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Thornhill MH, Dayer MJ, Durkin MJ, Lockhart PB, Baddour LM. Response to the Letter to the Editor: "Risk of Adverse Reactions to Oral Antibiotics Prescribed by Dentists". J Dent Res 2020; 99:864. [PMID: 32282272 DOI: 10.1177/0022034520917140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M H Thornhill
- Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - M J Dayer
- Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, UK
| | - M J Durkin
- Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - P B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - L M Baddour
- Division of Infectious Diseases, Department of Medicine and the Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
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Hasse B, Hannan MM, Keller PM, Maurer FP, Sommerstein R, Mertz D, Wagner D, Fernández-Hidalgo N, Nomura J, Manfrin V, Bettex D, Hernandez Conte A, Durante-Mangoni E, Tang THC, Stuart RL, Lundgren J, Gordon S, Jarashow MC, Schreiber PW, Niemann S, Kohl TA, Daley CL, Stewardson AJ, Whitener CJ, Perkins K, Plachouras D, Lamagni T, Chand M, Freiberger T, Zweifel S, Sander P, Schulthess B, Scriven JE, Sax H, van Ingen J, Mestres CA, Diekema D, Brown-Elliott BA, Wallace RJ, Baddour LM, Miro JM, Hoen B, Athan E, Bayer A, Barsic B, Corey GR, Chu VH, Durack DT, Fortes CQ, Fowler V, Hoen B, Krachmer AW, Durante-Magnoni E, Miro JM, Wilson WR. International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass. J Hosp Infect 2019; 104:214-235. [PMID: 31715282 DOI: 10.1016/j.jhin.2019.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/09/2023]
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Affiliation(s)
- B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland.
| | - M M Hannan
- Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - F P Maurer
- Diagnostic Mycobacteriology Group, National and WHO Supranational Reference Center for Mycobacteria, Research Center, Borstel, Germany
| | - R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mertz
- Departments of Medicine, Health Research Methods, Evidence and Impact, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg i.Br, Germany
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Nomura
- Kaiser Permanente Infectious Diseases, Los Angeles Medical Center, CA, USA
| | - V Manfrin
- Infectious and Tropical Diseases Department, San Bortolo Hospital, Vincenca, Italy
| | - D Bettex
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - A Hernandez Conte
- Department of Anaesthesiology, Kaiser Permanente, Los Angeles Medical Center, CA, USA
| | - E Durante-Mangoni
- Infectious and Transplant Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - T H-C Tang
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R L Stuart
- Monash Infectious Diseases, Monash Health, Australia
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - S Gordon
- Department of Infectious Diseases, Cleveland Clinic, OH, USA
| | - M C Jarashow
- Acute Communicable Disease Control, Los Angeles Department of Public Health, LA, USA
| | - P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - S Niemann
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - T A Kohl
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - C L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - C J Whitener
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - K Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - D Plachouras
- Healthcare-associated Infections, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - M Chand
- National Infection Service, Public Health England, London, UK; Guy's and St Thomas' NHS Foundation Trust, Imperial College London, UK
| | - T Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Zweifel
- Ophthalmology Unit, University of Zurich, Switzerland
| | - P Sander
- National Center for Mycobacteria, Zurich, Switzerland, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - J E Scriven
- Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Mestres
- Clinic for Cardiovascular Surgery, University Hospital and University of Zurich, Switzerland
| | - D Diekema
- Division of Infectious Diseases, University of Iowa, Carver College of Medicine, IA, USA
| | - B A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - R J Wallace
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - L M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Diseases, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - J M Miro
- Infectious Diseases Service at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France.
| | | | | | - E Athan
- Infectious Diseases Department at Barwon Health, University of Melbourne and Deakin University, Australia
| | - A Bayer
- Geffen School of Medicine at UCLA Senior Investigator - LA Biomedical Research Institute at Harbor-UCLA, USA
| | - B Barsic
- Department for Infectious Diseases, School of Medicine, University of Zagreb, Croatia
| | - G R Corey
- Duke University Medical Center, Hubert-Yeargan Center for Global Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - D T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Q Fortes
- Division of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V Fowler
- Departments of Medicine and Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France
| | - A W Krachmer
- Harvard Medical School, Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Durante-Magnoni
- Infectious and Transplant Medicine of the 'V. Monaldi' Teaching Hospital in Naples, University of Campania 'L. Vanvitelli', Italy
| | - J M Miro
- Infectious Diseases at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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Thornhill MH, Chambers JB, Prendergast BD, Dayer M, Cahill TJ, Lockhart PB, Baddour LM. Antibiotic prophylaxis: Back from the brink. Br Dent J 2018; 225:579-580. [DOI: 10.1038/sj.bdj.2018.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Tissot-Dupont H, Casalta JP, Gouriet F, Hubert S, Salaun E, Habib G, Fernandez-Gerlinger MP, Mainardi JL, Tattevin P, Revest M, Lucht F, Botelho-Nevers E, Gagneux-Brunon A, Snygg-Martin U, Chan KL, Bishara J, Vilacosta I, Olmos C, San Román JA, López J, Tornos P, Fernández-Hidalgo N, Durante-Mangoni E, Utili R, Paul M, Baddour LM, DeSimone DC, Sohail MR, Steckelberg JM, Wilson WR, Raoult D. International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines. Clin Microbiol Infect 2017; 23:736-739. [PMID: 28323194 DOI: 10.1016/j.cmi.2017.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/06/2017] [Accepted: 03/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. METHODS Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. RESULTS The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. CONCLUSION Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics.
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Affiliation(s)
- H Tissot-Dupont
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - J P Casalta
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - F Gouriet
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France
| | - S Hubert
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - E Salaun
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - G Habib
- Département de Cardiologie, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille Université, Marseille, France
| | - M P Fernandez-Gerlinger
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - J L Mainardi
- Unité Mobile de Microbiologie Clinique, Service de Microbiologie, Hôpital européen Georges-Pompidou, Université Paris Descartes, Paris, France
| | - P Tattevin
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - M Revest
- Service des Maladies Infectieuses et de Réanimation Médicale, Hôpital Pontchaillou, Université Rennes-I, Rennes, France
| | - F Lucht
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - E Botelho-Nevers
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - A Gagneux-Brunon
- Infectious Diseases Department, University Hospital of Saint-Etienne, France
| | - U Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K L Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - J Bishara
- Infectious Disease Unit Rabin Medical Centre, Beilinson Hospital Sackler Faculty of Medicine, Tel-Aviv University, Jabotinsky 39, Petah-Tiqva, Israel
| | - I Vilacosta
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - C Olmos
- Servicio de Cardiología, Instituto de Investigación Sanitaria Hospital Clínico San Carlos, Madrid, Spain
| | - J A San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - J López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain
| | - P Tornos
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - E Durante-Mangoni
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - R Utili
- Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy
| | - M Paul
- Ramban Health Care Campus, Haifa, Israel
| | - L M Baddour
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D C DeSimone
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Sohail
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - J M Steckelberg
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - D Raoult
- URMITE, Aix Marseille Université, UMR 7278, IRD 198, INSERM 1095, IHU-Méditerranée Infection, Marseille, France.
