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1. 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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2. Managing adult patients with infectious diseases in emergency departments: international ID-IRI study

Author

Cernat Roxana Carmen, Sholpan Kulzhanova, Yasemin Cag, Mohamed Elhassan Abbas Dafalla, Ozay Akyildiz, Amani El-Kholy, Ainur Sadykova, Ahmed Ashraf Wegdan, Anna Liskova, Jordi Rello, Fatma A. Amer, Ilyas Dokmetas, Behrouz Naghili, Natalia Dirani, Svjetlana Grgić, Michael M. Petrov, Sevil Alkan Ceviker, Jameela Alsalman, Jehan El-Kholy, Hakan Hasman, Serkan Oncu, Abu Hena Mostafa Kamal, Kalyan Koganti, Yasemin Yildiz-Kirazaldi, Mateja Jankovic Makek, Hulya Caskurlu, Rusmir Baljic, Selda Aslan, Razi Even Dar, Sergio Ramirez-Estrada, Mateja Logar, Cansu Bulut-Avsar, Joanna Zajkowska, Rosa Fontana Del Vecchio, Handan Alay, Aidos K Konkayev, Marzena Wojewodzka-Zelezniakowicz, Sally Hargreaves, Hakan Erdem, Amjad Mahboob, Ferran Llopis, Dumitru Irina Mgdalena, Ergys Ramosaco, Dilek Bulut, Ameen S. S. Alwashmi, Nikolay Mladenov, Esam Abdalla, Nirav Pandya, Lorenza Lambertenghi, Mustafa Altindiş, Hema Prakash Kumari, Andrea Marino, Yvon Ruch, Filiz Kizilates, Dirar Abdallah, Emine Kubra Dindar-Demiray, Antonio Cascio, Meliha Meric-Koc, Asiye Bahar-Kacmaz, Rehab H. El-Sokkary, Meltem Taşbakan, Ridvan Karaali, Handan Ankarali, Helena Monzón-Camps, Ilad Alavi-Darazam, Ghaydaa A. Shehata, Merve Sefa-Sayar, Fatma Kesmez-Can, Ege Üniversitesi, MERİÇ KOÇ, MELİHA, Erdem H., Hargreaves S., Ankarali H., Caskurlu H., Ceviker S.A., Bahar-Kacmaz A., Meric-Koc M., Altindis M., Yildiz-Kirazaldi Y., Kizilates F., Alsalman J., Cag Y., Kamal A.H.M., Dokmetas I., Dindar-Demiray E.K., Shehata G.A., Hasman H., Sadykova A., Llopis F., Ramosaco E., Logar M., Alay H., Kesmez-Can F., Ruch Y., Bulut D., Makek M.J., Marino A., Mahboob A., El-Kholy A., Abdallah D., Sefa-Sayar M., Karaali R., Aslan S., Dar R.E., Abdalla E., Monzon-Camps H., Baljic R., Mgdalena D.I., Naghili B., Abbas Dafalla M.E., Alwashmi A.S.S., Carmen C.R., Ramirez-Estrada S., Wojewodzka-Zelezniakowicz M., Akyildiz O., Zajkowska J., El-Sokkary R., Pandya N., Amer F., Alavi-Darazam I., Grgic S., Wegdan A.A., El-Kholy J., Bulut-Avsar C., Kulzhanova S., Tasbakan M., Kumari H.P., Dirani N., Koganti K., Konkayev A.K., Petrov M.M., Cascio A., Liskova A., Del Vecchio R.F., Lambertenghi L., Mladenov N., Oncu S., and Rello J.

Subjects
0301 basic medicine, Point prevalence survey, medicine.medical_specialty, Urologic Neoplasms, Referral, international ID-IRI study-, JOURNAL OF CHEMOTHERAPY, 2021 [Erdem H., Hargreaves S., ANKARALI H., ÇAŞKURLU H., Ceviker S. A. , Bahar-Kacmaz A., Meric-Koc M., ALTINDİŞ M., Yildiz-Kirazaldi Y., Kizilates F., et al., -Managing adult patients with infectious diseases in emergency departments], medicine.drug_class, Organ Dysfunction Scores, 030106 microbiology, Antibiotics, Practice Patterns, emergency, antibiotic, elderly, infection, sepsis, treatment, Global Health, Communicable Diseases, Sepsis, Hospital, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pharmacology (medical), Practice Patterns, Physicians', Developing Countries, Respiratory Tract Infections, Pharmacology, Emergency Service, Physicians', Adult patients, business.industry, Patient Acuity, Antimicrobial, medicine.disease, humanities, Drug Utilization, Anti-Bacterial Agents, Infectious Diseases, Oncology, 030220 oncology & carcinogenesis, Emergency medicine, Emergency, sepsi, business, Emergency Service, Hospital
Abstract

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 +/- 0.74. Sepsis (qSOFA >= 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 +/- 0.963) compared to upper-middle (0.17 +/- 0.482) and high-income (0.36 +/- 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required.

Published
2021

3. Contribution of sonicate-fluid cultures and broad-range PCR to microbiological diagnosis in vascular graft infections

Author

Mateja Logar, Barbara Kokošar Ulčar, Nikola Lakič, Tjaša Cerar, Blaz Pecavar, Samo Jeverica, and Tatjana Lejko-Zupanc

Subjects
Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, Pathogen detection, Liquid culture, Slovenia, 030106 microbiology, Polymerase Chain Reaction, Sensitivity and Specificity, Gastroenterology, Tertiary Care Centers, Sonication, 03 medical and health sciences, Internal medicine, Retrospective analysis, medicine, Humans, University medical, Surgical treatment, Aged, Retrospective Studies, Bacteriological Techniques, General Immunology and Microbiology, business.industry, General Medicine, Middle Aged, Antimicrobial, Blood Vessel Prosthesis, Infectious Diseases, Biofilms, Female, Vascular Grafting, business, Anaerobic exercise, Vascular graft
Abstract

