome (death or attributable readmission within 2 years; adjusted odds ratio, 0.36; 95% confidence interval, 0.13–0.99; P = .04). Open biopsy of vertebral tissue had a higher diagnostic yield (70%) than fine needle aspirate (41%) or core biopsy (30%). Despite receiving a median of 6 weeks of intravenous antibiotics, only 15% of patients had a full recovery on discharge from index admission.

Conclusions

Clinical outcomes for patients with PVO were poor. Obtaining a microbiological diagnosis is associated with a better outcome. However, prospective and randomized studies are essential to establishing optimal investigation and treatment pathways.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy037/4925997

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September 30, 2018 at 10:44 am

Comparative activity of ceftobiprole against coagulase-negative staphylococci from the BSAC Bacteraemia Surveillance Programme, 2013–2015

European Journal of Clinical Microbiology & Infectious Diseases, September 2018 V.37 N.9 P.1653–1659

https://doi.org/10.1007/s10096-018-3295-6

Anne Santerre Henriksen, Jennifer Smart & Kamal Hamed

Coagulase-negative staphylococci (CoNS) are a significant cause of bacteraemia, the treatment of which is becoming increasingly complex due to the emergence of multidrug-resistant strains. This study aimed to evaluate the in vitro activity of ceftobiprole, an advanced-generation cephalosporin, as compared with other antimicrobial agents against CoNS from patients with bacteraemia. As part of the British Society for Antimicrobial Chemotherapy (BSAC) Bacteraemia Surveillance Programme, 650 blood isolates of CoNS were obtained from patients with bacteraemia at 74 centres throughout the UK and Ireland for the years 2013–2015. Minimum inhibitory concentrations (MICs) of ceftobiprole and other antimicrobial agents were determined using the BSAC agar dilution method. Susceptibility was assessed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The majority of the isolates (63.2%) were Staphylococcus epidermidis. Overall, methicillin resistance, as determined by oxacillin susceptibility testing, was observed in 64.2% of isolates. The MIC50/90 of ceftobiprole was 1/2 mg/L, and 100% of CoNS isolates were inhibited at the EUCAST ceftobiprole non-species-specific pharmacokinetic/pharmacodynamic breakpoint of 4 mg/L. Only one isolate was resistant to vancomycin. Overall rates of resistance to ciprofloxacin, clindamycin, erythromycin and teicoplanin were 50.5, 25.1, 68.2 and 20.9%, respectively. In S. epidermidis, resistance to oxacillin was associated with increased resistance to other antimicrobials. Ceftobiprole demonstrated in vitro activity against all CoNS species isolated from patients with bacteraemia and was active against species resistant to other antistaphylococcal antimicrobials. The collection of clinical data regarding the efficacy of ceftobiprole in treating CoNS bacteraemia is warranted.

abstract

https://link.springer.com/article/10.1007/s10096-018-3295-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_37_9

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https://link.springer.com/content/pdf/10.1007%2Fs10096-018-3295-6.pdf

September 17, 2018 at 3:44 pm

Partial Oral vs Intravenous Antibiotic Treatment of Endocarditis

N Engl J of Medicine August 28, 2018

Iversen and Others

BACKGROUND

Patients with infective endocarditis on the left side of the heart are typically treated with intravenous antibiotic agents for up to 6 weeks. Whether a shift from intravenous to oral antibiotics once the patient is in stable condition would result in efficacy and safety similar to those with continued intravenous treatment is unknown.

METHODS

In a randomized, noninferiority, multicenter trial, we assigned 400 adults in stable condition who had endocarditis on the left side of the heart caused by streptococcus, Enterococcus faecalis, Staphylococcus aureus, or coagulase-negative staphylococci and who were being treated with intravenous antibiotics to continue intravenous treatment (199 patients) or to switch to oral antibiotic treatment (201 patients). In all patients, antibiotic treatment was administered intravenously for at least 10 days. If feasible, patients in the orally treated group were discharged to outpatient treatment. The primary outcome was a composite of all-cause mortality, unplanned cardiac surgery, embolic events, or relapse of bacteremia with the primary pathogen, from the time of randomization until 6 months after antibiotic treatment was completed.

RESULTS

After randomization, antibiotic treatment was completed after a median of 19 days (interquartile range, 14 to 25) in the intravenously treated group and 17 days (interquartile range, 14 to 25) in the orally treated group (P=0.48). The primary composite outcome occurred in 24 patients (12.1%) in the intravenously treated group and in 18 (9.0%) in the orally treated group (between-group difference, 3.1 percentage points; 95% confidence interval, −3.4 to 9.6; P=0.40), which met noninferiority criteria.

CONCLUSIONS

In patients with endocarditis on the left side of the heart who were in stable condition, changing to oral antibiotic treatment was noninferior to continued intravenous antibiotic treatment. (Funded by the Danish Heart Foundation and others; POET ClinicalTrials.gov number, NCT01375257.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa1808312?query=RP

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1808312

August 28, 2018 at 11:57 am

Should Acute Q-Fever Patients be Screened for Valvulopathy to Prevent Endocarditis?

Clinical Infectious Diseases August 1, 2018 V.67 N.3 P.360-366

Marit M A de Lange; Laura E V Gijsen; Cornelia C H Wielders; Wim van der Hoek; Arko Scheepmaker

We found no difference in occurrence of chronic Q-fever between patients with or without a newly detected valvulopathy at time of acute Q-fever diagnosis. Thus, universal screening is not justified and would lead to unnecessary and undesirable long-term antibiotic use.

