Posts filed under ‘F.O.D’

Blood Culture–Negative Endocarditis, Morocco

Emerging Infectious Diseases November 2017 V.23 N.11

Research Letter

Najma Boudebouch, M’hammed Sarih, Abdelfattah Chakib, Salma Fadili, Drissi Boumzebra, Zahira Zouizra, Badie Azamane Mahadji, Hamid Amarouch, Didier Raoult, and Pierre-Edouard Fournier

Institut Pasteur du Maroc, Casablanca, Morocco (N. Boudebouch, M. Sarih); Centre Hospitalier Universitaire Ibn Rochd, Casablanca (A. Chakib, S. Fadili, B.A. Mahadji); Centre Hospitalier Universitaire Ibn Toufail Marrakech, Marrakech, Morocco (D. Boumzebra, Z. Zouizra); Faculté des Sciences Ain Chock, Casablanca (H. Amarouch); Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France (D. Raoult, P.-E. Fournier)

We investigated the microorganisms causing blood culture–negative endocarditis (BCNE) in Morocco.

We tested 19 patients with BCNE by serologic methods, molecular methods, or both and identified Bartonella quintana, Staphylococcus aureus, Streptococcus equi, and Streptococcus oralis in 4 patients.

These results highlight the role of these zoonotic agents in BCNE in Morocco.

PDF

https://wwwnc.cdc.gov/eid/article/23/11/pdfs/16-1066.pdf

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October 18, 2017 at 8:23 am

Patterns of bacteraemia aetiology

Lancet Infectious Diseases October 2017 V.17 N.10

COMMENT

Alan Cross, Myron M Levine

Bloodstream infections are a leading cause of morbidity and mortality in both high-income and lower-income countries, but the causative organisms and risk factors differ. Human beings coexist with diverse bacterial flora on their skin and their nasal, pharyngeal, and gastrointestinal mucosae. Physical barriers and non-specific immune defences keep these bacteria in check.

However, various primary pathogens can invade via the respiratory mucosa (eg, some Streptococcus pneumoniae serotypes) or gastrointestinal (Salmonella Typhi) mucosa or integument (Staphylococcus aureus), then enter the bloodstream and provoke clinical syndromes such as sepsis, febrile bacteraemia, meningitis, or enteric fever…..

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30491-7.pdf

September 24, 2017 at 10:58 am

Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm? –  A prospective, multicenter cohort

Medicine: September 2017 – Volume 96 – Issue 38 – p e7913

Fernández-Cruz, Ana MD, PhDa,b,*; Muñoz, Patricia MD, PhDa,b,c,d; Sandoval, Carmen MDb,e; Fariñas, Carmen MD, PhDf; Gutiérrez-Cuadra, Manuel MD, PhDf; Pericás Pulido, Juan M. MD, PhDg; Miró, José M. MD, PhDg; Goenaga-Sánchez, Miguel Á. MDh; de Alarcón, Arístides MDi; Bonache-Bernal, Francisco MDj; Rodríguez, MªÁngeles MD, PhDk; Noureddine, Mariam MD, PhDl; Bouza Santiago, Emilio MD, PhDa,b,c,d; on behalf of the Spanish Collaboration on Endocarditis (GAMES)

Abstract

The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.

Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.

During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.

When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).

A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Infective_endocarditis_in_patients_with_cancer___a.11.aspx

PDF (CLIC en “ARTICLE as PDF”)

September 22, 2017 at 4:19 pm

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

Open Forum Infectious Diseases April 2017 V.4 N.2

Poorani Sekar; James R. Johnson; Joseph R. Thurn; Dimitri M. Drekonja; Vicki A. Morrison …

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.

PDF

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September 3, 2017 at 6:46 pm

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Open Forum Infectious Diseases April 2017 V.4 N.2

Philippe Lachance; Justin Chen; Robin Featherstone; Wendy I. Sligl

Background.

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods.

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results.

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions.