Vascular graft infections (VGI) are associated with considerable morbidity and mortality, and antimicrobial treatment is an important adjunct to surgical treatment. While microbial aetiology of VGI is often difficult to determine, other techniques such as sonication of implanted material may be used to enhance the recovery of biofilm-associated organisms.We performed a retrospective analysis of 22 consecutive patients treated for VGI at University Medical Centre Ljubljana from May 2011 through January 2015. Explanted vascular grafts were flooded with sterile Ringer solution, sonicated for 1 min at a frequency of 40 kHz and inoculated on solid and liquid culture media. Aerobic and anaerobic cultures were performed, incubated for 14 days and any significant bacterial growth was quantitatively evaluated. Additionally, broad-range PCR from sonicate fluid was performed. Microbiological results were compared with the results of preoperatively taken blood cultures and the results of intraoperative tissue cultures (material from peri-graft collection).Identification of the causative organism (irrespective of the method) was achieved in 95.8%. Preoperative blood cultures were positive in 35.3%, intraoperative tissue cultures in 31.8%, sonicate fluid culture in 79.2%, while broad-range PCR from sonicate fluid was positive in 66.7%. In 37.5% the pathogen detected in sonicate fluid culture or broad-range PCR was the only positive microbiological result.Sonicate fluid culture and broad-range PCR from explanted vascular grafts may contribute to optimization of antimicrobial treatment. Optimal timing of antibiotic therapy before explantation should be further assessed to improve diagnostic yield.

Published
2017
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4. Successful control of the first OXA-48 and/or NDM carbapenemase-producing Klebsiella pneumoniae outbreak in Slovenia 2014-2016

Author

Mateja Pirs, Samo Jeverica, Mateja Logar, O. Jordan Markočič, Katja Seme, T Lejko Zupanc, V. Križan Hergouth, T. Cerar Kišek, M. Mueller Premru, Tatjana Mrvič, and B. Žnidaršič

Subjects
Microbiology (medical), medicine.medical_specialty, Klebsiella pneumoniae, Slovenia, beta-Lactamases, Teaching hospital, Disease Outbreaks, Hospitals, University, Bacterial Proteins, Internal medicine, medicine, Pulsed-field gel electrophoresis, Disease Transmission, Infectious, Escherichia coli, Infection control, Humans, Typing, Screening cultures, Escherichia coli Infections, Cross Infection, Infection Control, Molecular Epidemiology, biology, business.industry, Outbreak, General Medicine, Carbapenemase producing, biology.organism_classification, Electrophoresis, Gel, Pulsed-Field, Klebsiella Infections, Molecular Typing, Infectious Diseases, business
Abstract

Summary Background Carbapenemase-producing Enterobacteriaceae (CPE) occur only sporadically in Slovenia. Aim To describe the first Slovenian carbapenemase-producing (CP) Klebsiella pneumoniae and Escherichia coli outbreak which occurred at the tertiary teaching hospital University Medical Centre Ljubljana from October 2014 to April 2015. Methods A CPE-positive case was defined as any patient infected or colonized with CPE. A strict definition of a contact patient was adopted. Measures to prevent cross-transmission included cohorting of all CPE carriers with strict contact precautions and assignment of dedicated healthcare workers, cohorting of all contact patients until obtaining the result of screening cultures, systematic rectal screening of contact patients, and tagging of all CPE-positive cases and their contacts. Educational campaigns on CPEs were implemented. Clinical specimens were processed using standard procedures. Pulsed-field gel electrophoresis (PFGE) was used to determine relatedness. Multi-locus sequence typing was performed on CP K. pneumoniae isolates that belonged to different pulsotypes. Findings Before the outbreak was brought under control, 40 patients were colonized or infected with OXA-48 and/or New Delhi metallo-β-lactamase (NDM)-producing CPE; in 38 patients OXA-48 and/or NDM-producing K. pneumoniae was detected, in seven OXA-48 and/or NDM-producing E. coli was found together with K. pneumoniae, and in two patients only CP E. coli was isolated. The outbreak was oligoclonal with two major CP K. pneumoniae clusters belonging to ST437 and ST147 in epidemiologically linked patients. Conclusion Initial standard control measures failed to prevent the outbreak. Once the problem had been recognized, strict infection control measures and the education of healthcare workers contributed to the successful control of the outbreak.

Published
2018

5. Validated Risk Score for Predicting 6-Month Mortality in Infective Endocarditis

Author

Lawrence P. Park, Vivian H. Chu, Gail Peterson, Athanasios Skoutelis, Tatjana Lejko‐Zupa, Emilio Bouza, Pierre Tattevin, Gilbert Habib, Ren Tan, Javier Gonzalez, Javier Altclas, Jameela Edathodu, Claudio Querido Fortes, Rinaldo Focaccia Siciliano, Orathai Pachirat, Souha Kanj, Andrew Wang, Liliana Clara, Marisa Sanchez, José Casabé, Claudia Cortes, Francisco Nacinovich, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, Silvia Kogan, Denis Spelman, Eugene Athan, Owen Harris, Karina Kennedy, 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, 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, Alberto Fica, Rodrigo Montagna Mella, Ricardo Fernandez, Liliana Franco, 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, Catherine Campagnac, Thanh Doco‐Lecompte, Christine Selton‐Suty, Jean‐Paul Casalta, Pierre‐Edouard Fournier, Didier Raoult, Franck Thuny, Francois Delahaye, Armelle Delahaye, Francois Vandenesch, Erwan Donal, Pierre Yves Donnio, Erwan Flecher, Christian Michelet, Matthieu Revest, 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, Sophia Athanasia, Ioannis Deliolanis, Helen Giamarellou, Tsaganos Thomas, Efthymia Giannitsioti, Elena Mylona, Olga Paniara, Konstantinos Papanicolaou, John Pyros, Konstantinos Papanikolaou, Gautam Sharma, Johnson Francis, Lathi Nair, Vinod Thomas, Krishnan Venugopal, Margaret M. Hannan, John P. Hurley, Amos Cahan, Dan Gilon, Sarah Israel, Maya Korem, Jacob Strahilevitz, Emanuele Durante‐Mangoni, Irene Mattucci, Daniela Pinto, Federica Agrusta, Alessandra Senese, Enrico Ragone, Riccardo Utili, 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, Giampiero Carosi, 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, Magid Halim, Yee‐Yun Liew, Ru‐San Tan, Mateja Logar, Manica Mueller‐Premru, Patrick Commerford, Anita Commerford, Eduan Deetlefs, Cass Hansa, Mpiko Ntsekhe, Manuel Almela, Yolanda Armero, Manuel Azqueta, Ximena Castañeda, Carlos Cervera, Carlos Falces, Cristina Garcia‐de‐la‐Maria, Guillermina Fita, Jose M. Gatell, Magda Heras, Jaime Llopis, Francesc Marco, Carlos A. Mestres, José M. Miró, Asuncion Moreno, Salvador Ninot, Carlos Paré, Juan M. Pericas, Jose Ramirez, Irene Rovira, Marta Sitges, Ignasi Anguera, Bernat Font, Joan Raimon Guma, Javier Bermejo, Miguel Angel Garcia Fernández, Victor Gonzalez‐Ramallo, Mercedes Marín, Patricia Muñoz, Miguel Pedromingo, Jorge Roda, Marta Rodríguez‐Créixems, Jorge Solis, Benito Almirante, 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, Vance G. Fowler, Thomas Holland, Tahaniyat Lalani, Daniel Mudrick, Zaniab Samad, Daniel Sexton, Martin Stryjewski, Christopher W. Woods, Stamatios Lerakis, Robert Cantey, Lisa Steed, Dannah Wray, Stuart A. Dickerman, Hector Bonilla, Joseph DiPersio, Sara‐Jane Salstrom, John Baddley, Mukesh Patel, Amy Stancoven, Donald Levine, Jonathan Riddle, Michael Rybak, Christopher H. Cabell, Khaula Baloch, Christy C. Dixon, Tina Harding, Marian Jones‐Richmond, Bob Sanderford, Judy Stafford, Kevin Anstrom, Arnold S. Bayer, A. W. Karchmer, Daniel J. Sexton, Vivian Chu, David T. Durack, Susannah Eykyn, Phillipe Moreillon, Duke University Medical Center, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Fonction, structure et inactivation d'ARN bactériens, Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-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 ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Service de cardiologie, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 ), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Jonchère, Laurent, Universitat de Barcelona, Mazaheri, Bahram (Beitragende*r), Naber, Christoph (Beitragende*r), and Neuerburg, Carl (Beitragende*r)

