Posts filed under ‘Infecciones cardio-vasculares’

Bartonella henselae Infective Endocarditis Detected by a Prolonged Blood Culture.

Intern Med. 2016;55(20):3065-3067. Epub 2016 Oct 15.

Mito T1, Hirota Y, Suzuki S, Noda K, Uehara T, Ohira Y, Ikusaka M.

Author information

1 Department of General Medicine, Chiba University Hospital, Japan.

Abstract

A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient’s history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5109581/pdf/1349-7235-55-3065.pdf

April 20, 2017 at 4:02 pm

Synergistic Interaction Between Phage Therapy and Antibiotics Clears Pseudomonas aeruginosa Infection in Endocarditis and Reduces Virulence

Journal of Infectious Diseases March 1, 2017

Frank Oechslin,1 Philippe Piccardi,1 Stefano Mancini,1 Jérôme Gabard,3 Philippe Moreillon,1 José M. Entenza,1 Gregory Resch,1 and Yok-Ai Que2 1 Department of Fundamental Microbiology, University of Lausanne, and  2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland; and  3 Pherecydes Pharma, Romainville, France

Background.

Increasing antibiotic resistance warrants therapeutic alternatives. Here we investigated the efficacy of bacteriophage-therapy (phage) alone or combined with antibiotics against experimental endocarditis (EE) due to Pseudomonas aeruginosa, an archetype of difficult-to-treat infection.

Methods.

In vitro fibrin clots and rats with aortic EE were treated with an antipseudomonas phage cocktail alone or combined with ciprofloxacin. Phage pharmacology, therapeutic efficacy, and resistance were determined.

Results.

In vitro, single-dose phage therapy killed 7 log colony-forming units (CFUs)/g of fibrin clots in 6 hours. Phage-resistant mutants regrew after 24 hours but were prevented by combination with ciprofloxacin (2.5 × minimum inhibitory concentration). In vivo, single-dose phage therapy killed 2.5 log CFUs/g of vegetations in 6 hours (P < .001 vs untreated controls) and was comparable with ciprofloxacin monotherapy. Moreover, phage/ciprofloxacin combinations were highly synergistic, killing >6 log CFUs/g of vegetations in 6 hours and successfully treating 64% (n = 7/11) of rats. Phage-resistant mutants emerged in vitro but not in vivo, most likely because resistant mutations affected bacterial surface determinants important for infectivity (eg, the pilT and galU genes involved in pilus motility and LPS formation).

Conclusions.

Single-dose phage therapy was active against P. aeruginosa EE and highly synergistic with ciprofloxacin. Phageresistant mutants had impaired infectivity. Phage-therapy alone or combined with antibiotics merits further clinical consideration.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/5/10.1093_infdis_jiw632/1/jiw632.pdf?Expires=1492519314&Signature=IX7VgknbY6WoG38D42jnp2D1bQJ42mOfQrwM6odCLBegLTrZ5Sr0Ae4~OQmtLaaLBIo4ZwREbkMQ3p4wTYaYKrvHv-oc3UwFqmXj2BVllcVyh0CkarlfbFie3u3A4l1V~OZRUEphJzLsToy2AEKtXKMr9sFbVDkwvaULGpMd75Okgsi9MprMryuVTBiRAaVkOI~-P0WFg~CTMXffzUK-DBaxKYk99VSObUKG6MPs99kAh02dM5tAK~HFGu080nIzj5c8vEibxAXHTN~L8O8rAAcWAcCXHTK1-seQVnDS3-6mcKKkAPf-Xle8TIghp4aSK5SXkIfpW4MyrfViOfhJ3A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

April 14, 2017 at 10:02 am

Mycobacterium goodii: A Case Report and Review of the Literature

Infectious Diseases in Clinical Practice March 2017 V.25 N.2 P.62-65

Salas, Natalie Mariam; Klein, Nicole

Mycobacterium goodii, a rapidly growing nontuberculous mycobacterium, is an emerging pathogen in nosocomial infections.

Its inherent resistance patterns make it a challenging organism to treat, and delays in identification can lead to poor outcomes.

We present a case of cardiac device pocket infection with M. goodii, complicated by both antibiotic resistance and drug reactions that highlight the challenges faced by clinicians trying to eradicate these infections.

We also present a brief review of the English literature surrounding this disease, including a table of all reported cases of M. goodii infections and their outcomes to act as guide for clinicians formulating treatment plans for these infections.

A clear understanding of diagnostic methods and treatment caveats is essential to curing infections caused by these organisms.

