Posts filed under ‘F.O.D’

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

Bloodstream infections in cancer patients. Risk factors associated with mortality

International Journal of Infectious Diseases June 2018 V.71 P.59-64

Beda Islas-Muñoz, Patricia Volkow-Fernández, Cynthia Ibanes-Gutiérrez, Alberto Villamar-Ramírez, Diana Vilar-Compte, Patricia Cornejo-Juárez

Highlights

  • Bloodstream infections (BSI) cause severe complications in cancer patients.
  • Secondary BSI and central-related BSI were the most common in solid tumors.
  • Primary BSI and mucosal barrier injury BSI were described in hematological patients.
  • Mortality at 30-days was increased with multidrug resistant Gram-negative bacteria.
  • Inappropriate antimicrobial treatment in the first 24 h was related with mortality.

Objective

The aim of this study was to evaluate the clinical characteristics and risk factors associated with mortality in cancer patients with bloodstream infections (BSI), analyzing multidrug resistant bacteria (MDR).

Methods

We conducted a prospective observational study at a cancer referral center from August 2016 to July 2017, which included all BSI.

Results

4220 patients were tested with blood cultures; 496 were included. Mean age was 48 years. In 299 patients with solid tumors, secondary BSI and Central Line-Associated BSI (CLABSI) were the most common (55.9% and 31.8%, respectively). In 197 hematologic patients, primary and mucosal barrier injury (MBI) BSI were the main type (38.6%). Gram-negative were the most frequent bacteria (72.8%), with Escherichia coli occupying the first place (n = 210, 42.3%), 48% were Extended-Spectrum Beta-Lactamase (ESBL) producers, and 1.8% were resistant to carbapenems. Mortality at day 30, was 22%, but reached 70% when patients did not receive an appropriate antimicrobial treatment. Multivariate analysis showed that progression or relapse of the oncologic disease, inappropriate antimicrobial treatment, and having resistant bacteria were independently associated with 30-day mortality.

Conclusions

Emergence of MDR bacteria is an important healthcare problem worldwide. Patients with BSI, particularly those patients with MDR bacteria have a higher mortality risk.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30081-X/pdf

July 14, 2018 at 7:25 pm

Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

International Journal of Infectious Diseases March 2018 V.68 P.102-107

Maria Carmo Pereira Nunes, Milton Henriques Guimarães-Júnior, Pedro Henrique Oliveira Murta Pinto, Rodrigo Matos Pinto Coelho, Thais Lins Souza Barros, Nicole de Paula Aarão Faleiro Maia, Dayane Amaral Madureira, Rodrigo Citton Padilha Reis, Paulo Henrique Nogueira Costa, Renato Bráulio, Cláudio Léo Gelape, Teresa Cristina Abreu Ferrari

Background

The early identification of patients at risk of complications of infective endocarditis (IE) using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE.

Methods

Two hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality.

Results

The mean age of the patients was 48.2 ± 16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%), and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03–1.28), development of heart failure (OR 6.43, 95% CI 2.14–19.33), and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11–71.89).

Conclusions

An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30017-1/pdf

July 14, 2018 at 7:09 pm

Pharmacokinetics of anidulafungin in critically ill patients with candidemia/invasive candidiasis.

Antimicrob Agents Chemother. 2013 Apr;57(4):1672-6.

Liu P1, Ruhnke M, Meersseman W, Paiva JA, Kantecki M, Damle B.

Author information

1 Clinical Pharmacology, Specialty Care, Pfizer Inc, Groton, Connecticut, USA.

Abstract

The pharmacokinetics of intravenous anidulafungin in adult intensive care unit (ICU) patients were assessed in this study and compared with historical data from a general patient population and healthy subjects. Intensive plasma sampling was performed over a dosing interval at steady state from 21 ICU patients with candidemia/invasive candidiasis. All patients received the recommended dosing regimen (a 200-mg loading dose on day 1, followed by a daily 100-mg maintenance dose), except for a 54-year-old 240-kg female patient (who received a daily 150-mg maintenance dose instead). Plasma samples were assayed for anidulafungin using a validated liquid chromatography-tandem mass spectrometry method. Pharmacokinetic parameters in ICU patients were calculated by a noncompartmental method. With the exclusion of the 240-kg patient, the median (minimum, maximum) age, weight, and body mass index (BMI) of 20 ICU patients were 57 (39, 78) years, 65 (48, 106) kg, and 23.3 (16.2, 33.8) kg/m(2), respectively. The average anidulafungin area under the curve over the 24-hour dosing interval (AUC(0-24)), maximum concentration (C(max)), and clearance (CL) in 20 ICU patients were 92.7 mg · h/liter, 7.7 mg/liter, and 1.3 liters/h, respectively. The exposure in the 240-kg patient at a daily 150-mg dose was within the range observed in ICU patients overall. The average AUC(0-24) and Cmax in the general patient population and healthy subjects were 110.3 and 105.9 mg · h/liter and 7.2 and 7.0 mg/liter, respectively. The pharmacokinetics of anidulafungin in ICU patients appeared to be comparable to those in the general patient population and healthy subjects at the same dosing regimen.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623353/pdf/zac1672.pdf

July 7, 2018 at 3:36 pm

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