1
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Heart Rhythm 2024; 21:e1-e29. [PMID: 38466251 DOI: 10.1016/j.hrthm.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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2
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Figgatt MC, Rosen DL, Chu VH, Wu LT, Schranz AJ. Long-term risk of serious infections and mortality among patients surviving drug use-associated infective endocarditis. Clin Infect Dis 2024:ciae214. [PMID: 38642403 DOI: 10.1093/cid/ciae214] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
Among a statewide cohort of 1,874 patients surviving hospitalization for drug use-associated endocarditis during 2017-2020, the 3-year risk of death or future hospitalization was 38% (16% for death prior to later infection, 14% for recurrent endocarditis, 14% for soft-tissue, 9% for bacteremia, 5% for bone/joint, and 4% for spinal infections).
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Affiliation(s)
- Mary C Figgatt
- Department of Medicine, University of Alabama, Birmingham, AL, USA
| | - David L Rosen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Vivian H Chu
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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3
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. J Nucl Cardiol 2024; 34:101786. [PMID: 38472038 DOI: 10.1016/j.nuclcard.2023.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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4
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Clin Infect Dis 2024:ciae046. [PMID: 38466039 DOI: 10.1093/cid/ciae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 03/12/2024] Open
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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5
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. JACC Cardiovasc Imaging 2024:S1936-878X(24)00036-6. [PMID: 38466252 DOI: 10.1016/j.jcmg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Baddour LM, Esquer Garrigos Z, Rizwan Sohail M, Havers-Borgersen E, Krahn AD, Chu VH, Radke CS, Avari-Silva J, El-Chami MF, Miro JM, DeSimone DC. Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association: Endorsed by the International Society for Cardiovascular Infectious Diseases. Circulation 2024; 149:e201-e216. [PMID: 38047353 DOI: 10.1161/cir.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The American Heart Association sponsored the first iteration of a scientific statement that addressed all aspects of cardiovascular implantable electronic device infection in 2010. Major advances in the prevention, diagnosis, and management of these infections have occurred since then, necessitating a scientific statement update. An 11-member writing group was identified and included recognized experts in cardiology and infectious diseases, with a career focus on cardiovascular infections. The group initially met in October 2022 to develop a scientific statement that was drafted with front-line clinicians in mind and focused on providing updated clinical information to enhance outcomes of patients with cardiovascular implantable electronic device infection. The current scientific statement highlights recent advances in prevention, diagnosis, and management, and how they may be incorporated in the complex care of patients with cardiovascular implantable electronic device infection.
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7
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Schranz AJ, Tak C, Wu LT, Chu VH, Wohl DA, Rosen DL. The Impact of Discharge Against Medical Advice on Readmission After Opioid Use Disorder-Associated Infective Endocarditis: a National Cohort Study. J Gen Intern Med 2023; 38:1615-1622. [PMID: 36344644 PMCID: PMC10212894 DOI: 10.1007/s11606-022-07879-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hospitalizations for infective endocarditis (IE) associated with opioid use disorder (O-IE) have increased in the USA and have been linked to high rates of discharge against medical advice (DAMA). DAMA represents a truncation of care for a severe infection, yet patient outcomes after DAMA are unknown. OBJECTIVE This study aimed to assess readmissions following O-IE and quantify the impact of DAMA on outcomes. DESIGN A retrospective study of a nationally representative dataset of persons' inpatient discharges in the USA in 2016 PARTICIPANTS: A total of 6018 weighted persons were discharged for O-IE, stratified by DAMA vs. other discharge statuses. Of these, 1331 (22%) were DAMA. MAIN MEASURES The primary outcome of interest was 30-day readmission rates, stratified by discharge type. We also examined the total number of hospitalizations during the year and estimated the effect of DAMA on readmission. KEY RESULTS Compared with non-DAMA, those experiencing DAMA were more commonly female, resided in metropolitan areas, lower income, and uninsured. Crude 30-day readmission following DAMA was 50%, compared with 21% for other discharge types. DAMA was strongly associated with readmission in an adjusted logistic regression model (OR 3.72, CI 3.02-4.60). Persons experiencing DAMA more commonly had ≥2 more hospitalizations during the period (31% vs. 18%, p<0.01), and were less frequently readmitted at the same hospital (49% vs 64%, p<0.01). CONCLUSIONS DAMA occurs in nearly a quarter of patients hospitalized for O-IE and is strongly associated with short-term readmission. Interventions to address the root causes of premature discharges will enhance O-IE care, reduce hospitalizations and improve outcomes.
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Affiliation(s)
- Asher J Schranz
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Casey Tak
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Vivian H Chu
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - David A Wohl
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - David L Rosen
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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8
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Téllez A, Ambrosioni J, Hernández-Meneses M, Llopis J, Ripa M, Chambers ST, Holland D, Almela M, Fernández-Hidalgo N, Almirante B, Bouza E, Strahilevitz J, Hannan MM, Harkness J, Kanafani ZA, Lalani T, Lang S, Raymond N, Read K, Vinogradova T, Woods CW, Wray D, Moreno A, Chu VH, Miro JM. Clinical characteristics and outcome of infective endocarditis due to Abiotrophia and Granulicatella compared to Viridans group streptococci. J Infect 2022; 85:137-146. [PMID: 35618152 DOI: 10.1016/j.jinf.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/21/2021] [Revised: 12/06/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and outcome of Abiotrophia and Granulicatella infective endocarditis and compare them with Viridans group streptococci infective endocarditis. METHODS All patients in the International Collaboration on Endocarditis (ICE) - prospective cohort study (PCS) and the ICE-PLUS cohort were included (n=8112). Data from patients with definitive or possible IE due to Abiotrophia species, Granulicatella species and Viridans group streptococci was analyzed. A propensity score (PS) analysis comparing the ABI/GRA-IE and VGS-IE groups according to a 1:2 ratio was performed. RESULTS Forty-eight (0.64%) cases of ABI/GRA-IE and 1,292 (17.2%) VGS-IE were included in the analysis. The median age of patients with ABI/GRA-IE was lower than VGS-IE (48.1 years vs. 57.9 years; p=0.001). Clinical features and the rate of in-hospital surgery was similar between ABI/GRA-IE and VGS-IE (52.1% vs. 45.4%; p=0.366). Unadjusted in-hospital death was lower in ABI/GRA-IE than VGS-IE (2.1% vs. 8.8%; p=0.003), and cumulative six-month mortality was lower in ABI/GRA-IE than VGS-IE (2.1% vs. 11.9%; p<0.001). After PS analysis, in-hospital mortality was similar in both groups, but six-month mortality was lower in the ABI/GRA IE group (2.1% vs. 10.4%; p=0.029). CONCLUSIONS Patients with ABI/GRA-IE were younger, had similar clinical features and rates of surgery and better prognosis than VGS-IE.
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Affiliation(s)
- Adrián Téllez
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Jaume Llopis
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; Department of Genetics, Microbiology and Statistics. Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Marco Ripa
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stephen T Chambers
- Department of Pathology, University of Otago, Christchurch and Christchurch Hospital, Christchurch, New Zealand
| | - David Holland
- Infectious Diseases Unit, Middlemore Hospital, Auckland, New Zealand
| | - Manel Almela
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Núria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel
| | - Margaret M Hannan
- Department of Medical Microbiology, Mater Hospitals, Dublin, Ireland
| | - John Harkness
- Department of Microbiology, St. Vincent's, Sydney, New South Wales, Australia
| | - Zeina A Kanafani
- Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, United States of America
| | - Selwyn Lang
- Department of Microbiology, Middlemore Hospital, Auckland, New Zealand
| | - Nigel Raymond
- Department of Infectious Diseases, Wellington Hospital, Wellington, New Zealand
| | - Kerry Read
- Department of Infectious Diseases, North Shore Hospital, Auckland, New Zealand
| | - Tatiana Vinogradova
- Institute of Experimental Cardiology, Russian Medical State University, Moscow, Russia
| | - Christopher W Woods
- Department of Medicine, VA Medical Centre, Durham, North Carolina, United States of America
| | - Dannah Wray
- Infectious Disease Division, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Asuncion Moreno
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian H Chu
- Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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9
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Pericàs JM, Llopis J, Athan E, Hernández-Meneses M, Hannan MM, Murdoch DR, Kanafani Z, Freiberger T, Strahilevitz J, Fernández-Hidalgo N, Lamas C, Durante-Mangoni E, Tattevin P, Nacinovich F, Chu VH, Miró JM. Prospective Cohort Study of Infective Endocarditis in People Who Inject Drugs. J Am Coll Cardiol 2021; 77:544-555. [PMID: 33538252 DOI: 10.1016/j.jacc.2020.11.062] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infective endocarditis (IE) in people who inject drugs (PWID) is an emergent public health problem. OBJECTIVES The purpose of this study was to investigate IE in PWID and compare it with IE in non-PWID patients. METHODS Two prospective cohort studies (ICE-PCS and ICE-Plus databases, encompassing 8,112 IE episodes from 2000 to 2006 and 2008 to 2012, with 64 and 34 sites and 28 and 18 countries, respectively). Outcomes were compared between PWID and non-PWID patients with IE. Logistic regression analyses were performed to investigate risk factors for 6-month mortality and relapses amongst PWID. RESULTS A total of 7,616 patients (591 PWID and 7,025 non-PWID) were included. PWID patients were significantly younger (median 37.0 years [interquartile range: 29.5 to 44.2 years] vs. 63.3 years [interquartile range: 49.3 to 74.0 years]; p < 0.001), male (72.5% vs. 67.4%; p = 0.007), and presented lower rates of comorbidities except for human immunodeficiency virus, liver disease, and higher rates of prior IE. Amongst IE cases in PWID, 313 (53%) episodes involved left-side valves and 204 (34.5%) were purely left-sided IE. PWID presented a larger proportion of native IE (90.2% vs. 64.4%; p < 0.001), whereas prosthetic-IE and cardiovascular implantable electronic device-IE were more frequent in non-PWID (9.3% vs. 27.0% and 0.5% vs. 8.6%; both p < 0.001). Staphylococcus aureus caused 65.9% and 26.8% of cases in PWID and non-PWID, respectively (p < 0.001). PWID presented higher rates of systemic emboli (51.1% vs. 22.5%; p < 0.001) and persistent bacteremia (14.7% vs. 9.3%; p < 0.001). Cardiac surgery was less frequently performed (39.5% vs. 47.8%; p < 0.001), and in-hospital and 6-month mortality were lower in PWID (10.8% vs. 18.2% and 14.4% vs. 22.2%; both p < 0.001), whereas relapses were more frequent in PWID (9.5% vs. 2.8%; p < 0.001). Prior IE, left-sided IE, polymicrobial etiology, intracardiac complications, and stroke were risk factors for 6-month mortality, whereas cardiac surgery was associated with lower mortality in the PWID population. CONCLUSIONS A notable proportion of cases in PWID involve left-sided valves, prosthetic valves, or are caused by microorganisms other than S. aureus.
