scholarly journals Retrospective analysis of endocarditis patients to investigate the eligibility for oral antibiotic treatment in routine daily practice

2020 ◽  
Author(s):  
J. C. Vroon ◽  
O. C. D. Liesdek ◽  
C. H. E. Boel ◽  
J. E. Arends ◽  
F. A. Niessen ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infective Endocarditis ◽  
Hospital Stay ◽  
Antibiotic Treatment ◽  
Oral Treatment ◽  
Daily Practice ◽  
Oral Antibiotic ◽  
Intravenous Antibiotics ◽  
European Society Of Cardiology ◽  
Stable Clinical Condition

Abstract Background According to the current guidelines of the European Society of Cardiology, patients with left-sided infective endocarditis are treated with intravenous antibiotics for 4–6 weeks, leading to extensive hospital stay and high costs. Recently, the Partial Oral Treatment of Endocarditis (POET) trial suggested that partial oral treatment is effective and safe in selected patients. Here, we investigated if such patients are seen in our daily clinical practice. Methods We enrolled 119 adult patients diagnosed with left-sided infective endocarditis in a retrospective, observational study. We identified those that would be eligible for switching to partial oral antibiotic treatment as defined in the POET trial (e.g. stable clinical condition without signs of infection). Secondary objectives were to provide insight into the time until each patient was eligible for partial oral treatment, and to determine parameters of longer hospital stay and/or need for extended intravenous antibiotic treatment. Results Applying the POET selection criteria, the condition of 38 patients (32%) was stable enough to switch them to partial oral treatment, of which 18 (47.3%), 8 (21.1%), 9 (23.7%) and 3 patients (7.9%) were eligible for switching after 10, 14, 21 days or 28 days of intravenous treatment, respectively. Conclusion One-third of patients who presented with left-sided endocarditis in routine clinical practice were possible candidates for switching to partial oral treatment. This could have major implications for both the patient’s quality of life and healthcare costs. These results offer an interesting perspective for implementation of such a strategy, which should be accompanied by a prospective cost-effectiveness analysis.

Antibiotic treatment regimens for bone infection after debridement: a study of 902 cases

2020 ◽  
Author(s):  
Xiaohua Wang(Former Corresponding Author) ◽  
Li Fang ◽  
Yueqi Chen ◽  
Shulin Wang ◽  
Huan Ma ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Antibiotic Treatment ◽  
Bone Infection ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Treatment Regimens ◽  
Intravenous Antibiotics ◽  
Abnormal Rate ◽  
Oral Group ◽  
Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

scholarly journals Partial oral antibiotic treatment for bacterial brain abscess: an open-label randomized non-inferiority trial (ORAL)

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacob Bodilsen ◽  
Matthijs C. Brouwer ◽  
Diederik van de Beek ◽  
Pierre Tattevin ◽  
Steven Tong ◽  
...  
Keyword(s):  
Brain Abscess ◽  
Antibiotic Treatment ◽  
Standard Treatment ◽  
Controlled Trial ◽  
Oral Treatment ◽  
Composite Endpoint ◽  
Primary Objective ◽  
Oral Antibiotic ◽  
Open Label ◽  
All Cause Mortality

