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1. Epidemiological changes of acute/recent human immunodeficiency virus type 1 infection in Barcelona, Spain (1997–2015): a prospective cohort study

Author

Nicolás, D, Ambrosioni Czyrko, Juan, de Lazzari, E, Suarez, A, Manzardo, C, Agüero, F, Mosquera, M M, Costa, J, Ligero, C, Marcos, M Á, Sánchez-Palomino, S, Fernandez, Eugenio, Plana, M, Yerly Ferrillo, Sabine, Gatell, J M, Miró, J M, and Hospital Clinic Acute/Recent HIV Study Group

Subjects
Adult, Male, Microbiology (medical), medicine.medical_specialty, Population, Human immunodeficiency virus (HIV), HIV Infections, medicine.disease_cause, Molecular taxonomy, Sexual and Gender Minorities, health services administration, Internal medicine, Epidemiology, HIV-1/isolation & purification, medicine, Humans, Prospective Studies, Homosexuality, Male, HIV Infections/epidemiology/transmission, education, Prospective cohort study, Phylogeny, ddc:616, Transients and Migrants, education.field_of_study, business.industry, Transmission (medicine), Homosexuality, General Medicine, Infectious Diseases, Spain, Acute Disease, Cohort, HIV-1, Spain/epidemiology, population characteristics, Female, business, geographic locations, Cohort study
Abstract

To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain).Prospective, single-centre cohort including all patients with an acute/recent HIV infection (180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission.A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM.The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.

Published
2019

2. Strategies to reengage patients lost to follow up in HIV care in high income countries, a scoping review

Author

Palacio-Vieira, J, Reyes-Uruena, JM, Imaz, A, Bruguera, A, Force, L, Llaveria, AO, Llibre, JM, Vilaro, I, Borras, FH, Falco, V, Riera, M, Domingo, P, de Lazzari, E, Miro, JM, Casabona, J, Gurgui M., and Hernandez, J.

Subjects
Linkage, Cohort studies, HIV, Reengagement, Lost to follow-up
Abstract

Background Despite remarkable achievements in antiretroviral therapy (ART), losses to follow-up (LTFU) might prevent the long-term success of HIV treatment and might delay the achievement of the 90-90-90 objectives. This scoping review is aimed at the description and analysis of the strategies used in high-income countries to reengage LTFU in HIV care, their implementation and impact. Methods A scoping review was done following Arksey & O ' Malley's methodological framework and recommendations from Joanna Briggs Institute. Peer reviewed articles were searched for in Pubmed, Scopus and Web of Science; and grey literature was searched for in Google and other sources of information. Documents were charted according to the information presented on LTFU, the reengagement procedures used in HIV units in high-income countries, published during the last 15 years. In addition, bibliographies of chosen articles were reviewed for additional articles. Results Twenty-eight documents were finally included, over 80% of them published in the United States later than 2015. Database searches, phone calls and/or mail contacts were the most common strategies used to locate and track LTFU, while motivational interviews and strengths-based techniques were used most often during reengagement visits. Outcomes like tracing activities efficacy, rates of reengagement and viral load reduction were reported as outcome measures. Conclusions This review shows a recent and growing trend in developing and implementing patient reengagement strategies in HIV care. However, most of these strategies have been implemented in the United States and little information is available for other high-income countries. The procedures used to trace and contact LTFU are similar across reviewed studies, but their impact and sustainability are widely different depending on the country studied.

Published
2021

3. Efficacy and safety of switching to dolutegravir plus lamivudine versus continuing triple antiretroviral therapy in virologically suppressed adults with HIV at 48 weeks (DOLAM): a randomised non-inferiority trial

Author

Rojas, J, de Lazzari, E, Negredo, E, Domingo, P, Tiraboschi, J, Ribera, E, Abdulghani, N, Puig, J, Mateo, MG, Podzamczer, D, Gutierrez, MM, Paredes, R, Clotet, B, Gatell, JM, Blanco, JL, Martinez, E, and DOLAM Study Grp

