Moving from intravenous to per os in the treatment of endocarditis: Time to switch to better branding

CMI Communications, Journal Year: 2025, Volume and Issue: unknown, P. 105068 - 105068

Published: Feb. 1, 2025

Language: Английский

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The Evolving Landscape of Infective Endocarditis: Difficult-to-Treat Resistance Bacteria and Novel Diagnostics at the Foreground

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(6), P. 2087 - 2087

Published: March 19, 2025

Infective endocarditis (IE) is a relatively rare but potentially life-threatening disease characterized by substantial mortality and long-term sequelae among the survivors. In recent decades, dramatic change in profile of patients diagnosed with IE has been observed primarily developed countries, most likely due to an aging population increase invasive medical procedures. Nowadays, typical patient usually older, complex comorbidities, history significant for cardiac disease, including degenerative heart valve prosthetic valves, or cardiovascular implantable electronic devices (CIEDs). Moreover, as risk factors change, predisposing them more healthcare-associated IE, microbiology also shifting; there are growing concerns regarding rise incidence caused difficult-to-treat resistance (DTR) bacteria at-risk frequent healthcare contact. The present review aims explore evolving landscape summarize current knowledge on novel diagnostics ensure timely diagnosis outline optimal therapy DTR bacterial IE.

Language: Английский

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From Heart to Eye

JACC Case Reports, Journal Year: 2025, Volume and Issue: 30(6), P. 103299 - 103299

Published: March 1, 2025

Language: Английский

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Management of methicillin-resistant staphylococcus aureus bloodstream infections: a comprehensive narrative review of available evidence focusing on current controversies and the challenges ahead

Expert Review of Anti-infective Therapy, Journal Year: 2025, Volume and Issue: unknown

Published: March 31, 2025

Bloodstream infections (BSIs) caused by Staphylococcus aureus are common worldwide, representing one of the most relevant issues in clinical infectious diseases practice. In particular, BSIs methicillin-resistant S. (MRSA-BSI) still today a challenge since mortality burden remains elevated although decades research. The following topics regarding MRSA-BSI were reviewed and discussed resorting to best available evidence retrieved from PubMed/MEDLINE up October 2024: i) epidemiology; ii) microbiology; iii) classification, with focus on complicated not forms; iv) structured approach patient; v) pharmacokinetics pharmacodynamics main antimicrobial options; vi) controversies therapeutic approach. Despite ongoing efforts better stratify manage MRSA-BSI, there is no universally accepted classification system accurately distinguishing between uncomplicated/low risk complicated/high forms. Biomarkers such as interleukin(IL)-10 hold promise order enable more precise stratification, premise for an appropriate treatment plan. There theoretical rationale implementing combination therapy including beta-lactam agent upfront, especially patients considered at higher unfavorable outcomes, but further data necessary, same applies newer adjuvants. Novel microbiological techniques may help guiding duration.

Language: Английский

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Clinical applications of artificial intelligence and machine learning in neurocardiology: a comprehensive review

Frontiers in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 12

Published: April 3, 2025

Neurocardiology is an evolving field focusing on the interplay between nervous system and cardiovascular that can be used to describe understand many pathologies. Acute ischemic stroke understood through this framework of interconnected, reciprocal relationship such occurs secondary cardiac pathology (the Heart-Brain axis), injury various neurological disease processes Brain-Heart axis). The timely assessment, diagnosis, subsequent management cerebrovascular diseases essential part bettering patient outcomes progression medicine. Artificial intelligence (AI) machine learning (ML) are robust areas research aid diagnostic accuracy clinical decision making better manage neurocardiology. In review, we identify some widely utilized upcoming AI/ML algorithms for most common sources stroke, strokes undetermined etiology, stroke. We found numerous highly accurate efficient products that, when integrated, provided improved efficacy prediction, identification, prognosis, within sphere focus cryptogenic strokes, there promising elucidating likely underlying causes thus, treatment options prevention. While still require a larger knowledge base or manual algorithmic training, in neurocardiology has potential provide more comprehensive healthcare treatment, increase access equitable healthcare, improve outcomes. Our review shows evident interest exciting new frontier with artificial learning.

Language: Английский

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Which trial do we need? Ampicillin versus ampicillin plus ceftriaxone for E. faecalis endocarditis: is it time to start re-considering monotherapy?