Abstract Background The advised standard treatment for bacterial brain abscess following surgery is 6 to 8 weeks of intravenous (IV) antibiotic treatment, but an early switch to oral antibiotic treatment has been suggested to be equally effective. Methods This investigator-initiated, international, multi-center, parallel group, open-label, randomized (1:1 allocation) controlled trial will examine if oral treatment after 2 weeks of IV antibiotic therapy is non-inferior to standard 6–8 weeks of IV antibiotics for bacterial brain abscess in adults (≥ 18 years of age). The study will be conducted at hospitals across Denmark, the Netherlands, France, Australia, and Sweden. Exclusion criteria are severe immunocompromise or impaired gastro-intestinal absorption, pregnancy, device-related brain abscesses, and brain abscess caused by nocardia, tuberculosis, or Pseudomonas spp. The primary objective is a composite endpoint at 6 months after randomization consisting of all-cause mortality, intraventricular rupture of brain abscess, unplanned re-aspiration or excision of brain abscess, relapse, or recurrence. The primary endpoint will be adjudicated by an independent blinded endpoint committee. Secondary outcomes include extended Glasgow Outcome Scale scores and all-cause mortality at end of treatment as well as 3, 6, and 12 months since randomization, completion of assigned treatment, IV catheter associated complications, durations of admission and antibiotic treatment, severe adverse events, quality of life scores, and cognitive evaluations. The planned sample size is 450 patients for a one-sided alpha of 0.025 and a power of 90% to exclude a difference in favor of standard treatment of more than 10%. Date of initiation of first study center was November 3, 2020, with active recruitment for 3 years and follow-up for 1 year of all patients. Discussion The results of this study may guide future recommendations for treatment of bacterial brain abscess. If early transition to oral antibiotics proves non-inferior to standard IV treatment, this will provide considerable health and costs benefits. Trial registration ClinicalTrials.gov NCT04140903, first registered 28.10.2019. EudraCT number: 2019-002845-39, first registered 03.07.2019

Clinical Experience of Implementing Oral Versus Intravenous Antibiotics (OVIVA) in a Specialist Orthopedic Hospital

2020 ◽  
Author(s):  
Tariq Azamgarhi ◽  
Ashik Shah ◽  
Simon Warren
Keyword(s):  
Clinical Practice ◽  
Joint Infection ◽  
Hospital Readmissions ◽  
Length Of Hospital Stay ◽  
Oral Antibiotic ◽  
Antibiotic Regimen ◽  
Prospective Data ◽  
Parenteral Antibiotic ◽  
Real World Setting ◽  
Intravenous Antibiotics

Abstract Background The Oral Versus Intravenous Antibiotics (OVIVA) Trial demonstrated that oral therapy, when used during the initial 6 weeks in the treatment in bone and joint infection (BJI), is noninferior to intravenous therapy. To date there are no reports describing reproducibility of these findings in a real-world setting. Methods We studied all patients diagnosed with BJI at our hospital 12 months pre- and postimplementation of the OVIVA trial findings into clinical practice. An infection consultant recommended antibiotic treatment and patients were followed up by an outpatient parenteral antibiotic therapy (OPAT) service. Prospective data from a local registry was used to analyze baseline clinical details, outcome, length of hospital stay (LOS), and costs. Results A cohort of 328 patients (145 pre- and 183 postimplementation) was analyzed. Postimplementation, 66.1% of patients were switched to a suitable oral antibiotic regimen. Definite failure at 1 year was 13.6% in the preimplementation group and 18.6% in the postimplementation group (P = .154). Postimplementation, definite failure was more common in patients requiring intravenous antibiotics due to lack of suitable oral options (intravenous, 26.7% and oral, 14.3%). Adverse drug reactions (ADRs) requiring closer monitoring or change to treatment were more common postimplementation (21.0% and 37.1%, respectively). ADR-related hospital readmissions were similar in both groups (2.1 and 2.2%). Comparing both groups, the postimplementation group showed a reduction of 4 days in the median LOS and a median cost reduction of £2764.28 per patient. Conclusions The OVIVA trial findings can be safely implemented into clinical practice when patients on oral antibiotics are followed up by an established OPAT service. Two-thirds of patients were switched to a suitable oral antibiotic regimen. Implementation led to reductions in hospital LOS and antibiotic costs.

Sacubitril/Valsartan in Clinical Practice: A Report of 2 Cases

Cardiology ◽  
2017 ◽  
Vol 138 (Suppl. 1) ◽  
pp. 7-10 ◽  
Author(s):  
Eugenio Cosentino
Keyword(s):  
Clinical Practice ◽  
Heart Function ◽  
Safety Issue ◽  
Daily Practice ◽  
Reduced Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Patients With Heart Failure ◽  
Ambulatory Patients ◽  
Esc Guidelines ◽  
European Society Of Cardiology

Following the results of the PARADIGM-HF trial, the European Society of Cardiology (ESC) guidelines recommend sacubitril/valsartan to replace ACE inhibitors in ambulatory patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal therapy and who fit trial criteria. However, the optimal use of sacubitril/valsartan in clinical practice needs further investigation. We report here the cases of 2 patients with HFrEH successfully treated with sacubitril/valsartan in our daily practice. Both subjects presented multiple comorbidities and received an implantable cardioverter defibrillator in primary prevention. In both patients, therapy with sacubitril/valsartan led to prompt (30 days) amelioration of heart function, with a corresponding decrease in NHYA class and without any relevant safety issue.

scholarly journals Antibiotic treatment for bone infection after debridement: 2 weeks or 6 weeks?