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Affiliation(s)
- Juan M Pericàs
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - Eugene Athan
- Department of Infectious Disease, Barwon Health and Deakin University, Geelong, Australia
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Margaret M Hannan
- Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Zeina Kanafani
- Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristiane Lamas
- Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil
| | | | - Pierre Tattevin
- Infectious diseases and intensive care unit, Pontchaillou University Hospital, Rennes, France
| | | | - Vivian H Chu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - José M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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10
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Fosbøl EL, Park LP, Chu VH, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Barsic B, Giannitsioti E, Hurley JP, Hannan MM, Wang A. The association between vegetation size and surgical treatment on 6-month mortality in left-sided infective endocarditis. Eur Heart J 2020; 40:2243-2251. [PMID: 30977784 DOI: 10.1093/eurheartj/ehz204] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/18/2018] [Accepted: 03/25/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS In left-sided infective endocarditis (IE), a large vegetation >10 mm is associated with higher mortality, yet it is unknown whether surgery during the acute phase opposed to medical therapy is associated with improved survival. We assessed the association between surgery and 6-month mortality as related to vegetation size. METHODS AND RESULTS Patients with definite, left-sided IE (2008-2012) from The International Collaboration on Endocarditis prospective, multinational registry were included. We compared clinical characteristics and 6-month mortality (by Cox regression with inverse propensity of treatment weighting) between patients with vegetation size ≤10 mm vs. >10 mm in maximum length by surgical treatment strategy. A total of 1006 patients with left sided IE were included; 422 with a vegetation size ≤10 mm (median age 66.0 years, 33% women) and 584 (median age 58.4 years, 34% women) patients with a large vegetation >10 mm. Operative risk by STS-IE score was similar between groups. Embolic events occurred in 28.4% vs. 44.3% (P < 0.001), respectively. Patients with a vegetation >10 mm was associated with higher 6-month mortality (25.1% vs. 19.4% for small vegetation, P = 0.035). However, after propensity adjustment, the association with higher mortality persisted only in patients with a large vegetation >10 mm vs. ≤10 mm: hazard ratio (HR) 1.55 (1.27-1.90); but only in patients with large vegetation managed medically [HR 1.86 (1.48-2.34)] rather than surgically [HR 1.01 (0.69-1.49)]. CONCLUSION Left-sided IE with vegetation size >10 mm was associated with an increased mortality at 6 months in this observational study but was dependent on treatment strategy. For patients with large vegetation undergoing surgical treatment, survival was similar to patients with smaller vegetation size.
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Affiliation(s)
- Emil L Fosbøl
- Duke University Medical Center, Durham, NC, USA.,Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Eugene Athan
- Barwon Health and Deakin University, Geelong, Australia
| | | | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Cristiane Lamas
- Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Christophe Tribouilloy
- University Hospital, Amiens, France.,INSERM U-1088, University of Picardie, Amiens, France
| | | | - Juan M Pericas
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Bruno Barsic
- School of Medicine University of Zagreb, Hospital for Infectious Diseases, Zagreb, Croatia
| | | | - John P Hurley
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Andrew Wang
- Duke University Medical Center, Durham, NC, USA
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11
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Fernández Hidalgo N, Gharamti AA, Aznar ML, Almirante B, Yasmin M, Fortes CQ, Plesiat P, Doco-Lecompte T, Rizk H, Wray D, Lamas C, Durante-Mangoni E, Tattevin P, Snygg-Martin U, Hannan MM, Chu VH, Kanafani ZA. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multinational Cohort. Open Forum Infect Dis 2020; 7:ofaa120. [PMID: 32462042 PMCID: PMC7240340 DOI: 10.1093/ofid/ofaa120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/08/2020] [Indexed: 12/02/2022] Open
Abstract
Background Beta-hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with BHS IE in a large multinational cohort and compare them with patients with viridans streptococcal IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multinational database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form developed by ICE collaborators. Results Among 1336 definite cases of streptococcal IE, 823 were caused by VGS and 147 by BHS. Patients with BHS IE had a lower prevalence of native valve (P < .005) and congenital heart disease predisposition (P = .002), but higher prevalence of implantable cardiac device predisposition (P < .005). Clinically, they were more likely to present acutely (P < .005) and with fever (P = .024). BHS IE was more likely to be complicated by stroke and other systemic emboli (P < .005). The overall in-hospital mortality of BHS IE was significantly higher than that of VGS IE (P = .001). In univariate analysis, variables associated with in-hospital mortality for BHS IE were age (odds ratio [OR], 1.044; P = .004), prosthetic valve IE (OR, 3.029; P = .022), congestive heart failure (OR, 2.513; P = .034), and stroke (OR, 3.198; P = .009). Conclusions BHS IE is characterized by an acute presentation and higher rate of stroke, systemic emboli, and in-hospital mortality than VGS IE. Implantable cardiac devices as a predisposing factor were more often found in BHS IE compared with VGS IE.
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Affiliation(s)
| | - Amal A Gharamti
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | | | - Mohamad Yasmin
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | | | | | | | | - Dannah Wray
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cristiane Lamas
- Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil
| | | | | | | | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina, USA
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12
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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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Wang A, Chu VH, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Barsic B, Giannitsioti E, Hurley JP, Hannan MM, Park LP. Corrigendum to "association between the timing of surgery for complicated, left-sided infective endocarditis and survival", American HeartJournal 2019, volume 210, April 2019, pages 108-116. Am Heart J 2019; 212:165. [PMID: 31003633 DOI: 10.1016/j.ahj.2019.03.006] [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: 10/27/2022]
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14
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Chu VH. Device-Associated Infections. Infect Dis Clin North Am 2019; 32:ix-x. [PMID: 30390739 DOI: 10.1016/j.idc.2018.09.001] [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: 11/24/2022]
Affiliation(s)
- Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Duke Box 102359, Durham, NC 27710, USA.
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15
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Hannan MM, Xie R, Cowger J, Schueler S, de By T, Dipchand AI, Chu VH, Cantor RS, Koval CE, Krabatsch T, Hayward CS, Nakatani T, Kirklin JK. Epidemiology of infection in mechanical circulatory support: A global analysis from the ISHLT Mechanically Assisted Circulatory Support Registry. J Heart Lung Transplant 2019; 38:364-373. [PMID: 30733158 DOI: 10.1016/j.healun.2019.01.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 10/05/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite advances in device technology and treatment strategies, infection remains a major cause of adverse events (AEs) in mechanical circulatory support (MCS) patients. To characterize the epidemiology of MCS infection, we examined the type, location, and timing of infection in the International Society for Heart and Lung Transplantation Registry (ISHLT) for Mechanically Assisted Circulatory Support (IMACS) over 3 years, 2013 to 2015. METHODS Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) definitions were used to categorize AE infections occurring in MCS patients within IMACS. The IMACS infection variables were mapped to ISHLT definitions for infection where feasible. Three categories of MCS infection were defined as ventricular assist device (VAD) specific, VAD related, and non-VAD. RESULTS There were 10,171 patients enrolled from January 2013 through December 2015. Infection was the most common AE, with 3,788 patients (37%) experiencing ≥ 1 infection, and 6,758 AE infections reported overall. Non-VAD infection was the largest category, 4,501: 34.0% pneumonias, 30.6% non-VAD-related bloodstream infections (BSIs), 24.15% urinary tract infections (UTIs), and 10.2% gastrointestinal infections. VAD-specific infection was the second largest category, 1,756: 82.9% driveline, 12.8% pocket, and 4.3% pump/or cannula infections. VAD-related infection was the smallest category, 501: 47.5% BSIs, 47.5% mediastinitis, and 5.0% mediastinitis/pocket infections. All 3 categories were more frequently reported ≤ 3 months after implant. CONCLUSIONS Non-VAD infection, including pneumonia, BSI, UTI, and gastrointestinal infection, was the leading category of infection in MCS patients and the most frequently reported ≤ 3 months after implant. These results provide evidence to support resourcing and strengthening infection prevention strategy early after implantation in MCS.
