Estudio games de endocarditis infecciosa en España

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 30/11/2015. Tesis formato europeo (compendio de artículos)INTRODUCTION. Infective Endocarditis History Review. The very term "endocarditis", referring to an individual tissue and an inflammatory process, goes back to early-nineteenth-century with clinicians such as Broussais and Bouillaud, [1]. However, it was very difficult during that period to define endocarditis in a simple, unequivocal manner[2]. Thus, the term "endocarditis" continued to be used for a disease which underwent endless development throughout the nineteenth century. William Bart Osler (1849-1919) is the eponym linked to infective endocarditis in general (Osler's disease) and one of its peripheral manifestations (Osler's nodes). He established that blood elements such as fibrin and platelets deposited on the damaged endocardium - substrate of nonbacterial thrombotic endocardiopathy - and constituted the nucleus of vegetation, devaluing the concept that it depended on secretions from the endocardium [6]. Stimulated by Osler's presentations, Lord Thomas Jeeves Horder (1871-1955)5, emphasized the pre-existence of valvulopathy and congenital cardiopathy, the importance of the oral and intestinal points of entry, the occurrence of mycotic aneurysm, the presence of splenomegaly and the identification of streptococcal etiology in more than 60% of the cases confirmed through necropsies [7]...INTRODUCCIÓN. Revisión Histórica de la Endocarditis Infecciosa. El término "endocarditis", se refiere a un tejido individual y a un proceso inflamatorio, que retrocede a la primera parte del siglo diecinueve, con médicos como Broussais y Bouillaud, antes de que surgiera la teoría de los gérmenes y el nacimiento de la bacteriología [1]. Sin embargo, fue muy difícil durante este período definir la endocarditis de forma simple e inequívoca. No siempre existió una clara relación entre las ideas y los argumentos eran confusos, tortuosos, circulares y no concluyentes. En su discusión sobre la sífilis, Ludwik Fleck, señaló que la enfermedad es un fenómeno cambiante que constantemente integra nueva información y conceptos [2]. Por lo tanto, el término "endocarditis" continúo siendo utilizado para definir una enfermedad que atravesó un largo proceso de desarrollo durante el siglo diecinueve. Simultáneamente, también existieron modificaciones en los vínculos etiológicos entre las anomalías anatómicas, los síntomas clínicos y las observaciones durante la autopsia. La patología de la enfermedad fue regularmente reformulada y su definición cambió de periodo a periodo y de país en país. La teoría de los gérmenes y el uso del microscopio cambio la visión y el concepto de la enfermedad a finales de siglo. El hecho de ser posible "ver" diminutas granulaciones hasta entonces invisibles no eran suficientes para transformar estas granulaciones en una herramienta analítica. La percepción de que la enfermedad es un todo relativamente coherente con los síntomas etiológicos, llevaron sin embargo a la realización de experimentos en el laboratorio [3]. Hugo Ribbert (1855-1920) realizó experimentos sobre la inducción de endocarditis infecciosa, inyectando Staphlylococcus aureus cultivado en patatas, en conejos e indentifico colonias bacterianas sobre la superficie de las válvulas cardíacas, especialmente en la chordae tendineae de la válvula mitral. En el mismo año, WK Wyssokowitsch (1854-1912), obtuvo la colonización de bacterias en la válvula aortica, inyectadas en el torrente sanguíneo de conejos a través de la arteria carótida. Gracias al conjunto de experimentos realizados en esa época, se obtuvieron dos conclusiones: a) la anterioridad de una endocardiopatía trombótica no bacteriana; b) la colonización del sustrato por bacterias circulantes. El siglo diecinueve termina con la asociación entre la lesión valvular, el punto de entrada y la circulación de microorganismos, la fiebre y las manifestaciones extra-cardíacas como la síntesis del diagnóstico de la endocarditis infecciosa [1, 4]...Depto. de MedicinaFac. de MedicinaTRUEunpu

Estudio games de endocarditis infecciosa en España

INTRODUCTION. Infective Endocarditis History Review. The very term "endocarditis", referring to an individual tissue and an inflammatory process, goes back to early-nineteenth-century with clinicians such as Broussais and Bouillaud, [1]. However, it was very difficult during that period to define endocarditis in a simple, unequivocal manner[2]. Thus, the term "endocarditis" continued to be used for a disease which underwent endless development throughout the nineteenth century. William Bart Osler (1849-1919) is the eponym linked to infective endocarditis in general (Osler's disease) and one of its peripheral manifestations (Osler's nodes). He established that blood elements such as fibrin and platelets deposited on the damaged endocardium - substrate of nonbacterial thrombotic endocardiopathy - and constituted the nucleus of vegetation, devaluing the concept that it depended on secretions from the endocardium [6]. Stimulated by Osler's presentations, Lord Thomas Jeeves Horder (1871-1955)5, emphasized the pre-existence of valvulopathy and congenital cardiopathy, the importance of the oral and intestinal points of entry, the occurrence of mycotic aneurysm, the presence of splenomegaly and the identification of streptococcal etiology in more than 60% of the cases confirmed through necropsies [7]..