FULL TEXT

https://academic.oup.com/cid/article/67/3/360/4877027

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August 12, 2018 at 8:13 pm

Infective Endocarditis in Argentina: What have we learn in the last 25 years?

International Journal of Infectious Diseases August 2018 V.73 Supplement P.19

Burgos, P. Fernandez Oses, A. Iribarren, R. Ronderos, M. Vrancic, M. Pennini, M. Merkt, F. Nacinovich

Background

The epidemiology of Endocarditid (IE) is changing due to a number of factors, including aging, health-related comorbidities and medical procedures.

The aim of this study is to assess the main clinical, epidemiologic and etiologic changes of IE in the last 25 years in Argentina.

Methods & Materials

Comparative analysis of three cross-sectional, observational registries which enrolled consecutive patients with IE: 2 multicentric studies (EIRA-1 [1992-1994] and EIRA-2 [2001-2002]) and 1 single third level cardiology referral center (CRC [2002-2017]). Categorical variables were compared using Chi-square test; continuous variables with Student’s t test or Mann-Whitney U test was used as applicable. A value of p < 0.05 was considered significant.

Results

A total of 1065 IE episodes were included; definite IE (modified Duke Criteria) >70% in the three periods considered. There were no differences regarding sex; patients were older in each period (p < 0.001). Device associated IE was more frequent in the last decade: pacemaker IE 5.4% vs 23% (p < 0.0001); PVIE 8.5% vs 19.2% vs 47.5% (p < 0.0001). IVDA (p < 0.0001) and congenital heart diseases (p = 0.001) significantly decrease as predisposing factors and pts without known predisposing heart diseases has increased (45% vs 33.8% vs 47.8%; p < 0.0001). Etiology changes were observed: VGS (30.8% vs 26.8% vs 15.94%; p < 0.001) and S. aureus IE (26% vs 30% vs 16.27%; p = 0.014) decreased significantly, being more frequent the infection by CNS (1.7% vs 8% vs 18,3%; p < 0.0001). Surgical treatment was more frequently implemented in the last decade (28.2% vs 24.3% vs 41.86%; p < 0.00001). Mortality remained stable in the three periods, with a tendency to decrease in the last period (23.5% vs 24.3% vs 17.2%; p = 0.06).

Conclusion

In Argentina, IE affects older people, particularly with intracardiac device (PM and PV). This is remarkable when comparing the multicenter studies with CRC. Staphylococcus spp predominates, with CNS being more frequent than S. aureus. Mortality showed a tendency to decrease probably related to the fact that surgery is more frequently implemented in CRC. These findings show a change in the profile of IE in Argentina and highlights the importance of managing this complex disease in centers with extensive experience in the care of patients with IE.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33552-5/pdf

July 29, 2018 at 11:54 am

A Review of Combination Antimicrobial Therapy for Enterococcus faecalis Bloodstream Infections and Infective Endocarditis

Clinical Infectious Diseases July 15, 2018 V.67 N.2 P.303-309

EDITOR’S CHOICE

Maya Beganovic; Megan K Luther; Louis B Rice; Cesar A Arias; Michael J Rybak …

Esta revisión destaca las opciones de tratamiento disponibles y sus limitaciones, y proporciona orientación para futuros esfuerzos de investigación para ayudar en el tratamiento de infecciones graves de Enterococcus faecalis, a saber, endocarditis infecciosa.

FULL TEXT

https://academic.oup.com/cid/article/67/2/303/4829420

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July 15, 2018 at 5:04 pm

July 2018 Comparative Sensitivity of Transthoracic and Transesophageal Echocardiography in Diagnosis of Infective Endocarditis Among Veterans With Staphylococcus aureus Bacteremia

Background

Echocardiography is fundamental for diagnosing infective endocarditis (IE) in patients with Staphylococcus aureus bacteremia (SAB), but whether all such patients require transesophageal echocardiography (TEE) is controversial.

Methods.

We identified SAB cases between February 2008 and April 2012. We compared sensitivity and specificity of transthoracic echocardiography (TTE) and TEE for evidence of IE, and we determined impacts of IE risk factors and TTE image quality on comparative sensitivities of TTE and TEE and their impact on clinical decision making.

Results.

Of 215 evaluable SAB cases, 193 (90%) had TTE and 130 (60%) had TEE. In 119 cases with both tests, IE was diagnosed in 29 (24%), for whom endocardial involvement was evident in 25 (86%) by TEE, vs only 6 (21%) by TTE (P < .001). Transesophageal echocardiography was more sensitive than TTE regardless of risk factors. Even among the 66 cases with adequate or better quality TTE images, sensitivity was only 4 of 17 (24%) for TTE, vs 16 of  17 (94%) for TEE (P < .001). Among 130 patients with TEE, the TEE results, alone or with TTE results, influenced treatment duration in 56 (43%) cases and led to valve surgery in at least 4 (6%). It is notable that, despite vigorous efforts to obtain both tests routinely, TEE was not done in 86 cases (40%) for various reasons, including pathophysiological contraindications (14%), patient refusal or other patient-related factors (16%), and provider declination or system issues (10%).

Conclusions.

Patients with SAB should undergo TEE when possible to detect evidence for IE, especially if the results might affect management.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx035/3044172

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July 15, 2018 at 3:52 pm

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