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

PDF

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September 3, 2017 at 6:43 pm

Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

Antimicrobial Agents and Chemotherapy Sept 2017 V.61 N.9

Carlota Gudiol, Cristina Royo-Cebrecos, Edson Abdala, Murat Akova, Rocío Álvarez, Guillermo Maestro-de la Calle, Angela Cano, Carlos Cervera, Wanessa T. Clemente, Pilar Martín-Dávila, Alison Freifeld, Lucía Gómez, Thomas Gottlieb, Mercè Gurguí, Fabián Herrera, Adriana Manzur, Georg Maschmeyer, Yolanda Meije, Miguel Montejo, Maddalena Peghin, Jesús Rodríguez-Baño, Isabel Ruiz-Camps, Teresa C. Sukiennik, Cristian Tebe, and Jordi Carratalà

aInfectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain

bDuran i Reynals Hospital, ICO, Barcelona, Spain

cInstituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

dHacettepe University School of Medicine, Ankara, Turkey

eClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain

fInfectious Diseases Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), 12 de Octubre University Hospital, School of Medicine, Universidad Complutense, Madrid, Spain

gReina Sofía University Hospital-IMIBIC-UCO, Córdoba, Spain

hUniversity Hospital of Alberta, Alberta, Canada

iDigestive Transplant Service, Hospital das Clínicas, Universidade Federal Minas Gerais, Belo Horizonte, Brazil

jInfectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain

kInternal Medicine, Infectious Diseases Section, University of Nebraska Medical Center, Omaha, Nebraska, USA

lInternal Medicine, University Hospital Mútua de Terrassa, Barcelona, Spain

mDepartment of Microbiology & Infectious Diseases, Concord Hospital, Concord, NSW, Australia

nInfectious Diseases Unit, Hospital de la Santa Creu i Sant Pau and Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

oInfectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina

pInfectious Diseases, Hospital Rawson, San Juan, Argentina

qDepartment of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, Berlin, Germany

rInfectious Disease Unit, Internal Medicine Department, Barcelona Hospital, SCIAS, Barcelona, Spain

sInfectious Diseases Unit, Cruces University Hospital, Bilbao, Spain

tInfectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy

uClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospitals Virgen Macarena and Virgen del Rocío—IBiS, Department of Medicine, University of Seville, Seville, Spain

vInfectious Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain

wHospital Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

xStatistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, Tarragona, Spain

yREIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain

β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients).

The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients.

PDF

http://aac.asm.org/content/61/8/e00164-17.full.pdf+html

 

Antimicrobial Agents and Chemotherapy August 2017 V.61 N.8

COMMENTARY

Use of β-Lactam/β-Lactamase Inhibitors for Extended-Spectrum-β-Lactamase Infections: Defining the Right Patient Population

Pranita D. Tamma and Maria Virginia Villegas

aJohns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA

bMolecular Genetics and Antimicrobial Resistance Unit—International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia

In a multicenter, multinational observational study that included neutropenic patients with bloodstream infections by extended-spectrum-β-lactamase-producing species, Gudiol et al. (Antimicrob. Agents Chemother. 61:e00164-17, 2017, https://doi.org/10.1128/AAC.00164-17) demonstrated that β-lactam/β-lactamase inhibitors are effective treatment options.

A review of this work, however, reminds us that some lingering questions remain for specific high-risk subgroups.

PDF

http://aac.asm.org/content/61/8/e01094-17.full.pdf+html

August 30, 2017 at 8:17 am

From Expert Protocols to Standardized Management of Infectious Diseases

Clinical Infectious Diseases  15 August 2017  V.65 N.suppl 1 S12–S19

Jean-Christophe Lagier; Camille Aubry; Marion Delord; Pierre Michelet; Hervé Tissot-Dupont …

We report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Méditerranée Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs.

First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome.

Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate.

Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria.

Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters.

Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/65/suppl_1/10.1093_cid_cix403/3/cix403.pdf?Expires=1502372492&Signature=LVAbXU3YuwNx~UkUFnKvXaFmayq1aLSWpor6xnVqc2jGiKuNc69M1UqI4xbuqSgRoOKoPhupwLOXRmDGZRMNfu1ydEj9NXbJnqvpBSeWUzfnWw~jYh2w3Y37B92GZwGPSe4XelatYtvhE7i8mqlvzzKKpL2cpkgYhApfvdGjdPIJ-cWZCHuU8dzEdHMOzmEjV-sJI1rBrwSqK4XlRyFojeLEKx5yBZxDukcIP2GQbPvbL1BYugZA~MAyA8mGR2GpExfsI14HZhD4mnTkj9UwjfA63wbptXdFn8jPuhfRCDI6Q52VtmEonPn~V4RR88mRqcV~l63vhtFfzysOXOk83A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

August 9, 2017 at 8:50 am

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