Abstract

Background Simplified antiretroviral therapy (ART) regimens are desirable for people with HIV. We investigated the efficacy and safety of switching from triple ART to dual dolutegravir plus lamivudine therapy. Methods DOLAM is a phase 4, randomised, open-label, non-inferiority trial, done at six HIV clinics in Catalonia, Spain. Adults with HIV-1 receiving a triple ART regimen, aged 18 years or older, with virological suppression, a CD4 nadir of at least 200 cells per ILL, who were HBsAg-negative, and without previous viral failure or resistance mutations to study drugs were eligible. Participants underwent computer-generated randomisation, stratified by the class of the third drug, and were assigned (1:1) to switch to oral dolutegravir 50 mg and lamivudine 300 mg once daily or to continue triple ART for 48 weeks. The primary endpoint was the proportion of people with an HIV RNA value of at least 50 copies per mL at week 48 (US Food and Drug Administration snapshot algorithm, 8% non-inferiority margin). Both the primary and safety outcomes were evaluated in the intention-to-treat exposed population. The study is completed and was registered with EudraCT 201500027435. Findings Between July 7, 2015, and Oct 31, 2018, 265 participants were randomly assigned to switch to dolutegravir plus lamivudine (n=131) or to maintain triple ART (n=134) and all received at least one dose. Nine (7%) participants in the dual therapy group and ten (7%) in the triple therapy group were excluded before 48 weeks, mostly due to treatment discontinuations or virological failure. Participants were predominantly male (116 [87%] of 134 in the triple ART group and 111 [85%] of 131 in the dolutegravir plus lamivudine group). The difference in the proportion of participants with HIV RNA values of at least 50 copies per mL at 48 weeks between the dual therapy group (three [2%] of 131) and triple therapy group (two [1%] of 134) was 0middot8 percentage points (95% CI -3middot3 to 5middot2), showing non-inferiority of dolutegravir plus lamivudine dual therapy compared with triple ART. 73 (56%) of 131 participants allocated to dual therapy had 150 adverse effects, compared with 78 (58%) of 134 participants allocated to triple therapy who also had 150 adverse events (p=0middot68). Drug discontinuation due to adverse effects occurred in four people in the triple therapy group and three people in the dual therapy group. Interpretation Our findings show the efficacy and safety of dolutegravir plus lamivudine as a simplified therapy switch option for selected people with HIV with virological suppression on triple ART.

Published
2021

5. Discontinuation of dolutegravir, elvitegravir/cobicistat and raltegravir because of toxicity in a prospective cohort

Author

Montoliu, A, Miro, JM, Domingo, P, Riera, M, Curran, A, Homar, F, Ambrosioni, J, Abdulghani, N, Force, L, Peraire, J, Vilaro, J, Masabeu, A, Orti, AJ, Dalmau, D, Casabona, J, Reyes, J, Bruguera, A, Muntada, E, Podzamczer, D, Llibre, JM, Navarro, G, Cortes, C, Falco, V, Mallolas, J, Manzardo, C, Imaz, A, Tiraboschi, J, Burgos, J, Mateo, MG, Gutierrez, MM, Murillas, J, Segura, F, Garcia-Gasalla, M, Puig, T, Vidal, F, Leon, E, Jaen, A, Almuedo, A, De Lazzari, E, Giralt, D, Martin, M, Gargoulas, F, Vanrell, T, Rubia, JC, Vila, J, Ferres, M, Morell, B, Tamayo, M, Laguno, M, Martinez, M, Blanco, JL, Garcia-Alcaide, F, Rojas, J, Martinez, E, Jou, A, Clotet, B, Saumoy, M, Silva, A, Prieto, P, Ribera, JNIE, Gurgui, M, Campins, AA, Fanjul, FJ, Leyes, M, Penaranda, M, Martin, L, Vilchez, H, Calzado, S, Cervantes, M, Amengual, MJ, Navarro, M, Payeras, T, Cifuentes, C, Comella, T, Vargas, M, Vilades, C, Barrufet, P, Chivite, I, Chamarro, E, Escrig, C, Cairo, M, Martinez-Lacasa, X, Font, R, Deig, E, Meyer, S, and Hernandez, J

Subjects
integrase strand transfer inhibitors, elvitegravir/cobicistat, neuropsychiatric toxicity, raltegravir, adverse events, dolutegravir
Abstract

Objectives The aim of the study was to assess the rates of discontinuation of integrase inhibitor regimens because of any neuropsychiatric adverse event (NPAE) and the factors associated with discontinuation. Methods A population-based, prospective, multicentre cohort study was carried out. Treatment-naive subjects starting therapy with a regimen containing integrase inhibitors, or those switching to such a regimen, with plasma HIV-1 RNA < 50 HIV-1 RNA copies/mL in 14 hospitals in Catalonia or the Balearic Islands (Spain) were included in the study. Every discontinuation because of adverse events (AEs) was double-checked directly with treating physicians. Multivariable Cox models identified factors correlated with discontinuation. Results A total of 4165 subjects (37% treatment-naive) started regimens containing dolutegravir (n = 1650; 91% with abacavir), raltegravir (n = 930) or elvitegravir/cobicistat (n = 1585). There were no significant differences among regimens in the rate of discontinuation because of any AE. Rates of discontinuation because of NPAEs were low but higher for dolutegravir/abacavir/lamivudine [2.1%; 2.9 (95% confidence interval (CI) 2.0, 4.2) discontinuations/100 patients/year] versus elvitegravir/cobicistat (0.5%; 0.8 (95% CI 0.3, 1.5) discontinuations/100 patients/year], with significant differences among centres for dolutegravir/abacavir/lamivudine and NPAEs (P = 0.003). We identified an association of female gender and lower CD4 count with increased risk of discontinuation because of any AE [Incidence ratio (IR) 2.3 (95% CI 1.4, 4.0) and 1.8 (95% CI 1.1, 2.8), respectively]. Female gender, age > 60 years and abacavir use were not associated with NPAE discontinuations. NPAEs were commonly grade 1-2, and had been present before and improved after drug withdrawal. Conclusions In this large prospective cohort study, patients receiving dolutegravir, raltegravir or elvitegravir/cobicistat did not show significant differences in the rate of discontinuation because of any toxicity. The rate of discontinuations because of NPAEs was low, but was significantly higher for dolutegravir than for elvitegravir/cobicistat, with significant differences among centres, suggesting that greater predisposition to believe that a given adverse event is caused by a given drug of some treating physicians might play a role in the discordance seen between cohorts.