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Affiliation(s)
- Margaret M Hannan
- Department of Clinical Microbiology, Mater Misercordiae University Hospital, University College Dublin, Dublin, Ireland.
| | - Rongbing Xie
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
| | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, Michigan
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Theo de By
- EUROMACS, EACTS, Windsor, United Kingdom
| | - Anne I Dipchand
- Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | - Ryan S Cantor
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
| | - Christine E Koval
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Krabatsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum, Berlin, Germany
| | - Christopher S Hayward
- Heart Failure and Transplant Unit, Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - James K Kirklin
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham, Alabama
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Schranz AJ, Fleischauer A, Chu VH, Wu LT, Rosen DL. Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Ann Intern Med 2019; 170:31-40. [PMID: 30508432 PMCID: PMC6548681 DOI: 10.7326/m18-2124] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown. Objective To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery, patient characteristics, length of stay, and charges. Design 10-year analysis of a statewide hospital discharge database. Setting North Carolina hospitals, 2007 to 2017. Patients All patients aged 18 years or older hospitalized for IE. Measurements Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition, and charges. Results Of 22 825 IE hospitalizations, 2602 (11%) were for DUA-IE. Valve surgery was performed in 1655 IE hospitalizations (7%), including 285 (17%) for DUA-IE. Annual DUA-IE hospitalizations increased from 0.92 to 10.95 and DUA-IE hospitalizations with surgery from 0.10 to 1.38 per 100 000 persons. In the final year, 42% of IE valve surgeries were performed in patients with DUA-IE. Compared with other surgical patients with IE, those with DUA-IE were younger (median age, 33 vs. 56 years), were more commonly female (47% vs. 33%) and white (89% vs. 63%), and were primarily insured by Medicaid (38%) or uninsured (35%). Hospital stays for DUA-IE were longer (median, 27 vs. 17 days), with higher median charges ($250 994 vs. $198 764). Charges for 282 DUA-IE hospitalizations exceeded $78 million. Limitation Reliance on administrative data and billing codes. Conclusion DUA-IE hospitalizations and valve surgeries increased more than 12-fold, and nearly half of all IE valve surgeries were performed in patients with DUA-IE. The swell of patients with DUA-IE is reshaping the scope, type, and financing of health care resources needed to effectively treat IE. Primary Funding Source National Institutes of Health.
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Affiliation(s)
- Asher J. Schranz
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
| | - Aaron Fleischauer
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention
| | - Vivian H. Chu
- Division of Infectious Diseases, Duke University School of Medicine
| | - Li-Tzy Wu
- Departments of Psychiatry and Behavioral Sciences and Medicine, Duke University School of Medicine
- Duke Clinical Research Institute, Duke University Medical Center
- Center for Child and Family Policy, Duke University
| | - David L. Rosen
- Division of Infectious Diseases, University of North Carolina at Chapel Hill
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Chu VH. Device-Associated Infections. Infect Dis Clin North Am 2018. [DOI: 10.1016/s0891-5520(18)30078-3] [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: 11/16/2022]
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Fernandez-Hidalgo N, Gharamti A, Aznar ML, Chu VH, Rizk H, Kanafani Z. 1048. Beta-Hemolytic Streptococcal Infective Endocarditis: Characteristics and Outcomes From a Large, Multi-National Cohort. Open Forum Infect Dis 2018. [PMCID: PMC6253808 DOI: 10.1093/ofid/ofy210.885] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background β-Hemolytic streptococci (BHS) are an uncommon cause of infective endocarditis (IE). The aim of this study was to describe the clinical features and outcomes of patients with β-hemolytic streptococcal infective endocarditis in a large multi-national cohort, and compare them to patients with oral Viridans IE, a more common cause of IE. Methods The International Collaboration on Endocarditis Prospective Cohort Study (ICE-PCS) is a large multi-national database that recruited patients with IE prospectively using a standardized data set. Sixty-four sites in 28 countries reported patients prospectively using a standard case report form (CRF) developed by ICE collaborators. Patients with BHS IE were compared with patients with IE due to Oral Viridans Streptococci (OVS). Results Among 1336 cases of streptococcal IE, 823 (62%) were caused by OVS and 147 (11%) by BHS. The majority of patients in both groups belonged to the male gender and had similar median age. Among the predisposing conditions, congenital heart disease and native valve predisposition were more commonly associated with OVS IE than with BHS IE (P < 0.005). The presence of endocavitary cardiac device is associated more with BHS IE than with OVS IE (P = 0.026). BHS were more likely to be penicillin-susceptible than OVS (P = 0.001). Clinically, patients with BHS IE are more likely to present acutely (P < 0.005) and with fever (P = 0.024). BHS IE is more likely to be complicated by stroke (P < 0.005) and other systemic embolism (P < 0.005). The overall in-hospital mortality of BHS IE was significantly higher than that of OVS IE (P = 0.001). The independent factors associated with in-hospital mortality for β-hemolytic streptococcal IE were age, per 1-year increment (OR 1.044; CI 1.014–1.075; P = 0.004) and prosthetic valve IE (OR 3.029; CI 1.171–7.837; P = 0.022). The complications associated with a higher in-hospital mortality were CHF (OR 2.513; CI 1.074–5.879; P = 0.034), especially CHF NYHA III or IV (OR 4.136; CI 1.707–10.025; P = 0.002), and stroke (OR 3.198; CI 1.343–7.619; P = 0.009). Conclusion Our findings suggest that BHS IE is an aggressive disease characterized by an acute presentation. It is associated with a significant rate of complications and a high rate of in-hospital mortality. This underlines the importance of early surgery to prevent the progression of disease. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Amal Gharamti
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon, Beirut, Lebanon
| | - María Luisa Aznar
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina
| | | | - Zeina Kanafani
- Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Schranz A, Fleischauer A, Chu VH, Rosen D. 155. Infective Endocarditis and Cardiac Valve Surgery During the Opioid Epidemic in North Carolina, 2007 to 2017. Open Forum Infect Dis 2018. [PMCID: PMC6252661 DOI: 10.1093/ofid/ofy209.025] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Infective endocarditis (IE) associated with drug use (DA-IE) is rising nationally. North Carolina (NC), a state hard-hit by the opioid epidemic, saw an over 12-fold increase in DA-IE from 2010 to 2015. Concerns about surgery exist due to the risk of ongoing drug use and reinfection after valvuloplasty. We evaluated trends, characteristics, and outcomes of valve surgery for DA-IE, compared with IE not associated with drug use (non-DA-IE), in NC. Methods We analyzed the NC Discharge Database, which includes administrative data from all hospital discharges in NC. Using International Classification of Diseases codes, we identified all persons ≥18 years of age with IE from July 1, 2007 to June 30, 2017. Hospitalizations were deemed DA-IE by a diagnosis code related to illicit drug use, dependence, poisoning or withdrawal (excepting marijuana), or Hepatitis C in a person born after 1965. All others were labeled non-DA-IE. Procedure codes were queried to identify cardiac valve surgery. Year-to-year trends in surgery for IE by drug-associated status were reported. Demographics, length of stay (LOS), charges, and disposition were compared among DA-IE and non-DA-IE. Results A total of 22,809 hospitalizations were coded for IE. Valve surgery occurred in 1,652. Of surgical hospitalizations, 17% overall and 42% in the final study year were DA-IE. Hospitalizations for DA-IE where surgery was done increased from <10 through 2012–2013 to 109 in 2016–2017 (figure). Compared with non-DA-IE, those undergoing surgery for DA-IE were younger (median age 33 vs. 56), female (47% vs. 33%), White (89% vs. 64%), uninsured (34% vs. 11%), insured by Medicaid (39% vs. 13%), and had tricuspid valve surgery (38% vs. 11%). DA-IE had longer median LOS (27 vs. 17 days) and were less often discharged home (51% vs. 59%). For the 287 DA-IE admissions with surgery, median hospital charges were $247,524, totaling over $79,000,000. All comparisons were significant at P < 0.0001. Conclusion From 2007 to 2017, valve surgeries for DA-IE in NC rose over tenfold and are approaching half of all surgeries for IE. This phenomenon is an underappreciated and morbid component of the opioid epidemic that burdens hospital and state resources. Research into best practices for managing patients with DA-IE and addressing addiction in this setting is critically needed. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Asher Schranz
- Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina
| | - David Rosen
- Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
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Affiliation(s)
- Andrew Wang
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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Thornhill MH, Gibson TB, Cutler E, Dayer MJ, Chu VH, Lockhart PB, O'Gara PT, Baddour LM. Antibiotic Prophylaxis and Incidence of Endocarditis Before and After the 2007 AHA Recommendations. J Am Coll Cardiol 2018; 72:2443-2454. [PMID: 30409564 DOI: 10.1016/j.jacc.2018.08.2178] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The American Heart Association updated its recommendations for antibiotic prophylaxis (AP) to prevent infective endocarditis (IE) in 2007, advising that AP cease for those at moderate risk of IE, but continue for those at high risk. OBJECTIVES The authors sought to quantify any change in AP prescribing and IE incidence. METHODS High-risk, moderate-risk, and unknown/low-risk individuals with linked prescription and Medicare or commercial health care data were identified in the Truven Health MarketScan databases from May 2003 through August 2015 (198,522,665 enrollee-years of data). AP prescribing and IE incidence were evaluated by Poisson model analysis. RESULTS By August 2015, the 2007 recommendation change was associated with a significant 64% (95% confidence interval [CI]: 59% to 68%) estimated fall in AP prescribing for moderate-risk individuals and a 20% (95% CI: 4% to 32%) estimated fall for those at high risk. Over the same period, there was a barely significant 75% (95% CI: 3% to 200%) estimated increase in IE incidence among moderate-risk individuals and a significant 177% estimated increase (95% CI: 66% to 361%) among those at high risk. In unknown/low-risk individuals, there was a significant 52% (95% CI: 46% to 58%) estimated fall in AP prescribing, but no significant increase in IE incidence. CONCLUSIONS AP prescribing fell among all IE risk groups, particularly those at moderate risk. Concurrently, there was a significant increase in IE incidence among high-risk individuals, a borderline significant increase in moderate-risk individuals, and no change for those at low/unknown risk. Although these data do not establish a cause-effect relationship between AP reduction and IE increase, the fall in AP prescribing in those at high risk is of concern and, coupled with the borderline increase in IE incidence among those at moderate risk, warrants further investigation.
