Posts filed under ‘Infecciones cardio-vasculares’

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

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdMwggHPBgkqhkiG9w0BBwagggHAMIIBvAIBADCCAbUGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMeFcAOsBub-Q7icrBAgEQgIIBhvFldBYwYOWKFTDnKiWkUjQyp_Gxbkh70UcMoyuF46dvh-nnVQTQy7ygLKkkpK6vTCU2tUMBizKzMT4XGA48UGtEM9DzFFasOBvRLsExTYiR39zBNKjAj1AwvwU84VDhgmJXtFxML40CHUM6ew40Ag8-FJQX5kS0NJEfis9te1G5VVL_DySxQeoW_79YrJfcIkbBEAQR5NdFmlINDBgaWIegD8wSyD1ejwbon7K_SiTsO7EDlEzq7nEJutnEGPqCJtFWeEmaFSC0_7mMEmkq7xKy9IQdPkRiLPNdPcWBoN-LkkwTK6SOMNyP3X8CKwkyNkPCZgcd-VVAN05Ydq3AGmsMQqNa8z0Fg9OXnJqaD9SjYKb5_cAX3bfVAx7I23aN7FMgAACaoK7AavAC9KdSPnitBIyIKcu2pNB7iyOTB2r8U5_BfSrTi_SHfYXApP72cbSWJVdWd1bnqmiCSHVVx5o9IrEvzPuVlORi0RRQQ7Wv7_dYRUY0LjbZsFiiJ5StZo4C1oq8YQ

Advertisements

September 3, 2017 at 6:46 pm

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

Moraxella osloensis, an emerging pathogen of endocarditis in immunocompromised patients?

Swiss Med Wkly. 2015 Sep 16;145:w14185.

Gagnard JC1, Hidri N2, Grillon A3, Jesel L4, Denes E5.

Author information

1 Infectious Diseases Department, Limoges Teaching Hospital, France.

2 Bacteriology Laboratory, Limoges Teaching Hospital, France.

3 Bacteriology Laboratory, Strasbourg Teaching Hospital, France.

4 Cardiology Department, Strasbourg Teaching Hospital, France.

5 CHU Dupuytren, 2 Ave Martin Luther King, LIMOGES, FRANCE.

Abstract

We report two cases of endocarditis due to Moraxella osloensis. Only one previous case of such infection has been described.

These infections occurred in immunocompromised patients (B-cell chronic lymphocytic leukaemia and kidney graft associated with Hodgkin’s disease) and both patients had a favourable outcome with a complete cure of their infectious endocarditis.

This bacterium could be an emerging pathogen revealed by MALDI-TOF. Indeed, its characterisation within the Moraxella group by use of biochemistry-based methods is difficult.

Moreover, this strain could be particularly involved in immunocompromised patients.

FULL TEXT

https://smw.ch/article/doi/smw.2015.14185

August 2, 2017 at 4:17 pm

Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management.

Infect Drug Resist. 2015 Jul 24;8:217-30.

O’Driscoll T1, Crank CW2.

Author information

1 Department of Pharmacy Practice, Chicago College of Pharmacy, Downers Grove, IL, USA.

2 Pharmacy Services, Rush-Copley Medical Center, Aurora, IL, USA.

Abstract

Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide.

Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements.

Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past.

Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections.

As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority.

Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy.

Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles.

Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521680/pdf/idr-8-217.pdf

August 1, 2017 at 9:06 pm

Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

International Journal of Infectious Diseases August 2017 V.60 N.8 P.3-6

Pedro Ayau, Ana C. Bardossy, Guillermo Sanchez, Ricardo Ortiz, Daniela Moreno, Pamela Hartman, Khulood Rizvi, Tyler C. Prentiss, Mary B. Perri, Meredith Mahan, Vanthida Huang, Katherine Reyes, Marcus J. Zervos

Highlights

  • The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.
  • 1,168 patients with confirmed MRSA BSI were identified over a 9-year period in which 30-day all-cause mortality was 16%.
  • There was no significant variability in 30-day mortality over our 9-year study period.
  • Our study showed that age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 are risk factors for 30-day mortality in patients with MRSA BSI.
  • Diabetes, PVD and readmission because of infection have statistically significant protective effects on 30-day mortality

Objectives

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.

Methods

This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records.

Results

30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 with Odds Ratio (OR) of 1.03 (CI 1.02–1.04), 2.29 (CI 1.40–3.75), 1.78 (CI 1.20–2.63), 1.65 (CI 1.08–2.25), 1.66 (CI 1.02 − 2.70) and 1.86 (CI 1.18 − 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36–0.78), 0.46 (CI 0.26–0.84) and 0.13 (CI0.05 − 0.32) respectively.

Conclusions

Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30146-7/pdf

July 30, 2017 at 12:57 pm

Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention.

MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29.

O’Grady NP1, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA.

Author information

1 National Institutes of Health, Bethesda, Maryland, USA.

Abstract

These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings.

This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery anesthesiology interventional radiology pulmonary medicine, pediatric medicine, and nursing.

The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology ofAmerica (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996 These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections.

Major areas of emphasis include

1) educating and training health-care providers who insert and maintain catheters;

2) using maximal sterile barrier precautions during central venous catheter insertion;

3) using a 2% chlorhexidine preparation for skin antisepsis;

4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and

5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).

These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

PDF

https://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf

ERRATUM

https://www.cdc.gov/mmwr/PDF/wk/mm5132.pdf

July 26, 2017 at 4:47 pm

Clinical Risk Factors for Infective Endocarditis in Staphylococcus aureus Bacteremia.

Tex Heart Inst J. Feb 1, 2017 V.44 N.1 P.10-15.

Salvador VB, Chapagain B, Joshi A, Brennessel DJ.

Abstract

Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis.

In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography.

The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia.

A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis.

There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus (P=0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker (P=0.006) or a prosthetic heart valve (P=0.003), and recent hospitalization (P=0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia.

The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups (P=0.437).

In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis.

Early evaluation with transesophageal echocardiography might well be warranted.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317353/pdf/i1526-6702-44-1-10.pdf

July 11, 2017 at 4:06 pm

Older Posts


Calendar

September 2017
M T W T F S S
« Aug    
 123
45678910
11121314151617
18192021222324
252627282930  

Posts by Month

Posts by Category