Published
2019

6. Determinants and Outcomes of Late Presentation of HIV Infection in Migrants in Catalonia, Spain: PISCIS Cohort 2004-2016

Author

Conway, AS, Esteve, A, Fernandez-Quevedo, M, Casabona, J, Miro, JM, Riera, AB, Montoliu, A, Reyes, J, Muntada, E, Bruguera, A, Podzamczer, D, Domingo, P, Llibre, JM, Riera, S, Navarro, G, Cortes, C, Falco, V, Gatell, JM, Manzardo, C, Clotet, B, Ferrer, E, Segura, F, Force, L, Vilaro, J, Masabeu, A, Leon, E, Cifuentes, C, Homar, F, Dalmau, D, Jaen, A, Mateo, MG, Gutierrez, MD, Loureiro, E, Curran, A, Puig, T, Agusti, C, Vidal, F, Peraire, J, Orti, A, Almuedo, A, De Lazzari, E, Giralt, D, Gargoulas, F, Rubia, JC, Vila, J, Ambrosioni, J, Zamora, L, Blanco, JL, Garcia-Alcaide, F, Martinez, E, Mallolas, J, Sirera, G, Romeu, J, Jou, A, Negredo, E, Saumoy, M, Imaz, A, Bolao, F, Cabellos, C, Pena, C, DiYacovo, S, Van Den Eynde, E, Sala, M, Cervantes, M, Amengual, MJ, Navarro, M, Segura, V, Barrufet, P, Payeras, T, Gurgui, M, Utrillo, L, Meyer, S, and Hernandez, J

Subjects
Migrant health, Spain, Cohort, HIV, HIV inequalities, Late presentation with HIV
Abstract

This study using the Catalan PISCIS cohort explores risk factors of migrants' late presentation and the impact of late presentation on their health outcomes. We analyse 9590 new HIV diagnoses enrolled in the cohort between 2004 and 2016. Univariate and multivariate logistic regression models are used to identify risk factors associated with late presentation among migrants, giving crude and adjusted odds ratios and their 95% confidence intervals. Cox regression models are estimated to identify risk factors associated with AIDS/death, and crude and adjusted hazard ratios and 95% confidence intervals are reported. Late presentation is higher in migrants than non-migrants. Among migrants, region of origin is associated with late presentation and AIDS/death during follow-up. The results highlight persisting inequalities in HIV diagnosis and care among migrants in Catalonia. Targeted interventions addressed to specific subgroups in the migrant population are needed.

Published
2019

7. Dolutegravir-based maintenance monotherapy versus dual therapy with lamivudine: a planned 24 week analysis of the DOLAM randomized clinical trial

Author

Blanco, JL, Rojas, J, Paredes, R, Negredo, E, Mallolas, J, Casadella, M, Clotet, B, Gatell, JM, de Lazzari, E, and Martinez, E

Abstract

Background: No controlled comparisons between dolutegravir/lamivudine or dolutegravir maintenance therapy have been done. We hypothesized that these options would have similar efficacy to triple ART. Methods: We used an open-label non-inferiority randomized controlled trial comprising two phases: phase A was established to test that experimental arms did not have an unacceptable (>= 5%) failure rate; phase B was intended to include the full number of patients followed for 48 weeks. Treated HIV-1-infected adults with viral load,50 copies/mL for >= 12months, no prior viral failure or resistance mutations to study drugs, nadir CD4.200 cells/mm(3), and hepatitis B virus surface antigen negative were randomized 1: 1: 1 to maintain triple therapy (control arm), or to switch to dolutegravir/lamivudine, or to dolutegravir monotherapy stratifying by anchor drug. Premature discontinuation was considered if viral failure or therapy interruption due to adverse events, concurrent illness, protocol deviation or patient's wish occurred. Blips were registered. Planned phase A results at 24 weeks are reported here. The study is registered at EudraCT: 201500027435. Results: Ninety-one (control, n = 31; dual therapy, n = 29; monotherapy, n = 31) patients were randomized. Three patients (none previously exposed to integrase inhibitors) prematurely discontinued treatment due to viral failure: dolutegravir/lamivudine (n = 1), no resistance mutations (subject A); dolutegravir (n = 2), N155H, S147G and Q148R resistance mutations (subject B), and E138K, G140S and N155H resistance mutations (subject C). There were no discontinuations for other reasons. One patient (dolutegravir/lamivudine) experienced a blip in viral load. The Data Safety Monitoring Board recommended stopping the dolutegravir monotherapy arm. Conclusions: In contrast to dolutegravir/lamivudine, a higher than expected risk of viral failure with development of cross-resistance integrase mutations occurred with dolutegravir maintenance monotherapy.