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Pardi DS, Shivashankar R, Khanna S, Baddour LM. Letter: clinical predictors of Clostridium difficile infection - advanced age and residential status are important factors for prediction and prevention - authors' reply. Aliment Pharmacol Ther 2015; 41:233. [PMID: 25511771 DOI: 10.1111/apt.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/30/2014] [Indexed: 12/08/2022]
Affiliation(s)
- D S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
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Al-Hasan MN, Juhn YJ, Bang DW, Yang HJ, Baddour LM. External validation of bloodstream infection mortality risk score in a population-based cohort. Clin Microbiol Infect 2014; 20:886-91. [PMID: 25455590 DOI: 10.1111/1469-0691.12607] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/07/2014] [Accepted: 02/18/2014] [Indexed: 12/22/2022]
Abstract
A risk score was recently derived to predict mortality in adult patients with Gram-negative bloodstream infection (BSI). The aim of this study was to provide external validation of the BSI mortality risk score (BSIMRS) in a population-based cohort. All residents of Olmsted County, Minnesota, with Escherichia coli and Pseudomonas aeruginosa BSI from 1 January 1998 to 31 December 2007 were identified. Logistic regression was used to examine the association between BSIMRS and mortality. Area under receiver operating characteristic curve (AUC) was calculated to quantify the discriminative ability of the BSIMRS to predict a variety of short-term and long-term outcomes. Overall, 424 unique Olmsted County residents with first episodes of E. coli and P. aeruginosa BSI were included in the study. Median age was 68 (range 0-99) years, 280 (66%) were women, 61 (14%) had cancer and 9 (2%) had liver cirrhosis. The BSIMRS was associated with 28-day mortality (p <0.001) with an AUC of 0.86. There was an almost 56% increase in 28-day mortality for each point increase in BSIMRS (OR 1.56, 95% CI 1.40-1.78). A BSIMRS ≥ 5 had a sensitivity of 74% and a specificity of 87% to predict 28-day mortality with a negative predictive value of 97%. The BSIMRS had AUC of 0.85, 0.85 and 0.81 for 7-, 14- and 365-day mortality, respectively. BSIMRS stratified mortality with high discrimination in a population-based cohort that included patients of all age groups who had a relatively low prevalence of cancer and liver cirrhosis.
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Affiliation(s)
- M N Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, SC, USA; Department of Medicine, Division of Infectious Diseases, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Rangu V, Syed FF, Friedman PA, Baddour LM, Asirvatham SJ, Steckelberg JM, Lohse CM, Wilson WR, Sohail MR. Presence of a central venous catheter is associated with a markedly increased risk of permanent pacemaker infection. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tleyjeh IM, Baddour LM. Early Cardiac Surgery After Ischemic Stroke in Patients With Infective Endocarditis May Not Be Safe. Clin Infect Dis 2013; 56:1844-5. [DOI: 10.1093/cid/cit097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Habib A, Irfan M, Baddour LM, Le KY, Anavekar NS, Lohse CM, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Sohail MR. Impact of prior aspirin therapy on clinical manifestations of cardiovascular implantable electronic device infections. Europace 2012; 15:227-35. [DOI: 10.1093/europace/eus292] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Al-Hasan MN, Eckel-Passow JE, Baddour LM. Impact of healthcare-associated acquisition on community-onset Gram-negative bloodstream infection: a population-based study: healthcare-associated Gram-negative BSI. Eur J Clin Microbiol Infect Dis 2011; 31:1163-71. [PMID: 21983895 DOI: 10.1007/s10096-011-1424-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 09/12/2011] [Indexed: 11/28/2022]
Abstract
We performed a population-based study to examine the influence of healthcare-associated acquisition on pathogen distribution, antimicrobial resistance, short- and long-term mortality of community-onset Gram-negative bloodstream infections (BSI). We identified 733 unique patients with community-onset Gram-negative BSI (306 healthcare-associated and 427 community-acquired) among Olmsted County, Minnesota, residents from 1 January 1998 to 31 December 2007. Multivariate logistic regression was used to examine the association between healthcare-associated acquisition and microbiological etiology and antimicrobial resistance. Multivariate Cox proportional hazards regression was used to evaluate the influence of the site of acquisition on mortality. Healthcare-associated acquisition was predictive of Pseudomonas aeruginosa (odds ratio [OR] 3.14, 95% confidence intervals [CI]: 1.59-6.57) and the group of Enterobacter, Citrobacter, and Serratia species (OR 2.23, 95% CI: 1.21-4.21) as causative pathogens of community-onset Gram-negative BSI. Healthcare-associated acquisition was also predictive of fluoroquinolone resistance among community-onset Gram-negative bloodstream isolates (OR 2.27, 95% CI: 1.18-4.53). Healthcare-associated acquisition of BSI was independently associated with higher 28-day (hazard ratio [HR] 3.73, 95% CI: 2.13-6.93) and 1-year mortality (HR 3.60, 95% CI: 2.57-5.15). Because of differences in pathogen distribution, antimicrobial resistance, and outcomes between healthcare-associated and community-acquired Gram-negative BSI, identification of patients with healthcare-associated acquisition of BSI is essential to optimize empiric antimicrobial therapy.
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Affiliation(s)
- M N Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of Kentucky Medical Center, 800 Rose Street, Lexington, KY 40536, USA.
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Abstract
Enterobacter species are the fourth most common cause of Gram-negative bloodstream infection (BSI). We examined temporal changes and seasonal variation in the incidence rate of Enterobacter spp. BSI, estimated 28-day and 1-year mortality, and determined in vitro antimicrobial resistance rates of Enterobacter spp. bloodstream isolates in Olmsted County, Minnesota, from 1 January 1998 to 31 December 2007. Multivariable Poisson regression was used to examine temporal changes and seasonal variation in incidence rate and Kaplan-Meier method was used to estimate 28-day and 1-year mortality. The median age of patients with Enterobacter spp. BSI was 58 years and 53% were female. The overall age- and gender-adjusted incidence rate of Enterobacter spp. BSI was 3.3 per 100,000 person-years (95% CI 2.3-4.4). There was a linear trend of increasing incidence rate from 0.8 (95% CI 0-1.9) to 6.2 (95% CI 3.0-9.3) per 100,000 person-years between 1998 and 2007 (p 0.002). There was no significant difference in the incidence rate of Enterobacter spp. BSI during the warmest 4 months compared to the remainder of the year (incidence rate ratio 1.06; 95% CI 0.47-2.01). The overall 28-day and 1-year mortality rates of Enterobacter spp. BSI were 21% (95% CI 8-34%) and 38% (95% CI 22-53%), respectively. Up to 13% of Enterobacter spp. bloodstream isolates were resistant to third-generation cephalosporins. To our knowledge, this is the first population-based study to describe the epidemiology and outcome of Enterobacter spp. BSI. The increase in incidence rate of Enterobacter spp. BSI over the past decade, coupled with its associated antimicrobial resistance, dictate the need for further investigation of this syndrome.
