Posts filed under ‘Infecciones cardio-vasculares’

Comparison Between Carbapenems and β-Lactam/β-Lactamase Inhibitors in the Treatment for Bloodstream Infections Caused by Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis

Open Forum Infect Dis. 16 May 2017;4(2):ofx099.

Muhammed M, Flokas ME, Detsis M, Alevizakos M, y col.  

Background.

Carbapenems are widely used for the management of bloodstream infections (BSIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). However, the wide use of carbapenems has been associated with carbapenem-resistant Enterobacteriaceae development.

Methods.

We searched the PubMed and Scopus databases (last search date was on June 1, 2016) looking for studies that reported mortality in adult patients with ESBL-PE BSIs that were treated with carbapenems or β-lactam/β-lactamase inhibitors (BL/BLIs).

Results.

Fourteen studies reported mortality data in adult patients with ESBL-PE BSI that were treated with carbapenems or BL/BLIs. Among them, 13 studies reported extractable data on empiric therapy, with no statistically significant difference in mortality of patients with ESBL-PE BSI that were treated empirically with carbapenems (22.1%; 121 of 547), compared with those that received empiric BL/BLIs (20.5%; 109 of 531; relative risk [RR], 1.05; 95% confidence interval [CI], 0.83–1.37; I2 = 20.7%; P = .241). In addition, 7 studies reported data on definitive therapy. In total, 767 patients (79.3%) received carbapenems and 199 patients (20.6%) received BL/BLIs as definitive therapy, and there was again no statistically significant difference (RR, 0.62; 95% CI, 0.25–1.52; I2 = 84.6%; P < .001). Regarding specific pathogens, the use of empiric BL/BLIs in patients with BSI due to ESBL-Escherichia coli was not associated with a statistically significant difference in mortality (RR, 1.014; 95% CI, 0.491–2.095; I2 = 62.5%; P = .046), compared with the use of empiric carbapenems.

Conclusions.

These data do not support the wide use of carbapenems as empiric therapy, and BL/BLIs might be effective agents for initial/empiric therapy for patients with BSI caused by likely ESBL-PE, and especially ESBL-E coli.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx099/3828264

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September 20, 2018 at 3:31 pm

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

PDF (CLIC en DOWNLOAD PDF)

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

Rapid Diagnosis of Staphylococcal Catheter-Related Bacteraemia in Direct Blood Samples by Real-Time PCR.

PLoS One. 2016 Aug 29;11(8):e0161684.

Zboromyrska Y1, De la Calle C2, Soto M3, Sampietro-Colom L3, Soriano A2, Alvarez-Martínez MJ1, Almela M1, Marco F1,4, Arjona R1, Cobos-Trigueros N2, Morata L2, Mensa J2, Martínez JA2, Mira A5, Vila J1,4.

Author information

1 Department of Clinical Microbiology, Biomedical Diagnostic Centre (CDB), Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain.

2 Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.

3 Health Technology Assessment Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.

4 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic, University of Barcelona, Barcelona, Spain.

5 CDB, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain.

Abstract

Catheter-related bacteremia (CRB) is an important cause of morbidity and mortality among hospitalized patients, being staphylococci the main etiologic agents. The objective of this study was to assess the use of a PCR-based assay for detection of staphylococci directly from blood obtained through the catheter to diagnose CRB caused by these microorganisms and to perform a cost-effectiveness analysis. A total of 92 patients with suspected CRB were included in the study. Samples were obtained through the catheter. Paired blood cultures were processed by standard culture methods and 4 ml blood samples were processed by GeneXpert-MRSA assay for the detection of methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus, and methicillin-resistant coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused by staphylococci were diagnosed among 92 suspected patients. GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA and 10 MR-CoNS in approximately 1 hour after specimen receipt. The sensitivity and specificity of GeneXpert were 87.5% (CI 95%: 60.4-97.8) and 92.1% (CI 95%: 83-96.7), respectively, compared with standard culture methods. The sensitivity of GeneXpert for S. aureus was 100%. Regarding a cost-effectiveness analysis, the incremental cost of using GeneXpert was of 31.1€ per patient while the incremental cost-effectiveness ratio of GeneXpert compared with blood culture alones was about 180€ per life year gained. In conclusion, GeneXpert can be used directly with blood samples obtained through infected catheters to detect S. aureus and MR-CoNS in approximately 1h after sampling. In addition, it is cost-effective especially in areas with high prevalence of staphylococcal CRB.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003366/pdf/pone.0161684.pdf

August 1, 2018 at 8:16 am

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

PDF (CLIC en PDF)

July 15, 2018 at 5:04 pm

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