Subjects
Male, Infeccions quirúrgiques, Surgical wound infection, Medizin, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, Clinical Studies, Registries, 030212 general & internal medicine, Original Research, Framingham Risk Score, Endocarditis, Hazard ratio, Middle Aged, Prognosis, infection, mortality, prognosis, surgery, valves, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, 3. Good health, Infective endocarditis, Cohort, Female, Mortality/Survival, Cardiology and Cardiovascular Medicine, Risk assessment, Infection, Cohort study, Adult, medicine.medical_specialty, Lower risk, Risk Assessment, Sensitivity and Specificity, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Internal medicine, Mortalitat, medicine, Humans, Infectious Endocarditis, Mortality, Propensity Score, Aged, Models, Statistical, Cirurgia, business.industry, Proportional hazards model, Reproducibility of Results, medicine.disease, Surgery, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Valvular Heart Disease, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business
Abstract

Background Host factors and complications have been associated with higher mortality in infective endocarditis ( IE ). We sought to develop and validate a model of clinical characteristics to predict 6‐month mortality in IE . Methods and Results Using a large multinational prospective registry of definite IE (International Collaboration on Endocarditis [ ICE ]–Prospective Cohort Study [ PCS ], 2000–2006, n=4049), a model to predict 6‐month survival was developed by Cox proportional hazards modeling with inverse probability weighting for surgery treatment and was internally validated by the bootstrapping method. This model was externally validated in an independent prospective registry ( ICE ‐ PLUS , 2008–2012, n=1197). The 6‐month mortality was 971 of 4049 (24.0%) in the ICE ‐ PCS cohort and 342 of 1197 (28.6%) in the ICE ‐ PLUS cohort. Surgery during the index hospitalization was performed in 48.1% and 54.0% of the cohorts, respectively. In the derivation model, variables related to host factors (age, dialysis), IE characteristics (prosthetic or nosocomial IE , causative organism, left‐sided valve vegetation), and IE complications (severe heart failure, stroke, paravalvular complication, and persistent bacteremia) were independently associated with 6‐month mortality, and surgery was associated with a lower risk of mortality (Harrell's C statistic 0.715). In the validation model, these variables had similar hazard ratios (Harrell's C statistic 0.682), with a similar, independent benefit of surgery (hazard ratio 0.74, 95% CI 0.62–0.89). A simplified risk model was developed by weight adjustment of these variables. Conclusions Six‐month mortality after IE is ≈25% and is predicted by host factors, IE characteristics, and IE complications. Surgery during the index hospitalization is associated with lower mortality but is performed less frequently in the highest risk patients. A simplified risk model may be used to identify specific risk subgroups in IE .

Published
2016
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6. Longterm reduction rate in catheter related bloodstream infections after implementation of a new strategy

Author

M Prosen, T Lejko Zupanc, and Mateja Logar

Subjects
Microbiology (medical), medicine.medical_specialty, business.industry, Public Health, Environmental and Occupational Health, Reduction rate, Drug resistance, Bioinformatics, Catheter, Infectious Diseases, Medical microbiology, Bloodstream infection, medicine, Oral Presentation, Pharmacology (medical), Icu stay, Intensive care medicine, business
Abstract

Catheter-related bloodstream infection (CRBSI) accounts for 10% to 20% of hospital-acquired infections and is associated with both increased ICU stay and mortality. CRBSI represent a considerable toll on patients and hospital resources. A lot of effort is put into the prevention of CRBSI.[1].

Published
2015
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7. Evaluation of the immunochromatographic (Leptocheck) test for detection of specific antibodies against leptospires

Author

Mateja Logar, Daša Podgoršek, Eva Ružić-Sabljić, Gorazd Lešničar, Tjaša Cerar, Emil Pal, Zvonko Baklan, and Tatjana Remec

Subjects
Adult, Male, Sensitivity and Specificity, Chromatography, Affinity, Serology, law.invention, Young Adult, Leptospira, law, Direct agglutination test, medicine, Humans, Leptospirosis, Polymerase chain reaction, biology, business.industry, Zoonosis, Reproducibility of Results, General Medicine, biology.organism_classification, medicine.disease, Virology, Antibodies, Bacterial, Test (assessment), Specific antibody, Early Diagnosis, Female, Reagent Kits, Diagnostic, business
Abstract

Leptospirosis is a febrile worldwide zoonosis. Routine diagnosis of leptospiral infection is based on demonstration of specific antibodies with serological tests. Performance of the reference serological test, the microscopic agglutination test (MAT), requires significant expertise. The aim of our study was to find out if leptospiral infection can be proven with simple, rapid, commercially available immunochromatographic Leptocheck test in order to introduce it for the first level diagnosis in emergency cases with less specialized laboratory staff. In all, 590 serum samples of patients with clinical manifestations suggestive of leptospirosis were collected and tested with MAT and Leptocheck test. For confirmation of the results some other diagnostic methods such as polymerase chain reaction (PCR) and Leptospira isolation were performed. Results of both serological tests were consistent in 576/590 (97.63 %) cases but Leptocheck gave more positive results in comparison to MAT (36 and 12, respectively) at first patient’s testing. Following up the patient, MAT became positive in majority of Leptocheck positive patients at first visit. Leptospiral DNA was detected in nine blood and six urine samples belonging to thirteen different patients while only two samples were culture positive. In comparison with serological tests, PCR and culture have low sensitivity. According to our findings we conclude that Leptocheck test can prove leptospiral infection and could be used for rapid diagnosis of leptospirosis, later the sample should be confirmed with MAT.

