Posts filed under ‘Infecciones cardio-vasculares’

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

Telavancin: a novel semisynthetic lipoglycopeptide agent to counter the challenge of resistant Gram-positive pathogens.

Ther Adv Infect Dis. March 2017 V.4 N.2 P.49-73.    

Das B1, Sarkar C2, Das D3, Gupta A4, Kalra A1, Sahni S1.

Author information

1 Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India.

2 Department of Pharmacology & Clinical Pharmacology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS) Shillong, Shillong, India.

3 Department of Computer Science & Engineering, Faculty of Engineering, Manipal University Jaipur, Dehmi Kalan, Jaipur Ajmer Expressway, Rajasthan, India.

4 Department of Surgery, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, India.

Abstract

Telavancin (TD-6424), a semisynthetic lipoglycopeptide vancomycin-derivative, is a novel antimicrobial agent developed by Theravance for overcoming resistant Gram-positive bacterial infections, specifically methicillin-resistant Staphylococcus aureus (MRSA).

The US Food and Drug Administration (USFDA) had approved telavancin in 2009 for the treatment of complicated skin and skin structure infections (cSSSIs) caused by Gram-positive bacteria, including MRSA (S. aureus, Streptococcus agalactiae, Streptococcus pyogenes, Streptococcus anginosus group, or Enterococcus faecalis).

Telavancin has two proposed mechanisms of action. In vitro, telavancin has a rapid, concentration-dependent bactericidal effect, due to disruption of cell membrane integrity. Telavancin has demonstrable in vitro activity against aerobic and anaerobic Gram-positive bacteria. Telavancin and vancomycin have similar spectra of activity. Gram-negative bacteria are usually non-susceptible to telavancin.

Telavancin has been successfully tested in various animal models of bacteremia, endocarditis, meningitis, and pneumonia. Phase II Telavancin versus Standard Therapy for Treatment of Complicated Skin and Soft-Tissue Infections due to Gram-Positive Bacteria (FAST 1 and FAST 2) and phase III [Assessment of Telavancin in Complicated Skin and Skin Structure Infections 1 (ATLAS 1 and ATLAS 2)] clinical trials have been conducted for evaluating telavancin’s efficacy and safety in cSSSIs.

Phase III clinical trials have been carried out for evaluating telavancin’s safety and efficacy in nosocomial pneumonia [Assessment of Telavancin for Treatment of Hospital acquired Pneumonia 1 and 2 (ATTAIN 1 and ATTAIN 2)].

A phase II randomized, double-blind, clinical trial has been carried out for evaluating telavancin’s safety and efficacy in uncomplicated S. aureus bacteremia [Telavancin for Treatment of Uncomplicated S. aureus Bacteremia (ASSURE)]. Pacemaker lead-related infective endocarditis due to a vancomycin intermediate S. aureus (VISA) strain (non-daptomycin susceptible) was successfully treated with parenteral telavancin for 8 weeks.

Telavancin extensively binds to serum albumin (~93%) and has a relatively small volume of distribution. Telavancin is not biotransformed by any cytochrome P450 microsomal enzymes and excreted mainly in the urine. Though well-tolerated, worrisome adverse effects, including renal dysfunction and QTc prolongation are of potential concern.

Given its extensive binding to plasma proteins, long half-life, and a long post-antibiotic effect, it represents a promising addition to the therapeutic armamentarium in combating infections caused by resistant Gram-positive pathogens, namely, MRSA.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467880/pdf/10.1177_2049936117690501.pdf

July 11, 2017 at 4:04 pm

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

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