scholarly journals A Randomized Controlled Clinical Trial on Therapeutic Effects of Teicoplanin and Vancomycin after Cardiac Surgery due to MRSA infective endocarditis in ICU Patients

2020 ◽  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Adverse Effects ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Therapeutic Effects ◽  
Glycopeptide Antibiotics ◽  
Therapy Regimen ◽  
Duke Criteria ◽  
Vancomycin Group

Background: Infective endocarditis (IE) is a relatively rare disease but with significant rates of morbidity and mortality. The goal of IE treatment is to eradicate the foci of infection, including antimicrobial therapy with or without surgery. The decision on the selection of an empirical therapy regimen is diverse and based on patient characteristics. Vancomycin and teicoplanin are bacteriostatic glycopeptide antibiotics used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, including MRSA-IE, and patients allergic to penicillin who are infected with methicillin-sensitive Staphylococcus aureus. Objective: The current study aimed to compare the efficacy and adverse effects of vancomycin and teicoplanin in the treatment of patients with MRSA-IE. Materials and Methods: This parallel, randomized, and controlled trial study was carried out on the efficacy and safety of teicoplanin versus vancomycin in the treatment of MRSA endocarditis within August 2012 and April 2017. The present study recruited adult patients with a definite or possible diagnosis of IE based on the Modified Duke Criteria. A central computer-generated random number list was used to allocate the patients (1:1) to the treatment with teicoplanin or vancomycin. Vancomycin was intravenously administered at a dose of 30 mg/kg/day in two doses. Teicoplanin was administered at a loading dose of 6-12 mg/kg every 12 h in four doses and then continued once a day. Results: Out of 86 patients screened with suspected IE, 66 patients were randomly assigned to the vancomycin (n=33) and teicoplanin (n=33) groups. The mean age values of the study subjects were 41±11.8 and 39±13.1 years in the vancomycin and teicoplanin groups, respectively. In addition, 27 patients (81.8%) in the vancomycin group met the criteria for microbiological cure, compared to 25 subjects (89.3%) in the teicoplanin group. In this regard, the observed difference was not statistically significant (P=0.41). Moreover, 26 (78.8%) and 23 (82.1%) patients in the vancomycin and teicoplanin groups achieved clinical cure, respectively (P=0.97). Overall, the patients in the vancomycin group experienced more adverse events in comparison to those of the teicoplanin group (P=0.04). The rate of acute kidney injury over time, especially in the first week of therapy, was higher in the vancomycin group than that reported for the teicoplanin group (P=0.05). Six and four patients in the vancomycin and teicoplanin groups required dialysis, respectively. The use of dialysis was not different between the two groups (P=0.88). Seven (21.3%) and five (17.9%) patients in the vancomycin and teicoplanin groups died, respectively, which was not statistically different between the two groups (P=0.74). Conclusions: It was concluded that the administration of vancomycin or teicoplanin does not significantly change the outcome of patients undergoing empirical treatment for MRSA-IE. This finding indicates the patients are similar in clinical outcomes and mortalities despite some adverse effects, such as skin rashes; therefore, teicoplanin can be considered a treatment choice for these diseases.

Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

2019 ◽  
Author(s):  
Yuanfang Wang ◽  
Mei Kang ◽  
Ya Liu ◽  
Siyin Wu ◽  
Weili Zhang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Resistance Rate ◽  
Native Valve ◽  
Duke Criteria ◽  
Preventive Medication ◽  
History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

scholarly journals Addition of Rifampin to Standard Therapy for Treatment of Native Valve Infective Endocarditis Caused by Staphylococcus aureus

2008 ◽  
Vol 52 (7) ◽  
pp. 2463-2467 ◽  
Author(s):  
David J. Riedel ◽  
Elizabeth Weekes ◽  
Graeme N. Forrest
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Drug Interactions ◽  
Standard Therapy ◽  
Cohort Analysis ◽  
Urban Hospital ◽  
Hepatitis C Infection ◽  
Native Valve ◽  
Duke Criteria ◽  
The Impact

ABSTRACT Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

Right-sided infective endocarditis

ESC CardioMed ◽  
2018 ◽  
pp. 1726-1728
Author(s):  
José A. San Román ◽  
Javier López
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Diagnostic Yield ◽  
Diuretic Therapy ◽  
Clinical Manifestations ◽  
Right Heart Failure ◽  
Right Heart ◽  
Duke Criteria ◽  
Initial Imaging