Published
2015

8. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study

Author

Richard Watkin, Pierre-Edouard Fournier, David R. Murdoch, Yoav Keynan, Florent Chevalier, Tania Mara Varejão Strabelli, Imran Zainal Abidin, Denis Spelman, Roger Bedimo, Jeffrey J. Post, Francesc Marco, Alan C Street, Claudio Querido Fortes, Francisco Nacinovich, Antonio Goglio, Stephen T. Chambers, Fredy Suter, Claire Sorel, Alessandro Tebini, Phillip Jones, Robyn Dever, Emilio Bouza, G. Ralph Corey, Karina Kennedy, Alfredo José Mansur, Nigel Raymond, Guillermina Fita, Martin E. Stryjewski, Joan R. Guma, Asunción Moreno, John W. Baddley, Johnson Francis, Magnus Johansson, José H. Casabé, Margaret M. Hannan, Krishnan Venugopal, Thanh Doco-Lecompte, Jacob Strahilevitz, Annibale Raglio, Carl Neuerburg, Vichai Senthong, Cass Hansa, Ana Pangerčić, Adina Ionac, Vladimir Krajinović, Christine Selton-Suty, Marwa Mishaal, Mateja Logar, Erwan Donal, Elena Mylona, Clara Weksler, Joseph Di Persio, Antoine Jeu, Pilar Tornos, Konstantinos Papanicolaou, François Vandenesch, Tom S.J. Elliott, Jan van der Meer, Patricia Muñoz, Regina Aparecida De Medeiros Tranchesi, Lathi Nair, Dannah Wray, Arnold S. Bayer, Pamela Konecny, David L. Gordon, Gilbert Habib, Armênio Costa Guimarães, Alberto Fica, Mercedes Marín, Francesco Giuseppe De Rosa, Marian Jones-Richmond, Marcelo Luiz Campos Vieira, Max Grinberg, Luis Afonso, Khaula Baloch, Pimchitra Pachirat, Anna Lisa Crowley, Marie Line Erpelding, Miguel Pedromingo, Daniel W. Mudrick, John Harkness, Barbora Zaloudikova, Christophe Tribouilloy, Cristina Garcia-de-la-Maria, Kerry Read, Athanasios Skoutelis, Marco Rizzi, Michael J. Rybak, Ioannis Deliolanis, Stuart Dickerman, Carol A. Kauffman, John L Klein, Suzanne Ryan, Christopher W. Woods, Gautam Sharma, Silvia Magri, Susannah J. Eykyn, Veronica Ravasio, Auristela De Oliveira Ramos, J. Leroy, Bruno Baršić, Burabha Pussadhamma, Jameela Edathodu, Franck Thuny, Eduan Deetlefs, Yvette Bernard, Rinaldo Focaccia Siciliano, Lito E. Papanicolas, Salvador Ninot, Nuria Fernández-Hidalgo, Zaniab Samad, Arístides de Alarcón, Neijla Aissa, Claudia Cortés, Thomas L. Holland, Tina Harding, Tania A. Baban, Irene Rovira, Ethan Rubinstein, Jorge Solis, Maya Korem, Giampiero Carosi, Marie Francoise Tripodi, Andrew Wang, Orathai Pachirat, Davide Forno, Ana Cláudia Passos De Brito, Catherine Campagnac, Anna L. Casey, Ana del Río, Gail E. Peterson, Carlos Falces, Christopher H. Cabell, François Delahaye, Emanuele Durante-Mangoni, Mattucci Irene, Despina Kotsanas, Javier Bermejo, Pierre Tattevin, Richard Lawrence, John Pyros, José M. Gatell, Jérémie Violette, Igor Rudez, Peter A. Lambert, Jean Paul Casalta, Jiri Pol, Kulichenko Vadim, Pablo Fernandez Oses, Ximena Castañeda, José Ramírez, Rita Trinchero, Sarah Israel, Mariangela Lattanzio, Eugene Athan, Arthur J. Morris, Bahram Mazaheri, Leeanne Grigg, Mohamad Yasmine, Adriana Andrade, Owen Harris, Syahidah Syed Tamin, Adolf W. Karchmer, Joan Pericas, Manica Mueller-Premru, Ozerecky Kirill, Eduardo Rivera Martínez, Christina Eyton, Josip Vincelj, Marisa Santos, Marisa Sanchez, David T. Durack, Dan Gilon, Marcelo Goulart Paiva, G. Ferraiuoli, Susanna Cuccurullo, Chipigina Ns, Lars Olaison, Patrick Plésiat, Michael P. Feneley, Amy B. Stancoven, Efthymia Giannitsioti, Cristiane da Cruz Lamas, Silvia Kogan, Kevin J. Anstrom, Manuel Almela, Liliana Clara, Stamatios Lerakis, Massimo Imazio, Rainer Gattringer, Javier Altclas, Wilma F. Golebiovski, Cristian Mornos, Damon P. Eisen, Pierre-Yves Donnio, Bernat Font, Eric Alestig, Liana Signorini, Sandra Braun Jones, Pamela S. Douglas, Helen Giamarellou, Gabriel Israel Soto Nieto, Tatjana Lejko-Zupanc, Benito Almirante, Dan Rusinaru, Anita Commerford, Yolanda Armero, Donald P. Levine, Mukesh Patel, M. Azqueta, Mpiko Ntsekhe, Phillipe Moreillon, Matthieu Revest, Adriana Sucari, Ashour Zainab, Olga Paniara, Víctor González-Ramallo, Miguel Ángel García Fernández, Ricardo Parra, Christoph Naber, Hector Bonilla, John P. Hurley, Rodrigo Montagna Mella, James A. Karlowsky, Lisa L. Steed, Armelle Delahaye, Marta Rodríguez-Créixems, José M. Miró, Enrico Cecchi, Enrico Ragone, Catherine Chirouze, J. Roda, David Holland, Marta Sitges, Luh Nah Lum, Patricia García, Thomas Redick, Theresa Kulman, Paul A. Pappas, Carlos Paré, Riccardo Utili, Stefan Dragulescu, Robert Cantey, Paolo Grossi, Vivian H. Chu, Porl Reinbott, Bruno Hoen, Amani El Kholy, Judy Stafford, Tomáš Freiberger, Hussien Rizk, Corentine Alauzet, Ricardo Ronderos, Ru San Tan, Christian Michelet, Suzanne F. Bradley, R. Casillo, Thomas Tsaganos, M. Cereceda, Laura A. Drew, Magid Halim, François Alla, Tahaniyat Lalani, Carlos A. Mestres, David Rees, Sara Jane Salstrom, O. M. Butkevich, Patrick J. Commerford, Ignasi Anguera, Franz Wiesbauer, Ulrika Snygg-Martin, Lawrence P. Park, Didier Raoult, Tony M. Korman, Giovanni Dialetto, Zeina Kanafani, Antonio Toniolo, Suzana Bukovski, Christy C. Dixon, Tatiana Vinogradova, Jorge Thierer, Souha S. Kanj, Vinod Thomas, Daniel J. Sexton, Vance G. Fowler, Andrew M. Morris, S. Athanasia, Ren Tan, Carlos Cervera, Chirouze, C, Alla, F, Fowler VG, Jr, Sexton, Dj, Corey, Gr, Chu, Vh, Wang, A, Erpelding, Ml, DURANTE MANGONI, Emanuele, Fernández Hidalgo, N, Giannitsioti, E, Hannan, Mm, Lejko Zupanc, T, Miró, Jm, Muñoz, P, Murdoch, Dr, Tattevin, P, Tribouilloy, C, Hoen, B., Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Duke University Medical Center, Monaldi Hospital, Mater Hospitals, University Medical Center Ljubljana, Institut d'Investigacions Biomèdiques August Pi i Sunyer ( IDIBAPS ), Universitat de Barcelona ( UB ), Clinical Microbiology and Infectious Diseases Department, Universidad Complutense de Madrid [Madrid] ( UCM ), Department of Pathology, University of Otago, Microbiology Unit, Canterbury Health Laboratories, Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne ( UPJV ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Pointe-à-Pitre/Abymes [Guadeloupe], 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)-Hôpital Saint-Jacques, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Universidad Complutense de Madrid = Complutense University of Madrid [Madrid] (UCM), University of Otago [Dunedin, Nouvelle-Zélande], Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Service des maladies infectieuses et réanimation médicale [Rennes], Hôpital Pontchaillou-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