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Affiliation(s)
- Martin H Thornhill
- Unit of Oral & Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom; Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina.
| | - Teresa B Gibson
- Truven Health Analytics/IBM Watson Health, Ann Arbor, Michigan
| | - Eli Cutler
- Truven Health Analytics/IBM Watson Health, Ann Arbor, Michigan
| | - Mark J Dayer
- Department of Cardiology, Taunton and Somerset NHS Trust, Taunton, Somerset, United Kingdom
| | - Vivian H Chu
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina
| | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
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Holland TL, Raad I, Boucher HW, Anderson DJ, Cosgrove SE, Aycock PS, Baddley JW, Chaftari AM, Chow SC, Chu VH, Carugati M, Cook P, Corey GR, Crowley AL, Daly J, Gu J, Hachem R, Horton J, Jenkins TC, Levine D, Miro JM, Pericas JM, Riska P, Rubin Z, Rupp ME, Schrank J, Sims M, Wray D, Zervos M, Fowler VG. Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial. JAMA 2018; 320:1249-1258. [PMID: 30264119 PMCID: PMC6233609 DOI: 10.1001/jama.2018.13155] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The appropriate duration of antibiotics for staphylococcal bacteremia is unknown. OBJECTIVE To test whether an algorithm that defines treatment duration for staphylococcal bacteremia vs standard of care provides noninferior efficacy without increasing severe adverse events. DESIGN, SETTING, AND PARTICIPANTS A randomized trial involving adults with staphylococcal bacteremia was conducted at 16 academic medical centers in the United States (n = 15) and Spain (n = 1) from April 2011 to March 2017. Patients were followed up for 42 days beyond end of therapy for those with Staphylococcus aureus and 28 days for those with coagulase-negative staphylococcal bacteremia. Eligible patients were 18 years or older and had 1 or more blood cultures positive for S aureus or coagulase-negative staphylococci. Patients were excluded if they had known or suspected complicated infection at the time of randomization. INTERVENTIONS Patients were randomized to algorithm-based therapy (n = 255) or usual practice (n = 254). Diagnostic evaluation, antibiotic selection, and duration of therapy were predefined for the algorithm group, whereas clinicians caring for patients in the usual practice group had unrestricted choice of antibiotics, duration, and other aspects of clinical care. MAIN OUTCOMES AND MEASURES Coprimary outcomes were (1) clinical success, as determined by a blinded adjudication committee and tested for noninferiority within a 15% margin; and (2) serious adverse event rates in the intention-to-treat population, tested for superiority. The prespecified secondary outcome measure, tested for superiority, was antibiotic days among per-protocol patients with simple or uncomplicated bacteremia. RESULTS Among the 509 patients randomized (mean age, 56.6 [SD, 16.8] years; 226 [44.4%] women), 480 (94.3%) completed the trial. Clinical success was documented in 209 of 255 patients assigned to algorithm-based therapy and 207 of 254 randomized to usual practice (82.0% vs 81.5%; difference, 0.5% [1-sided 97.5% CI, -6.2% to ∞]). Serious adverse events were reported in 32.5% of algorithm-based therapy patients and 28.3% of usual practice patients (difference, 4.2% [95% CI, -3.8% to 12.2%]). Among per-protocol patients with simple or uncomplicated bacteremia, mean duration of therapy was 4.4 days for algorithm-based therapy vs 6.2 days for usual practice (difference, -1.8 days [95% CI, -3.1 to -0.6]). CONCLUSIONS AND RELEVANCE Among patients with staphylococcal bacteremia, the use of an algorithm to guide testing and treatment compared with usual care resulted in a noninferior rate of clinical success. Rates of serious adverse events were not significantly different, but interpretation is limited by wide confidence intervals. Further research is needed to assess the utility of the algorithm. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01191840.
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Affiliation(s)
- Thomas L. Holland
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Issam Raad
- The University of Texas MD Anderson Cancer Center, Houston
| | | | | | - Sara E. Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Vivian H. Chu
- Duke University Medical Center, Durham, North Carolina
| | - Manuela Carugati
- Duke University Medical Center, Durham, North Carolina
- San Gerardo Hospital, Monza, Italy
| | - Paul Cook
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | | | - Jennifer Daly
- University of Massachusetts Medical School, Worcester
| | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ray Hachem
- The University of Texas MD Anderson Cancer Center, Houston
| | - James Horton
- Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Jose M. Miro
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan M. Pericas
- Hospital Clinic–IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary Rubin
- David Geffen School of Medicine, University of California at Los Angeles
| | | | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston
| | | | - Vance G. Fowler
- Duke University Medical Center, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Abstract
Infections associated with cardiac implantable electronic devices are increasing and are associated with significant morbidity and mortality. This article reviews the epidemiology, microbiology, and risk factors for acquisition of these infections. The complex diagnostic and management strategies associated with these serious infections are reviewed with an emphasis on recent updates and advances, as well as existing controversies. Additionally, the latest in preventative strategies are reviewed.
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Affiliation(s)
- Christopher J Arnold
- Division of Infectious Diseases and International Health, University of Virginia Health System, PO Box 800545, Charlottesville, VA 22908-0545, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Hospital, Duke Box 102359, Durham, NC 27710, USA.
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Abstract
IMPORTANCE Infective endocarditis occurs in approximately 15 of 100 000 people in the United States and has increased in incidence. Clinicians must make treatment decisions with respect to prophylaxis, surgical management, specific antibiotics, and the length of treatment in the setting of emerging, sometimes inconclusive clinical research findings. OBSERVATIONS Community-associated infective endocarditis remains the predominant form of the disease; however, health care accounts for one-third of cases in high-income countries. As medical interventions are increasingly performed on older patients, the disease incidence from cardiac implanted electronic devices is also increasing. In addition, younger patients involved with intravenous drug use has increased in the past decade and with it the proportion of US hospitalization has increased to more than 10%. These epidemiological factors have led to Staphylococcus aureus being the most common cause in high-income countries, accounting for up to 40% of cases. The mainstays of diagnosis are still echocardiography and blood cultures. Adjunctive imaging such as cardiac computed tomographic and nuclear imaging can improve the sensitivity for diagnosis when echocardiography is not conclusive. Serological studies, histopathology, and polymerase chain reaction assays have distinct roles in the diagnosis of infective endocarditis when blood culture have tested negative with the highest yield obtained from serological studies. Increasing antibiotic resistance, particularly to S aureus, has led to a need for different antibiotic treatment options such as newer antibiotics and combination therapy regimens. Surgery can confer a survival benefit to patients with major complications; however, the decision to pursue surgery must balance the risks and benefits of operations in these frequently high-risk patients. CONCLUSIONS AND RELEVANCE The epidemiology and management of infective endocarditis are continually changing. Guidelines provide specific recommendations about management; however, careful attention to individual patient characteristics, pathogen, and risk of sequela must be considered when making therapeutic decisions.
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Affiliation(s)
- Andrew Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Aslam S, Xie R, Cowger J, Kirklin JK, Chu VH, Schueler S, de By T, Gould K, Morrissey O, Lund LH, Martin S, Goldstein D, Hannan M. Bloodstream infections in mechanical circulatory support device recipients in the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support Registry: Epidemiology, risk factors, and mortality. J Heart Lung Transplant 2018; 37:1013-1020. [PMID: 29936085 DOI: 10.1016/j.healun.2018.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 11/10/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We used multicenter international data from the International Society of Heart and Lung Transplantation Mechanically Assisted Circulation Support (IMACS) registry to determine bloodstream infection (BSI) event rate, independent risk factors, and association with mortality. METHODS Included were patients registered in IMACS from January 2013 through December 2015, assessed BSI event rate of mechanical circulatory support (MCS) and non-MCS-related BSIs, and conducted univariate and multivariate analyses between BSI with baseline characteristics and mortality. RESULTS We documented 1,606 BSIs in 1,231 of 10,171 MCS recipients (12%), with an event rate of 2.43 BSIs/100 patient-months within 3 months after implant (early onset) and 1.03 BSIs/100 patient-months after 3 months (late onset). Of these episodes, 1,378 (85.8%) were non- MCS-related BSI. Increasing body mass index and bilirubin were independent correlates of MCS-related BSI. Independent correlates of non-MCS-related BSI included older age, higher body mass index, previous cardiac surgery, baseline chronic renal disease and dialysis, pre-implant frailty, presence of biventricular assist device, total artificial heart or right ventricular assist device, and Interagency Registry for Mechanically Assisted Circulatory Support category 1. Survival after 3 months after implant of patients who developed early-onset BSI was 56.9% at 24 months vs 77.4% in patients without early-onset BSI (p < 0.001). Early-onset BSI was an independent correlate of mortality at 3 months after implantation (hazard ratio, 2.56; 95% confidence interval, 2.09-3.15; p < 0.001). CONCLUSIONS Early-onset BSI was associated with significantly increased 24-month mortality. More than 85% of these BSIs were not device related. There is an opportunity for infection prevention practices to decrease the BSI event rate, which may affect 24-month survival. These data can also serve as benchmarking for individual institutions.
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Affiliation(s)
- Saima Aslam
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, La Jolla, California.
| | - Rongbing Xie
- James and John Kirklin Institute for Research in Surgical Outcomes (KIRSO), Division of Cardiothoracic Surgery, Department of Surgery, The University of Alabama at Birmingham, Alabama
| | - Jennifer Cowger
- Division of Cardiovascular Medicine, Henry Ford Hospitals, Detroit, Michigan
| | - James K Kirklin
- Division of Cardiothoracic Surgery. Director, Kirklin Institute for Research in Surgical Outcomes (KIRSO), Department of Surgery, University of Alabama at Birmingham, Alabama
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Stephan Schueler
- Department of Cardiothoracic Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Theo de By
- QUIP Project Manager, EUROMACS Managing Director, EUROMACS, Berlin, Germany
| | - Kate Gould
- Department of Microbiology, Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Orla Morrissey
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Lars H Lund
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stanley Martin
- Division of Infectious Diseases. Geisinger Health System, Danville, Pennsylvania
| | - Daniel Goldstein
- Department of Cardiothoracic Surgery, Montefiore Medical Center, New York, New York
| | - Margaret Hannan
- Division of Infectious Diseases, Mater Miscordiae University Hospital, Dublin, Ireland
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Holland TL, Boucher HW, Raad I, Anderson DJ, Cosgrove SE, Aycock S, Baddley JW, Chow SC, Chu VH, Cook PP, Corey GR, Daly JS, Hachem RY, Chaftari AM, Horton JM, Jenkins TC, Gu J, Levine DP, Miro JM, Riska P, Rubin ZA, Rupp ME, Schrank J, Sims M, Wray D, Zervos MJ, Fowler V. Doing the Same with Less: A Randomized, Multinational, Open-Label, Adjudicator-Blinded Trial of an Algorithm vs. Standard of Care to Determine Treatment Duration for Staphylococcal Bacteremia. Open Forum Infect Dis 2017. [PMCID: PMC5632232 DOI: 10.1093/ofid/ofx162.072] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The appropriate duration of antibiotics for staphylococcal bloodstream infection (BSI) is unknown. An algorithm to identify patients with staphylococcal BSI who can be safely treated with shorter courses of therapy would improve care and reduce total antibiotic use.
