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12 pages, 756 KiB

Open AccessArticle

Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study

by Carlo Tascini, Simone Giuliano, Vittorio Attanasio, Luca Segreti, Andrea Ripoli, Francesco Sbrana, Sergio Severino, Chiara Sordelli, Sara Hana Weisz, Agnese Zanus-Fortes, Gabriele Maria Leanza, Novella Carannante, Andrea Di Cori, Maria Grazia Bongiorni, Giulio Zucchelli and Stefano De Vivo

Antibiotics 2023, 12(6), 1001; https://doi.org/10.3390/antibiotics12061001 - 02 Jun 2023

Cited by 1 | Viewed by 1092

Abstract

(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage [...] Read more.

(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

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12 pages, 293 KiB

Open AccessArticle

Ampicillin and Ceftobiprole Combination for the Treatment of Enterococcus faecalis Invasive Infections: “The Times They Are A-Changin”

by Simone Giuliano, Jacopo Angelini, Denise D’Elia, Monica Geminiani, Roberto Daniele Barison, Alessandro Giacinta, Assunta Sartor, Floriana Campanile, Francesco Curcio, Menino Osbert Cotta, Jason A. Roberts, Massimo Baraldo and Carlo Tascini

Antibiotics 2023, 12(5), 879; https://doi.org/10.3390/antibiotics12050879 - 09 May 2023

Cited by 5 | Viewed by 1757

Abstract

Background: Enterococcus faecalis is responsible for a large variety of severe infections. This study is a case series reporting our experience in the treatment of E. faecalis invasive infections with ampicillin in combination with ceftobiprole (ABPR). Methods: We retrospectively analyzed all the medical [...] Read more.

Background: Enterococcus faecalis is responsible for a large variety of severe infections. This study is a case series reporting our experience in the treatment of E. faecalis invasive infections with ampicillin in combination with ceftobiprole (ABPR). Methods: We retrospectively analyzed all the medical records of patients admitted to the University Hospital of Udine from January to December 2020 with a diagnosis of infective endocarditis or primary or non-primary complicated or uncomplicated bacteremia caused by E. faecalis. Results: Twenty-one patients were included in the final analysis. The clinical success rate was very high, accounting for 81% of patients, and microbiological cure was obtained in 86% of patients. One relapse was recorded in one patient who did not adhere to the partial oral treatment prescribed. Therapeutic drug monitoring (TDM) was always performed for ampicillin and ceftobiprole, and serum concentrations of both drugs were compared to the MICs of the different enterococcal isolates. Conclusions: ABPR is a well-tolerated antimicrobial regimen with anti-E. faecalis activity. TDM can help clinicians optimize medical treatments to achieve the best possible efficacy with fewer side effects. ABPR might be a reasonable option for the treatment of severe invasive infections caused by E. faecalis due to the high level of enterococcal penicillin-binding protein (PBP) saturation. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

9 pages, 382 KiB

Open AccessArticle

Adherence to 2015 ESC Guidelines for the Treatment of Infective Endocarditis: A Retrospective Multicentre Study (LEIOT Study)

by Carlo Pallotto, Cesare Bolla, Serena Penpa, Giovanni Genga, Cristina Sarda, Elisabetta Svizzeretto, Andrea Tommasi, Elisa Stolaj, Andrea Salvaderi, Giorgia Piceni, Antonio Maconi, Guido Chichino, Daniela Francisci and on behalf of the LEIOT Study Group

Antibiotics 2023, 12(4), 705; https://doi.org/10.3390/antibiotics12040705 - 04 Apr 2023

Cited by 2 | Viewed by 1397

Abstract

Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about [...] Read more.

Background: Infective endocarditis (IE) is still a severe disease with elevated morbidity and mortality. Nevertheless, the last European guidelines (GL) date back to 2015, and a recent survey described a diffuse suboptimal adherence to their recommendations. Here, we described a real-life scenario about adherence to IE treatment GL. Methods: This was a retrospective, multicentric, case–control study. All the cases of IE admitted to our wards from 2016 to 2020 were enrolled. Patients were divided into two groups, according to the non-adherence (group A, cases) or adherence (group B, controls) to 2015 ESC guidelines. Only targeted treatments were considered. Groups were compared for demographic, clinical, microbiological, and laboratory data and outcome. As a post hoc analysis, we analysed the characteristics of deviations from the guidelines and how these deviations affected mortality. Results: A total of 246 patients were enrolled, with 128 (52%) in group A and 118 (48%) in group B. Groups were homogeneous except for aetiologies: staphylococcal and blood-culture-negative IE were more frequent in group A, while streptococcal and enterococcal IE were more frequent in group B (p < 0.001). In-hospital mortality was comparable in the two groups. The most frequent causes of deviations from the guidelines were use of daptomycin, in addition to standard treatments and the missing administration of rifampin or gentamycin. Conclusions: Adherence to 2015 ESC guidelines was limited but it did not affect mortality. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

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15 pages, 283 KiB

Open AccessArticle

Perception Regarding the NICE Guideline on Antibiotic Prophylaxis against Infective Endocarditis Following Dental Procedures: A Cross-Sectional Study

by Siti Salmiah Mohd Yunus, Syed Nabil, Muhd Fazlynizam Rashdi, Abd Jabar Nazimi, Rifqah Nordin, Huann Lan Tan, Oteh Maskon, Hamat H. Che Hassan, Tzar Mohd Nizam Khaithir, Aznida Firzah Abdul Aziz, Yee Guan Ng, Ridwan Yeop Ismail and Roszalina Ramli

Antibiotics 2023, 12(4), 696; https://doi.org/10.3390/antibiotics12040696 - 02 Apr 2023

Cited by 1 | Viewed by 1508

Abstract

This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This cross-sectional study was performed from September 2017 to March 2019. The [...] Read more.

