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

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Association Between CMV Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients – Systematic Review and Meta-Analysis July 2018

Background

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

https://academic.oup.com/ofid/article/4/2/ofx029/2991368

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Ceftaroline for Severe MRSA Infections – A Systematic Review

JULY 2018

Ceftaroline is approved by the Food and Drug Administration for acute bacterial skin and skin-structure infections and community-acquired bacterial pneumonia, including cases with concurrent bacteremia. Use for serious methicillin-resistant Staphylococcus aureus (MRSA) infections has risen for a multitude of reasons. The aim of this article is to review the literature evaluating clinical outcomes and safety of ceftaroline prescribed for serious MRSA infections. We conducted a literature search in Ovid (Medline) and PubMed for reputable case reports, clinical trials, and reviews focusing on the use of ceftaroline for treatment of MRSA infections. Twenty-two manuscripts published between 2010 and 2016 met inclusion criteria. Mean clinical cure was 74% across 379 patients treated with ceftaroline for severe MRSA infections. Toxicities were infrequent. Ceftaroline treatment resulted in clinical and microbiologic cure for severe MRSA infections. Close monitoring of hematological parameters is necessary with prolonged courses of ceftaroline.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx084/3778088

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REVIEW – Inhaled antibiotics beyond aminoglycosides, polymyxins and aztreonam: A systematic review

Internat J of Antimicrob Agents March 2015 V.45 N.3

Matthew E. Falagas, Kyriakos K. Trigkidis, Konstantinos Z. Vardakas

Highlights

• Evaluation of published evidence regarding uncommon inhaled antibiotics.
• Clinical and microbiological outcomes.
• Future prospects.

We sought to evaluate published evidence regarding clinical or microbiological outcomes related to the use of inhaled antibiotics other than aminoglycosides, polymyxins and aztreonam. A systematic search of PubMed and Scopus databases as well as bibliographies of eligible articles was performed. In total, 34 eligible studies were identified. Among several inhaled β-lactams, ceftazidime was used with varying success in the prevention and treatment of ventilator-associated pneumonia (VAP) and improved clinical outcomes in chronic Pseudomonas aeruginosa lower respiratory tract infections (LRTIs) in patients with cystic fibrosis (CF) or bronchiectasis. Inhaled vancomycin, as an adjunctive therapy, was effective in treating Gram-positive VAP, whilst inhaled levofloxacin, ciprofloxacin and an inhaled combination of fosfomycin and tobramycin were associated with improved microbiological or clinical outcomes in chronic LRTI in patients with CF or bronchiectasis. In conclusion, published evidence is heterogeneous with regard to antibiotics used, studied indications, patient populations and study designs. Therefore, although the currently available data are encouraging, no safe conclusion regarding the effectiveness and safety of the drugs in question can be reached.

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(14)00329-X/fulltext

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https://www.ijaaonline.com/article/S0924-8579(14)00329-X/pdf

REVIEW – The clinical positioning of telavancin in Europe

Internat J of Antimicrob Agents March 2015 V.45 N.3

Robert Masterton, Giuseppe Cornaglia, Patrice Courvalin, Hartmut M. Lode, Jordi Rello, Antoni Torres

Highlights

• Clinical experience with the lipoglycopeptide telavancin in Europe is limited.
• Telavancin has potent in vitro activity against Gram-positive isolates, e.g. meticillin-resistant Staphylococcus aureus (MRSA) and glycopeptide-intermediate S. aureus (GISA).
• Telavancin is non-inferior to vancomycin for nosocomial Gram-positive pneumonia.
• Baseline moderate-to-severe renal impairment increases mortality risk of telavancin.
• Where renal function permits, telavancin is an alternative to vancomycin or linezolid.

Telavancin was the first marketed lipoglycopeptide. Although licensed in Europe in 2011 for the treatment of nosocomial pneumonia caused by meticillin-resistant Staphylococcus aureus (MRSA), it did not become clinically available until March 2014. Given the limited clinical experience with telavancin in Europe, this review provides an overview of its antimicrobial and clinical activity as well as its position among today’s antimicrobials, with particular focus on the implications of its licensing requirements. Telavancin has potent in vitro activity against isolates of Gram-positive pathogens, including MRSA and glycopeptide-intermediate S. aureus strains. In addition, at clinically attainable doses telavancin inhibits Gram-positive isolates of antibiotic-resistant strains from biofilm models. The in vitro potency of telavancin has been corroborated in the clinical setting. Comparative clinical studies of telavancin demonstrate non-inferiority compared with vancomycin in the treatment of hospital-acquired Gram-positive pneumonia, with high cure rates for telavancin-treated patients with monomicrobial S. aureus infection, including isolates with reduced vancomycin susceptibility. These studies also demonstrate an overall similar safety profile for telavancin and vancomycin, although importantly, patients with moderate-to-severe renal impairment at baseline are at greater risk for mortality with telavancin and this feature must be taken into account when selecting patients for its usage. In Europe, telavancin is a useful alternative for patients with difficult-to-treat, hospital-acquired MRSA pneumonia when there are very few alternatives. For example, it should be considered in such patients when vancomycin and linezolid are not suitable and where renal function permits.