Methods
Adult patients with staphylococcal BSI were randomized to treatment based on algorithm-based therapy (ABT) or to standard of care (SOC). Co-primary outcomes were clinical success, as determined by a blinded Adjudication Committee, and serious adverse event (SAE) rates. The prespecified secondary outcome measure was antibiotic days by treatment group, among patients without complicated BSI. Prespecified durations of therapy in ABT were: S. aureus BSI (SAB): uncomplicated: 14 days; complicated: 4–6 weeks. Coagulase-negative staphylococci BSI (CoNSB): simple (1 positive blood culture) (0–3 days), uncomplicated (>1 positive blood culture) (5 days), complicated (7–28 days). Outcomes were compared using intention-to-treat principles. The target sample size was 500 patients, to ensure 90% power for establishing noninferiority within a margin of 15%.
Results
Between April 2011 and March 2017, 509 adults with suspected staphylococcal BSI at 16 sites in the US and Spain were randomized to ABT (N = 255) or SOC (N = 254). There were 116 patients with SAB (23%) and 385 (76%) with CoNSB (Figure 1). Overall success rate in the ABT group was 82.0% vs. 81.5% in the SOC group, difference 0.5%, 95% CI −5.2% to 6.1%. SAEs were reported in 32.9% of ABT vs. 28.3% of SOC patients (OR 1.2, 95% CI 0.9 to 1.8). Among evaluable patients without complicated BSI, mean duration of therapy was 4.4 days in the ABT group vs. 6.4 days in the SOC group (difference −2.0 days, 95% CI −3.3 to −-0.7, P = 0.003). Among patients with uncomplicated SAB, treatment durations were similar (15.3 days in ABT vs. 16.3 days in SOC, difference −1 day, 95% CI −3.89 to 1.91, P = 0.497), whereas for uncomplicated CoNSB, duration was shorter in the ABT group (5.3 days in ABT vs. 8.4 days in SOC, difference −3 days, 95% CI −4.87 to −1.34, P < 0.001).
Conclusion
The use of a treatment algorithm for staphylococcal BSI was associated with significant reductions in duration of antibiotic therapy in patients without complicated BSI, without significant differences in overall success or SAEs.
Disclosures
V. Fowler Jr., NIH: Investigator, Contract HHSN272200900023C
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Affiliation(s)
| | | | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
| | | | - Suzanne Aycock
- Duke Clinical Research Institute, Durham, North Carolina
| | - John W Baddley
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Vivian H Chu
- Duke University Medical Center, Durham, North Carolina
| | - Paul P Cook
- Infectious Diseases, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - G Ralph Corey
- Duke University Medical Center, Durham, North Carolina
| | - Jennifer S Daly
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Ray Y Hachem
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | | | | | - Jiezhun Gu
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Jose M Miro
- Hospital Clinic-IDIBAPS, Barcelona, Spain
- Hospital Clínic-IDIBAPS. University of Barcelona, Barcelona, Spain
| | - Paul Riska
- Albert Einstein College of Medicine, Bronx, New York
| | - Zachary A Rubin
- David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
| | - Mark E Rupp
- Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
| | - John Schrank
- Greenville Health System, Greenville, South Carolina
| | | | - Dannah Wray
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Vance Fowler
- Duke University Medical Center, Durham, North Carolina
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Pericàs JM, Messina JA, Garcia-de-la-Mària C, Park L, Sharma-Kuinkel BK, Marco F, Wray D, Kanafani ZA, Carugati M, Durante-Mangoni E, Tattevin P, Chu VH, Moreno A, Fowler VG, Miró JM. Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis. Clin Microbiol Infect 2017; 23:544-549. [PMID: 28159672 DOI: 10.1016/j.cmi.2017.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/19/2017] [Accepted: 01/22/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. METHODS All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal β-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes and multiplex PCR for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and 1-year mortality, and vancomycin MIC phenotype. RESULTS Sixty-two cases met the inclusion criteria. Vancomycin MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with infective endocarditis due to high and low vancomycin MIC isolates. Isolates with high and low vancomycin MIC had similar distributions of virulence genes and clonal lineages. In-hospital and 1-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), p 0.780; and 43% (12/28) vs. 29% (10/34), p 0.298, for low and high vancomycin MIC respectively). CONCLUSIONS In this international cohort of patients with left-sided MSSA endocarditis treated with antistaphylococcal β-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome or virulence gene repertoire.
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Affiliation(s)
- J M Pericàs
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J A Messina
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - C Garcia-de-la-Mària
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - L Park
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Global Health Institute, Durham, NC, USA
| | - B K Sharma-Kuinkel
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - F Marco
- Department of Microbiology, Institute for Global Health, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - D Wray
- Infectious Disease Division, Medical University of South Carolina, Charleston, SC, USA
| | - Z A Kanafani
- Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - M Carugati
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA
| | - E Durante-Mangoni
- Internal Medicine, Department of Clinical and Experimental Medicine, University of Campania 'Luigi Vanvitelli', Italy; Unit of Infectious and Transplant Medicine, 'V. Monaldi' Hospital, AORN dei Colli, Naples, Italy
| | - P Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - V H Chu
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - V G Fowler
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Romaine A, Ye D, Ao Z, Fang F, Johnson O, Blake T, Benjamin DK, Cotten CM, Testoni D, Clark RH, Chu VH, Smith PB, Hornik CP. Safety of histamine-2 receptor blockers in hospitalized VLBW infants. Early Hum Dev 2016; 99:27-30. [PMID: 27390109 PMCID: PMC4969147 DOI: 10.1016/j.earlhumdev.2016.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/20/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Histamine-2 receptor (H2) blockers are often used in very low birth weight infants despite lack of population specific efficacy and safety data. AIMS We sought to describe safety and temporal trends in histamine-2 receptor (H2) blocker use in hospitalized very low birth weight (VLBW) infants. STUDY DESIGN We conducted a retrospective cohort study using a clinical database populated by an electronic health record shared by 348 neonatal intensive care units in the United States. SUBJECTS We included all VLBW infants without major congenital anomalies. OUTCOME MEASURES We used multivariable logistic regression with generalizing estimating equations to evaluate the association between days of H2 blocker exposure and risk of: 1) death or necrotizing enterocolitis (NEC); 2) death or sepsis; and 3) death, NEC, or sepsis. RESULTS Of 127,707 infants, 20,288 (16%) were exposed to H2 blockers for a total of 6,422,352days. Median gestational age for infants exposed to H2 blockers was 27weeks (25th 75th percentile 26, 29). H2 blocker use decreased from 18% of infants in 1997 to 8% in 2012 (p<0.001). On multivariable analysis, infants were at increased risk of the combined outcome of death, NEC, or sepsis on days exposed to H2 blockers (odds ratio=1.14) (95% confidence interval 1.08, 1.19). CONCLUSIONS H2 blocker use is associated with increased risk of the combined outcome of death, NEC, or sepsis in hospitalized VLBW infants.
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Affiliation(s)
| | - Daniel Ye
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Zachary Ao
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Francia Fang
- Duke Clinical Research Institute, Durham, NC, USA.
| | | | - Taylor Blake
- Duke Clinical Research Institute, Durham, NC, USA.
| | | | | | | | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL,USA.
| | - Vivian H Chu
- Duke Clinical Research Institute, Durham, NC, USA.
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Affiliation(s)
- Vivian H Chu
- Duke University Medical Center, Durham, North Carolina.
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Park LP, Chu VH, Peterson G, Skoutelis A, Lejko-Zupa T, Bouza E, Tattevin P, Habib G, Tan R, Gonzalez J, Altclas J, Edathodu J, Fortes CQ, Siciliano RF, Pachirat O, Kanj S, Wang A. Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis. J Am Heart Assoc 2016; 5:e003016. [PMID: 27091179 PMCID: PMC4859286 DOI: 10.1161/jaha.115.003016] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Host factors and complications have been associated with higher mortality in infective endocarditis (IE). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE. Methods and Results Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ICE]–Prospective Cohort Study [PCS], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry (ICE‐PLUS, 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE‐PCS cohort and 342 of 1197 (28.6%) in the ICE‐PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE, causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions Six‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE.