Right-sided infective endocarditis (RSIE) can be classified into three epidemiological groups: intravenous drug users (IDUs), intravascular device carriers, and the ‘three noes’ group (no left-sided, no device, no IDUs). RSIE represents 5–10% of all infective endocarditis episodes in adults. The most common clinical manifestations of RSIE are fever and respiratory symptoms. The microbiological profile is dominated by Staphylococcus species, especially methicillin-sensitive Staphylococcus aureus. The modified Duke criteria should be used for the diagnosis of this entity, although their sensitivity and specificity are lower than in left-sided infective endocarditis. Regarding imaging in RSIE, the diagnostic yield of transthoracic echocardiography (TTE) is comparable with transoesophageal echocardiography, so TTE should be the initial imaging technique when RSIE is clinically suspected. The empirical antibiotic treatment should include antibiotics against staphylococci, such as vancomycin or daptomycin in combination with gentamicin and then adapted to the antibiogram. In non-complicated episodes of isolated tricuspid endocarditis caused by methicillin-sensitive Staphylococcus aureus, a 2-week regimen with cloxacillin can be safely used. In other cases, a standard 4–6 weeks is mandatory. Careful selection of patients for surgery is needed and surgery is only indicated in cases of microorganisms difficult to eradicate, or bacteraemia for more than 7 days despite adequate antimicrobial therapy, persistent tricuspid valve vegetations larger than 20 mm after recurrent pulmonary emboli with or without concomitant right heart failure, or right heart failure secondary to severe tricuspid regurgitation with poor response to diuretic therapy. Mortality of RSIE in IDUs is about 7%.

scholarly journals Clinical Features and Outcome of Infective Endocarditis in a University Hospital in Romania

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 158
Author(s):  
Emilia Elena Babeș ◽  
Diana Anca Lucuța ◽  
Codruța Diana Petcheși ◽  
Andreea Atena Zaha ◽  
Cristian Ilyes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
University Hospital ◽  
Hospital Death ◽  
Coagulase Negative Staphylococcus ◽  
Index Number ◽  
Duke Criteria

Background and Objectives: Characterization of patients with endocarditis regarding demographic, clinical, biological and imagistic data, blood culture results and possible correlation between different etiologic factors and host status characteristics. Material and methods: This is a retrospective observational descriptive study conducted on patients older than 18 years admitted in the past 10 years, in the Cardiology Clinic of the Clinical County Emergency Hospital Oradea Romania, with clinical suspicion of bacterial endocarditis. Demographic data, clinical, paraclinical investigations and outcome were registered and analyzed. Results: 92 patients with definite infective endocarditis (IE) according to modified Duke criteria were included. The mean age of patients was 63.80 ± 13.45 years. A percent of 32.6% had health care associated invasive procedure performed in the 6 months before diagnosis of endocarditis. Charlson’s comorbidity index number was 3.53 ± 2.029. Most common clinical symptoms and signs were: shortness of breath, cardiac murmur, fever. Sixty-six patients had native valve endocarditis, 26 patients had prosthetic valve endocarditis and one patient was with congenital heart disease. Blood cultures were positive in 61 patients. Among positive culture patient’s staphylococcus group was the most frequently involved: Staphylococcus aureus (19.6%) and coagulase negative Staphylococcus (18.5%). Most frequent complications were heart failure, acute renal failure and embolic events. Conclusions: Staphylococcus aureus IE was associated with the presence of large vegetations, prosthetic valve endocarditis and intracardiac abscess. Coagulase negative Staphylococcus (CoNS) infection was associated with prosthetic valve dysfunction. Streptococcus gallolyticus etiology correlated with ischemic embolic stroke and the presence of large vegetations. Cardiovascular surgery was recommended in 67.4% of patients but was performed only on half of them. In hospital death occurred in 33.7% of patients and independent predictors of mortality were congestive heart failure and septic shock.

scholarly journals 683. Epidemiology and Microbiology of Infective Endocarditis: A Six Year Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S444-S444
Author(s):  
Niyas Vettakkara Kandy Muhammed ◽  
Rajalakshmi Ananthanarayanan ◽  
Aswathy Sasidharan
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Blood Culture ◽  
Detection System ◽  
Tertiary Care ◽  
Prosthetic Valve Endocarditis ◽  
Health Indicators ◽  
Developed Countries ◽  
Care Hospital ◽  
Duke Criteria