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Affiliation(s)
- M N Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, KY 40536, USA.
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Scow JS, Throckmorton AD, Hoskin TL, Boughey JC, Boostrom SY, Holifield AC, Baddour LM, Degnim AC. Abstract P5-14-10: Risk Factors Associated with Surgical Site Infection after Breast Operations. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p5-14-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Surgical site infection (SSI) is a problematic cause of morbidity following breast/axillary surgery. The breast/axilla has a higher rate of SSI than expected for clean wounds. We evaluated risk factors associated with SSI after breast/axillary operations.
Methods: A retrospective review of breast/axillary procedures from July 2004 to July 2006 was performed. SSI was defined using Centers for Disease Control and Prevention criteria, including cases with cellulitis as the only criterion of infection. Data collected included patient demographics, BMI, surgical procedure, ASA class, antibiotic use, drains, and prior radiation (RT).
RESULTS: We identified 389 patients who underwent 678 procedures. Thirty-seven SSI (5.5% of procedures) were identified, of which 24 (65%) had only cellulitis. Median time from surgery to SSI diagnosis was 9 days (range 2-112), with 81% occurring in the first 30 days. Univariate analysis identified prior RT, BMI, type of procedure, operative time, use of drain, and postoperative seroma to be associated with SSI (all P<0.05). With multivariate analysis, procedure type remained significant overall (p=0.04). Specifically, mastectomy with sentinel lymph node biopsy (SLNB) and modified radical mastectomy remained significantly associated with higher risk of SSI, with hazard ratios (HR) of 6.3 and 13.5 fold respectively compared to SLNB alone. Seroma (HR 9.0, 95% CI 2.7-29.3), prior RT (HR 3.4, 1.2-9.9), and BMI >=30 (HR 3.1, 1.6-6.2) also remained significantly associated with SSI.
CONCLUSION(S): SSI are more frequent after breast/axillary operations than other clean wounds and are associated with prior RT, obesity, more extensive and longer procedures, and postoperative seroma.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-14-10.
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Affiliation(s)
- JS Scow
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - AD Throckmorton
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - TL Hoskin
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - JC Boughey
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - SY Boostrom
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - AC Holifield
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - LM Baddour
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
| | - AC. Degnim
- Mayo Clinic, Rochester, MN; Baptist Memorial Medical Group Inc, Memphis, TN
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Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Seasonal variation in Escherichia coli bloodstream infection: a population-based study. Clin Microbiol Infect 2009; 15:947-50. [PMID: 19845704 DOI: 10.1111/j.1469-0691.2009.02877.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Seasonal variation in the rates of infection with certain Gram-negative organisms has been previously examined in tertiary-care centres. We performed a population-based investigation to evaluate the seasonal variation in Escherichia coli bloodstream infection (BSI). We identified 461 unique patients in Olmsted County, Minnesota, from 1 January 1998 to 31 December 2007, with E. coli BSI. Incidence rates (IR) and IR ratios were calculated using Rochester Epidemiology Project tools. Multivariable Poisson regression was used to examine the association between the IR of E. coli BSI and average temperature. The age- and gender-adjusted IR of E. coli BSI per 100 000 person-years was 50.2 (95% CI 42.9-57.5) during the warmest 4 months (June through September) compared with 37.1 (95% CI 32.7-41.5) during the remainder of the year, resulting in a 35% (95% CI 12-66%) increase in IR during the warmest 4 months. The average temperature was predictive of increasing IR of E. coli BSI (p 0.004); there was a 7% (95% CI 2-12%) increase in the IR for each 10-degree Fahrenheit (c. 5.5 degrees C) increase in average temperature. To our knowledge, this is the first study to demonstrate seasonal variation in E. coli BSI, with a higher IR during the warmest 4 months than during the remainder of the year.
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Affiliation(s)
- M N Al-Hasan
- Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY 40536, USA.
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15
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Fadel HJ, Tleyjeh IM, Steckelberg JM, Wilson WR, Baddour LM. Evaluation of antibiotic therapy following valve replacement for native valve endocarditis. Eur J Clin Microbiol Infect Dis 2009; 28:1395-8. [PMID: 19705174 DOI: 10.1007/s10096-009-0784-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 07/11/2009] [Indexed: 12/20/2022]
Abstract
We retrospectively evaluated 105 patients at the Mayo Clinic between 1970 and 2006 with native valve endocarditis who underwent acute valve surgery. The objective was to determine if outcomes differed based on whether they had received an antibiotic regimen recommended for native valve endocarditis or one for prosthetic valve endocarditis. Fifty-two patients had streptococcal and 53 had staphylococcal infections. Patients with each type of infection were divided into two groups: the first received postoperative monotherapy (with a beta-lactam or vancomycin), and the second received combination therapy (with an aminoglycoside for streptococcal infection, and gentamicin and/or rifampin for staphylococcal infection). The duration and types of antibiotics given pre- and postoperatively, valve cultures results, antibiotic-related adverse events, relapses, and mortality rates within 6 months of surgery were analyzed. Cure rates were similar regardless of the regimen administered. With the small number of patients in each group, a multicenter study with a larger cohort of patients is needed to better define optimal postoperative treatment regimens in this population.
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Affiliation(s)
- H J Fadel
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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16
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Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidence rate and outcome of Gram-negative bloodstream infection in solid organ transplant recipients. Am J Transplant 2009; 9:835-43. [PMID: 19344469 DOI: 10.1111/j.1600-6143.2009.02559.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bacterial infections are common complications of solid organ transplantation (SOT). In this study, we defined the incidence, mortality and in vitro antimicrobial resistance rates of Gram-negative bloodstream infection (BSI) in SOT recipients. We identified 223 patients who developed Gram-negative BSI among a cohort of 3367 SOT recipients who were prospectively followed at the Mayo Clinic (Rochester, MN) from January 1, 1996 to December 31, 2007. The highest incidence rate (IR) of Gram-negative BSI was observed within the first month following SOT (210.3/1000 person-years [95% confidence interval (CI): 159.3-268.3]), with a sharp decline to 25.7 (95% CI: 20.1-32.1) and 8.2 (95% CI: 6.7-10.0) per 1000 person-years between 2 and 12 months and more than 12 months following SOT, respectively. Kidney recipients were more likely to develop Gram-negative BSI after 12 months following transplantation than were liver recipients (10.3 [95% CI: 7.9-13.1] vs. 5.2 [95% CI: 3.1-7.8] per 1000 person-years). The overall unadjusted 28-day all-cause mortality of Gram-negative BSI was 4.9% and was lower in kidney than in liver recipients (1.6% vs. 13.2%, p < 0.001). We observed a linear trend of increasing resistance among Escherichia coli isolates to fluoroquinolone antibiotics from 0% to 44% (p = 0.002) throughout the study period. This increase in antimicrobial resistance may influence the choice of empiric therapy.