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Affiliation(s)
| | | | | | - Athanasios Skoutelis
- 5th Department of Medicine and Infectious Diseases Unit, "Evangelismos" General Hospital, Athens, Greece
| | | | - Emilio Bouza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | | | - Ren Tan
- The Canberra Hospital, Woden, Australia
| | | | | | - Jameela Edathodu
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | | | | | - Souha Kanj
- American University of Beirut Medical Center, Beirut, Lebanon
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32
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Limeres Posse J, Álvarez Fernández M, Fernández Feijoo J, Medina Henríquez J, Lockhart PB, Chu VH, Diz Dios P. Intravenous amoxicillin/clavulanate for the prevention of bacteraemia following dental procedures: a randomized clinical trial. J Antimicrob Chemother 2016; 71:2022-30. [PMID: 27029851 DOI: 10.1093/jac/dkw081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/22/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Although controversy exists regarding the efficacy of antibiotic prophylaxis for patients at risk of infective endocarditis, expert committees continue to publish recommendations for antibiotic prophylaxis regimens. This study aimed to evaluate the efficacy of four antimicrobial regimens for the prevention of bacteraemia following dental extractions. METHODS The study population included 266 adults requiring dental extractions who were randomly assigned to the following five groups: control (no prophylaxis); 1000/200 mg of amoxicillin/clavulanate intravenously; 2 g of amoxicillin by mouth; 600 mg of clindamycin by mouth; and 600 mg of azithromycin by mouth. Venous blood samples were collected from each patient at baseline and at 30 s, 15 min and 1 h after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The trial was registered at ClinicalTrials.gov with ID number NCT02115776. RESULTS The incidence of bacteraemia in the control, amoxicillin/clavulanate, amoxicillin, clindamycin and azithromycin groups was: 96%, 0%, 50%, 87% and 81%, respectively, at 30 s; 65%, 0%, 10%, 65% and 49% at 15 min; and 18%, 0%, 4%, 19% and 18% at 1 h. Streptococci were the most frequently identified bacteria. The percentage of positive blood cultures at 30 s post-extraction was lower in the amoxicillin/clavulanate group than in the amoxicillin group (P < 0.001). The incidence of bacteraemia in the clindamycin group was similar to that in the control group. CONCLUSIONS Bacteraemia following dental extractions was undetectable with amoxicillin/clavulanate prophylaxis. Alternative antimicrobial regimens should be sought for patients allergic to the β-lactams.
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Affiliation(s)
- J Limeres Posse
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain
| | - M Álvarez Fernández
- Research Laboratory, Department of Clinical Microbiology, Xeral-Cíes Hospital (CHUVI), Vigo, Spain
| | - J Fernández Feijoo
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain Primary Dental Care Unit, Galician Healthcare Service-SERGAS, Santiago de Compostela, Spain
| | - J Medina Henríquez
- Department of Anaesthesiology, Santiago de Compostela University Hospital (CHUS), Santiago de Compostela, Spain
| | - P B Lockhart
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University, Durham, NC, USA
| | - P Diz Dios
- Special Needs Unit and OMEQUI Research Group, School of Medicine and Dentistry, Santiago de Compostela University, Santiago de Compostela, Spain Primary Dental Care Unit, Galician Healthcare Service-SERGAS, Santiago de Compostela, Spain
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Gulack BC, Laughon MM, Clark RH, Burgess T, Robinson S, Muhammad A, Zhang A, Davis A, Morton R, Chu VH, Arnold CJ, Hornik CP, Smith PB. Enteral Feeding with Human Milk Decreases Time to Discharge in Infants following Gastroschisis Repair. J Pediatr 2016; 170:85-9. [PMID: 26703875 PMCID: PMC4769929 DOI: 10.1016/j.jpeds.2015.11.046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/26/2015] [Accepted: 11/16/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the effect of enteral feeding with human milk on the time from initiation of feeds to discharge after gastroschisis repair through review of a multi-institutional database. STUDY DESIGN Infants who underwent gastroschisis repair between 1997 and 2012 with data recorded in the Pediatrix Medical Group Clinical Data Warehouse were categorized into 4 groups based on the percentage of days fed human milk out of the number of days fed enterally. Cox proportional hazards regression modeling was performed to determine the adjusted effect of human milk on the time from initiation of feeds to discharge. RESULTS Among 3082 infants, 659 (21%) were fed human milk on 0% of enteral feeding days, 766 (25%) were fed human milk on 1%-50% of enteral feeding days, 725 (24%) were fed human milk on 51%-99% of enteral feeding days, and 932 (30%) were fed human milk on 100% of enteral feeding days. Following adjustment, being fed human milk on 0% of enteral feeding days was associated with a significantly increased time to discharge compared with being fed human milk on 100% of enteral feeding days (hazard ratio [HR] for discharge per day, 0.46; 95% CI, 0.40-0.52). The same was found for infants fed human milk on 1%-50% of enteral feeding days (HR, 0.37; 95% CI, 0.32-0.41) and for infants fed human milk on 51%-99% of enteral feeding days (HR, 0.51; 95% CI, 0.46-0.57). CONCLUSION The use of human milk for enteral feeding of infants following repair of gastroschisis significantly reduces the time to discharge from initiation of feeds.
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Affiliation(s)
- Brian C Gulack
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Matthew M Laughon
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Terrance Burgess
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Sybil Robinson
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Abdurrauf Muhammad
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Angela Zhang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Adrienne Davis
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Robert Morton
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
| | - Vivian H Chu
- Department of Medicine, Duke University Medical Center, Durham, NC
| | | | - Christoph P Hornik
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - P Brian Smith
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC; Department of Pediatrics, Duke University Medical Center, Durham, NC.
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Qi R, Joo HS, Sharma-Kuinkel B, Berlon NR, Park L, Fu CL, Messina JA, Thaden JT, Yan Q, Ruffin F, Maskarinec S, Warren B, Chu VH, Fortes CQ, Giannitsioti E, Durante-Mangoni E, Kanafani ZA, Otto M, Fowler VG. Increased in vitro phenol-soluble modulin production is associated with soft tissue infection source in clinical isolates of methicillin-susceptible Staphylococcus aureus. J Infect 2016; 72:302-8. [PMID: 26778460 DOI: 10.1016/j.jinf.2015.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 08/13/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Phenol-soluble modulins (PSM) are amphipathic proteins produced by Staphylococcus aureus that promote virulence, inflammatory response, and biofilm formation. We previously showed that MRSA isolates from soft tissue infection (SSTI) produced significantly higher levels of PSM than MRSA isolates from hospital-acquired pneumonia (HAP) or infective endocarditis (IE). In this investigation, we sought to validate this finding in methicillin-susceptible S. aureus (MSSA) isolates. METHODS MSSA isolates (n = 162) from patients with SSTI, HAP, and IE were matched 1:1:1 based on geographic origin of the infection to form 54 triplets (North America n = 27, Europe n = 25, Australia n = 2). All isolates underwent spa typing and were classified using eGenomics. In vitro PSM production was quantified by high-performance liquid chromatography/mass spectrometry. Fischer's Exact Test and the Kruskal-Wallis test were used for statistical analysis. RESULTS Spa1 was more common in SSTI (14.81% SSTI, 3.70% HAP, 1.85% IE) (p < 0.03). Spa2 was more common in HAP (0% SSTI, 12.96% HAP, 3.70% IE) (p < 0.01). Levels of PSMα1-4 all differed significantly among the three clinical groups, with SSTI isolates producing the highest levels and IE producing the lowest levels of PSMα1-4. Spa1 isolates produced significantly more delta-toxin (p < 0.03) than non-Spa1 isolates. No associations between PSM levels and clinical outcome of SSTI, HAP, or IE were identified. CONCLUSION Production of PSMα1-4 is highest in SSTI MSSA isolates, supporting the hypothesis that these peptides are important for SSTI pathogenesis. These findings are similar to those described in MRSA, and demonstrate that associations between PSM levels and type of infection are independent of the methicillin-resistance status of the isolate.
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Affiliation(s)
- Robert Qi
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Hwang-Soo Joo
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Batu Sharma-Kuinkel
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Nicholas R Berlon
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lawrence Park
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Chih-Lung Fu
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Julia A Messina
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Joshua T Thaden
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Qin Yan
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Stacey Maskarinec
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Bobby Warren
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Claudio Q Fortes
- Hospital Universitario Clementino Fraga Filho/UFRJ, Rio de Janeiro, Brazil
| | | | - Emanuele Durante-Mangoni
- Internal Medicine Section, Department of Cardiothoracic Sciences, and Division of Infectious and Transplant Medicine, Second University of Naples at Monaldi Hospital, Napoli, Italy
| | - Zeina A Kanafani
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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35
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Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A. Response to Letter Regarding Article, "Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis: A Prospective Study From the International Collaboration on Endocarditis". Circulation 2015; 132:e184-5. [PMID: 26438777 DOI: 10.1161/circulationaha.115.016782] [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] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Eugene Athan
- Barwon Health and Deakin University, Geelong, Australia
| | | | - Tomas Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Cristiane Lamas
- Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil
| | - Jose M Miro
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | - Christophe Tribouilloy
- University Hospital, Amiens, FranceINSERM U-1088, University of Picardie, Amiens, France
| | | | - Juan M Pericas
- Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | | | | | - John P Hurley
- Mater Misericordiae University Hospital, Dublin, Ireland
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Abstract
BACKGROUND Cefepime and ceftazidime are cephalosporins used for the treatment of serious Gram-negative infections. These cephalosporins are used off-label in the setting of minimal safety data for young infants. METHODS We identified all infants discharged from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012 who were exposed to either cefepime or ceftazidime in the first 120 days of life. We reported clinical and laboratory adverse events occurring in infants exposed to cefepime or ceftazidime and used multivariable logistic regression to compare the odds of seizures and death between the 2 groups. RESULTS A total of 1761 infants received 13,293 days of ceftazidime, and 594 infants received 4628 days of cefepime. Laboratory adverse events occurred more frequently on days of therapy with ceftazidime than with cefepime (373 vs. 341 per 1000 infant days, P < 0.001). Seizure was the most commonly observed clinical adverse event, occurring in 3% of ceftazidime-treated infants and 4% of cefepime-treated infants (P = 0.52). Mortality was similar between the ceftazidime and cefepime groups (5% vs. 3%, P = 0.07). There was no difference in the adjusted odds of seizure [odds ratio (OR) = 0.96 (95% confidence interval: 0.89-1.03)] or the combined outcome of mortality or seizures [OR = 1.00 (0.96-1.04)] in infants exposed to ceftazidime versus those exposed to cefepime. CONCLUSIONS In this cohort of infants, cefepime was associated with fewer laboratory adverse events than ceftazidime, although this may have been due to a significant difference in clinical exposures and severity of illness between the 2 groups. There was no difference in seizure risk or mortality between the 2 drugs.