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adults

AbstractThe use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. The short-term use of peripheral catheters has been found to be associated with the risk of nosocomial bacteraemia, resulting in morbidity and mortality. Staphylococcus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been prepared by a panel of experts of the Spanish Society of Cardiovascular Infections, in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy, and the Spanish Society of Thoracic-Cardiovascular Surgery, and aims to define and establish guidelines for the management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance, registering, diagnosis and treatment of infection, indications for removal, as well as placing an emphasis on continuous education as a drive toward quality. Implementation of these guidelines will allow uniformity in use, thus minimizing the risk of infections and their complications

2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult.

Aquest document també està publicat a: 'Cirugía Cardiovascular' http://dx.doi.org/10.1016/j.circv.2016.06.001The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications

A contemporary picture of enterococcal endocarditis

BACKGROUND: Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking. OBJECTIVES: The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort. METHODS: This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses. RESULTS: Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse. CONCLUSIONS: Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE. Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. KEYWORDS: enterococci; epidemiology; heart failure; infective endocarditis; prosthetic valves; relapse

Four weeks versus six weeks of ampicillin plus ceftriaxone in Enterococcus faecalis native valve endocarditis: A prospective cohort study

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.This work was supported in part by the “Fondo de Investigaciones Sanitarias” (FIS) grant 17/01251 from the “Instituto de Salud Carlos III”, Madrid, Spain awarded to JMM. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19. JMP was member of the Endocarditis Team of the Hospital Clinic of Barcelona, Spain when this project was approved by the GAMES Steering Committee.

Clinical Factors Associated with Reinfection versus Relapse in Infective Endocarditis: Prospective Cohort Study

We aimed to identify clinical factors associated with recurrent infective endocarditis (IE) episodes. The clinical characteristics of 2816 consecutive patients with definite IE (January 2008?2018) were compared according to the development of a second episode of IE. A total of 2152 out of 2282 (94.3%) patients, who were discharged alive and followed-up for at least the first year, presented a single episode of IE, whereas 130 patients (5.7%) presented a recurrence; 70 cases (53.8%) were due to other microorganisms (reinfection), and 60 cases (46.2%) were due to the same microorganism causing the first episode. Thirty-eight patients (29.2%), whose recurrence was due to the same microorganism, were diagnosed during the first 6 months of follow-up and were considered relapses. Relapses were associated with nosocomial endocarditis (OR: 2.67 (95% CI: 1.37?5.29)), enterococci (OR: 3.01 (95% CI: 1.51?6.01)), persistent bacteremia (OR: 2.37 (95% CI: 1.05?5.36)), and surgical treatment (OR: 0.23 (0.1?0.53)). On the other hand, episodes of reinfection were more common in patients with chronic liver disease (OR: 3.1 (95% CI: 1.65?5.83)) and prosthetic endocarditis (OR: 1.71 (95% CI: 1.04?2.82)). The clinical factors associated with reinfection and relapse in patients with IE appear to be different. A better understanding of these factors would allow the development of more effective therapeutic strategies

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES)

Prevention, Diagnosis and Management of Post-Surgical Mediastinitis in Adults Consensus Guidelines of the Spanish Society of Cardiovascular Infections (SEICAV), the Spanish Society of Thoracic and Cardiovascular Surgery (SECTCV) and the Biomedical Research Centre Network for Respiratory Diseases (CIBERES) doctors and radiologists. Despite the clinical and economic consequences of sternal wound infections, to date, there are no specific guidelines for the prevention, diagnosis and management of mediastinitis based on a multidisciplinary consensus. The purpose of the present document is to provide evidencebased guidance on the most effective diagnosis and management of patients who have experienced or are at risk of developing a post-surgical mediastinitis infection in order to optimise patient outcomes and the process of care. The intended users of the document are health care providers who help patients make decisions regarding their treatment, aiming to optimise the benefits and minimise any harm as well as the workload.Funding: J.M. Miró was a recipient of a personal 80:20 research grant from IDIBAPS during the period 2017–2021

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Assessment of the anti-biofilm effect of micafungin in an animal model of catheter-related candidemia.

In cases where catheter-related candidemia (CRC) must be managed without catheter withdrawal, antifungal lock therapy using highly active anti-biofilm (HAAB) agents is combined with systemic treatment. However, the activity of HAAB agents has never been studied in in vivo models using bioluminescence. We assessed the efficacy of micafungin using a bioluminescent Candida albicans SKCA23-ACTgLuc strain in an animal model of CRC. We divided 33 female Wistar rats into five groups: sham (A), infected nontreated (B), treated with lock therapy (0.16 mg/ml) (C), systemically treated only (1 mg/kg) (D), and systemically treated+lock (E). Catheters were colonized 24 h before insertion into the femoral vein (day 0). Treatment started on day 1 and lasted 7 days, followed by 7 days of surveillance. Bioluminescence assays were carried out on days 1, 3, 5, and 14, together with daily monitoring of clinical variables. Postmortem microbiological cultures from the catheter and several tissue samples were also obtained. Overall, 28 rats (84.8%) completed the study. Group B animals showed significant weight loss at days 2, 4, and 5 compared with groups C and D (P < .05). In group B, no animals survived after day 7, 75% had CRC, and bioluminescence remained constant 5 days after catheter implantation. Positive catheter culture rates in groups C, D, and E were, respectively, 83.3%, 62.5%, and 25.0% (P = .15). Micafungin proved to be a HAAB agent when administered both systemically and in lock therapy in an animal model of CRC, although the bioluminescence signal persists after treatment. This persistence should be further analyzed.S