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Affiliation(s)
- M N Al-Hasan
- Department of Medicine, Division of Infectious Diseases, University of Kentucky, Lexington, KY, USA.
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17
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Abstract
Propionibacterium species rarely cause infective endocarditis. When identified in blood cultures, they may be inappropriately disregarded as skin flora contaminants. The purpose of this study was to characterize the clinical presentation and management of endocarditis due to Propionibacterium species. All cases of endocarditis due to Propionibacterium species that were treated at the Mayo Clinic, Rochester, USA were retrospectively reviewed, and the English language medical literature was searched for all previously published reports. Seventy cases, which included eight from the Mayo Clinic, were identified (clinical details were available for only 58 cases). The median age of patients was 52 years, and 90% were males. In 79% of the cases, the infection involved prosthetic material (39 prosthetic valves, one left ventricular Teflon patch, one mitral valve ring, one pulmonary artery prosthetic graft, three pacemakers, and one defibrillator). Blood cultures were positive in 62% of cases. All 22 cases with negative blood cultures were microbiologically confirmed by either positive valve tissue cultures (n = 21) or molecular methods (n = 1). Endocarditis was complicated by abscess formation in 36% of cases. The majority (81%) of patients underwent surgery, either for valve replacement and debridement of a cardiac abscess, or removal of an infected device. Crude in-hospital mortality was 16%. The median duration of postoperative antibiotic treatment was 42 days. Patients were commonly treated with a penicillin derivative alone or in combination with gentamicin. On the basis of the above data, it is recommended that infective endocarditis should be strongly suspected when Propionibacterium species are isolated from multiple blood cultures, particularly in the presence of a cardiovascular device.
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Affiliation(s)
- M R Sohail
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Degnim AC, Hoskin TL, Cheville AL, Miller JP, Gamble GL, Baddour LM, Donohue JH, Thomsen KM, Maloney SD, Boughey JC. Skin thickness as a measure of breast lymphedema. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3103
Introduction: Lymphedema is well-known in the arm but can also occur in the breast. Diagnosis is currently non-standardized and based on clinical impression. We sought to determine if skin thickness could serve as a useful measure in the diagnosis of breast lymphedema (BLE).
 Methods: Patients undergoing unilateral non-mastectomy procedures were enrolled on this prospective clinical study preoperatively and evaluated for signs and symptoms of lymphedema in the operated breast in the postoperative period. Patients with established BLE were also studied. BLE diagnosis was independent of ultrasound findings and was based on a graded physical exam targeting clinical signs of edema and erythema. Skin thickness was measured with ultrasound at the 6 o'clock position of both breasts. Differences in skin thickness were assessed by the ratio of skin thickness in the operated and contralateral breasts, with comparison of means by two-sample t-test. Receiver operating characteristic curves were constructed to estimate the area under the curve (AUC) and to determine optimal cutpoints.
 Results: Ninety-seven women were studied; 85 were enrolled preoperatively and 12 postoperatively after a diagnosis of BLE. Median length of follow-up overall was 8 months. Of the 97 women, 46 had BLE at one or more follow-up visit with median time to first diagnosis of 3 months. Mean measured skin thickness was 2.3 ± 0.5mm in unaffected breasts and 3.2 ± 1.0 mm in operated breasts. Women with BLE had significantly greater skin thickness in the operated breast compared to the contralateral breast, with a mean skin thickness ratio of 1.83 ± 0.57 in patients with BLE compared to 1.18 ± 0.40 among those without BLE (p<0.0001). Skin thickness ratio provided excellent discrimination for BLE, with an area under the curve (AUC) of 0.86. At a ratio of 1.32 or greater (32% greater skin thickness in operated versus contralateral breast), sensitivity and specificity for diagnosing BLE were 81% and 82% respectively. A single measure of skin thickness in the operated breast also correlated well with diagnosis of BLE, with skin thickness of 3.2 mm or greater demonstrating sensitivity of 78% and specificity of 82%, AUC 0.82.
 Conclusions: Breast lymphedema results in skin edema and increased skin thickness that can be quantified with ultrasound. Measuring breast skin thickness- either as a single reading or as a ratio to the unaffected breast- may be useful in the diagnosis of breast lymphedema.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3103.
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Affiliation(s)
- AC Degnim
- 1 Surgery, Mayo Clinic, Rochester, MN
| | - TL Hoskin
- 2 Biostatistics, Mayo Clinic, Rochester, MN
| | - AL Cheville
- 3 Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - JP Miller
- 1 Surgery, Mayo Clinic, Rochester, MN
| | - GL Gamble
- 3 Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - LM Baddour
- 4 Infectious Disease, Mayo Clinic, Rochester, MN
| | | | - KM Thomsen
- 2 Biostatistics, Mayo Clinic, Rochester, MN
| | - SD Maloney
- 2 Biostatistics, Mayo Clinic, Rochester, MN
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19
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Assi MA, Sandid MS, Baddour LM, Roberts GD, Walker RC. Risk factor analysis of Histoplasma capsulatum fungemia. Med Mycol 2009. [DOI: 10.1080/13693780902755299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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20
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Tleyjeh IM, Steckelberg JM, Georgescu G, Ghomrawi HMK, Hoskin TL, Enders FB, Mookadam F, Huskins WC, Wilson WR, Baddour LM. The association between the timing of valve surgery and 6-month mortality in left-sided infective endocarditis. Heart 2008; 94:892-6. [DOI: 10.1136/hrt.2007.118968] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Alanee SRJ, McGee L, Jackson D, Chiou CC, Feldman C, Morris AJ, Ortqvist A, Rello J, Luna CM, Baddour LM, Ip M, Yu VL, Klugman KP. Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study. Clin Infect Dis 2007; 45:46-51. [PMID: 17554699 DOI: 10.1086/518538] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Accepted: 01/27/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The introduction of conjugate pneumococcal vaccination for children has reduced the burden of invasive disease due to pneumococcal conjugate vaccine (PCV) types (i.e., serotypes 9V, 14, 6B, 18C, 23F, 19F, and 4) in adults. As nonvaccine serotypes become predominant causes of invasive disease among adults, it is necessary to evaluate the disease severity and mortality associated with infection due to nonvaccine serotypes, compared with PCV serotypes, in adults. METHODS The association of pneumococcal serotype and host-related variables with disease severity and mortality was statistically examined (with multivariable analysis) in 796 prospectively enrolled, hospitalized adult patients with bacteremia due to Streptococcus pneumoniae. RESULTS In multivariate analyses of risk in patients with invasive pneumococcal disease, older age (age, > or = 65 years; P = .004), underlying chronic disease (P = .025), immunosuppression (P = .035), and severity of disease (P < .001) were significantly associated with mortality; no association was found between nosocomial infection with invasive serotypes 1, 5, and 7 and mortality. The risk factors meningitis (P = .001), suppurative lung complications (P < or = .001), and preexisting lung disease (P = .051) were significantly associated with disease severity, independent of infecting serotype. No differences were seen in disease severity or associated mortality among patients infected with PCV serotypes, compared with patients infected with nonvaccine serotypes. CONCLUSIONS Our data support the notion that host factors are more important than isolate serotype in determining the severity and outcome of invasive pneumococcal disease and that these outcomes are unlikely to change in association with nonvaccine serotype infection in the post-conjugate vaccine era.