Subjects
Male, diagnosis, International Cooperation, Medizin, blood culture, Cohort Studies, surgery, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Prospective Studies, Prospective cohort study, Endocarditis, Mortality rate, heart valve, Middle Aged, Staphylococcal Infections, Heart Valves, prosthetic valve, 3. Good health, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Infective endocarditis, Cohort, endocarditis, Female, Cohort study, Adult, Microbiology (medical), Staphylococcus aureus, medicine.medical_specialty, Endocarditis, Staphylococcus aureus, heart valve, combined treatment, blood culture, clinical microbiology, etiology, diagnosis, Prosthesis-Related Infections, etiology, Staphylococcal infections, Internal medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, 1-year mortality, Prosthetic valve, Surgery, Aged, Humans, Survival Analysis, medicine, combined treatment, clinical microbiology, Proportional hazards model, business.industry, medicine.disease, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Background - The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. Methods - Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. Results - EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). Conclusions - In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.

Published
2015
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9. Tick-borne encephalitis in Slovenia from 2000 to 2004: Comparison of the course in adult and elderly patients

Author

Tatjana Avsic-Zupanc, Franc Strle, Mateja Logar, Daša Cerar, and Petra Bogovič

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, Adolescent, Photophobia, Leukocytosis, Slovenia, Epidemiology, Humans, Medicine, Pleocytosis, Aged, Retrospective Studies, Aged, 80 and over, Chi-Square Distribution, business.industry, Mortality rate, Age Factors, Tick-borne encephalitis, Retrospective cohort study, General Medicine, Length of Stay, Middle Aged, medicine.disease, Treatment Outcome, Acute Disease, Female, medicine.symptom, business, Chi-squared distribution, Encephalitis, Tick-Borne, Encephalitis
Abstract

OBJECTIVE: To present epidemiological data and clinical characteristics of tick-borne encephalitis (TBE) in adult patients, and to compare findings in the subgroup over the age of 60 years with those aged 60 or under. METHODS: The information for this retrospective study was obtained by review of medical documentation. All patients over 15 years of age hospitalized at the Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia, between 2000 and 2004 with pleocytosis (cerebrospinal fluid leukocyte count >5 × 106 cells/l) and the presence of serum IgM antibodies against TBE virus qualified for inclusion in this report. Patients were divided into two groups according to their age (patients over the age of 60 were classified as seniors and those aged 60 or under as adults); the findings in the two groups were compared. RESULTS: Of 448 patients with TBE, 318 were in the adult group and 130 in the senior group. Males predominated in both groups. A biphasic course of the illness was reported by 56% of patients. There were no significant differences in the majority of clinical parameters in the initial phase of TBE but several distinctions between adults and seniors were found in the second phase of the illness. Adults more often presented with fever, headache, stiff neck and photophobia, whereas seniors more frequently reported fatigue, altered consciousness and decreased muscle strength, these differences indicating a more classic course of TBE in the younger group and a somehow different and more severe acute disease in the older group. More severe acute disease and less favorable outcome in seniors was further corroborated by the occurrence of urine retention (18/318, 5.7% versus 27/130, 20.8%; P < 0.001), frequency of pareses (10/318, 3.1% versus 7/130, 5.4%; P = 0.002) and the need for antiedematous treatment (103/318, 32.4% versus 61/130, 46.9%; P = 0.005), as well as by the duration of treatment, duration of hospital stay and the death rate (0/318 versus 3/130, 2.3%; P = 0.024). Several distinctions were present also in laboratory findings, including higher cerebrospinal fluid leukocyte count in the adults than in the seniors (107 × 106 cells/l versus 47 × 106 cells/l; P < 0.001). CONCLUSION: Direct comparison of the course and outcome of TBE revealed several distinctions between patients over 60 years of age and those aged 60 or under and corroborates previous assumptions that TBE is a more serious illness in the elderly population.

