Short-course antibiotic treatment is as effective as conventional antibiotic regimen for implantable electronic device-related infective endocarditis

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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Epidemiology and antibiotic treatment of infective endocarditis: an update

Heart ◽

10.1136/hrt.2005.072595 ◽

2006 ◽

Vol 92 (11) ◽

pp. 1694-1700 ◽

Cited By ~ 35

Author(s):

B. Hoen

Keyword(s):

Infective Endocarditis ◽

Antibiotic Treatment

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New aspects in the antibiotic treatment of infective endocarditis

European Heart Journal ◽

10.1093/eurheartj/8.suppl_j.341 ◽

1987 ◽

Vol 8 (suppl J) ◽

pp. 341-345 ◽

Cited By ~ 1

Author(s):

H. Lode

Keyword(s):

Infective Endocarditis ◽

Antibiotic Treatment

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Positive predictive value of infective endocarditis in the Danish National Patient Registry: a validation study

Epidemiology and Infection ◽

10.1017/s0950268818001401 ◽

2018 ◽

Vol 146 (15) ◽

pp. 1965-1967 ◽

Cited By ~ 9

Author(s):

Lauge Østergaard ◽

Kasper Adelborg ◽

Jens Sundbøll ◽

Lars Pedersen ◽

Emil Loldrup Fosbøl ◽

...

Keyword(s):

Infective Endocarditis ◽

Positive Predictive Value ◽

Predictive Value ◽

Medical Records ◽

Electronic Device ◽

Patient Registry ◽

Cardiac Implantable Electronic Device ◽

National Patient Registry ◽

Danish National Patient Registry ◽

National Patient

AbstractThe positive predictive value of an infective endocarditis diagnosis is approximately 80% in the Danish National Patient Registry. However, since infective endocarditis is a heterogeneous disease implying long-term intravenous treatment, we hypothesiszed that the positive predictive value varies by length of hospital stay. A total of 100 patients with first-time infective endocarditis in the Danish National Patient Registry were identified from January 2010 – December 2012 at the University hospital of Aarhus and regional hospitals of Herning and Randers. Medical records were reviewed. We calculated the positive predictive value according to admission length, and separately for patients with a cardiac implantable electronic device and a prosthetic heart valve using the Wilson score method. Among the 92 medical records available for review, the majority of the patients had admission length ⩾2 weeks. The positive predictive value increased with length of admission. In patients with admission length <2 weeks the positive predictive value was 65% while it was 90% for admission length ⩾2 weeks. The positive predictive value was 81% for patients with a cardiac implantable electronic device and 87% for patients with a prosthetic valve. The positive predictive value of the infective endocarditis diagnosis in the Danish National Patient Registry is high for patients with admission length ⩾2 weeks. Using this algorithm, the Danish National Patient Registry provides a valid source for identifying infective endocarditis for research.

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Prosthetic valve endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0392 ◽

2018 ◽

pp. 1720-1723

Author(s):

José A. San Román ◽

Javier López

Keyword(s):

Computed Tomography ◽

Infective Endocarditis ◽

Antibiotic Treatment ◽

Prosthetic Valve ◽

Photon Emission ◽

Clinical Manifestations ◽

Prosthetic Valve Endocarditis ◽

Native Valve ◽

Native Valve Endocarditis ◽

Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

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1505. Shorter-Course Antibiotic Treatment for Pediatric Ventilator-Associated Tracheitis Is Safe and Effective

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1369 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S548-S548

Author(s):

Mirela Grabic ◽

Jason G Lake ◽

Jelena Debelnogich ◽

Christina Krucylak ◽

Jason Newland

Keyword(s):

Antibiotic Treatment ◽

Pediatric Intensive Care ◽

Chi Square ◽

Stewardship Program ◽

Short Course ◽

Antibiotic Duration ◽

Physician Perception ◽

The Impact ◽

Common Infection ◽

Made In

Abstract Background Ventilator-associated tracheitis (VAT) is a common infection in children cared for in pediatric intensive care units (PICU). Short-course antibiotic treatment (5 days) has been shown to be effective. In October 2016, we implemented a PICU VAT guideline for short-course therapy. We assessed the impact of this intervention. Methods We conducted a retrospective cohort study of PICU patients diagnosed with VAT from October 2016 to June 2018. The antimicrobial stewardship program (ASP) identified potential patients through daily chart review. Only those patients with a clinician diagnosis and who were receiving antibiotics for VAT, either enterally or parenterally, were included. Frequencies and proportions were calculated. Chi-square or Fisher exact tests were used to compare proportions. Results ASP identified 251 potential patients, 105 (42%) of whom met inclusion criteria. The median age was 7 years (range: 0–21). Twenty-eight (27%) were tracheostomy dependent. The most commonly prescribed antibiotics were cefepime (43%), ceftriaxone (17%), and vancomycin (14%). Median antibiotic duration was 13 days (range: 1–29); 57 (52%) received > 5 days and 48 (44%) received 5 days. Only 3 (6%) patients who received 5 days of antibiotics required retreatment within 10 days of their initial course vs. 11 (19%) who received > 5 days (P = 0.09). A diagnosis of ventilator-associated pneumonia (VAP) within 10 days of completing VAT treatment was made in 2 (4%) patients who received 5 days vs. 3 (5%) of patients who received > 5 days (P = 1.0). C. difficile infection within 90 days occurred in 2 (4%) patients who received > 5 days vs. 1 (2%) who received 5 days (P = 1.0). Conclusion Short-course antibiotic therapy for VAT was not associated with retreatment for VAT or subsequent diagnosis of VAP. Development of C. difficile was similar between groups. Adherence to the guideline was approximately 50%, perhaps due to physician perception of disease severity. Additional work is needed to refine the diagnosis of VAT and assess the interaction between illness severity and treatment duration. Disclosures All authors: No reported disclosures.

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