Published
2018

8. Influence of Vancomycin Minimum Inhibitory Concentration on the Outcome of Methicillin-Susceptible Staphylococcus aureus Left-Sided Infective Endocarditis Treated with Anti-staphylococcal Beta-Lactam Antibiotics; a Prospective Cohort Study by the International Collaboration on Endocarditis

Author

Athan, E., Harris, O., Korman, T. M., Kotsanas, D., Jones, P., Reinbott, P., Ryan, S., Fortes, C. Q., Garcia, P., Jones, S. B., Barsic, B., Bukovski, S., Selton-Suty, C., Aissa, N., Doco-Lecompte, T., Delahaye, F., Vandenesch, F., Tattevin, P., Hoen, B., Plesiat, P., Giamarellou, H., Giannitsioti, E., Tarpatzi, E., Durante-Mangoni, E., Iossa, D., Orlando, S., Ursi, M. P., Pafundi, P. C., D' Amico, F., Bernardo, M., Cuccurullo, S., Dialetto, G., Covino, F. E., Manduca, S., Della Corte, A., De Feo, M., Tripodi, M. F., Baban, T., Kanafani, Z. A., Kanj, S. S., Sfeir, J., Yasmine, M., Morris, A., Murdoch, D. R., Premru, M. M., Lejko-Zupanc, T., Almela, M., Ambrosioni, J., Azqueta, M., Brunet, M., Cervera, C., De Lazzari, E., Falces, C., Fuster, D., Garcia-de-la-Maria, C., Garcia-Gonzalez, J., Gatell, J. M., Marco, F., Miro, J. M., Moreno, A., Ortiz, J., Ninot, S., Pare, J. C., Pericas, J. M., Quintana, E., Ramirez, J., Sandoval, E., Sitges, M., Tolosana, J. M., Vidal, B., Vila, J., Bouza, E., Rodriguez-Creixems, M., Ramallo, V., Bradley, S., Wray, D., Steed, L., Cantey, R., Peterson, G., Stancoven, A., Woods, C., Corey, G. R., Reller, L. B., Fowler, V. G., Chu, V. H., Messina, J. A., Park, L., Sharma-Kuinkel, B. K., Carugati, M., Munoz, P., Baloch, K., Dixon, C. C., Harding, T., Jones-Richmond, M., Pappas, P., Park, L. P., Redick, T., Stafford, J., Anstrom, K., Bayer, A. S., Cabell, C. H., Karchmer, A. W., Sexton, D. J., Wang, A., Chu, V., Durack, D. T., Eykyn, S., Moreillon, P., Olaison, L., Raoult, D., Rubinstein, E., Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Duke University Medical Center, University of Barcelona, Medical University of South Carolina [Charleston] (MUSC), American University of Beirut [Beyrouth] (AUB), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Université de Tsukuba = University of Tsukuba, Pericàs, J M, Messina, J A, Garcia-de-la-Mària, C, Park, L, Sharma-Kuinkel, B K, Marco, F, Wray, D, Kanafani, Z A, Carugati, M, Durante Mangoni, E, Tattevin, P, Chu, V H, Moreno, A, Fowler, V G, Miró, J M, De Feo, Marisa, Athan, E11, Harris, O11, Korman, Tm12, Kotsanas, D13, Jones, P14, Reinbott, P14, Ryan, S14, Fortes, Cq15, Garcia, P16, Jones, Sb16, Barsic, B17, Bukovski, S17, Selton-Suty, C18, Aissa, N18, Doco-Lecompte, T18, Delahaye, F19, Vandenesch, F19, Tattevin, P20, Hoen, B21, Plesiat, P21, Giamarellou, H22, Giannitsioti, E22, Tarpatzi, E22, Durante-Mangoni, E23, Iossa, D23, Orlando, S23, Ursi, Mp23, Pafundi, Pc23, D' Amico, F23, Bernardo, M23, Cuccurullo, S23, Dialetto, G23, Covino, Fe23, Manduca, S23, DELLA CORTE, Alessandro, De Feo, M23, Tripodi, Mf24, Baban, T25, Kanafani, Za25, Kanj, Ss25, Sfeir, J25, Yasmine, M25, Morris, A26, Murdoch, Dr27, Premru, Mm28, Lejko-Zupanc, T28, Almela, M29, Ambrosioni, J29, Azqueta, M29, Brunet, M29, Cervera, C29, De Lazzari, E29, Falces, C29, Fuster, D29, Garcia-de-la-Mària, C29, Garcia-Gonzalez, J29, Gatell, Jm29, Marco, F29, Miró, Jm29, Moreno, A29, Ortiz, J29, Ninot, S29, Paré, Jc29, Pericas, Jm29, Quintana, E29, Ramirez, J29, Sandoval, E29, Sitges, M29, Tolosana, Jm29, Vidal, B29, Vila, J29, Bouza, E30, Muñoz, P, Rodríguez-Créixems, M30, Ramallo, V30, Bradley, S31, Wray, D32, Steed, L32, Cantey, R32, Peterson, G33, Stancoven, A33, Woods, C34, Corey, Gr34, Reller, Lb34, Fowler VG, Jr34, Chu, Vh34, Baloch, K, Chu, Vh, Corey, Gr, Dixon, Cc, Fowler VG, Jr, Harding, T, Jones-Richmond, M, Pappas, P, Park, Lp, Redick, T, Stafford, J, Anstrom, K, Athan, E, Bayer, A, Cabell, Ch, Hoen, B, Karchmer, Aw, Miró, Jm, Murdoch, Dr, Sexton, Dj, Wang, A, Chu, V, Durack, Dt, Eykyn, S, Moreillon, P, Olaison, L, Raoult, D, Rubinstein, E, and Sexton, Dj.

