Posts filed under ‘Infecciones relacionadas a prótesis’

Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review

International Journal of Infectious Diseases February 2018 V.67 P.3–6

Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli

Highlights

  • Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
  • A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
  • At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
  • PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
  • This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.

Objective

To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.

Methods

Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.

Results

One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.

Conclusions

Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30228-X/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30228-X/pdf

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February 18, 2018 at 4:03 pm

Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with Staphylococcus aureus

International Journal of Antimicrobial Agents January 2018 V.51 N.1 P.38–42

Marjan Wouthuyzen-Bakker, Eduard Tornero, Laura Morata, Prashant V. Nannan Panday, Paul C. Jutte, Guillem Bori, Greetje A. Kampinga, Alex Soriano

Highlights

  • Excellent outcome with moxifloxacin/rifampin combination therapy in the treatment of early PJI caused by MSSA.
  • Moxifloxacin is an attractive agent in treatment of PJI.
  • Dose adjustments are not required in patients with renal insufficiency.
  • Moxifloxacin exhibits a high genetic barrier for resistance.
  • Moxifloxacin/rifampin may be used as an alternative for levofloxacin/rifampin in the treatment of early PJI caused by MSSA.

Objectives

The combination of a fluoroquinolone with rifampin is one of the cornerstones in the treatment of prosthetic joint infections (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin–susceptible Staphylococcus aureus (MSSA) and, therefore, is an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with early acute PJI caused by MSSA treated with either moxifloxacin/rifampin or levofloxacin/rifampin.

Methods

Medical files of patients treated with moxifloxacin/rifampin (University Medical Centre Groningen) or levofloxacin/rifampin (Hospital Clinic Barcelona) were retrospectively reviewed (2005–2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up.

Results

Differences in baseline characteristics between the two cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C–reactive protein and Cemented prosthesis), were similar in the two groups (2.9 [1.5 SD] for the moxifloxacin group vs. 2.2 [1.2 SD] for the levofloxacin group [P?=?0.16]). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (P?=?0.36), treatment was successful in 89% vs. 87.5%, respectively (P?=?0.89). None of the failures in the moxifloxacin group were due to rifampin– or moxifloxacin–resistant S. aureus strains.

Conclusion

Our data indicate that moxifloxacin combined with rifampin is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA.

abstract

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/fulltext

PDF

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/pdf

February 5, 2018 at 6:05 pm

Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: Nationwide population based cohort and a case crossover study

BMJ September 7, 2017 V.358 

Sarah Tubiana, epidemiologist12, Pierre-Olivier Blotière, statistician2, Bruno Hoen, professor3, Philippe Lesclous, professor4, Sarah Millot, associate professor5, Jérémie Rudant, epidemiologist2 , Alain Weill, epidemiologist2, Joel Coste, professor2, François Alla, professor2, Xavier Duval, professor1

1INSERM, IAME, UMR 1137, Paris, France; Université Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France; INSERM CIC-1425, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France

2Department of Studies in Public Health, French National Health Insurance, Paris Cedex 20, France

3Service de Maladies Infectieuses et Tropicales et Inserm-CIC 1424, Centre Hospitalier Universitaire de Pointe-à-Pitre, Pointe-à-Pitre, France; Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre, Guadeloupe, France

4INSERM, U 1229, RMeS, Nantes, France, UFR d’Odontologie, Université de Nantes, Nantes, France, CHU Hôtel Dieu, Nantes, France

5Department of Odontology, CHRU Université de Montpellier, France; UMR 1149 INSERM, CRI. Université Paris Diderot, France

Abstract

Objective

To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves.

Design

Nationwide population based cohort and a case crossover study.

Setting

French national health insurance administrative data linked with the national hospital discharge database.

Participants

All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014.

Main outcome measures

Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods.

Results

The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% v 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03).

Conclusion

Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves.

FULL TEXT

http://www.bmj.com/content/358/bmj.j3776

PDF

http://www.bmj.com/content/bmj/358/bmj.j3776.full.pdf

January 6, 2018 at 12:11 pm

Antimicrobial susceptibility testintg in biofilm-growing bacteria

Clinical Microbiology and Infection October 2014 V.20 N.10 P.981-990

M.D. Macia, E. Rojo-Molinero, A. Oliver

Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces.

The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied.

The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria.

Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies.

Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms.

Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria.

Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing.

Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65364-7/pdf

November 15, 2017 at 2:57 pm

Closing the Brief Case: Bacteremia and Vertebral Osteomyelitis Due to Staphylococcus schleiferi

Journal of Clinical Microbiology November 2017 V.55 N.11 P.3309-3310

Melanie L. Yarbrough, Yasir Hamad, Carey-Ann D. Burnham and Ige A. George

aDepartment of Pathology & Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA

bDepartment of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA

ANSWERS TO SELF-ASSESSMENT QUESTIONS

PDF

http://jcm.asm.org/content/55/11/3309.full.pdf+html

October 26, 2017 at 3:29 pm

The Brief Case: Bacteremia and Vertebral Osteomyelitis Due to Staphylococcus schleiferi

Journal of Clinical Microbiology November 2017 V.55 N.11 P.3157-3161

Melanie L. Yarbrough, Yasir Hamad, Carey-Ann D. Burnham and Ige A. George

aDepartment of Pathology & Immunology, Division of Laboratory and Genomic Medicine, Washington University School of Medicine, St. Louis, Missouri, USA

bDepartment of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA

A 60-year-old female was admitted to a hospital in Missouri with back pain and pathological fractures of multiple thoracic vertebrae. Four months prior to presentation, the patient began experiencing low back pain without inciting trauma. Over the next 2 months, the pain continued to worsen and she experienced a 20-lb weight loss and drenching night sweats, prompting her to seek care. During the initial encounter, the patient denied experiencing fevers. She was not immunocompromised and had no risk factors for tuberculosis and no history of recent travel, hospitalization, or invasive procedures. Magnetic resonance imaging (MRI) revealed abnormal enhancement and edema involving the T6, T7, and T8 vertebral bodies with associated prevertebral and postvertebral soft tissue enhancement and edema. A fluoroscopy-guided T7 vertebral body biopsy revealed acute and chronic osteomyelitis with no evidence of malignancy, prompting an infectious disease consult…

PDF

http://jcm.asm.org/content/55/11/3157.full.pdf+html

October 26, 2017 at 3:28 pm

Septic arthritis in a native knee due to Corynebacterium striatum.

Reumatol Clin. 2017 Mar 7. 

Septic arthritis in a native knee due to Corynebacterium striatum.

[Article in English, Spanish]

Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.

Author information

1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.

2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.

3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.

4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.

Abstract

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

PDF (CLIC en PDF)

http://www.reumatologiaclinica.org/es/linkresolver/artritis-septica-rodilla-nativa-por/S1699258X17300335/

October 22, 2017 at 12:43 pm

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