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Affiliation(s)
- S R J Alanee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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22
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Mookadam F, Cikes M, Baddour LM, Tleyjeh IM, Mookadam M. Corynebacterium jeikeium endocarditis: a systematic overview spanning four decades. Eur J Clin Microbiol Infect Dis 2006; 25:349-53. [PMID: 16767481 DOI: 10.1007/s10096-006-0145-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Skin flora is an important source of microorganisms that cause infective endocarditis. While staphylococcal and beta-hemolytic streptococcal species are well-recognized components of skin flora that can cause infective endocarditis, other skin flora rarely produce endocardial infection. One species of Corynebacterium has received the most attention, Corynebacterium jeikeium. This bacterium, a gram-positive rod that is a strict aerobe, is known to cause mechanical prosthetic valve infection and vancomycin is generally required for treatment of this multidrug-resistant organism. Following treatment of an unusual case of bioprosthetic valve endocarditis due to C. jeikeium, a Medline search for English-language articles published from January 1966 to October 2004 was performed. Reports of C. jeikeium endocarditis cases with culture of either blood or cardiac surgery tissue samples positive for C. jeikeium and with clinical and echocardiographic findings of infective endocarditis were reviewed. Clinical data and results of diagnostic procedures were examined. All 38 patients with C. jeikeium endocarditis reported in the literature had at least one predisposing condition for the development of infective endocarditis. The majority of patients (74%) had involvement of a prosthetic heart valve. The mortality attributed to C. jeikeium endocarditis was 33% and was similar in patients who did and did not undergo valve replacement. This relatively high mortality rate mandates that clinicians be aware of this rare endocardial infection. C. jeikeium is a rare cause of endocarditis and it more commonly infects prosthetic valves. Careful scrutiny is required when C. jeikeium is isolated from a blood culture, particularly in patients with underlying prosthetic cardiac valves.
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Affiliation(s)
- F Mookadam
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, E Shea Boulevard, Scottsdale, AZ 13400, USA.
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23
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24
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Tleyjeh IM, Georgescu G, Virk A, Barajas ED, Mirzoyev Z, Anavekar N, Baddour LM. Cytomegalovirus cholangitis presenting with recurrent hemobilia. Eur J Clin Microbiol Infect Dis 2005; 24:634-6. [PMID: 16175357 DOI: 10.1007/s10096-005-0016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cytomegalovirus (CMV) cholangitis is a rare manifestation of CMV infection that has previously been described only in HIV-infected patients and solid-organ-transplant recipients. Reported here is a case of CMV cholangitis that occurred in a patient on chronic corticosteroid therapy who presented with recurrent hemobilia and biliary obstruction and was successfully treated with ganciclovir and cholecystostomy. A search of the medical literature revealed no previous case of this kind.
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Affiliation(s)
- I M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
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25
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Rayner CR, Baddour LM, Birmingham MC, Norden C, Meagher AK, Schentag JJ. Linezolid in the Treatment of Osteomyelitis: Results of Compassionate Use Experience. Infection 2004; 32:8-14. [PMID: 15007736 DOI: 10.1007/s15010-004-3029-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2003] [Accepted: 07/29/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND This case series examines osteomyelitis patients enrolled into a prospective, open label, noncomparative, non-randomized compassionate use program. Patients received 600 mg bid iv or po linezolid. PATIENTS AND METHODS 89 patients were enrolled into the compassionate use program with the diagnosis of osteomyelitis and were evaluated for clinical efficacy, safety and tolerability. Informed consent was obtained from the patients or their guardians and guidelines for human experimentation of the US Department of Health and Human Services and/or those of the investigators' institutions were followed in the conduct of this clinical research. RESULTS 55 cases of osteomyelitis met the inclusion criteria for clinical assessment. The 55 courses included long bone (53%), diabetic foot (18%), sternal wound (14.5%) and vertebral osteomyelitis (15%). Clinical assessment at longterm follow-up occurred at a median of 195 days after the last dose, and the clinical cure rate in 22 evaluable cases was 81.8% and failure rate 18.2%. The most common clinical adverse drug events (ADEs) were gastrointestinal disturbances. Reduction in hemoglobin/hematocrit and in platelet counts were the most common laboratory ADEs. CONCLUSION Linezolid iv or po was successful in treating patients with osteomyelitis caused by resistant grampositive organisms or those with intolerance or nonresponsiveness to other potentially effective treatments. Larger comparator controlled studies should be performed to confirm these findings.
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Affiliation(s)
- C R Rayner
- Facility for Anti-infective Drug Development and Innovation, Victorian College of Pharmacy, Monash University, 381 Royal Parade, 3052, Parkville, VIC, Australia.
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Abstract
BACKGROUND Long-term suppressive antimicrobial therapy is an alternative treatment choice in patients with medical device-related infection who are not eligible for surgical device removal for attempted cure. There is a paucity of data published that examines this treatment option. METHODS Members of the Infectious Diseases Society of America's Emerging Infections Network were polled to identify patients with intravascular device-related infections who were not candidates for surgery and were given long-term antimicrobial therapy to suppress clinical manifestations of infection. RESULTS Clinical and microbiologic data were collected retrospectively for 51 patients. Sixty-nine percent of patients were men; vascular grafts were the most common type of medical device infected [30 (58.8%) patients]. Sixty-three percent (32 of 51) of cases involved gram-positive cocci. A variety of antimicrobials were administered as chronic suppressive therapy, with beta-lactams used most frequently (39.2%). Therapy ranged from 3 months to 10 years. Three (7.32%) of 41 patients in whom follow-up data were available developed relapsing infection while on long-term suppressive therapy. Three other patients suffered drug adverse events. CONCLUSIONS Overall, long-term suppressive therapy was well-tolerated and efficacious in preventing signs of infection relapse.
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Affiliation(s)
- L M Baddour
- Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center at Knoxville, 37920-6999, USA.
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Baddour LM, Haden KH, Allen JW. Primary skeletal muscle lymphoma presenting as refractory cellulitis. Cutis 2001; 68:223-6. [PMID: 11579790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The right torso of a 55-year-old woman showed diffuse skin and soft-tissue changes suggestive of cellulitis. However, several clinical and radiologic features, including the subacute and non-toxic nature of the illness and the patient's lack of response to antibiotic therapy, indicated a noninfectious etiology. Malignancy was suggested by striking changes seen on computed tomographic scanning--including extensive infiltration and enlargement of the musculature of the right shoulder girdle, the intercostal musculature, the latissimus dorsi, and the rhomboids; focal enlargement of the right paraspinal muscles; and enlargement of the psoas and the iliacus muscles and of the musculature around the hip joint. The mediastinal, hilar, and paraaortic regions showed no adenopathy. A large hypodense lesion of approximately 4.5 cm, which was seen in the caudate lobe of the liver, raised the concern of a metastatic focus of malignancy. Because of these findings, an immediate muscle biopsy was performed. Results showed a non-Hodgkin's lymphoma with a B-cell phenotype. Although primary skeletal muscle lymphoma is very uncommon in patients without human immunodeficiency virus infection, clinical presentation of refractory cellulitis, as seen in the current case, is extremely rare.