Subjects
0301 basic medicine, Male, medicine.disease_cause, 0302 clinical medicine, 80 and over, Medicaments antibacterians, 030212 general & internal medicine, Endocarditi, Prospective Studies, Aged, 80 and over, Endocarditis, Bacterial, General Medicine, Middle Aged, Staphylococcal Infections, 3. Good health, Anti-Bacterial Agents, Fenotip, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Treatment Outcome, Phenotype, Staphylococcus aureus, Infective endocarditis, Staphylococcus aureu, Vancomycin, Genotype, Vancomycin MIC, Adult, Aged, Endocarditis, Bacterial, Female, Humans, Microbial Sensitivity Tests, Molecular Typing, Multiplex Polymerase Chain Reaction, Survival Analysis, Virulence Factors, beta-Lactams, medicine.drug, Microbiology (medical), 030106 microbiology, Biology, Staphylococcal infections, Article, Microbiology, 03 medical and health sciences, Minimum inhibitory concentration, medicine, Etest, Endocarditis Staphylococcus aureus, biochemical phenomena, metabolism, and nutrition, medicine.disease, Antibacterial agents, Methicillin Susceptible Staphylococcus Aureus
Abstract

Objectives: Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is >= 1.5 mg/L. We aimed to validate this using the International Collaboration on Endocarditis cohort and to analyse whether specific genetic characteristics were associated with a high vancomycin MIC (> 1.5mg/L) phenotype.Methods: All patients with left-sided MSSA infective endocarditis treated with antistaphylococcal beta-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC was determined by Etest as either high (>= 1.5 mg/L) or low (

Published
2017

9. Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles

Author

De Lazzari E, A. Moreno, Mauri E, Ignasi Anguera, Xavier Claramonte, del Rio A, M. Azqueta, Matínez-Lacasa X, Miró Jm, Quaglio G, Francesc Marco, Manuel Almela, Omar Sued, José M. Gatell, María J. Jiménez-Expósito, García-de la María C, Natividad Benito, C.A. Mestres, Gumá, and Universitat de Barcelona

Subjects
Adult, Male, Pacemaker, Artificial, medicine.medical_specialty, Prosthesis-Related Infections, Staphylococcus lugdunensis, Cohort Studies, Mitral valve, Humans, Medicine, Endocarditis, Staphylococcal infections, Prospective Studies, Abscess, Prospective cohort study, Aged, Ultrasonography, biology, business.industry, Mortality rate, Infeccions per estafilococs, Electronic Pages, Cardiac Pacing, Artificial, Endocarditis, Bacterial, Middle Aged, Staphylococcal Infections, medicine.disease, biology.organism_classification, Survival Analysis, Anti-Bacterial Agents, Surgery, Treatment Outcome, medicine.anatomical_structure, Estudi de casos, Embolism, Heart Valve Prosthesis, Infective endocarditis, Female, Case studies, Cardiology and Cardiovascular Medicine, business
Abstract

Objective: To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. Design: Prospective cohort study. Setting: Study at two centres (a tertiary care centre and a community hospital). Patients: 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. Methods: Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms “endocarditis” and “Staphylococcus lugdunensis” published between 1989 and December 2003. Main outcome measures: Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. Results: 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. Conclusions: S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

