scholarly journals Evaluation of Perioperative Data in Patients with Infective Endocarditis Due to Antibiotic-Resistant Strains, Operated with the Use of Hyperthermic Perfusion

2019 ◽  
pp. 36-48
Author(s):  
H. B. Koltunova ◽  
O. A. Krykunov ◽  
R. V. Buriak
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Significant Degree ◽  
Hospital Treatment ◽  
Antibiotic Resistant ◽  
Surgical Interventions ◽  
Carbapenem Resistant ◽  
Complex Approach ◽  
Resistant Strains

Objectives. Due to reduction of terms of in-hospital treatment and increased range of community-acquired medical interventions risk of infective endocarditis (IE) due to antibiotic-resistant microorganisms increases. Surgical treatment of IE due to antibiotic resistant strains requires complex approach including the terms of surgical intervention, rational etiotropic antibiotic therapy, adequate materials for intracardiac reconstructions, hyperthermic per-fusion during bypass and careful perioperative management. The objective of the study was to describe the influence of antibiotic resistance on clinical course and results of surgical treatment in patients with infective endocarditis, operated with the use of hyperthermic perfusion. Materials and methods. Clinical data of 227 consequent patients with active infective endocarditis, operated from 01/01/2016 to 01/11/2018 were analyzed. The mean age was 48.7 ± 15.5 years. Gram-positive microorganisms were identified in 210 (92.5%) cases. Among them vancomycin-resistant strains composed – 46 (22.1%)cases. Gram-negative cultures were found in 17 (7.5%) cases. In this group the rate of carbapenem-resistant strains reached 47.1% (8 cases). Patients were operated with the use of total controlled hyperthermic perfusion (TCHP). Comparative analysis of perioperative data was carried out. Results. The group of patients with IE due to antibiotic-resistant strains (N = 54) was characterized by a higher frequency of redo interventions for replacement of infected valves – 7 (12.9%) cases, intracardiac abscesses – 13 (24.1%) cases, and lower frequency of valve-repair procedures – 5 (9.2%) cases, indicating a significant degree of initial degradation of the valve (p < 0.05). Despite the absence of influence of the duration of aortic cross-clamping time, the total bypass time in the antibiotic-resistant group was significantly higher (p = 0.021). Analysis of hemodynamic status of patients revealed that the dose and duration of sympatho-mimetic administration were significantly higher in the group of patients with resistant microorganisms: dobutamine – 3.7 ± 0.6 ?g/kg/min and 113.2 ± 2.1 hours; norepinephrine – 0.09 ± 0.01 ?g/kg/min and 12.3 ± 2.1 hours respectively (p < 0.001). Surgical interventions in patients with IE due to antibiotic-resistant strains, had higher frequency of postoperative heart failure – 30.8% cases (p = 0.002) and hospital mortality – 5,8% (p = 0.017) cases. Conclusions. Application of TCHP allowed to decrease hospital mortality to 5.8% in surgical treatment of patients with IE, caused by antibiotic-resistant strains of microorganisms.

scholarly journals Fighting Antibiotic-Resistant Klebsiella pneumoniae with “Sweet” Immune Targets

mBio ◽  
2018 ◽  
Vol 9 (3) ◽  
Author(s):  
Roberto Adamo ◽  
Immaculada Margarit
Keyword(s):  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Therapeutic Approaches ◽  
Antibiotic Resistant ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Surface Polysaccharides ◽  
Resistant Strains ◽  
Murine Monoclonal Antibodies

ABSTRACT Antibiotics and vaccines have greatly impacted human health in the last century by dramatically reducing the morbidity and mortality associated with infectious diseases. The recent challenge posed by the emergence of multidrug-resistant bacteria could possibly be addressed by novel immune prophylactic and therapeutic approaches. Among the newly threatening pathogens, Klebsiella pneumoniae is particularly worrisome in the nosocomial setting, and its surface polysaccharides are regarded as promising antigen candidates. The majority of Klebsiella carbapenem-resistant strains belong to the sequence type 158 (ST258) lineage, with two main clades expressing capsular polysaccharides CPS1 and CPS2. In a recent article, S. D. Kobayashi and colleagues (mBio 9:e00297-18, 2018, https://doi.org/10.1128/mBio.00297-18) show that CPS2-specific IgGs render ST258 clade 2 bacteria more sensitive to human serum and phagocytic killing. E. Diago-Navarro et al. (mBio 9:e00091-18, 2018, https://doi.org/10.1128/mBio.00091-18) generated two murine monoclonal antibodies recognizing distinct glycotopes of CPS2 that presented functional activity against multiple ST258 strains. These complementary studies represent a step toward the control of this dangerous pathogen.