PDF (CLIC on PDF)

 

February 28, 2017 at 5:05 pm

REVISION – Bacteriemia en el paciente crıtico

Med Intensiva. 2009;33(7):336–345

Sabatier, R. Peredo y J. Valles

Centro de Críticos, Hospital de Sabadell, Institut Universitari Parc Taul´ı, UAB, CIBER de Enfermedades Respiratorias, España

La bacteriemia es, junto con la neumoníıa asociada a la ventilación mecánica, la infeccion nosocomial mas frecuente en los pacientes crıticos y se asocia a una importante morbimortalidad. La principal causa de bacteriemia en estos pacientes son los cateteres intravasculares y,  por consiguiente, los microorganismos grampositivos se equiparan en frecuencia a los microorganismos gramnegativos como causantes de estas infecciones. Ademas, y con una frecuencia cada vez mas elevada, en muchas ocasiones estos microorganismos son multirresistentes, lo que dificulta la eleccion del tratamiento antibiotico empırico.

Tambien las infecciones graves adquiridas en la comunidad representan una parte importante de los pacientes que por inestabilidad hemodinamica o disfuncion organica requieren ingreso en la unidad de cuidados intensivos. Una parte importante presenta tambien bacteriemia, y representa aproximadamente un 30% del global de las bacteriemias de los pacientes crıticos. En estos casos mas de un 70% se manifiesta como sepsis grave o shock septico, y se acompañan tambien de una significativa mortalidad.

Ademas, recientemente se ha diferenciado a una poblacion de pacientes con infecciones adquiridas en la comunidad, pero que tienen algun contacto reciente o intermitente con algun tipo de asistencia sanitaria que presentan unas caracterısticas especıficas y equiparables en muchas ocasiones a las infecciones nosocomiales que deberıan tenerse en cuenta en el momento de la eleccion del tratamiento antibiotico empırico.

El objetivo de esta revision es conocer las caracterısticas, los orıgenes, las etiologıas y las complicaciones mas frecuentes de los pacientes crıticos con bacteriemia nosocomial, bacteriemia comunitaria o bacteriemia asociada a cuidados sanitarios con el fin de reconocerlas precozmente e iniciar un tratamiento de soporte y antibiotico empırico eficaz que pueda mejorar el pronostico de estos pacientes.

PDF

http://scielo.isciii.es/pdf/medinte/v33n7/revision.pdf

December 7, 2016 at 7:03 pm

Coagulase-negative staphylococci.

Clin Microbiol Rev. October 2014 V.27 N.4 P.:870-926.

Becker K1, Heilmann C2, Peters G2.

Author information

1Institute of Medical Microbiology, University Hospital Münster, Münster, Germany kbecker@uni-muenster.de.

2Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.

Abstract

The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic.

Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species.

They account substantially for foreign body-related infections and infections in preterm newborns.

While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis.

In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections.

This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum.

In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4187637/pdf/zcm870.pdf

November 18, 2016 at 1:23 pm

Ceftaroline fosamil: A super-cephalosporin?

Cleve Clin J Med. 2015 Jul;82(7):437-44.

Ghamrawi RJ1, Neuner E2, Rehm SJ3,4.

Author information

1Clinical Pharmacist Specialist, Adult Antimicrobial Stewardship Department of Pharmacy, University Hospitals Case Medical Center, Cleveland, OH, USA.

2Infectious Diseases Clinical Specialist, Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA. E-mail: neunere@ccf.org.

3Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.

4Clinical Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.

Abstract

Ceftaroline is a broad-spectrum cephalosporin used to treat infections caused by a variety of microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Streptococcus pneumoniae.

However, it is not active against Pseudomonas aeruginosa, Bacteroides fragilis, and carbapenem-resistant Enterobacteriaceae.

Its approved indications include community-acquired bacterial pneumonia and bacterial infections of skin and skin structures.

It has also been used off-label to treat osteomyelitis, endocarditis, and meningitis caused by ceftaroline-susceptible organisms.

PDF

http://www.ccjm.org/view-pdf.html?file=uploads/media/Ghamrawi_CeftarolineFosamil

November 8, 2016 at 8:24 am

Managing infective endocarditis in the elderly: new issues for an old disease.

Clin Interv Aging. 2016 Sep 2;11:1199-206.

Forestier E1, Fraisse T2, Roubaud-Baudron C3, Selton-Suty C4, Pagani L5.

Author information

1Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France.

2Acute Geriatric Department, Centre Hospitalier, Alès, France.

3Geriatric Department, University Hospital, Bordeaux, France.

4Department of Cardiology, University Hospital, Nancy, France.

5Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France.

Abstract

The incidence of infective endocarditis (IE) rises in industrialized countries.

Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients.

Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies.

Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden.

However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient’s functional status and comorbidities.

Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy.

Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear.

The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly.

Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015881/pdf/cia-11-1199.pdf

October 14, 2016 at 3:55 pm

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