10. Infective Endocarditis in Patients on Chronic Hemodialysis

Author

Juan M. Pericàs, Jaume Llopis, Maria Jesús Jiménez-Exposito, Wissam M. Kourany, Benito Almirante, Giampiero Carosi, Emanuele Durante-Mangoni, Claudio Querido Fortes, Efthymia Giannitsioti, Stamatios Lerakis, Rodrigo Montagna-Mella, Juan Ambrosioni, Ru-San Tan, Carlos A. Mestres, Dannah Wray, Orathai Pachirat, Asuncion Moreno, Vivian H. Chu, Elisa de Lazzari, Vance G. Fowler, Jose M. Miró, Liliana Clara, Marisa Sanchez, José Casabé, Claudia Cortes, Francisco Nacinovich, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, Javier Altclas, Silvia Kogan, Denis Spelman, Eugene Athan, Owen Harris, Karina Kennedy, Ren Tan, David Gordon, Lito Papanicolas, Tony Korman, Despina Kotsanas, Robyn Dever, Phillip Jones, Pam Konecny, Richard Lawrence, David Rees, Suzanne Ryan, Michael P. Feneley, John Harkness, Jeffrey Post, Porl Reinbott, Rainer Gattringer, Franz Wiesbauer, Adriana Ribas Andrade, Ana Cláudia Passos de Brito, Armenio Costa Guimarães, Max Grinberg, Alfredo José Mansur, Rinaldo Focaccia Siciliano, Tania Mara Varejao Strabelli, Marcelo Luiz Campos Vieira, Regina Aparecida de Medeiros Tranchesi, Marcelo Goulart Paiva, Auristela de Oliveira Ramos, Clara Weksler, Giovanna Ferraiuoli, Wilma Golebiovski, Cristiane Lamas, James A. Karlowsky, Yoav Keynan, Andrew M. Morris, Ethan Rubinstein, Sandra Braun Jones, Patricia Garcia, M. Cereceda, Alberto Fica, Rodrigo Montagna Mella, Ricardo Fernandez, Liliana Franco, Javier Gonzalez, Astrid Natalia Jaramillo, Bruno Barsic, Suzana Bukovski, Vladimir Krajinovic, Ana Pangercic, Igor Rudez, Josip Vincelj, Tomas Freiberger, Jiri Pol, Barbora Zaloudikova, Zainab Ashour, Amani El Kholy, Marwa Mishaal, Dina Osama, Hussien Rizk, Neijla Aissa, Corentine Alauzet, Francois Alla, CHU Catherine Campagnac, Thanh Doco-Lecompte, Christine Selton-Suty, Jean-Paul Casalta, Pierre-Edouard Fournier, Gilbert Habib, Didier Raoult, Franck Thuny, Francois Delahaye, Armelle Delahaye, Francois Vandenesch, Erwan Donal, Pierre Yves Donnio, Erwan Flecher, Christian Michelet, Matthieu Revest, Pierre Tattevin, Florent Chevalier, Antoine Jeu, Jean Paul Rémadi, Dan Rusinaru, Christophe Tribouilloy, Yvette Bernard, Catherine Chirouze, Bruno Hoen, Joel Leroy, Patrick Plesiat, Christoph Naber, Carl Neuerburg, Bahram Mazaheri, Carl Neuerburg Sophia Athanasia, Ioannis Deliolanis, Helen Giamarellou, Tsaganos Thomas, Elena Mylona, Olga Paniara, Konstantinos Papanicolaou, John Pyros, Athanasios Skoutelis, Konstantinos Papanikolaou, Gautam Sharma, Johnson Francis, Lathi Nair, Vinod Thomas, Krishnan Venugopal, Margaret M. Hannan, John P. Hurley, Maor Wanounou, Dan Gilon, Sarah Israel, Maya Korem, Jacob Strahilevitz, Domenico Iossa, Serena Orlando, Maria Paola Ursi, Pia Clara Pafundi, Fabiana D’Amico, Mariano Bernardo, Susanna Cuccurullo, Giovanni Dialetto, Franco Enrico Covino, Sabrina Manduca, Alessandro Della Corte, Marisa De Feo, Marie Françoise Tripodi, Enrico Cecchi, Francesco De Rosa, Davide Forno, Massimo Imazio, Rita Trinchero, Paolo Grossi, Mariangela Lattanzio, Antonio Toniolo, Antonio Goglio, Annibale Raglio, Veronica Ravasio, Marco Rizzi, Fredy Suter, Silvia Magri, Liana Signorini, Zeina Kanafani, Souha S. Kanj, Ahmad Sharif-Yakan, Imran Abidin, Syahidah Syed Tamin, Eduardo Rivera Martínez, Gabriel Israel Soto Nieto, Jan T.M. van der Meer, Stephen Chambers, David Holland, Arthur Morris, Nigel Raymond, Kerry Read, David R. Murdoch, Stefan Dragulescu, Adina Ionac, Cristian Mornos, O.M. Butkevich, Natalia Chipigina, Ozerecky Kirill, Kulichenko Vadim, Tatiana Vinogradova, Jameela Edathodu, Magid