Abstract Background The epidemiology and microbiology of infective endocarditis (IE) is not well studied in India. Studies from developed countries report a culture positivity of more than 90% in IE, while in India it has been lower (40–70%). Viridans Group Streptococci (VGS) are the commonest organism identified from previous Indian studies. The state of Kerala in India has better health indicators compared to the rest of India and it is likely that the epidemiology of IE in Kerala may be different. We therefore studied the epidemiology and microbiology of IE in patients admitted to a tertiary care hospital in Kerala over six years (2015 – 2020). Methods An electronic medical record search was conducted to identify patients who satisfied definite or possible IE criteria as per modified Duke criteria. Three sets of blood cultures were sent in BacT/Alert blood culture bottles for all suspected cases of IE. Blood culture was done using BacT-ALERT 3D automated microbial detection system (bioMérieux, France) and organisms were identified using VITEK-2 system. Transthoracic echocardiogram was done for all patients and a transoesophageal echocardiogram was done when indicated. Results 70 patients satisfied the inclusion criteria. Majority (70.4%) were male; mean age was 50.7±16.3 years. 71% patients had underlying valvular heart disease. Diabetes mellitus (53.5%) was the most common comorbidity followed by chronic kidney disease (18.3%). Mitral valve was most commonly affected (53.5%) followed by the aortic valve (19.7%) and both valves were involved in 5.7%. Right sided valves were affected in 8.5%. Prosthetic valve endocarditis accounted for 10% of cases. No echocardiographic evidence of endocarditis was seen in 11.3%. Blood culture was positivity was 64.8%. Staphylococcus aureus (20%) was the most common organism isolated, followed by VGS (17.1%). 50% of the Staphylococcus aureus isolated were methicillin resistant. Among 57 patients in whom an outcome was recorded, mortality was 12.2%. Microbiology profile of infective endocarditis Conclusion Staphylococcus aureus has emerged as the most common etiological agent of IE in our study, in contrast to previous studies from India where VGS was predominant. The high prevalence of MRSA is of concern. Disclosures All Authors: No reported disclosures

Melatonin Receptor Agonists for Delirium Prevention

2016 ◽  
Vol 51 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Cheri K. Walker ◽  
Mark A. Gales
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Controlled Trial ◽  
Controlled Clinical Trial ◽  
Medical Patients ◽  
Melatonin Receptor ◽  
Controlled Clinical Trials ◽  
Receptor Agonists ◽  
Delirium Prevention ◽  
Melatonin Receptor Agonists

Objective: To review the prospective controlled trials available for the use of melatonin receptor agonists for delirium prevention. Data Sources: A MEDLINE literature search (1946 to July 2016) was conducted using the search terms delirium, melatonin, ramelteon, tryptophan, and melatonin-receptor agonist. Prospective controlled clinical trials with delirium prevention as an outcome were included. The references of identified articles were reviewed to identify other relevant articles. Study Selection and Data Extraction: Controlled clinical trials in humans, limited to the English language, were reviewed. Five randomized and 1 nonrandomized prospective controlled clinical trial exploring the use of melatonin receptor agonists for delirium prevention were evaluated. Data Synthesis: Melatonin agonist therapy for delirium prevention has produced conflicting results in clinical trials. Delirium incidence ranged from no change to significant reductions of approximately 12% to 30%. Four trials were conducted with melatonin as the investigated agent, 1 with l-tryptophan, and 1 with ramelteon. The study setting also varied, with 4 trials being conducted in surgical patients and 2 trials in medical patients. Melatonin provided conflicting results, with 3 trials showing decreased delirium incidence and the largest randomized controlled trial showing no benefit. No benefit was found using l-tryptophan in delirium prevention. The single, small ramelteon trial showed decreased delirium incidence. Safety evaluations during trials were limited. Three trials found adverse effects similar to placebo, whereas the remaining 3 trials did not evaluate adverse effects. Conclusions: The routine use of melatonin receptor agonists for delirium prevention cannot be recommended at this time.

scholarly journals 154. Do I Really Need a Transesophageal Echo? Comparing Echocardiographic Modalities in Native Valve Infective Endocarditis due to Methicillin-Resistant Staphylococcus aureus