scholarly journals The clinical features and prognosis of infective endocarditis in the elderly from 2007-2016 in a tertiary hospital in China

2019 ◽  
Author(s):  
Zhenzhu Wu ◽  
Yi Chen ◽  
Tingting Xiao ◽  
Tianshui Niu ◽  
Qingyi Shi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Renal Insufficiency ◽  
Hospital Mortality ◽  
Older Patients ◽  
The Elderly ◽  
Tertiary Hospital ◽  
Old Patients ◽  
Younger Patients ◽  
One Year

Abstract Background Infective endocarditis (IE) is a serious disease, with a worse prognosis in the elderly. Aims To explore the clinical features and prognosis of old patients with IE in a tertiary hospital. Methods A retrospective cohort study was conducted. A total of 407 patients diagnosed as IE were divided into two groups: 348 patients under 65 years old and 59 patients over 65 years old. Results For older patients, clinical symptoms such as fever, anemia, and heart murmur were as common as in younger patients. Comorbidities like hypertension (P＜0.001) and diabetes (P=0.023) were more common in older patients. Complications like renal insufficiency (P=0.027) and arrhythmia (P＜0.001) were also more common in older patients. The old patients had a lower operation rate (40.7% vs 60.6%, P=0.004) and higher in-hospital mortality (20.3% vs 8.9%, P=0.008) compared with the younger patients. Pitt score ≥4 (P=0.043, OR=28.0, 95% CI 1.1-700.4) and renal insufficiency (P=0.011, OR=34.2, 95% CI 2.2-521.2) were independent risk factors of in-hospital mortality for older patients. Surgical treatment was a significant predictor of one-year mortality even after adjusting for the confounders (HR = 1.722, 95% CI 0.563-5.365, P = 0.005).The one-year survival rate was higher for older patients with surgical intervention than those without (95.8% vs 68.6%, P=0.007). Conclusions IE in older patients present with more comorbidities and complications as well as a higher mortality than younger patients. Surgery were underused in old patients and old patients with surgical treatment had better long-term prognosis.

scholarly journals Antibiotic-ResistantAcinetobacter baumanniiIncreasing Success Remains a Challenge as a Nosocomial Pathogen

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Ana Maria Gonzalez-Villoria ◽  
Veronica Valverde-Garduno
Keyword(s):  
Acinetobacter Baumannii ◽  
Current Status ◽  
Future Prospects ◽  
Nosocomial Pathogen ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Current State ◽  
Resistant Strains ◽  
Key Events

Antibiotic-resistant infectious bacteria currently imply a high risk and therefore constitute a strong challenge when treating patients in hospital settings. Characterization of these species and of particular strains is a priority for the establishment of diagnostic tests and preventive procedures. The relevance ofAcinetobacter baumanniias a problematic microorganism in inpatient facilities, particularly intensive care units, has increased over time. This review aims to draw attention to (i) the historical emergence of carbapenem-resistantAcinetobacter baumannii, (ii) the current status of surveillance needs in Latin America, and (iii) recent data suggesting thatA. baumanniicontinues to spread and evolve in hospital settings. First, we present synopsis of the series of events leading to the discovery and precise identification of this microorganism in hospital settings. Then key events in the acquisition of antibiotic-resistant genes by this microorganism are summarized, highlighting the race between new antibiotic generation and emergence ofA. baumanniiresistant strains. Here we review the historical development of this species as an infectious threat, the current state of its distribution, and antibiotic resistance characteristics, and we discuss future prospects for its control.

scholarly journals Antimicrobial activity of a repurposed harmine-derived compound on extensively drug-resistant Acinetobacter baumannii clinical isolates