Halim, Yee-Yun Liew, Tatjana Lejko-Zupanc, Mateja Logar, Manica Mueller-Premru, Patrick Commerford, Anita Commerford, Eduan Deetlefs, Cass Hansa, Mpiko Ntsekhe, Manel Almela, Manuel Azqueta, Merce Brunet, Pedro Castro, Elisa De Lazzari, Carlos Falces, David Fuster, Guillermina Fita, Cristina Garcia- de- la- Maria, Javier Garcia-Gonzalez, Jose M. Gatell, Francesc Marco, José M. Miró, José Ortiz, Salvador Ninot, J. Carlos Paré, Juan M. Pericas, Eduard Quintana, Jose Ramirez, Irene Rovira, Elena Sandoval, Marta Sitges, Adrian Tellez, José M. Tolosana, Barbara Vidal, Jordi Vila, Ignasi Anguera, Bernat Font, Joan Raimon Guma, Javier Bermejo, Emilio Bouza, Miguel Angel Garcia Fernández, Victor Gonzalez-Ramallo, Mercedes Marín, Patricia Muñoz, Miguel Pedromingo, Jorge Roda, Marta Rodríguez-Créixems, Jorge Solis, Nuria Fernandez-Hidalgo, Pilar Tornos, Arístides de Alarcón, Ricardo Parra, Eric Alestig, Magnus Johansson, Lars Olaison, Ulrika Snygg-Martin, Pimchitra Pachirat, Burabha Pussadhamma, Vichai Senthong, Anna Casey, Tom Elliott, Peter Lambert, Richard Watkin, Christina Eyton, John L. Klein, Suzanne Bradley, Carol Kauffman, Roger Bedimo, G. Ralph Corey, Anna Lisa Crowley, Pamela Douglas, Laura Drew, Thomas Holland, Tahaniyat Lalani, Daniel Mudrick, Zaniab Samad, Daniel Sexton, Martin Stryjewski, Andrew Wang, Christopher W. Woods, Robert Cantey, Lisa Steed, Stuart A. Dickerman, Hector Bonilla, Joseph DiPersio, Sara-Jane Salstrom, John Baddley, Mukesh Patel, Gail Peterson, Amy Stancoven, Donald Levine, Jonathan Riddle, Michael Rybak, Christopher H. Cabell, Pericas, J. M., Llopis, J., Jimenez-Exposito, M. J., Kourany, W. M., Almirante, B., Carosi, G., Durante-Mangoni, E., Fortes, C. Q., Giannitsioti, E., Lerakis, S., Montagna-Mella, R., Ambrosioni, J., Tan, R. -S., Mestres, C. A., Wray, D., Pachirat, O., Moreno, A., Chu, V. H., de Lazzari, E., Fowler, V. G., Miro, J. M., Clara, L., Sanchez, M., Casabe, J., Cortes, C., Nacinovich, F., Oses, P. F., Ronderos, R., Sucari, A., Thierer, J., Altclas, J., Kogan, S., Spelman, D., Athan, E., Harris, O., Kennedy, K., Tan, R., Gordon, D., Papanicolas, L., Korman, T., Kotsanas, D., Dever, R., Jones, P., Konecny, P., Lawrence, R., Rees, D., Ryan, S., Feneley, M. P., Harkness, J., Post, J., Reinbott, P., Gattringer, R., Wiesbauer, F., Andrade, A. R., Passos de Brito, A. C., Guimaraes, A. C., Grinberg, M., Mansur, A. J., Siciliano, R. F., Varejao Strabelli, T. M., Campos Vieira, M. L., de Medeiros Tranchesi, R. A., Paiva, M. G., de Oliveira Ramos, A., Weksler, C., Ferraiuoli, G., Golebiovski, W., Lamas, C., Karlowsky, J. A., Keynan, Y., Morris, A. M., Rubinstein, E., Jones, S. B., Garcia, P., Cereceda, M., Fica, A., Mella, R. M., Fernandez, R., Franco, L., Gonzalez, J., Jaramillo, A. N., Barsic, B., Bukovski, S., Krajinovic, V., Pangercic, A., Rudez, I., Vincelj, J., Freiberger, T., Pol, J., Zaloudikova, B., Ashour, Z., El Kholy, A., Mishaal, M., Osama, D., Rizk, H., Aissa, N., Alauzet, C., Alla, F., Campagnac, C. C., Doco-Lecompte, T., Selton-Suty, C., Casalta, J. -P., Fournier, P. -E., Habib, G., Raoult, D., Thuny, F., Delahaye, F., Delahaye, A., Vandenesch, F., Donal, E., Donnio, P. Y., Flecher, E., Michelet, C., Revest, M., Tattevin, P., Chevalier, F., Jeu, A., Remadi, J. P., Rusinaru, D., Tribouilloy, C., Bernard, Y., Chirouze, C., Hoen, B., Leroy, J., Plesiat, P., Naber, C., Neuerburg, C., Mazaheri, B., Sophia Athanasia, C. N., Deliolanis, I., Giamarellou, H., Thomas, T., Mylona, E., Paniara, O., Papanicolaou, K., Pyros, J., Skoutelis, A., Papanikolaou, K., Sharma, G., Francis, J., Nair, L., Thomas, V., Venugopal, K., Hannan, M. M., Hurley, J. P., Wanounou, M., Gilon, D., Israel, S., Korem, M., Strahilevitz, J., Iossa, D., Orlando, S., Ursi, M. P., Pafundi, P. C., D'Amico, F., Bernardo, M., Cuccurullo, S., Dialetto, G., Covino, F. E., Manduca, S., Della