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S103-S103
Author(s):  
James Livesay ◽  
William Lorson ◽  
R Eric Heidel ◽  
Mahmoud Shorman
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Tertiary Care ◽  
Care Facility ◽  
High Morbidity ◽  
Transthoracic Echocardiogram ◽  
Methicillin Resistant ◽  
Cardiac Devices ◽  
Duke Criteria

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is associated with high morbidity and mortality. Management commonly includes six-weeks of antibiotics and surgical intervention, if the patient has complications. Current guidelines recommend obtaining an echocardiogram. Transesophageal echocardiogram (TEE) is preferred over transthoracic echocardiogram (TTE). We wanted to evaluate the role of a TEE in changing management of MRSA IE. Methods A retrospective cohort of patients with MRSA IE was analyzed between January 2013 and July 2017 at a tertiary care facility in East Tennessee. Patients with prosthetic valves or cardiac devices were excluded. Demographic, echocardiographic, antibiotic, blood culture, mortality, and intravenous drug use data were collected (Figure 1). Results Seventy-eight patients met the inclusion criteria. TTE was performed on 73 patients while five patients proceeded directly to TEE. Of the 73 patients that had a TTE, 33 (45.2%) detected the presence of vegetation and 40 (54.8%) did not. Of the 33 patients with a positive TTE, 15 subsequently underwent TEE, confirming IE. Out of the 40 patients with a negative TTE, 34 underwent TEE, of which 22 (64.7%) showed a vegetation. (Figure 2). A total of ten patients (12.8%) from the study underwent surgery. Of these ten, three (30%) had a positive TTE only, with no subsequent TEE. Five (50%) had both a positive TTE and TEE, and two (20%) had a negative TTE but positive TEE. Conclusion Transthoracic echocardiogram was adequate to visualize vegetations in 45.2% of patients. Completing a TEE increased the sensitivity of visualizing a vegetation, but management was most often not altered. Only two patients (5%) with a negative TTE, but positive TEE proceeded to surgery because of the findings. This causes us to question whether a subsequent TEE needs to be pursued when a TTE is negative in the setting of definite or possible IE by the modified Duke criteria. Even if a vegetation is seen on TEE the patient would most likely receive the same treatment, 6 weeks of intravenous antibiotics, as if no vegetation was seen. Forgoing a TEE reduces risk to the patient of undergoing a procedure, and reduces costs to the healthcare system. Disclosures All authors: No reported disclosures.

Therapeutic Effects of Hab Shabyar on Open-Angle Glaucoma: A Double-Blinded, Randomized, Placebo-Controlled Trial

2019 ◽  
Vol 8 ◽  
pp. 1218
Author(s):  
Ebrahim Khalil BaniHabib ◽  
Ali Mostafai ◽  
Seyyed Mohammad Bagher Fazljou ◽  
Ghadir Mohammdi
Keyword(s):  
Placebo Group ◽  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Controlled Trial ◽  
Intervention Group ◽  
Therapeutic Effects ◽  
Open Angle ◽  
The Mean ◽  
The Right ◽  
Double Blinded

Background: Open-angle glaucoma (OAG) is one of the leading causes of blindness worldwide. This study evaluates the therapeutic effects of hab shabyar in patients with open-angle glaucoma. Materials and Methods: In this clinical randomized controlled trial, 50 patients with OAG were randomized into two groups. The intervention group was received a drop of timolol plus 500 mg of hab shabyar every 12 hours. The placebo group was received a drop of timolol every 12 hours plus 500 mg of wheat germ as a placebo. The intraocular pressure in patients with OAG was measured in each group and compared at before the intervention (t1), one month (t2), and two months (t3) after the intervention. Results: The mean decrease in intraocular pressure for the right eye at three times in the intervention group was statistically significant, but the mean decrease in the placebo group was not significant. Similar results were obtained for the left eye at t1 when compared to t3. The patients in the intervention group expressed more satisfaction than the patients in the placebo group (P≤0.001). Conclusion: Our study demonstrated that consumption of timolol plus hab shabyar instead of consuming of timolol alone was probably more effective for reducing intraocular pressure in patients with OAG.[GMJ.2019;In press:e1218]

Sign in / Sign up

Export Citation Format

Share Document