Published
2006
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10. Comparison of Erythema Migrans Caused by Borrelia afzelii and Borrelia garinii

Author

J Cimperman, Vera Maraspin, Eva Ruzic-Sabljic, Franc Strle, Mateja Logar, Tomaž Jurca, and Stanka Lotric-Furlan

Subjects
Adult, Male, Microbiology (medical), Pathology, medicine.medical_specialty, Adolescent, medicine.disease_cause, Borrelia afzelii, Severity of Illness Index, Statistics, Nonparametric, Age Distribution, Borrelia burgdorferi Group, parasitic diseases, medicine, Humans, Sex Distribution, Borrelia burgdorferi, Aged, Probability, Aged, 80 and over, Adult patients, biology, business.industry, Lyme borreliosis, Incidence, General Medicine, Middle Aged, Prognosis, bacterial infections and mycoses, biology.organism_classification, Infectious Diseases, Erythema Chronicum Migrans, Erythema migrans, Abnormal Liver Function Test, Female, Borrelia garinii, business, Skin lesion
Abstract

We compared epidemiological and clinical characteristics of patients with erythema migrans (EM) caused by Borrelia afzelii and Borrelia garinii. 200 consecutive adult patients with B. afzelii isolated from the skin lesion and 53 consecutive adult patients with EM caused by B. garinii qualified for the present study. Comparison of the two groups revealed several distinctions. Patients with EM caused by B. garinii were older, had their skin lesions more often located on the trunk but less often on extremities, had shorter incubation and faster evolution of EM, more often reported associated local and certain systemic symptoms, had abnormal liver function test results more often and were more frequently seropositive. Early localized Lyme borreliosis caused by B. afzelii and B. garinii has distinct epidemiological and clinical characteristics. Clinical features of EM depend upon the genospecies of Borrelia burgdorferi sensu lato causing the illness.

Published
2004
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11. Quantitative evaluation of the severity of acute illness in adult patients with tick-borne encephalitis

Author

Mateja Logar, Tatjana Avsic-Zupanc, Petra Bogovič, Franc Strle, and Stanka Lotric-Furlan

Subjects
Adult, Male, medicine.medical_specialty, Pathology, Article Subject, Adolescent, Central nervous system, Slovenia, lcsh:Medicine, Disease, macromolecular substances, Severity of Illness Index, General Biochemistry, Genetics and Molecular Biology, Acute illness, Young Adult, Internal medicine, Surveys and Questionnaires, Severity of illness, medicine, Humans, Young adult, Aged, Aged, 80 and over, General Immunology and Microbiology, Adult patients, business.industry, lcsh:R, Tick-borne encephalitis, General Medicine, Middle Aged, medicine.disease, medicine.anatomical_structure, Acute Disease, Female, business, Encephalitis, Encephalitis, Tick-Borne, Research Article
Abstract

The aim of the present study was to quantify the severity of acute illness in patients with tick-borne encephalitis and to ascertain this approach by comparing it to standard clinical assessment. We designed scoring system for quantification of the severity of acute illness in patients with tick-borne encephalitis. Certain number of points was allotted to the presence, intensity, and duration of individual symptoms/signs. According to the obtained score the disease was classified as mild, moderate, and severe. Tick-borne encephalitis was assessed clinically as mild when only signs/symptoms of meningeal involvement were found, moderate in case of monofocal neurological signs and/or mild to moderate signs/symptoms of central nervous system dysfunction, and severe in patients with multifocal neurological signs and/or symptoms of severe dysfunction of central nervous system. By designed scoring system 282 adult patients, 146 males and 136 females, average aged 52.2 ± 15.5 years (range 15–82 years), with confirmed tick-borne encephalitis, were prospectively assessed. In 279/282 (98.9%) patients the severity according to clinical assessment matched with the score ranges for mild, moderate, and severe disease. The proposed approach enables precise and straightforward appraisal of the severity of acute illness and could be useful for comparison of findings within/between study groups.

Published
2013

12. Infective endocarditis caused by Cellulomonas spp. in an intravenous drug user: case report

Author

Mateja Logar and Tatjana Lejko-Zupanc

Subjects
Adult, Male, medicine.medical_specialty, biology, business.industry, General Medicine, Disease, Endocarditis, Bacterial, Mycotic aneurysm, biology.organism_classification, medicine.disease, Surgery, Diagnosis, Differential, Intravenous Drug User, Aortic valve replacement, Infective endocarditis, Heart failure, medicine, Endocarditis, Humans, Cellulomonas, business, Substance Abuse, Intravenous
Abstract

Cellulomonas spp. are often believed to be of low virulence. There are only a few reports of human infections. We report the first case of endocarditis caused by Cellulomonas in an intravenous drug abuser. The diagnosis of infective endocarditis (IE) in this case was definite using the Duke criteria. The course of the disease was complicated with a heart failure and possible mycotic aneurysm in the left leg. After the end of antimicrobial therapy aortic valve replacement was done because of severe heart failure.

Published
2013

13. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure

Author

Todd Kiefer, Lawrence Park, Christophe Tribouilloy, Claudia Cortes, Roberta Casillo, Vivian Chu, Francois Delahaye, Emanuele Durante-Mangoni, Jameela Edathodu, Carlos Falces, Mateja Logar, José M. Miró, Christophe Naber, Marie Françoise Tripodi, David R. Murdoch, Philippe Moreillon, Riccardo Utili, Andrew Wang, for the ICE-PCS Investigators, Kiefer, T, Park, L, Tribouilloy, C, Cortes, C, Casillo, R, Chu, V, Delahaye, F, DURANTE MANGONI, Emanuele, Edathodu, J, Falces, C, Logar, M, Miro, Jm, Naber, C, Tripodi, Mf, Murdoch, Dr, Moreillon, P, Utili, Riccardo, and Wang, A.

Subjects
Male, medicine.medical_specialty, Medizin, Article, Cohort Studies, medicine, Endocarditis, Humans, Hospital Mortality, Prospective Studies, Mortality, Prospective cohort study, Stroke, Aged, Heart Failure, business.industry, Proportional hazards model, Cardiovascular Surgical Procedures, General Medicine, Middle Aged, medicine.disease, Heart Valves, Surgery, Echocardiography, Infective endocarditis, Heart failure, Cohort, Female, business, Cohort study
Abstract

Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described.To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome.The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006.In-hospital and 1-year mortality.Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P.001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P.001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality.In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.