Corte, A., De Feo, M., Tripodi, M. F., Cecchi, E., De Rosa, F., Forno, D., Imazio, M., Trinchero, R., Grossi, P., Lattanzio, M., Toniolo, A., Goglio, A., Raglio, A., Ravasio, V., Rizzi, M., Suter, F., Magri, S., Signorini, L., Kanafani, Z., Kanj, S. S., Sharif-Yakan, A., Abidin, I., Tamin, S. S., Martinez, E. R., Soto Nieto, G. I., van der Meer, J. T. M., Chambers, S., Holland, D., Morris, A., Raymond, N., Read, K., Murdoch, D. R., Dragulescu, S., Ionac, A., Mornos, C., Butkevich, O. M., Chipigina, N., Kirill, O., Vadim, K., Vinogradova, T., Edathodu, J., Halim, M., Liew, Y. -Y., Lejko-Zupanc, T., Logar, M., Mueller-Premru, M., Commerford, P., Commerford, A., Deetlefs, E., Hansa, C., Ntsekhe, M., Almela, M., Azqueta, M., Brunet, M., Castro, P., Falces, C., Fuster, D., Fita, G., Garcia- de- la- Maria, C., Garcia-Gonzalez, J., Gatell, J. M., Marco, F., Ortiz, J., Ninot, S., Pare, J. C., Quintana, E., Ramirez, J., Rovira, I., Sandoval, E., Sitges, M., Tellez, A., Tolosana, J. M., Vidal, B., Vila, J., Anguera, I., Font, B., Guma, J. R., Bermejo, J., Bouza, E., Garcia Fernandez, M. A., Gonzalez-Ramallo, V., Marin, M., Munoz, P., Pedromingo, M., Roda, J., Rodriguez-Creixems, M., Solis, J., Fernandez-Hidalgo, N., Tornos, P., de Alarcon, A., Parra, R., Alestig, E., Johansson, M., Olaison, L., Snygg-Martin, U., Pachirat, P., Pussadhamma, B., Senthong, V., Casey, A., Elliott, T., Lambert, P., Watkin, R., Eyton, C., Klein, J. L., Bradley, S., Kauffman, C., Bedimo, R., Corey, G. R., Crowley, A. L., Douglas, P., Drew, L., Holland, T., Lalani, T., Mudrick, D., Samad, Z., Sexton, D., Stryjewski, M., Wang, A., Woods, C. W., Cantey, R., Steed, L., Dickerman, S. A., Bonilla, H., Dipersio, J., Salstrom, S. -J., Baddley, J., Patel, M., Peterson, G., Stancoven, A., Levine, D., Riddle, J., Rybak, M., Cabell, C. H., Bristol-Myers Squibb Company, Vall d'Hebron University Hospital [Barcelona], Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Laboratoire Chrono-environnement (UMR 6249) (LCE)

Subjects
Male, relapses, medicine.medical_treatment, infective endocarditi, 030204 cardiovascular system & hematology, Kidney Failure, Cohort Studies, Catheters, Indwelling, 0302 clinical medicine, Surgical, Epidemiology, cardiac surgery, enterococci, hemodialysis, infective endocarditis, Staphylococcus aureus, Aged, Anti-Bacterial Agents, Arteriovenous Shunt, Surgical, Cardiac Surgical Procedures, Endocarditis, Female, Humans, Kidney Failure, Chronic, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Renal Dialysis, Staphylococcal Infections, 030212 general & internal medicine, Chronic, Prospective cohort study, health care economics and organizations, relapse, Arteriovenous Shunt, 3. Good health, Cardiac surgery, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Indwelling, Infective endocarditis, Hemodialysis, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Catheters, education, 03 medical and health sciences, Internal medicine, medicine, business.industry, medicine.disease, hemodialysi, Etiology, Complication, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background - Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives - This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods - Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results - A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p

Published
2021

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