This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This cross-sectional study was performed from September 2017 to March 2019. The self-administered questionnaire comprised two sections: background information of the specialists and their opinions on the NICE guideline. The questionnaire was distributed to 794 potential participants, and 277 responded (response rate of 34.9%). In general, 49.8% of the respondents believed that clinicians should adhere to the guideline, although the majority of oral and maxillofacial surgeons (54.5%) actually disagreed with this view. The dental procedures that were perceived as presented moderate-to-high risk for IE were minor surgery for an impacted tooth with a recent episode of infection, dental implant surgery, periodontal surgery and dental extraction in patients with poor oral hygiene. The cardiac conditions that were strongly recommended for antibiotic prophylaxis were severe mitral valve stenosis or regurgitation and previous IE. Less than half of Malaysian clinical specialists agreed with the changes in the 2008 NICE guideline, contributing to their insistence that antibiotic prophylaxis is still needed for high-risk cardiac conditions and selected invasive dental procedures. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

14 pages, 1058 KiB

Open AccessArticle

Conventional Hospitalization versus Sequential Outpatient Parenteral Antibiotic Therapy for Staphylococcus aureus Bacteremia: Post-Hoc Analysis of a Multicenter Observational Cohort

by Nerea Castillo-Fernández, Pedro María Martínez Pérez-Crespo, Elena Salamanca-Rivera, Laura Herrera-Hidalgo, Arístides de Alarcón, María Dolores Navarro-Amuedo, Teresa Marrodán Ciordia, María Teresa Pérez-Rodríguez, Juan Sevilla-Blanco, Alfredo Jover-Saenz, Jonathan Fernández-Suárez, Carlos Armiñanzas-Castillo, José María Reguera-Iglesias, Clara Natera Kindelán, Lucía Boix-Palop, Eva León Jiménez, Fátima Galán-Sánchez, Alfonso del Arco Jiménez, Alberto Bahamonde-Carrasco, David Vinuesa García, Alejandro Smithson Amat, Jordi Cuquet Pedragosa, Isabel María Reche Molina, Inés Pérez Camacho, Esperanza Merino de Lucas, Belén Gutiérrez-Gutiérrez, Jesús Rodríguez Baño and Luis Eduardo López Cortés Show full author list Hide full author list

Antibiotics 2023, 12(1), 129; https://doi.org/10.3390/antibiotics12010129 - 09 Jan 2023

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Abstract

It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective [...] Read more.

It is not known whether sequential outpatient parenteral antimicrobial (OPAT) is as safe and effective as conventional hospitalization in patients with S. aureus bacteremia (SAB). A post-hoc analysis of the comparative effectiveness of conventional hospitalization versus sequential OPAT was performed in two prospective Spanish cohorts of patients with S. aureus bacteremia. The PROBAC cohort is a national, multicenter, prospective observational cohort of patients diagnosed in 22 Spanish hospitals between October 2016 and March 2017. The DOMUS OPAT cohort is a prospective observational cohort including patients from two university hospitals in Seville, Spain from 2012 to 2021. Multivariate regression was performed, including a propensity score (PS) for receiving OPAT, stratified analysis according to PS quartiles, and matched pair analyses based on PS. Four hundred and thirteen patients were included in the analysis: 150 in sequential OPAT and 263 in the full hospitalization therapy group. In multivariate analysis, including PS and center effect as covariates, 60-day treatment failure was lower in the OPAT group than in the full hospitalization group (p < 0.001; OR 0.275, 95%CI 0.129–0.584). In the PS-based matched analyses, sequential treatment under OPAT was not associated with higher 60-day treatment failure (p = 0.253; adjusted OR 0.660; % CI 0.324–1.345). OPAT is a safe and effective alternative to conventional in-patient therapy for completion of treatment in well-selected patients with SAB, mainly those associated with a low-risk source and without end-stage kidney disease. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

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Review

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12 pages, 296 KiB

Open AccessReview

Native-Valve Aspergillus Endocarditis: Case Report and Literature Review

by Claudio Caroselli, Lorenzo Roberto Suardi, Laura Besola, Alessandro Fiocco, Andrea Colli and Marco Falcone

Antibiotics 2023, 12(7), 1190; https://doi.org/10.3390/antibiotics12071190 - 14 Jul 2023

Cited by 1 | Viewed by 1318

Abstract

Aspergillus endocarditis represents the second etiological cause of prosthetic endocarditis following Candida spp. On the other hand, native-valve endocarditis due to Aspergillus are anecdotally reported with increasing numbers in the last decade due to new diagnostic technologies such as polymerase chain reaction (PCR) [...] Read more.