2021 ◽  
Author(s):  
Anke Breine ◽  
Megane Van Gysel ◽  
Mathias Elsocht ◽  
Clemence Whiteway ◽  
Chantal Philippe ◽  
...  
Keyword(s):  
Acinetobacter Baumannii ◽  
Reference Strain ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Extensively Drug Resistant ◽  
Resistant Strains ◽  
High Degree

Synopsis Objectives: The spread of antibiotic resistant bacteria is an important threat for human healthcare. Acinetobacter baumannii bacteria impose one of the major issues, as multidrug- to pandrug-resistant strains have been found, rendering some infections untreatable. In addition, A. baumannii is a champion in surviving in harsh environments, being capable of resisting to disinfectants and to persist prolonged periods of desiccation. Due to the high degree of variability found in A. baumannii isolates, the search for new antibacterials is challenging. Here, we screened a compound library to identify compounds active against recent isolates of A. baumannii bacteria. Methods: A repurposing drug screen was undertaken to identify A. baumannii growth inhibitors. One hit was further characterized by determining its IC50 and testing its activity on 43 recent clinical A. baumannii isolates, amongst which 40 are extensively drug- and carbapenem-resistant strains. Results: The repurposing screen led to the identification of a harmine-derived compound, called HDC1, which proved to have bactericidal activity on the multidrug-resistant AB5075-VUB reference strain with an IC50 of 48.23 [mu]M. In addition, HDC1 impairs growth of all 43 recent clinical A. baumannii isolates. Conclusions: We identified a compound with inhibitory activity on all tested, extensively drug-resistant clinical A. baumannii isolates.

scholarly journals Antibiotic Resistance and Genotypes of Nosocomial Strains of Acinetobacter baumannii in Kazakhstan

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 382
Author(s):  
Alyona Lavrinenko ◽  
Eugene Sheck ◽  
Svetlana Kolesnichenko ◽  
Ilya Azizov ◽  
Anar Turmukhambetova
Keyword(s):  
Antibiotic Resistance ◽  
High Risk ◽  
Susceptibility Testing ◽  
Antibiotic Susceptibility Testing ◽  
Antibiotic Resistant ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Resistance Rates ◽  
Chromosomal Loci ◽  
Pcr Genotyping

The aim of this study was to determine the prevalence of A. baumannii antibiotic-resistant strains in Kazakhstan and to characterize genotypes related to epidemic “high-risk” clones. Two hundred and twenty four A. baumannii isolates from four cities of Kazakhstan in 2011–2019 were studied. Antibiotic susceptibility testing was performed by using broth microdilutions method according to EUCAST (v 11.0) recommendations. The presence of blaOXA-23-like, blaOXA-24/40-like,blaOXA-58-like,blaVIM,blaIMP, and blaNDM genes was determined by PCR. Genotyping was performed using high-throughput real-time PCR detection of 21 SNPs at 10 chromosomal loci used in existing MLST schemes. Resistance rates to imipenem, meropenem, amikacin, gentamicin, and ciprofloxacin were 81.3%, 78.6%, 79.9%, 65.2%, and 89.3%, respectively. No colistin resistant isolates were detected. The values of the MIC 50% and the MIC 90% of tigecycline were 0.125 mg/L, only four isolates (1.8%) had the ECOFF value >0.5 mg/L. The presence of acquired carbapenemase genes was found in 82.2% strains, including blaOXA-23-like (78.6%) or blaOXA-58-like (3.6%) genes. The spreading of carbapenem resistant A. baumannii strains in Kazakhstan was associated with epidemic “high-risk” clonal groups, predominantly, CG208(92)OXF/CG2PAS (80.8%) and less often CG231(109)OXF/CG1PAS (1.8%).

scholarly journals Surgical treatment for infective endocarditis in the ageing society: a nationwide retrospective study in Japan

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001627
Author(s):  
Hiroyuki Kiriyama ◽  
Hidehiro Kaneko ◽  
Hidetaka Itoh ◽  
Tatsuya Kamon ◽  
Kojiro Morita ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Propensity Score ◽  
Elderly Patients ◽  
Hospital Mortality ◽  
Current Status ◽  
Matched Cohort ◽  
Very Elderly ◽  
Ageing Society ◽  
Diagnosis Procedure Combination