Published
2011

14. Comparison of erythema migrans caused by Borrelia burgdorferi and Borrelia garinii

Author

Stanka Lotric-Furlan, Gary P. Wormser, J Cimperman, Katarina Ogrinc, Daša Stupica, John Nowakowski, Franc Strle, Robert B. Nadelman, Vera Maraspin, Mateja Logar, and Eva Ružić-Sabljić

Subjects
myalgia, Adult, Male, medicine.medical_specialty, Glossitis, Adolescent, Slovenia, New York, Comorbidity, Tick, medicine.disease_cause, Microbiology, Severity of Illness Index, Young Adult, Borrelia burgdorferi Group, Risk Factors, Virology, Surveys and Questionnaires, parasitic diseases, medicine, Humans, Borrelia burgdorferi, Aged, Aged, 80 and over, Lyme Disease, biology, business.industry, Middle Aged, bacterial infections and mycoses, medicine.disease, biology.organism_classification, Dermatology, Glossitis, Benign Migratory, Infectious Diseases, Immunology, Erythema migrans, Lyme disease microbiology, Borrelia garinii, Chills, Female, medicine.symptom, business
Abstract

A comparison of patients with erythema migrans due to Borrelia garinii versus Borrelia burgdorferi has not been reported.One hundred nineteen patients from New York State with erythema migrans caused by B. burgdorferi were compared with 116 patients from Slovenia with erythema migrans due to B. garinii infection.Patients with B. garinii infection were older, more often reported a tick bite, and developed larger lesions (median largest diameter: 18 and 14 cm, respectively; p = 0.01) that more often had central clearing (61.2% compared with 35.3%; p0.0001). Patients infected with B. burgdorferi, however, more often had systemic symptoms (68.9% vs. 37.1%; p0.0001), including fatigue (p0.0001), arthralgia (p = 0.0003), myalgia (p0.0001), headache (p = 0.0008), fever and/or chills (p0.0001), and stiff neck (p0.0001), and more often had abnormal physical findings (57.1% compared with 11.2%; p0.0001), such as fever (p = 0.0002) or regional lymphadenopathy (p0.0001). There was a trend for more patients with B. burgdorferi infection to have multiple erythema migrans skin lesions (13.4% compared with 5.2%; p = 0.051), and among patients with multiple erythema migrans the number of lesions was greater in B. burgdorferi-infected patients (median: 5.5 compared with 2.0; p = 0.006).The results of the present study indicate that in patients with erythema migrans the clinical features vary according to whether infection is caused by B. garinii or B. burgdorferi.

Published
2011

15. Erythema migrans in solid-organ transplant recipients

Author

J Cimperman, Franc Strle, Vera Maraspin, Mateja Logar, Eva Ružić-Sabljić, and Stanka Lotric-Furlan

Subjects
Microbiology (medical), Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Antibiotics, Organ transplantation, Immunocompromised Host, Lyme disease, medicine, Humans, business.industry, Immunosuppression, Organ Transplantation, Middle Aged, medicine.disease, Dermatology, Anti-Bacterial Agents, Transplantation, Infectious Diseases, Immunology, Erythema chronicum migrans, Erythema migrans, Erythema Chronicum Migrans, Female, medicine.symptom, Immunocompetence, business
Abstract

Six adult solid-organ transplant recipients who had chronic drug-induced immunosuppression and who presented with solitary erythema migrans were treated with antibiotics administered at the same dosage and for the same duration used for the treatment of early, localized Lyme borreliosis in immunocompetent patients. The patients had a smooth course of illness and a favorable outcome but did not develop a measurable borrelial serum antibody response.

Published
2006

16. Doxycycline versus ceftriaxone for the treatment of patients with chronic Lyme borreliosis

Author

Katarina Ogrinc, Eva Ruzic-Sabljic, Mateja Logar, Daša Cerar, Stanka Lotric-Furlan, and Franc Strle

Subjects
Adult, Male, medicine.medical_specialty, Time Factors, medicine.drug_class, Antibiotics, Administration, Oral, Cerebrospinal fluid, Internal medicine, medicine, Humans, Pleocytosis, Aged, Cerebrospinal Fluid, Doxycycline, Lyme Disease, business.industry, Lyme borreliosis, Ceftriaxone, Antibody titer, General Medicine, Middle Aged, Antibodies, Bacterial, Surgery, Anti-Bacterial Agents, Treatment Outcome, Immunoglobulin M, Borrelia burgdorferi, Immunoglobulin G, Injections, Intravenous, Erythema migrans, Female, business, medicine.drug, Follow-Up Studies
Abstract

BACKGROUND: Therapeutic guidelines for treatment of late manifestations of Lyme borreliosis have not yet become well established. Patients with symptoms suggesting central nervous system involvement are often treated with courses of intravenous ceftriaxone. This is an expensive treatment approach with potentially severe side effects. We compared the efficacy, side effects and costs of doxycycline and ceftriaxone in the treatment of such patients. PATIENTS AND METHODS: Adult patients qualified for the study if they had nonspecific symptoms suggesting central nervous system involvement for more than six months (but without overt clinical signs of the involvement), had positive serum borrelial antibody titers and/or erythema migrans prior to the onset of symptoms, had not been previously treated with antibiotics and did not have pleocytosis in the cerebrospinal fluid. Patients were given either 100 mg of oral doxycycline twice daily for 4 weeks (23 patients) or 2 g of intravenous ceftriaxone daily for 2 weeks followed by 100 mg of doxycycline twice daily for another 2 weeks (23 patients). Clinical outcome was assessed during a 12-month follow-up period. RESULTS: Improvement in the frequency and/or the intensity of symptoms was reported by more than two-thirds of the 46 patients enroled in the study. The two treatment regimens were found to be correspondingly effective. Photosensitivity reactions and gastrointestinal symptoms were noted more often among patients receiving doxycycline than in those receiving ceftriaxone. Treatment with doxycycline proved to be much cheaper than with ceftriaxone. CONCLUSIONS: In patients with previously untreated chronic Lyme borreliosis with symptoms suggesting central nervous system involvement but without overt clinical signs of it, and without pleocytosis in the cerebrospinal fluid, treatment with doxycycline is as effective as with ceftriaxone. Treatment with doxycycline is cheap and relatively safe, but gastrointestinal symptoms and photosensitivity reactions can be expected more often than with ceftriaxone.