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Affiliation(s)
- L M Baddour
- Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center, 1924 Alcoa Hwy, U-114, Knoxville, TN 37920-6999, USA.
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Baddour LM, Googe PB, Prince TL. Possible role of cellular immunity: a case of cellulitis. Clin Infect Dis 2001; 32:E17-21. [PMID: 11106315 DOI: 10.1086/317530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2000] [Revised: 05/23/2000] [Indexed: 11/04/2022] Open
Abstract
On the basis of the observation that there was a "skip" area in an otherwise diffuse drug eruption where cellulitis had previously occurred, it is theorized that both delayed hypersensitivity type of dermatologic drug reaction and cellulitis share pathogenic mechanisms.
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Affiliation(s)
- L M Baddour
- Departments of Medicine and Pathology, University of Tennessee Medical Center, Knoxville, TN 37920-6999, USA.
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Lentino JR, Baddour LM, Wray M, Wong ES, Yu VL. Staphylococcus aureus and other bacteremias in hemodialysis patients: antibiotic therapy and surgical removal of access site. Infection 2000; 28:355-60. [PMID: 11139154 DOI: 10.1007/s150100070005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bacteremia is commonplace in patients undergoing hemodialysis since the vascular access site is a ready source of infection. Mortality is notably high. However, uncertainties exist with respect to therapy including indications for surgical removal of vascular access site and duration of therapy. We therefore conducted a large-scale collaborative study of bacteremia in hemodialysis patients in six US academic medical centers to define the epidemiology of such infections and to address issues of management. PATIENTS AND METHODS We conducted a prospective observational study over 2 years. Severity of illness at onset of bacteremia was defined by objective criteria. Patients were followed for 90 days to assess late complications including endocarditis and mortality. Univariate and multivariate analyses were used to assess risk factors for mortality. RESULTS Patients experiencing 127 consecutive episodes of bacteremia were enrolled. The most common cause of bacteremia was Staphylococcus aureus (31%), followed by aerobic gram-negative bacilli (28%) and coagulase-negative staphylococci (13%). Polymicrobial bacteremia occurred in 6% of patients. The most frequent focus of infection was the access site for hemodialysis, although urinary tract, gastrointestinal tract and lung were also implicated. Aerobic gram-negative bacilli and enterococci usually originated from the urinary tract. S. aureus was significantly more likely to cause infection of the access site than other bacteria (p = 0.0001). S. aureus endocarditis was diagnosed in two patients who were receiving antibiotic therapy for S. aureus bacteremia. Removal of the infected access site (shunt, fistula, catheter) was performed for 86% of the patients (95% of the intravenous catheters and 80% of the arteriovenous fistulas/shunts). Overall mortality was 33% at 90 days and was significantly associated with severity of illness at onset of antibiotic therapy and age >60 years. Mortality was not significantly different in patients undergoing surgical removal of infected access site versus those treated with antibiotics alone. CONCLUSION When S. aureus was isolated from the blood, the access site was the most frequent source. Surgical removal of the access site did not have a notable impact on mortality. Until a randomized trial proves otherwise, it appears that surgical removal of the access site can be individualized. Selected patients who are less severely ill (based on objective criteria) can maintain their hemodialysis access site and be treated with 2 weeks of antibiotic therapy.
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Affiliation(s)
- J R Lentino
- Loyola University Stritch School of Medicine, Hines VA Hospital, IL 60141-5000, USA
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Brewer VH, Hahn KA, Rohrbach BW, Bell JL, Baddour LM. Risk factor analysis for breast cellulitis complicating breast conservation therapy. Clin Infect Dis 2000; 31:654-9. [PMID: 11017810 DOI: 10.1086/314021] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/1999] [Revised: 12/01/1999] [Indexed: 11/03/2022] Open
Abstract
Women who undergo breast conservation therapy for early-stage breast cancer can develop breast cellulitis, a complication for which risk factors are undefined. A matched case-control investigation was conducted to identify risk factors for the development of breast cellulitis among patients who have undergone breast conservation therapy. Patients comprised 17 patients with cases of breast cellulitis diagnosed after partial mastectomies that had been performed from 1992 through 1997 and 34 control patients who were matched to case-patients by date of breast lumpectomy and by primary surgeon. Statistical analyses indicated the following factors were associated with breast cellulitis: drainage of a hematoma (P=.010); postoperative ecchymosis (P=.021); lymphedema (odds ratio [OR], 10. 154; 95% confidence interval [CI], 1.348-208.860); resected breast tissue volume (OR, 1.456; 95% CI, 1.035-2.168); and previous number of breast seroma aspirations (OR, 3.445; 95% CI, 1.036-19.771). This is the first matched case-control study to identify risk factors for the development of breast cellulitis after breast conservation therapy.
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Affiliation(s)
- V H Brewer
- Department of Comparative Medicine, College of Veterinary Medicine, University of Tennessee-Knoxville, and Departments of Surgery and Medicine, University of Tennessee Medical Center at Knoxville, Knoxville, TN 37920, USA
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Baddour LM, Hicks DV, Tayidi MM, Roberts SK, Walker E, Smith RJ, Sweitzer DS, Herrington JA, Painter BG. Risk factor assessment for the acquisition of fluoroquinolone-resistant isolates of Pseudomonas aeruginosa in a community-based hospital. Microb Drug Resist 2000; 1:219-22. [PMID: 9158778 DOI: 10.1089/mdr.1995.1.219] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A case-control study was performed in a community-based nonteaching hospital to assess patient risk factors for the acquisition of fluoroquinolone-resistant isolates of Pseudomonas aeruginosa. Fifty-five patients who were hospitalized between July 1, 1993 and December 31, 1993 and who had P. aeruginosa recovered from a clinical specimen were included in the analysis. Two patient populations were designated based on the fluoroquinolone susceptibility of their P. aeruginosa isolates. Statistical evaluation using univariate analysis of demographic and clinical data from the 42 patients with quinolone-susceptible P. aeruginosa and the 13 patients with quinolone-resistant P. aeruginosa demonstrated that prior receipt of a fluoroquinolone was the only significant risk factor for the subsequent emergence of fluoroquinolone resistance among P. aeruginosa isolated from patients hospitalized in this small community-based institution (p = 0.0196). Multivariate analysis supported the finding that prior receipt of a fluoroquinolone was the major risk factor for the isolation of fluoroquinolone-resistant P. aeruginosa (p = 0.0004); isolation of this Gram-negative bacillus from sputum (p = 0.0306) and a history of recent surgery (p = 0.0058) were also significantly associated as risk factors for resistance.