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Affiliation(s)
- Christopher J. Arnold
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Jessica Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Nathan Cho
- Duke Clinical Research Institute, Durham, NC
| | - James Tian
- Duke Clinical Research Institute, Durham, NC
| | | | - Vivian H. Chu
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Duke University, Durham, NC
| | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
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Lauridsen TK, Park L, Tong SYC, Selton-Suty C, Peterson G, Cecchi E, Afonso L, Habib G, Paré C, Tamin S, Dickerman S, Bayer AS, Johansson MC, Chu VH, Samad Z, Bruun NE, Fowler VG, Crowley AL. Echocardiographic Findings Predict In-Hospital and 1-Year Mortality in Left-Sided Native Valve Staphylococcus aureus Endocarditis: Analysis From the International Collaboration on Endocarditis-Prospective Echo Cohort Study. Circ Cardiovasc Imaging 2015; 8:e003397. [PMID: 26162783 DOI: 10.1161/circimaging.114.003397] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Staphylococcus aureus left-sided native valve infective endocarditis (LNVIE) has higher complication and mortality rates compared with endocarditis from other pathogens. Whether echocardiographic variables can predict prognosis in S aureus LNVIE is unknown. METHODS AND RESULTS Consecutive patients with LNVIE, enrolled between January 2000 and September 2006, in the International Collaboration on Endocarditis were identified. Subjects without S aureus IE were matched to those with S aureus IE by the propensity of having S aureus. Survival differences were determined using log-rank significance tests. Independent echocardiographic predictors of mortality were identified using Cox-proportional hazards models that included inverse probability of treatment weighting and surgery as a time-dependent covariate. Of 727 subjects with LNVIE and 1-year follow-up, 202 had S aureus IE. One-year survival rates were significantly lower for patients with S aureus IE overall (57% S aureus IE versus 80% non-S aureus IE; P<0.001) and in the propensity-matched cohort (59% S aureus IE versus 68% non-S aureus IE; P<0.05). Intracardiac abscess (hazard ratio, 2.93; 95% confidence interval, 1.52-5.40; P<0.001) and left ventricular ejection fraction <40% (odds ratio, 3.01; 95% confidence interval, 1.35-6.04; P=0.004) were the only independent echocardiographic predictors of in-hospital mortality in S aureus LNVIE. Valve perforation (hazard ratio, 2.16; 95% confidence interval, 1.21-3.68; P=0.006) and intracardiac abscess (hazard ratio, 2.25; 95% confidence interval, 1.26-3.78; P=0.004) were the only independent predictors of 1-year mortality. CONCLUSIONS S aureus is an independent predictor of 1-year mortality in subjects with LNVIE. In S aureus LNVIE, intracardiac abscess and left ventricular ejection fraction <40% independently predicted in-hospital mortality and intracardiac abscess and valve perforation independently predicted 1-year mortality.
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Affiliation(s)
- Trine K Lauridsen
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Lawrence Park
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Steven Y C Tong
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Christine Selton-Suty
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Gail Peterson
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Enrico Cecchi
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Luis Afonso
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Gilbert Habib
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Carlos Paré
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Syahidah Tamin
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Stuart Dickerman
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Arnold S Bayer
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Magnus C Johansson
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Vivian H Chu
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Zainab Samad
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Niels E Bruun
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Vance G Fowler
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.)
| | - Anna Lisa Crowley
- From the Department of Medicine, Duke University, Durham, NC (T.K.L., L.P., V.H.C., Z.S., V.G.F., A.L.C.); Department of Cardiology, Gentofte University, Copenhagen, Denmark (T.K.L., N.E.B.); Department of Infectious Diseases, Charles Darwin University, Darwin, Northern Territory, Australia (S.Y.C.T.); Department of Cardiology, CHU Nancy-Brabois, Nancy, France (C.S.-S.); Department of Medicine, UT-Southwestern Medical Center, Dallas, TX (G.P.); Department of Cardiology, Maria Vittoria Hospital, Torino, Italy (E.C.); Department of Medicine, Wayne State University, Detroit, MI (L.A.); Faculté de Médecine de Marseille, Marseille, France (G.H.); Department of Cardiology, University of Barcelona, Spain (C.P.); Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia (S.T.); Department of Medicine, New York University (S.D.); Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, University of California, Los Angeles (A.S.B.); Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (M.C.J.); Duke Clinical Research Institute, Durham, NC (V.H.C., V.G.F., A.L.C.); and Clinical Institute, Aalborg University, Aalborg, Denmark (N.E.B.).
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Arnold CJ, Ericson J, Kohman J, Corey KL, Oh M, Onabanjo J, Hornik CP, Clark RH, Benjamin DK, Smith PB, Chu VH. Rifampin use and safety in hospitalized infants. Am J Perinatol 2015; 32:565-70. [PMID: 25594217 PMCID: PMC4433596 DOI: 10.1055/s-0034-1543955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study aims to examine the use and safety of rifampin in the hospitalized infants. STUDY DESIGN Observational study of clinical and laboratory adverse events among infants exposed to rifampin from 348 neonatal intensive care units managed by the Pediatrix Medical Group between 1997 and 2012. RESULT Overall, 2,500 infants received 4,279 courses of rifampin; mean gestational age was 27 weeks (5th, 95th percentile; 23, 36) and mean birth weight was 1,125 g (515; 2,830). Thrombocytopenia (121/1,000 infant days) and conjugated hyperbilirubinemia (25/1,000 infant days) were the most common laboratory adverse events. The most common clinical adverse events were medical necrotizing enterocolitis (64/2,500 infants, 3%) and seizure (60/2,500 infants, 2%). CONCLUSION The overall incidence of adverse events among infants receiving rifampin appears low; however, additional studies to further evaluate safety and dosing of rifampin in this population are needed.
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Affiliation(s)
- Christopher J. Arnold
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC
| | - Jessica Ericson
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | | | - Morgan Oh
- Duke Clinical Research Institute, Durham, NC
| | | | - Christoph P. Hornik
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | | | - Daniel K. Benjamin
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - P. Brian Smith
- Duke Clinical Research Institute, Durham, NC
- Department of Pediatrics, Duke University, Durham, NC
| | - Vivian H. Chu
- Duke Clinical Research Institute, Durham, NC
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC
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Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A. Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis. Circulation 2015; 131:131-40. [DOI: 10.1161/circulationaha.114.012461] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined.
Methods and Results—
The International Collaboration on Endocarditis–PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non–cardiac device–related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and
Staphyloccus aureus
etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE.
Conclusions—
Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period.
S aureus
IE was significantly associated with nonsurgical management.
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Affiliation(s)
- Vivian H. Chu
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Lawrence P. Park
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Eugene Athan
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Francois Delahaye
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Tomas Freiberger
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Cristiane Lamas
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Jose M. Miro
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Daniel W. Mudrick
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Jacob Strahilevitz
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Christophe Tribouilloy
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Emanuele Durante-Mangoni
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Juan M. Pericas
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Nuria Fernández-Hidalgo
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Francisco Nacinovich
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Hussien Rizk
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Vladimir Krajinovic
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Efthymia Giannitsioti
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - John P. Hurley
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Margaret M. Hannan
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Andrew Wang
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
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Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu VH, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis 2014; 60:741-9. [PMID: 25389255 DOI: 10.1093/cid/ciu871] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
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Affiliation(s)
- Catherine Chirouze
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon
| | - François Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA4360 INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | - Vance G Fowler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Sexton
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Ralph Corey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marie-Line Erpelding
- INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | | | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Margaret M Hannan
- Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - José M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David R Murdoch
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes
| | | | - Bruno Hoen
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France
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Alagna L, Park LP, Nicholson BP, Keiger AJ, Strahilevitz J, Morris A, Wray D, Gordon D, Delahaye F, Edathodu J, Miró JM, Fernández-Hidalgo N, Nacinovich FM, Shahid R, Woods CW, Joyce MJ, Sexton DJ, Chu VH. Repeat endocarditis: analysis of risk factors based on the International Collaboration on Endocarditis - Prospective Cohort Study. Clin Microbiol Infect 2014; 20:566-75. [PMID: 24102907 DOI: 10.1111/1469-0691.12395] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [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: 04/25/2013] [Revised: 08/14/2013] [Accepted: 09/12/2013] [Indexed: 12/01/2022]
Abstract
Repeat episodes of infective endocarditis (IE) can occur in patients who survive an initial episode. We analysed risk factors and 1-year mortality of patients with repeat IE. We considered 1874 patients enrolled in the International Collaboration on Endocarditis - Prospective Cohort Study between January 2000 and December 2006 (ICE-PCS) who had definite native or prosthetic valve IE and 1-year follow-up. Multivariable analysis was used to determine risk factors for repeat IE and 1-year mortality. Of 1874 patients, 1783 (95.2%) had single-episode IE and 91 (4.8%) had repeat IE: 74/91 (81%) with new infection and 17/91 (19%) with presumed relapse. On bivariate analysis, repeat IE was associated with haemodialysis (p 0.002), HIV (p 0.009), injection drug use (IDU) (p < 0.001), Staphylococcus aureus IE (p 0.003), healthcare acquisition (p 0.006) and previous IE before ICE enrolment (p 0.001). On adjusted analysis, independent risk factors were haemodialysis (OR, 2.5; 95% CI, 1.2-5.3), IDU (OR, 2.9; 95% CI, 1.6-5.4), previous IE (OR, 2.8; 95% CI, 1.5-5.1) and living in the North American region (OR, 1.9; 95% CI, 1.1-3.4). Patients with repeat IE had higher 1-year mortality than those with single-episode IE (p 0.003). Repeat IE is associated with IDU, previous IE and haemodialysis. Clinicians should be aware of these risk factors in order to recognize patients who are at risk of repeat IE.