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(14)00384-7/fulltext

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https://www.ijaaonline.com/article/S0924-8579(14)00384-7/pdf

REVIEW – Time for action—Improving the design and reporting of behaviour change interventions for antimicrobial stewardship in hospitals: Early findings from a systematic review

Internat J of Antimicrob Agents March 2015 V.45 N.3

Peter Davey, Claire Peden, Esmita Charani, Charis Marwick, Susan Michie

Highlights

• We include interventions with prescribing outcomes published by the end of December 2012.
• Reporting of behaviour change techniques (BCTs) lacked important details.
• Interventions did not include BCTs shown to be effective in other contexts.
• The antimicrobial stewardship community must improve their understanding of BCTs.

There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information. We identified 116 studies reporting 123 interventions. Reporting of BCTs was poor, with little detail of BCT characteristics. Feedback was only reported for 17 (13.8%) of the interventions, and self-monitoring was used in only 1 intervention. Goals were reported for all interventions but were poorly specified, with only three of the nine characteristics reported for ≥50% of interventions. A goal threshold and timescale were specified for just 1 of the 123 interventions. Only 29 authors (25.0%) responded to the request for additional information. In conclusion, both the content and reporting of interventions for antimicrobial stewardship fell short of scientific principles and practices. There is a strong evidence base regarding BCTs in other contexts that should be applied to antimicrobial stewardship now if we are to further our understanding of what works, for whom, why and in what contexts.

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(14)00401-4/fulltext

PDF

https://www.ijaaonline.com/article/S0924-8579(14)00401-4/pdf

Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

LANCET June 2018

Fundamento

La meningitis viral se reconoce cada vez más, pero se sabe poco acerca de la frecuencia con la que ocurre o las causas y los resultados en el Reino Unido. El objetivo fue determinar la incidencia, las causas y las secuelas en adultos del Reino Unido para mejorar el tratamiento de los pacientes y ayudar en la planificación de los servicios de salud.

Métodos

Realizaron un estudio de cohorte observacional prospectivo multicéntrico de adultos con sospecha de meningitis en 42 hospitales en toda Inglaterra. Anidado en este estudio, en la región noroeste del Servicio Nacional de Salud (NHS) (ahora parte de NHS England North), se realizó un estudio epidemiológico. Los pacientes eran elegibles si tenían 16 años o más, tenían meningitis clínicamente sospechada y se les realizó una punción lumbar o, si la punción lumbar estaba contraindicada, tenían sospecha clínica de meningitis y un patógeno apropiado identificado en el hemocultivo o en la PCR de sangre. Se excluyeron las personas con dispositivos ventriculares. Calculamos la incidencia de meningitis viral utilizando datos de pacientes de la región noroeste solo y usamos estos datos para estimar el número de casos estandarizados de población en el Reino Unido. Resultados de calidad de vida autoinformados y resultados neuropsicológicos de los pacientes, utilizando el EuroQol EQ-5D-3L, la Encuesta de salud de forma abreviada de 36 elementos (SF-36) y el cronograma de evaluación neuropsicológica de Aldenkamp y Baker, durante 1 año después de la admisión .

Recomendaciones

1126 pacientes se inscribieron entre el 30 de septiembre de 2011 y el 30 de septiembre de 2014. 638 (57%) pacientes tuvieron meningitis: 231 (36%) casos fueron virales, 99 (16%) fueron bacterianos y 267 (42%) tuvieron una causa desconocida 41 (6%) casos tuvieron otras causas. La incidencia anual estimada de meningitis viral fue de 2.73 por 100 000 y la de meningitis bacteriana fue de 1.24 por 100 000. La mediana de la estancia hospitalaria de los pacientes con meningitis viral fue de 4 días (IQR 3-7), aumentando a 9 días (6-12) en aquellos tratados con antivirales. La punción lumbar previa dio como resultado que se identificara más pacientes con una causa específica que aquellos que tuvieron una punción lumbar tardía. En comparación con la población del Reino Unido correspondiente a la edad, los pacientes con meningitis viral tuvieron una pérdida media de 0-2 años de vida ajustados por calidad (SD 0 · 04) en ese primer año.

Interpretación

Los virus son la causa más común de meningitis en adultos del Reino Unido y conducen a una morbilidad sustancial a largo plazo. Los retrasos en la punción lumbar y el tratamiento innecesario con antivirales se asociaron con estancias hospitalarias más prolongadas. Los diagnósticos rápidos y los tratamientos de racionalización pueden reducir la carga de la meningitis en los servicios de salud.

Fondos

Meningitis Research Foundation e Instituto Nacional de Investigaciones sobre la Salud del Reino Unido.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30245-7/fulltext

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30245-7.pdf