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Affiliation(s)
- L M Baddour
- Department of Medicine, University of Tennessee Medical Center at Knoxville 37920-6999, USA
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33
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Abstract
Cellulitis is a commonly seen clinical syndrome that is most often associated with beta-haemolytic streptococci and Staphylococcus aureus. Several medical conditions and a variety of procedures can predispose to the development of cellulitis by a common mechanism: venous and lymphatic compromise. The precise pathophysiologic and immunologic details involved in the predisposition to cellulitis remain poorly understood. Therapy is directed at resolution of acute infection and prevention of recurrent episodes of cellulitis.
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Affiliation(s)
- L M Baddour
- Section of Infectious Diseases, Department of Medicine, The University of Tennessee Medical Center at Knoxville, Graduate School of Medicine, 1924 Alcoa Highway U-114, Knoxville, TN 37920-6999, USA.
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34
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Winstead JM, McKinsey DS, Tasker S, De Groote MA, Baddour LM. Meningococcal pneumonia: characterization and review of cases seen over the past 25 years. Clin Infect Dis 2000; 30:87-94. [PMID: 10619738 DOI: 10.1086/313617] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Fifty-eight cases of meningococcal pneumonia were included in this review. Fifty cases previously described in the literature from 1974 through 1998 and 8 new cases were included in this series. The median age of patients was 57.5 years, and pleuritic chest pain was described in 21 (53.9%) of 39 cases. Blood cultures were positive in 42 (79.3%) of 53 cases for which results were mentioned. Despite the presence of bacteremia, patients did not develop the syndrome of meningococcemia with its associated complications. Serogroup Y meningococci were most commonly recovered and accounted for 44.2% of identified isolates. Therapy has dramatically changed over the past 25 years; prior to 1991, penicillin antibiotics were most often used. Since 1991, 12 (80%) of 15 patients received cephalosporin antibiotics. Only 5 (8.62%) of 58 patients died. Secondary cases of meningococcal infections following exposure to patients with meningococcal pneumonia were noted in 2 instances.
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Affiliation(s)
- J M Winstead
- Department of Medicine, University of Tennessee Medical Center at Knoxville, Knoxville, TN 37920-6999, USA
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35
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Baddour LM, Smith EA. Multidrug resistance among Streptococcus pneumoniae isolated at a university hospital in eastern Tennessee. Clin Infect Dis 1999; 29:224-5. [PMID: 10433604 DOI: 10.1086/520173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- L M Baddour
- Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center at Knoxville, 37920-6999, USA.
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36
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Abstract
Immunization has been used for many years to prevent certain infectious diseases. Often it is targeted to populations at increased risk of a particular infection. Patients at increased risk of infective endocarditis can be identified and would be eligible candidates for immunization if vaccines were available to prevent common bacterial causes of infective endocarditis. The idea of using preventive therapy among patients at increased risk of infective endocarditis is not novel, and recommendations for use of antibiotics prior to performing certain invasive procedures have been in place for years. Findings from immunization experiments using animal models of experimental endocarditis support the notion that vaccine development is appropriate for study in humans, and these findings are reviewed in this paper.
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Affiliation(s)
- LM Baddour
- Department of Medicine, Section of Infectious Diseases, Box 114, University of Tennessee Medical Center at Knoxville, 1924 Alcoa Highway, Knoxville, TN 37920-6999, USA
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37
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Abstract
Gram-positive cocci account for the large majority of cases of infective endocarditis. Pathogenesis investigations of endocarditis have therefore focused on purported virulence factors in staphylococci, viridans group streptococci and enterococci. In addition to novel molecular techniques that have been adapted for use in the examination of gram-positive cocci, animal models of experimental endocarditis have been employed to support or discount the role of specific bacterial components in production of infective endocarditis. This review details recent work that addresses endocarditis pathogenesis and highlights pertinent findings from these investigations.
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Affiliation(s)
- L M Baddour
- Department of Medicine, Section of Infectious Diseases, University of Tennesse Medical Centre, Knoxville, TN 37920, USA.
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38
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Baddour LM, Harris E, Huycke MM, Smith AE, Himelright IM. Outbreak of pseudobacteremia due to multidrug-susceptible Enterococcus faecium. Clin Infect Dis 1999; 28:1333-4. [PMID: 10451185 DOI: 10.1086/517791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- L M Baddour
- Department of Medicine, University of Tennessee Medical Center at Knoxville, USA.
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39
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Abstract
Breast conservation therapy has gained acceptance as treatment for limited disease due to breast cancer. Unfortunately, a minority of patients who undergo this therapy will develop cellulitis of the breast, often recurrently, months to years later. A definitive pathogen has not been identified in the large majority of cases reported to date. Whilst some patients develop systemic toxicity with local skin changes of cellulitis, others manifest no fever, chills or leukocytosis. Local breast findings gradually clear with antibiotic treatment: when breast changes persist, non-inflammatory causes, including tumour recurrence, of the breast should be considered. More study is needed to define risk factors for the development of breast cellulitis complicating breast conservation therapy.
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Affiliation(s)
- L M Baddour
- Department of Medicine, University of Tennessee Medical Center at Knoxville, USA.
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40
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Mertz KR, Baddour LM, Bell JL, Gwin JL. Breast cellulitis following breast conservation therapy: a novel complication of medical progress. Clin Infect Dis 1998; 26:481-6. [PMID: 9502474 DOI: 10.1086/516322] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Breast cellulitis is a novel complication of the recently accepted practice of breast conservation therapy. This phenomenon represents an anatomic shift from ipsilateral upper extremity cellulitis seen in past years when mastectomy with axillary lymph node dissection was performed for treatment of limited disease due to breast cancer. Thirteen episodes of breast cellulitis in nine women who underwent breast conservation therapy for stage I or II breast cancer are presented. The mean duration from the end of radiotherapy to the initial episode of cellulitis was 4.9 months. Eighty-three percent of episodes occurred in patients who had radiologically demonstrated fluid collections at the surgical lumpectomy site prior to the onset of cellulitis. Eight (61.5%) of 13 episodes occurred within 3 months of a follow-up mammogram of the treated breast. Two patients developed recurrent cellulitis within a 6-month period. Breast cellulitis may be more commonly seen in clinical practice as an increasing number of patients undergo breast-sparing procedures for treatment of limited disease due to cancer.