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Affiliation(s)
- L Alagna
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
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Lalani T, Chu VH, Park LP, Cecchi E, Corey GR, Durante-Mangoni E, Fowler VG, Gordon D, Grossi P, Hannan M, Hoen B, Muñoz P, Rizk H, Kanj SS, Selton-Suty C, Sexton DJ, Spelman D, Ravasio V, Tripodi MF, Wang A. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med 2013; 173:1495-504. [PMID: 23857547 DOI: 10.1001/jamainternmed.2013.8203] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. INTERVENTIONS Valve replacement during index hospitalization (early surgery) vs medical therapy. MAIN OUTCOMES AND MEASURES In-hospital and 1-year mortality. RESULTS Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.
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Affiliation(s)
- Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Bethesda, Maryland
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Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabé JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelj J, Bayer AS, Wang A. Influence of the Timing of Cardiac Surgery on the Outcome of Patients With Infective Endocarditis and Stroke. Clin Infect Dis 2012; 56:209-17. [DOI: 10.1093/cid/cis878] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Barsic
- Hospital for Infectious Diseases, School of Medicine, Zagreb, Croatia
| | | | | | - Paul Pappas
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Javier Altclas
- Barcelona Centre for International Health Research, Spain
| | | | | | - Vivian H. Chu
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | - Lars Olaison
- Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ana Pangercic
- University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Mukesh Patel
- University of Alabama at Birmingham, Birmingham Veterans Affairs Medical Center
| | - Igor Rudez
- Dubrava University Hospital, Zagreb, Croatia
| | | | | | - Arnold S. Bayer
- Geffen School of Medicine at the University of California, Los Angeles
| | - Andrew Wang
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
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Athan E, Chu VH, Tattevin P, Selton-Suty C, Jones P, Naber C, Miró JM, Ninot S, Fernández-Hidalgo N, Durante-Mangoni E, Spelman D, Hoen B, Lejko-Zupanc T, Cecchi E, Thuny F, Hannan MM, Pappas P, Henry M, Fowler VG, Crowley AL, Wang A. Clinical characteristics and outcome of infective endocarditis involving implantable cardiac devices. JAMA 2012; 307:1727-35. [PMID: 22535857 DOI: 10.1001/jama.2012.497] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Infection of implantable cardiac devices is an emerging disease with significant morbidity, mortality, and health care costs. OBJECTIVES To describe the clinical characteristics and outcome of cardiac device infective endocarditis (CDIE) with attention to its health care association and to evaluate the association between device removal during index hospitalization and outcome. DESIGN, SETTING, AND PATIENTS Prospective cohort study using data from the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), conducted June 2000 through August 2006 in 61 centers in 28 countries. Patients were hospitalized adults with definite endocarditis as defined by modified Duke endocarditis criteria. MAIN OUTCOME MEASURES In-hospital and 1-year mortality. RESULTS CDIE was diagnosed in 177 (6.4% [95% CI, 5.5%-7.4%]) of a total cohort of 2760 patients with definite infective endocarditis. The clinical profile of CDIE included advanced patient age (median, 71.2 years [interquartile range, 59.8-77.6]); causation by staphylococci (62 [35.0% {95% CI, 28.0%-42.5%}] Staphylococcus aureus and 56 [31.6% {95% CI, 24.9%-39.0%}] coagulase-negative staphylococci); and a high prevalence of health care-associated infection (81 [45.8% {95% CI, 38.3%-53.4%}]). There was coexisting valve involvement in 66 (37.3% [95% CI, 30.2%-44.9%]) patients, predominantly tricuspid valve infection (43/177 [24.3%]), with associated higher mortality. In-hospital and 1-year mortality rates were 14.7% (26/177 [95% CI, 9.8%-20.8%]) and 23.2% (41/177 [95% CI, 17.2%-30.1%]), respectively. Proportional hazards regression analysis showed a survival benefit at 1 year for device removal during the initial hospitalization (28/141 patients [19.9%] who underwent device removal during the index hospitalization had died at 1 year, vs 13/34 [38.2%] who did not undergo device removal; hazard ratio, 0.42 [95% CI, 0.22-0.82]). CONCLUSIONS Among patients with CDIE, the rate of concomitant valve infection is high, as is mortality, particularly if there is valve involvement. Early device removal is associated with improved survival at 1 year.
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Affiliation(s)
- Eugene Athan
- Department of Infectious Diseases, Barwon Health, Geelong, Australia
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Federspiel JJ, Stearns SC, Peppercorn AF, Chu VH, Fowler VG. Increasing US rates of endocarditis with Staphylococcus aureus: 1999-2008. ACTA ACUST UNITED AC 2012; 172:363-5. [PMID: 22371926 DOI: 10.1001/archinternmed.2011.1027] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Nienaber JJC, Sharma Kuinkel BK, Clarke-Pearson M, Lamlertthon S, Park L, Rude TH, Barriere S, Woods CW, Chu VH, Marín M, Bukovski S, Garcia P, Corey GR, Korman T, Doco-Lecompte T, Murdoch DR, Reller LB, Fowler VG. Methicillin-susceptible Staphylococcus aureus endocarditis isolates are associated with clonal complex 30 genotype and a distinct repertoire of enterotoxins and adhesins. J Infect Dis 2011; 204:704-13. [PMID: 21844296 DOI: 10.1093/infdis/jir389] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Using multinational collections of methicillin-susceptible Staphylococcus aureus (MSSA) isolates from infective endocarditis (IE) and soft tissue infections (STIs), we sought to (1) validate the finding that S. aureus in clonal complex (CC) 30 is associated with hematogenous complications and (2) test the hypothesis that specific genetic characteristics in S. aureus are associated with infection severity. METHODS IE and STI isolates from 2 cohorts were frequency matched by geographic origin. Isolates underwent spa typing to infer CC and multiplex polymerase chain reaction for presence of virulence genes. RESULTS 114 isolate pairs were genotyped. IE isolates were more likely to be CC30 (19.5% vs 6.2%; P = .005) and to contain 3 adhesins (clfB, cna, map/eap; P < .0001 for all) and 5 enterotoxins (tst, sea, sed, see, and sei; P ≤ .005 for all). CC30 isolates were more likely to contain cna, tst, sea, see, seg, and chp (P < .05 for all). CONCLUSIONS MSSA IE isolates were significantly more likely to be CC30 and to possess a distinct repertoire of virulence genes than MSSA STI isolates from the same region. The genetic basis of this association requires further study.
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Affiliation(s)
- Juhsien J C Nienaber
- Duke University Medical Center Division of Infectious Diseases and International Health, Durham, North Carolina, USA
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Thornhill MH, Dayer MJ, Forde JM, Corey GR, Chu VH, Couper DJ, Lockhart PB. Impact of the NICE guideline recommending cessation of antibiotic prophylaxis for prevention of infective endocarditis: before and after study. BMJ 2011; 342:d2392. [PMID: 21540258 PMCID: PMC3086390 DOI: 10.1136/bmj.d2392] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify the change in prescribing of antibiotic prophylaxis before invasive dental procedures for patients at risk of infective endocarditis, and any concurrent change in the incidence of infective endocarditis, following introduction of a clinical guideline from the National Institute for Health and Clinical Excellence (NICE) in March 2008 recommending the cessation of antibiotic prophylaxis in the United Kingdom. DESIGN Before and after study. SETTING England. Population All patients admitted to hospital in England with a primary or secondary discharge diagnosis of acute or subacute infective endocarditis. MAIN OUTCOME MEASURES Monthly number of prescriptions for antibiotic prophylaxis consisting of a single 3 g oral dose of amoxicillin or a single 600 mg oral dose of clindamycin, and monthly number of cases of infective endocarditis, infective endocarditis related deaths in hospital, or cases of infective endocarditis with a possible oral origin for streptococci. RESULTS After the introduction of the NICE guideline there was a highly significant 78.6% reduction (P < 0.001) in prescribing of antibiotic prophylaxis, from a mean 10,277 (SD 1068) prescriptions per month to 2292 (SD 176). Evidence that the general upward trend in cases of infective endocarditis before the guideline was significantly altered after the guideline was lacking (P = 0.61). Using a non-inferiority test, an increase in the number of cases of 9.3% or more could be excluded after the introduction of the guideline. Similarly an increase in infective endocarditis related deaths in hospital of 12.3% or more could also be excluded. CONCLUSION Despite a 78.6% reduction in prescribing of antibiotic prophylaxis after the introduction of the NICE guideline, this study excluded any large increase in the incidence of cases of or deaths from infective endocarditis in the two years after the guideline. Although this lends support to the guideline, ongoing data monitoring is needed to confirm this, and further clinical trials should determine if antibiotic prophylaxis still has a role in protecting some patients at particularly high risk.
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Affiliation(s)
- Martin H Thornhill
- University of Sheffield School of Clinical Dentistry, Sheffield S10 2TA, UK.
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Abstract
The first use of echocardiography in infective endocarditis (IE) was described in 1973. Since then, echocardiography has emerged as a major tool for the diagnosis and management of this disease. In general, transthoracic echocardiography (TTE) is adequate for diagnosing IE in cases where cardiac structures-of-interest are well visualized. Specific situations where transesophageal echocardiography is preferred over TTE include the presence of a prosthetic device, suspected periannular complications, children with complex congenital cardiac lesions, selected patients with Staphylococcus aureus bacteremia, and certain pre-existing valvular abnormalities that make TTE interpretation problematic (eg, calcific aortic stenosis). Echocardiography is also useful for risk stratification. Evidence suggests that vegetation size can predict embolic complications, although the data are inconsistent. Careful clinical assessment is essential to the proper use of echocardiography in diagnosing IE, visualizing complications related to IE, and evaluating candidacy for surgical intervention.
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Affiliation(s)
- Vivian H Chu
- Duke University Medical Center, Box 3850, Durham, NC 27710, USA.
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