ObjectiveThe current status of surgical treatment for infective endocarditis (IE) among very elderly people is unclear.MethodsWe extracted data on patients in Japan with community-acquired IE who were admitted and discharged between April 2010 and February 2018 using a nationwide inpatient, the Diagnosis Procedure Combination database. We divided patients into three groups: non-elderly (<65 years), elderly (65–79 years) and very elderly (≥80 years). A 1:1 propensity score matching was performed to compare proportions of surgical treatment and in-hospital mortality among the groups.ResultsWe identified 20 667 eligible patients (median age 70 years, 61.0% men). The proportion of very elderly patients significantly increased (19.1% in 2010 to 29.7% in 2018). The proportion of surgical treatment was significantly lower, and in-hospital mortality was significantly higher in very elderly patients. This tendency was more pronounced among patients with in-hospital complications such as heart failure, stroke or embolism. Surgical treatment was significantly associated with lower in-hospital mortality even in very elderly patients, both in an unmatched (OR 0.61; 95% CI 0.47 to 0.78) and a propensity score matched cohort (OR 0.61; 95% CI 0.43 to 0.85).ConclusionsThe proportion of very elderly patients with IE was increasing, and very elderly patients had higher in-hospital mortality. The proportion of surgical treatment for IE among very elderly patients was low, but it was associated with lower in-hospital mortality. Further studies are needed to establish the optimal strategy for IE among very elderly patients.

scholarly journals Surgical treatment for infective endocarditis and hospital mortality in a Brazilian single-center

2013 ◽  
Vol 28 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Mauricio de Nassau Machado ◽  
Marcelo Arruda Nakazone ◽  
Jamil Ali Murad-Júnior ◽  
Lilia Nigro Maia
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Single Center

scholarly journals A Contemporary Strategy for the Surgical Treatment of Destructive Forms of Infective Endocarditis

2018 ◽  
Vol 8 (2) ◽  
pp. 10-18
Author(s):  
A. P. Medvedev ◽  
V. E. Babokin ◽  
Yu. A. Sobolev ◽  
V. V. Pichugin ◽  
V. A. Chiginev ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Valves ◽  
Heart Defects ◽  
Integrated Approach ◽  
Multiple Organ ◽  
Functional Class ◽  
Surgical Interventions

Introduction. Despite recent achievements in medicine, many issues in the diagnosis and treatment of infective endocarditis (IE) remain outstanding. This is mainly due both to an increase in the incidence and changes in the clinical picture of this nosology. An important factor here is the continuing presence of existing principles governing the approach to the surgical treatment of infective endocarditis, including prosthetic endocarditis.Objective: to evaluate the effectiveness of an integrated approach to the treatment of infective endocarditis in patients with valvular heart disease on the basis of 37 years of experience.Materials and methods. An analysis of the surgical treatment of 1097 patients with infectious lesions of the valvular heart apparatus was carried out. The mean age of the sample was 35.1 ± 9.7 years (from 4 months to 68 years); 67.2 % were men, while women made up 32.8 %. Additionally, 122 patients had infectious lesions affecting 2 or more valves. In 109 cases, valvular prosthetic endocarditis was diagnosed; in 37 patients, IE was detected against the background of congenital heart defects. 99 patients had perianular abscesses. Of all surgical interventions carried out, 18 were repeated, including those with non-valvular congenital heart defects.Results and discussion. Overall hospital mortality was 4.3 % (47 patients). In patients with IE complicated by a congenital heart defect (CHD), mortality was 14.7 %; with endocarditis of mechanical heart valves — 13.2 %; in drug-dependent patients — 4.5 %; with infectious destruction of native heart valves — 2.8 %; in patients with a background of electrodeinduced endocarditis, no deaths during hospitalisation were observed.Conclusions. The effectiveness of surgical intervention of infective endocarditis can reach 85.4 %. When supplemented with pathogenetic and etiotropic therapy, surgical correction of affected heart structures contributes to the rapid and reliable sanitation of all infection foci, as well as to a reduction in multiple organ failure. Timely surgery significantly reduces the degree of heart failure and improves the NYHA functional class. In the long term, reconstructive interventions contribute to a better heart recovery than prosthetic operations. It should be noted that the proposed treatment approach for this group of patients creates conditions for adequate labour and social rehabilitation in a distant postoperative period. 