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Affiliation(s)
- K R Mertz
- Department of Surgery, The University of Tennessee Graduate School of Medicine, Knoxville 37920, USA
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41
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Baddour LM. Infective endocarditis caused by beta-hemolytic streptococci. The Infectious Diseases Society of America's Emerging Infections Network. Clin Infect Dis 1998; 26:66-71. [PMID: 9455511 DOI: 10.1086/516266] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis caused by beta-hemolytic streptococci is infrequently seen. Members of the Infectious Diseases Society of America's Emerging Infections Network (EIN) were polled for cases of beta-hemolytic streptococcal endocarditis that were seen between 1 January 1994 and 31 December 1996. Thirty-one cases were submitted by 22 members. The patients' ages ranged from 4 months to 79 years, and 18 (58.1%) were males. Prosthetic valve infection occurred in six cases and intravenous drug abuse was noted in only one case. Diabetes mellitus was noted in 10 patients (32.3%). Group B beta-hemolytic streptococci accounted for over two-thirds of isolates (21 [67.7%] of 31). Twenty-five patients (80.7%) developed complications of infective endocarditis, and 15 (48.4%) underwent surgical intervention with valvular revision or excision. Sixty-one percent (19 of 31) received aqueous crystalline penicillin G either as monotherapy or in combination with gentamicin sulfate. In contrast to previously published data, the mortality rate (12.9%) among patients in this survey was remarkably low. There was no infection relapse documented in 16 of the remaining 27 patients for whom posttreatment follow-up information was available.
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Affiliation(s)
- L M Baddour
- Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center at Knoxville 37920-6999, USA
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42
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Pipp ML, Means ND, Sixbey JW, Morris KL, Gue CL, Baddour LM. Acute Epstein-Barr virus infection complicated by severe thrombocytopenia. Clin Infect Dis 1997; 25:1237-9. [PMID: 9402388 DOI: 10.1086/516114] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We describe one patient with acute Epstein-Barr virus (EBV) infection associated with severe thrombocytopenia and review 36 additional cases reported in the literature. Complications of EBV infection due to severe thrombocytopenia occurred in 10 (27.0%) of 37 patients, and 2 (5.4%) of 37 patients died. Although acute EBV infections are generally benign and self-limiting, thrombocytopenia, a potentially serious complication, should not be overlooked.
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Affiliation(s)
- M L Pipp
- Department of Medicine, Graduate School of Medicine, The University of Tennessee Medical Center at Knoxville, 37920-6999, USA
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43
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McFarland JM, Baddour LM, Nelson JE, Elkins SK, Craven RB, Cropp BC, Chang GJ, Grindstaff AD, Craig AS, Smith RJ. Imported yellow fever in a United States citizen. Clin Infect Dis 1997; 25:1143-7. [PMID: 9402373 DOI: 10.1086/516111] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The last imported case of yellow fever seen in this country was in 1924. We report a case of yellow fever acquired by an American tourist who visited the jungles of Brazil along the Rio Negro and Amazon Rivers. The patient died 6 days after hospital admission and 10 days after his first symptoms appeared. Yellow fever virus was recovered from clinical specimens, and the isolate was genetically similar to the E genotype IIB of South American yellow fever viruses. This patient's illness represents a case of vaccine-preventable death since he failed to be immunized with a recommended preexposure yellow fever vaccine.
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Affiliation(s)
- J M McFarland
- Department of Medicine, Graduate School of Medicine, The University of Tennessee Medical Center at Knoxville, 37920-6999, USA
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Baddour LM, Googe PB, Stevens SL. Biopsy specimen findings in patients with previous lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery. J Am Acad Dermatol 1997; 37:246-9. [PMID: 9270511 DOI: 10.1016/s0190-9622(97)80132-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND No previous study has examined the immune and inflammatory mechanisms involved in the pathogenesis of lower extremity cellulitis after saphenous venectomy for coronary artery bypass graft surgery. OBJECTIVE Our purpose was to determine the histopathologic, immunologic, and inflammatory findings in skin biopsy specimens from saphenous venectomy limbs of patients with previous bouts of cellulitis. METHODS Biopsy specimens were obtained from five patients with previous episodes of cellulitis. Specimens of the contralateral lower extremity of each patient were obtained for controlled comparisons. RESULTS Histopathologic findings did not provide evidence that could account for the tendency for cellulitis to develop. Moreover, the distribution of CD1a, HLA-DR, intercellular adhesion molecule-1, and lymphocyte function-associated antigen type 1 were similar in specimens from the postvenectomy and contralateral legs. No tumor necrosis factor-alpha expression was found in specimens from the lower extremities. CONCLUSION The mechanisms responsible for the production of this disorder do not involve the mediators studied.
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Affiliation(s)
- L M Baddour
- Department of Medicine, Graduate School of Medicine, University of Tennessee Medical Center at Knoxville, USA
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46
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Abstract
Middle lobe syndrome is a clinical term used to describe right middle lobe atelectasis with or without bronchial compression. Fungal disease has been implicated rarely as a cause of middle lobe syndrome. This is a patient with Blastomyces dermatitidis infection who presented with right middle lobe syndrome.
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Affiliation(s)
- J D Kinzy
- Department of Medicine, University of Tennessee Medical Center at Knoxville, USA
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47
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Abstract
Most patients with acute cellulitis due to Streptococcus pyogenes have a striking onset of high fever and systemic toxicity. Even if hospitalization is deemed necessary for initial treatment, most patients respond promptly to appropriate antibiotic therapy and can be managed as outpatients for most of the treatment regimen. Described is a 48-year-old, previously healthy woman with acute cellulitis and lymphadenitis who did not initially respond to treatment despite proved in vitro activity against the patient's S. pyogenes isolate. The strain grew as a mucoid colony phenotype on blood agar plates. The mucoid characteristic of the strain may have accounted for the patient's lack of response to initial therapy, and previously published clinical and laboratory data support this impression.
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Affiliation(s)
- L M Baddour
- Department of Medicine, University of Tennessee Medical Center at Knoxville, 37920-6999, USA
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48
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Abstract
Strongyloides stercoralis usually causes chronic asymptomatic infection in humans. However, in patients with AIDS, malignancy, and individuals receiving corticosteroids, disseminated infection can develop, associated with an extremely high mortality rate and frequent treatment failure with thiabendazole. Recently, ivermectin was found to be very effective in such patients. The authors report a case of strongyloidiasis in a patient with hypogammaglobulinemia in which ivermectin failed to clear Strongyloides larvae from stool, despite repeated courses of treatment throughout 14 months.
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Affiliation(s)
- M Ashraf
- Department of Medicine, University of Tennessee Medical Center, Knoxville, USA
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49
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Affiliation(s)
- L M Baddour
- Department of Medicine, Section of Infectious Diseases, Graduate School of Medicine, University of Tennessee Medical Center at Knoxville, USA
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50
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Abstract
Prompt valve replacement is advocated in patients in whom candidal prosthetic valve endocarditis develops. Unfortunately, some patients with this condition are considered nonsurgical candidates, and they are unable to tolerate long-term administration of amphotericin B with or without flucytosine. Herein we describe a patient with Candida parapsilosis-induced prosthetic valve endocarditis in whom oral administration of fluconazole during an 11-month period successfully suppressed the fungal infection. Three previously published cases indicate that long-term noncurative suppressive therapy for C. parapsilosis-induced prosthetic valve endocarditis may allow prolonged symptom-free survival for such patients.
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Affiliation(s)
- L M Baddour
- Section of Infectious Diseases, University of Tennessee Medical Center at Knoxville 37920-6999, USA
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