2019 ◽  
Author(s):  
Xiaohua Wang ◽  
Li Fang ◽  
Shulin Wang ◽  
Huan Ma ◽  
Hongwen Zhao ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Antibiotic Treatment ◽  
Bone Infection ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Intravenous Antibiotics ◽  
Abnormal Rate ◽  
Oral Group ◽  
Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

scholarly journals The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry

2019 ◽  
Vol 5 (3) ◽  
pp. 202-207 ◽  
Author(s):  
Gilbert Habib ◽  
Patrizio Lancellotti ◽  
Paola-Anna Erba ◽  
Anita Sadeghpour ◽  
Marwa Meshaal ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Infective Endocarditis ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Imaging Techniques ◽  
Research Programme ◽  
Non Invasive ◽  
All Cause Mortality ◽  
Secondary Endpoints ◽  
European Society Of Cardiology

Abstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis (IE) and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of IE and data from the 2001 Euro Heart Survey. Methods and results Patients (n = 3116) aged over 18 years with a diagnosis of IE based on the ESC 2015 IE diagnostic criteria were prospectively identified between 1 January 2016 and 31 March 2018. Individual patient data were collected across 156 centres and 40 countries. The primary endpoint is all-cause mortality in hospital and at 1 year. Secondary endpoints are 1-year morbidity (all-cause hospitalization, any cardiac surgery, and IE relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of IE. Conclusion EURO-ENDO is an international registry of care and outcomes of patients hospitalized with IE which will provide insights into the contemporary profile and management of patients with this challenging disease.

scholarly journals Antibiotic treatment regimens for bone infection after debridement ： a study of 902 cases

2020 ◽  
Author(s):  
Xiaohua Wang ◽  
Li Fang ◽  
Shulin Wang ◽  
Yueqi Chen ◽  
Huan Ma ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Antibiotic Treatment ◽  
Bone Infection ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Treatment Regimens ◽  
Intravenous Antibiotics ◽  
Abnormal Rate ◽  
Oral Group ◽  
Liver And Kidney

Abstract Purpose: Our aim was to investigate the clinical efficacy and complications of antibiotics treatment duration for the patients of bone infection. Methods: We retrospectively analyzed the patients with bone infection admitted to our hospital between March 2013 and October 2018. The surgical debridement was performed and the patients were divided into three groups: IV group (Intravenous antibiotics for 2 weeks); Oral group (Intravenous antibiotics for 2 weeks followed by oral antibiotics for 4 weeks); Rifampicin group (Intravenous antibiotics for 2 weeks followed by oral antibiotics plus rifampicin for 4 weeks). The infection control rate and complications were compared. Results ： A total of 902 patients were enrolled, the infection sites included 509 tibias, 228 femurs, 32 humeri, 23 radii and ulnae, 40 calcanei, 23 multiple-site infections and the other sites 47 cases. After at least 6 months of follow-up, 148 (16.4%) patients had recurrence of infection. The recurrence rate of IV group was 17.9%, which was no significant higher than that of Oral group (10.1%) or Rifampicin group (10.5%). The abnormal rate of Glutamic-pyruvic transaminase(ALT) in IV group was 15.1%, which was lower than that of Oral group (18.0%) and Rifampicin group (27.4%), P=0.026. The positive rates of proteinuria in the three groups were 3.2%, 4.5%, and 9.3%, respectively, P=0.020. Conclusion: After debridement of bone infection, the additional oral antibiotic treatment may increase the damage of liver and kidney, and can not significantly reduce the infection recurrence rate. Therefore, it is recommended to adopt short-term systemic antibiotic treatment after debridement.

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