Published
2006

17. P46 FUNGAL ENDOCARDITIS – REVIEW OF NINE CASES

Author

Mateja Logar, T. Lejko Zupanc, and A. Pikelj Pečnik

Subjects
Microbiology (medical), Infectious Diseases, business.industry, Medicine, Fungal endocarditis, Pharmacology (medical), General Medicine, business, Microbiology
Published
2013
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19. P48 INFECTIVE ENDOCARDITIS CAUSED BY NEISSERIA MUCOSA

Author

T. Rojko, T. Lejko Zupanc, and Mateja Logar

Subjects
Microbiology (medical), Infectious Diseases, business.industry, Infective endocarditis, medicine, Pharmacology (medical), General Medicine, medicine.disease, business, Neisseria mucosa, HACEK endocarditis, Microbiology
Published
2013
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20. Culture Proven Treatment Failures in Patients with Erythema Migrans Treated with Azithromycin, Amoxicillin, Cefuroxime Axetil, or Doxycycline

Author

Vera Maraspin, Mateja Logar, Daša Cerar, E Ruzić-Sabljić, Franc Strle, Stanka Lotric-Furlan, Andreja Pikelj-Pecnik, and J Cimperman

Subjects
Microbiology (medical), Doxycycline, medicine.medical_specialty, business.industry, General Medicine, Amoxicillin, Azithromycin, Dermatology, Infectious Diseases, medicine, Erythema migrans, In patient, business, Cefuroxime, medicine.drug
Published
2008
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21. Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis

Author

Patricia Muñoz, Eugene Athan, Arthur J. Morris, Christine Selton-Suty, José H. Casabé, Paul A. Pappas, Carlos Paré, Christopher H. Cabell, Lars Olaison, G. Ralph Corey, Vance G. Fowler, Sandra Braun Jones, Benito Almirante, Pierre Tattevin, Andrew Wang, Diana Iarussi, Marco Rizzi, Mateja Logar, and Christopher Naber

Subjects
Male, medicine.medical_specialty, Prosthesis-Related Infections, Internal medicine, Epidemiology, Prevalence, medicine, Humans, Endocarditis, Hospital Mortality, Prospective Studies, Registries, Prospective cohort study, Aged, Cross Infection, business.industry, Endocarditis, Bacterial, General Medicine, Odds ratio, Middle Aged, Staphylococcal Infections, Prognosis, medicine.disease, Surgery, Heart Valve Prosthesis, Bacteremia, Infective endocarditis, Cohort, Female, business, Cohort study
Abstract

ContextProsthetic valve endocarditis (PVE) is associated with significant mortality and morbidity. The contemporary clinical profile and outcome of PVE are not well defined.ObjectivesTo describe the prevalence, clinical characteristics, and outcome of PVE, with attention to health care–associated infection, and to determine prognostic factors associated with in-hospital mortality.Design, Setting, and ParticipantsProspective, observational cohort study conducted at 61 medical centers in 28 countries, including 556 patients with definite PVE as defined by Duke University diagnostic criteria who were enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study from June 2000 to August 2005.Main Outcome MeasureIn-hospital mortality.ResultsDefinite PVE was present in 556 (20.1%) of 2670 patients with infective endocarditis. Staphylococcus aureus was the most common causative organism (128 patients [23.0%]), followed by coagulase-negative staphylococci (94 patients [16.9%]). Health care–associated PVE was present in 203 (36.5%) of the overall cohort. Seventy-one percent of health care–associated PVE occurred within the first year of valve implantation, and the majority of cases were diagnosed after the early (60-day) period. Surgery was performed in 272 (48.9%) patients during the index hospitalization. In-hospital death occurred in 127 (22.8%) patients and was predicted by older age, health care–associated infection (62/203 [30.5%]; adjusted odds ratio [OR], 1.62; 95% confidence interval [CI], 1.08-2.44; P = .02), S aureus infection (44/128 [34.4%]; adjusted OR, 1.73; 95% CI, 1.01-2.95; P = .05), and complications of PVE, including heart failure (60/183 [32.8%]; adjusted OR, 2.33; 95% CI, 1.62-3.34; P

Published
2007
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22. Tick borne encephalitis without cerebrospinal fluid pleocytosis

Author

Daša Stupica, Blaž Pečavar, Franc Strle, Tatjana Avšič-Županc, Fajko F. Bajrović, and Mateja Logar

Subjects
Male, Fever, Leukocytosis, Slovenia, Case Report, Antibodies, Viral, Encephalitis Viruses, Tick-Borne, Cerebrospinal fluid, parasitic diseases, medicine, Encephalitis Viruses, Animals, Humans, Aged, biology, business.industry, Tick-borne encephalitis, Meningoencephalitis, medicine.disease, biology.organism_classification, bacterial infections and mycoses, Virology, Tick-borne encephalitis virus, Infectious Diseases, Immunoglobulin M, Infectious disease (medical specialty), Immunoglobulin G, Immunology, business, Meningitis, Encephalitis, Encephalitis, Tick-Borne
Abstract

Background Tick borne encephalitis is the most frequent vector-transmitted infectious disease of the central nervous system in Europe and Asia. The disease caused by European subtype of tick borne encephalitis virus has typically a biphasic clinical course with the second phase presenting as meningitis, meningoencephalitis, or meningoencephalomyelitis. Cerebrospinal fluid pleocytosis is considered a condition sine qua non for the diagnosis of neurologic involvement in tick borne encephalitis, which in routine clinical practice is confirmed by demonstration of serum IgM and IgG antibodies to tick borne encephalitis virus. Case presentation Here we present a patient from Slovenia, an area highly endemic for tick borne encephalitis, with encephalitis but without cerebrospinal fluid pleocytosis in whom tick borne encephalitis virus infection of the central nervous system was demonstrated. Conclusion Cerebrospinal fluid pleocytosis is not mandatory in encephalitis caused by tick borne encephalitis virus. In daily clinical practice, in patients with neurologic symptoms/signs compatible with tick borne encephalitis and the risk of exposure to ticks in a tick borne encephalitis endemic region, the search for central nervous system infection with tick borne encephalitis virus is warranted despite the lack of cerebrospinal fluid pleocytosis.

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