Association between surgical treatment and in-hospital mortality in patients with infective endocarditis stratified by NYHA classification: a nationwide retrospective study in Japan

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Kiriyama ◽  
H Kaneko ◽  
T Kamon ◽  
H Itoh ◽  
T Jo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Surgical Treatment ◽  
Infective Endocarditis ◽  
Hospital Mortality ◽  
Surgical Intervention ◽  
Nyha Class ◽  
Multivariable Logistic Regression Analysis ◽  
Multivariable Logistic Regression Model ◽  
Multivariable Logistic Regression ◽  
Nyha Classification

Abstract Background Heart failure (HF) is one of the major complications of infective endocarditis (IE). The ESC guideline described that surgical treatment should be performed for the patients with IE complicated with HF. However, decision making of surgical indication in real-world clinical setting is not easy for patients with IE concomitant with HF due to complicated conditions, and the clinical benefit of surgical intervention for IE and HF is unclear. Purpose We sought to uncover the association between surgical treatment and in-hospital mortality among the patients admitted for community-acquired IE respectively according to the severity of HF symptoms (NYHA class I to IV). Methods We studied 3,403 patients diagnosed as IE (mean age 65.9 years, 61.6% males) with records of baseline NYHA classification (I to IV) who survived for more than 2 days, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were classified into four groups: 919 patients (27.0%) in NYHA I, 1,007 patients (29.6%) in NYHA II, 767 patients (22.5%) in NYHA III, and 710 patients (20.9%) in NYHA IV. A multivariable logistic regression model adjusted for age, gender, Barthel Index, Charlson Comorbidity Index, and usage of inotropic therapy at admission was performed to evaluate the association between the surgical treatment and in-hospital mortality. Results Patients with higher NYHA classification were significantly older and were more likely to be female than those with lower NYHA classification. At admission, patients with higher NYHA classification had lower baseline activities and higher comorbidities, and also had more complications including stroke, shock and disseminated intravascular coagulation than those with lower NYHA classification. In-hospital mortality was seen in 406 patients (11.9%) in the entire cohort. The mortality rate significantly increased with the NYHA class (NYHA I, 3.6%; NYHA II, 8.4%; NYHA III, 11.9%; NYHA IV, 27.9%: p&lt;0.001). According to the multivariable logistic regression analysis, surgical treatment was independently associated with lower in-hospital mortality (Odds ratio 0.395, 95% Confidence Interval 0.297–0.526; p&lt;0.001). A fragmentated analysis in each NYHA classification showed that the survival benefit of surgical intervention was pronounced in patients with higher NYHA class (Figure). The limitation of our study was including the potential unmeasured confounders, which lead to overestimate the relationship between the surgical treatment and in-hospital mortality even after excluding the critically ill patients who died within 2 days and adjusting for the measured confounders. Conclusion Surgical treatment was associated with lower in-hospital mortality among the patients with IE complicated with HF, particularly among those with more advanced HF status. Our study implies that surgical treatment might be beneficial for the patients with advanced HF. Funding Acknowledgement Type of funding source: None

scholarly journals Decreased susceptibility to tigecycline inEscherichia colimediated by a mutation inmlaA

2016 ◽  
pp. AAC.01603-16
Author(s):  
Fang He ◽  
Juan Xu ◽  
Jianfeng Wang ◽  
Qiong Chen ◽  
Xiaoting Hua ◽  
...  
Keyword(s):  
Gram Positive ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Carbapenem Resistant ◽  
Resistant Strains ◽  
Carbapenem Resistant Enterobacteriaceae

Tigecycline, a type of glycylcycline, is a novel expanded-spectrum antibiotic that active against most Gram-negative and Gram-positive bacteria, including antibiotic-resistant strains such as carbapenem-resistant Enterobacteriaceae (1-3).…

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