Aspergillus endocarditis represents the second etiological cause of prosthetic endocarditis following Candida spp. On the other hand, native-valve endocarditis due to Aspergillus are anecdotally reported with increasing numbers in the last decade due to new diagnostic technologies such as polymerase chain reaction (PCR) on samples like valve tissue or entire blood. We performed a review of the literature presenting one case report observed at Pisa University Hospital. Seventy-four case reports have been included in a period between 1950–2022. Immunocompromised status (patients with solid tumor/oncohematological cancer or transplanted patients) was confirmed to be the main risk factor for this rare opportunistic infection with a high rate of metastatic infection (above all, central nervous system) and mortality. Diagnosis relies on serum galactomannan and culture with PCR on valve tissue or whole blood. Cardiac surgery was revealed to be a life-saving priority as well as appropriate antifungal therapy including b-liposomal amphotericin or new triazoles (isavuconazole). The endocarditis team, facing negative blood culture endocarditis affecting an immunocompromised patient, should investigate this difficult-to-treat pathogen. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

11 pages, 614 KiB

Open AccessFeature PaperReview

Trichosporon asahii Infective Endocarditis of Prosthetic Valve: A Case Report and Literature Review

by Alice Mulè, Francesco Rossini, Alessio Sollima, Angelica Lenzi, Benedetta Fumarola, Silvia Amadasi, Erika Chiari, Silvia Lorenzotti, Barbara Saccani, Evelyn Van Hauwermeiren, Paola Lanza, Alberto Matteelli, Francesco Castelli and Liana Signorini

Antibiotics 2023, 12(7), 1181; https://doi.org/10.3390/antibiotics12071181 - 13 Jul 2023

Cited by 3 | Viewed by 1367

Abstract

Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, [...] Read more.

Trichosporon spp. endocarditis is a severe and hard-to-treat infection. Immunosuppressed subjects and carriers of prosthetic valves or intracardiac devices are at risk. This article presents the case of an immunocompetent 74-year-old man affected by endocarditis of the prosthetic aortic valve. After Bentall surgery, cultures of the removed valve demonstrated Trichosporon ashaii as the etiological agent. The patient was treated with amphotericin B at first and subsequently with fluconazole. Given the fragility of the patient and the aggressiveness of the pathogen, life-long prophylactic therapy with fluconazole was prescribed. After 5 years follow-up, no drug-related toxicities were reported and the patient never showed any signs of recurrence. The review of the literature illustrates that Trichosporon spp. endocarditis may present even many years after heart surgery, and it is often associated with massive valve vegetations, severe embolic complications, and unfavorable outcome. Due to the absence of international guidelines, there is no unanimous therapeutic approach, but amphotericin B and azoles are usually prescribed. Additionally, a prompt surgical intervention seems to be of paramount importance. When dealing with a life-threatening disease, such as mycotic endocarditis of prosthetic valves, it is essential to consider and treat even rare etiological agents such as Trichosporon spp. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

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28 pages, 492 KiB

Open AccessReview

Treatment of Enterococcus faecalis Infective Endocarditis: A Continuing Challenge

by Laura Herrera-Hidalgo, Beatriz Fernández-Rubio, Rafael Luque-Márquez, Luis E. López-Cortés, Maria V. Gil-Navarro and Arístides de Alarcón

Antibiotics 2023, 12(4), 704; https://doi.org/10.3390/antibiotics12040704 - 04 Apr 2023

Cited by 4 | Viewed by 6318

Abstract

Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as [...] Read more.

Today, Enterococcus faecalis is one of the main causes of infective endocarditis in the world, generally affecting an elderly and fragile population, with a high mortality rate. Enterococci are partially resistant to many commonly used antimicrobial agents such as penicillin and ampicillin, as well as high-level resistance to most cephalosporins and sometimes carbapenems, because of low-affinity penicillin-binding proteins, that lead to an unacceptable number of therapeutic failures with monotherapy. For many years, the synergistic combination of penicillins and aminoglycosides has been the cornerstone of treatment, but the emergence of strains with high resistance to aminoglycosides led to the search for new alternatives, like dual beta-lactam therapy. The development of multi-drug resistant strains of Enterococcus faecium is a matter of considerable concern due to its probable spread to E. faecalis and have necessitated the search of new guidelines with the combination of daptomycin, fosfomycin or tigecycline. Some of them have scarce clinical experience and others are still under investigation and will be analyzed in this review. In addition, the need for prolonged treatment (6–8 weeks) to avoid relapses has forced to the consideration of other viable options as outpatient parenteral strategies, long-acting administrations with the new lipoglycopeptides (dalbavancin or oritavancin), and sequential oral treatments, which will also be discussed. Full article

(This article belongs to the Special Issue Infectious Endocarditis: Diagnosis and Antimicrobial Therapy)

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