A comparison of different antibiotic regimens for the treatment of infective endocarditis.

Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but due to the differences in presentation, populations affected, and the wide variety of micro-organisms that can be responsible, their use is not standardised. This is an update of a review previously published in 2016. Objectives: To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference Proceedings Citation Index - Science on 6 January 2020. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. Selection criteria: We included randomised controlled trials (RCTs) assessing the effects of antibiotic regimens for treating definitive infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates, and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. Data collection and analysis: Two review authors independently performed study selection, 'Risk of bias' assessment, and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of the evidence. We described the included studies narratively. Main results: Six small RCTs involving 1143 allocated/632 analysed participants met the inclusion criteria of this first update. The included trials had a high risk of bias. Three trials were sponsored by drug companies. Due to heterogeneity in outcome definitions and different antibiotics used data could not be pooled. The included trials compared miscellaneous antibiotic schedules having uncertain effects for all of the prespecified outcomes in this review. Evidence was either low or very low quality due to high risk of bias and very low number of events and small sample size. The results for all-cause mortality were as follows: one trial compared quinolone (levofloxacin) plus standard treatment (antistaphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin), and rifampicin) versus standard treatment alone and reported 8/31 (26%) with levofloxacin plus standard treatment versus 9/39 (23%) with standard treatment alone; risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49 to 2.56. One trial compared fosfomycin plus imipenem 3/4 (75%) versus vancomycin 0/4 (0%) (RR 7.00, 95% CI 0.47 to 103.27), and one trial compared partial oral treatment 7/201 (3.5%) versus conventional intravenous treatment 13/199 (6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The results for rates of cure with or without surgery were as follows: one trial compared daptomycin versus low-dose gentamicin plus an antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or vancomycin and reported 9/28 (32.1%) with daptomycin versus 9/25 (36%) with low-dose gentamicin plus antistaphylococcal penicillin or vancomycin; RR 0.89, 95% CI 0.42 to 1.89. One trial compared glycopeptide (vancomycin or teicoplanin) plus gentamicin with cloxacillin plus gentamicin (13/23 (56%) versus 11/11 (100%); RR 0.59, 95% CI 0.40 to 0.85). One trial compared ceftriaxone plus gentamicin versus ceftriaxone alone (15/34 (44%) versus 21/33 (64%); RR 0.69, 95% CI 0.44 to 1.10), and one trial compared fosfomycin plus imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR 0.50, 95% CI 0.07 to 3.55). The included trials reported adverse events, the need for cardiac surgical interventions, and rates of uncontrolled infection, congestive heart failure, relapse of endocarditis, and septic emboli, and found no conclusive differences between groups (very low-quality evidence). No trials assessed quality of life. Authors' conclusions: This first update confirms the findings of the original version of the review. Limited and low to very low-quality evidence suggests that the comparative effects of different antibiotic regimens in terms of cure rates or other relevant clinical outcomes are uncertain. The conclusions of this updated Cochrane Review were based on few RCTs with a high risk of bias. Accordingly, current evidence does not support or reject any regimen of antibiotic therapy for the treatment of infective endocarditis.post-print876 K

Impact Of Hospital Infections On Patients Outcomes Undergoing Cardiac Surgery At Santa Casa De Misericórdia De Marília [impacto Das Infecções Hospitalares Na Evolução De Pacientes Submetidos à Cirurgia Cardíaca Na Santa Casa De Misericórdia De Marília]

Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%), 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%), urinary tract infection (2.8%), pneumonia (2.3%), and bloodstream infection (1.7%). The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age ≥ 60 years (OR 1.59, 95% CI 1.09 to 2.31), ICU stay ≥ 2 days (OR 5, 49, 95% CI 2.98 to 10, 09), mechanical ventilation ≥ 2 days (OR11, 93, 95% CI 6.1 to 23.08), use of urinary catheter ≥ 3 days (OR 4.85 95% CI 2.95-7.99). Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24). Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0), use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0), insulin use (OR 1.8; 95% CI 1.2 to 2.8), surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0) pneumonia (OR 4.3; 95% CI 2.1 to 8.9) and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2). Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.292167176(2011), World Health Organization. Report on the burden of endemic health care-associated infection worldwide. Geneva: WHO Document Production ServicesUmscheid, C.A., Mitchell, M.D., Doshi, J.A., Agarwal, R., Williams, K., Brennan, P.J., Estimating the proportion of healthcare associated infections that are reasonably preventable and the related mortality and costs (2011) Infect Control Hosp Epidemiol, 32 (2), pp. 101-114Kollef, M.H., Sharpless, L., Vlasnik, J., Pasque, C., Murphy, D., Fraser, V.J., The impact of nosocomial infections on patient outcomes following cardiac surgery (1997) Chest, 112 (3), pp. 666-675Hortal, J., Muñoz, P., Cuerpo, G., Litvan, H., Rosseel, P., Bouza, E., Ventilator-associated pneumonia in patients undergoing major heart surgery: An incidence study in European (2009) Crit Care, 13 (3), p. 80. , European Study Group on Nosocomial InfectionEuropean Workgroup of Cardiothorac IntensivistsBouza, E., Hortal, J., Muñoz, P., Pascau, J., Pérez, M.J., Hiesmayr, M., Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: A one-day European prevalence study (ESGNI-008) (2006) J Hosp Infect, 64 (3), pp. 224-230. , European Study Group on Nosocomial InfectionsEuropean Workgroup of Cardiothoracic IntensivistsLe Guillou, V., Tavolacci, M.P., Baste, J.M., Hubscher, C., Bedoit, E., Bessou, J.P., Surgical site infection after central venous catheter-related infection in cardiac surgery (2011) Analysis of a Cohort of 7557 Patients. J Hosp Infect, 79 (3), pp. 236-241Horan, T.C., Andrus, M., Dudeck, M.A., CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting (2008) Am J Infect Control, 36 (5), pp. 309-332Fowler Jr., V.G., O'Brien, S.M., Muhlbaier, L.H., Corey, G.R., Ferguson, T.B., Peterson, E.D., (2005) Clinical Predictors of Major Infections After Cardiac Surgery. Circulation, 30 (9 SUPPL.), pp. 358-365. , 112de Santo, L.S., Bancone, C., Santarpino, G., Romano, G., de Feo, M., Scardone, M., Microbi-ologically documented nosocomial infections after cardiac surgery: An 18-month prospective tertiary care center report (2008) Eur J Cardiothorac Surg, 33 (4), pp. 666-672Manniën, J., Wille, J.C., Kloek, J.J., van Benthem, B.H., Surveillance and epidemiology of surgical site infections after cardiothoracic surgery in The Netherlands (2011) J Thorac Cardio-vasc Surg, 141 (4), pp. 899-904. , 2002-2007Berg, T.C., Kjørstad, K.E., Akselsen, P.E., Seim, B.E., Løwer, H.L., Stenvik, M.N., National sur-veillance of surgical site infections after coronary artery bypass grafting in Norway: Inci-dence and risk factors (2011) Eur J Cardiothorac Surg, 40 (6), pp. 1291-1297Vosylius, S., Sipylaite, J., Ivaskevicius, J., Determinants of outcome in elderly patients admitted to the intensive care unit (2005) Age Ageing, 34 (2), pp. 157-162Sá, M.P., Soares, E.F., Santos, C.A., Figueiredo, O.J., Lima, R.O., Escobar, R.R., Risk factors for mediastinitis after coronary artery bypass grafting surgery (2011) Rev Bras Cir Cardio-vasc, 26 (1), pp. 27-35Tiveron, M.G., Fiorelli, A.I., Mota, E.M., Mejia, O.A.V., Brandão, C.M.A., Dallan, L.A.O., Fatores de risco pré-operatórios para mediastinite após cirurgia cardíaca: Análise de 2768 pacientes (2012) Rev Bras Cir Cardiovasc, 27 (2), pp. 203-210Magedanz, E.H., Bodanese, L.C., Guaragna, J.C.V.C., Albuquerque, L.C., Martins, V., Minossi, S.D., Elaboração de escore de risco para mediastinite pós-cirurgia de revascularização do miocárdio (2010) Rev Bras Cir Cardiovasc, 25 (2), pp. 154-159Steingrimsson, S., Gottfredsson, M., Kristinsson, K.G., Gudbjartsson, T., Deep sternal wound in-fections following open heart surgery in Iceland: A population-based study (2008) Scand Cardio-vasc J, 42 (3), pp. 208-213Risnes, I., Abdelnoor, M., Almdah, S.M., Svennevig, J.L., Mediastinitis after coronary artery by-pass grafting risk factors and long-term survival (2010) Ann Thorac Surg, 89 (5), pp. 1502-1509Filsoufi, F., Castillo, J.G., Rahmanian, P.B., Broumand, S.R., Silvay, G., Carpentier, A., Epide-miology of deep sternal wound infection in cardiac surgery (2009) J Cardiothorac Vasc Anesth, 23 (4), pp. 488-494Knapik, P., Nadziakiewicz, P., Urbanska, E., Saucha, W., Herdynska, M., Zembala, M., Cardiopul-monary bypass increases postoperative glycemia and insulin consumption after coronary surgery (2009) Ann Thorac Surg, 87 (6), pp. 1859-1865Riera, M., Ibáñez, J., Herrero, J., De Ibarra, J.I.S., Enríquez, F., Campillo, C., Respiratory tract in-fections after cardiac surgery: Impact on hospital morbidity and mortality (2010) J Cardiovasc Surg (Torino), 51 (6), pp. 907-914Garey, K.W., Kumar, N., Dao, T., Tam, V.H., Gentry, L.O., Risk factors for postoperative chest wound infections due to gram-negative bactéria in cardiac surgery patients (2006) J Chemother, 18 (4), pp. 402-408Inkster, T., Antibiotic prophylaxis for cardiac surgery: A shift away from traditional cephalosporins? 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Evaluation of Silver Ion-Releasing Scaffolds in a 3D Coculture System of MRSA and Human Adipose-Derived Stem Cells for Their Potential Use in Treatment or Prevention of Osteomyelitis

Bone infection, also called osteomyelitis, can result when bacteria invade a bone. Treatment of osteomyelitis usually requires surgical debridement and prolonged antimicrobial therapy. The rising incidence of infection with multidrug-resistant bacteria, in particular methicillin-resistant staphylococcus aureus (MRSA), however, limits the antimicrobial treatment options available. Silver is well known for its antimicrobial properties and is highly toxic to a wide range of microorganisms. We previously reported our development of biocompatible, biodegradable, nanofibrous scaffolds that released silver ions in a controlled manner. The objective of this study was to determine the efficacy of these scaffolds in treating or preventing osteomyelitis. To achieve this objective, antimicrobial efficacy was determined using a 3D coculture system of human adipose-derived stem cells (hASC) and MRSA. Human ASC were seeded on the scaffolds and induced to undergo osteogenic differentiation in both the absence and presence of MRSA. Our results indicated that the silver ion-releasing scaffolds not only inhibited biofilm formation, but also supported osteogenesis of hASC. Our findings suggest that these biocompatible, degradable, silver ion-releasing scaffolds can be used at an infection site to treat osteomyelitis and/or to coat bone implants as a preventative measure against infection postsurgery