Clinical Microbiology and Infection, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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A preliminary retrospective study of the safety of Vancomycin area under the curve in patients treated with concomitant use of Vancomycin and gentamicin

Journal of Pharmaceutical Health Care and Sciences, Journal Year: 2025, Volume and Issue: 11(1)

Published: April 14, 2025

Abstract Background Despite numerous studies on safety, acute kidney injury (AKI) caused by vancomycin and/or gentamicin remains a persistent medical issue. However, it unclear whether AUC below 600 mg·h/L in combination with trough level at least 2 µg/mL are reliable indices to reduce the risk of AKI patients treated concomitant and gentamicin. Objective The aim was elucidate pharmacokinetic factors associated development receiving use setting therapeutic drug monitoring (TDM). Methods A retrospective study conducted 15 TDM. were classified into group no-AKI group. Vancomycin area under curve (AUC), levels, duration investigated. Results Six (40%) developed during period. In ( n = 6), significant higher [median (range) 561 (543‒712) compared 9), 380 (185‒600) mg·h/L, p 0.026)], although no differences treatment found between two groups. Receiver operating characteristic analysis showed that best cut-off for predicting 523 0.852, sensitivity 1.000 specificity 0.778 0.025). Conclusions 1–2 µg/mL, 530 − is risk.

Language: Английский

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Infective Endocarditis

Oxford University Press eBooks, Journal Year: 2025, Volume and Issue: unknown, P. 371 - 376

Published: April 1, 2025

Abstract This chapter guides the reader on diagnosis and management of infective endocarditis in hospitalized patients.

Language: Английский

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Interpreting Blood Culture Results as Early Guidance for Infective Endocarditis

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(5), P. e258079 - e258079

Published: May 1, 2025

Few bedside tools with defined accuracy have been described that are useful to alter bayesian prior probability for infective endocarditis (IE) in patients bacteremia. To evaluate the of simple blood culture parameters guide pretest IE. This multicenter, retrospective case-control study data adults IE vs without was conducted at 3 acute care public hospitals Los Angeles County Department Health Services between December 2018 and August 2022. Patients were individuals aged 18 years or older who had positive cultures met inclusion criteria, including cases Duke criteria definite possible IE, control did not concern endocarditis. Positive methicillin-susceptible Staphylococcus aureus, methicillin-resistant S Enterococcus faecalis, low-risk Streptococcus species, high-risk species. The primary outcome negative likelihood ratio (LR) having based on number admission. LRs, evaluation 2 more 4 bottles admission, bacteremia lasting least days, combination groups secondary outcomes. A total 252 eligible (182 male [72%]; median [IQR] age, 54 [38-65] years), 164 88 cases, 455 controls (321 [71%]; 53 [41-63] years) identified. LR point estimates only 1 admission ranged from 0.05 (95% CI, 0.01-0.37) E faecalis 0.12 0.03-0.49) aureus. Sensitivity analysis restricted found similar results. Blood clearance by day also modestly helpful LRs aureus (0.24; 95% 0.13-0.42) species (0.34; 0.21-0.56). If (LR, 4.21; 2.53-7.02) streptococci 5.35; 3.39-8.42) all organisms persistent (with ranging 1.78 [95% 1.36-2.34] 9.60 3.43-44.60]). both true, 1.63 1.17-2.28) 8.59 3.43-21.55) organisms. In this initial days adjust These findings may help diagnostic therapeutic decisions around early during hospitalization.

Language: Английский

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Cefazolin versus Antistaphylococcal Penicillins for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Systematic Review and Meta-Analysis

Clinical Microbiology and Infection, Journal Year: 2025, Volume and Issue: unknown

Published: May 1, 2025

There is debate on whether cefazolin or antistaphylococcal penicillins should be the first-line treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Ongoing trials are investigating non-inferior to (flu)cloxacillin, but it remains uncertain these findings apply other penicillins. We conducted a systematic review and meta-analysis comparing each of individual MSSA Data SourcesWe updated 2019 specifically focused evaluating outcomes by penicillins.Study Eligibility CriteriaComparative observational studies.ParticipantsPatients with bacteremia.InterventionsCefazolin versus penicillins.Assessment Risk BiasThe risk bias in non-randomized studies interventions tool.Methods SynthesisThe primary outcome was 30-day all-cause mortality we assessed non-inferiority using prespecified margin pooled odds ratio (OR) <1.2 raw unadjusted data. Secondary were 90-day mortality, treatment-related adverse events (TRAEs), discontinuation due toxicity, nephrotoxicity. No randomized data have been published. 30 at moderate high included, which comprised 3869 patients who received 11644 (flucloxacillin=6721, unspecified=2440, nafcillin=1305, cloxacillin=1258, oxacillin=120). Cefazolin associated reduced (OR=0.73, 95%CI=0.62-0.85) compared penicillins, meeting pre-specified non-inferiority. This effect consistent flucloxacillin (OR=0.92, 95%CI=0.73-1.16), nafcillin (OR=0.58, 95%CI=0.28-1.17), cloxacillin (OR=0.42, 95%CI=0.11-1.58), oxacillin (OR=0.31, 95%CI=0.03-2.75). Point estimates favored TRAEs, nephrotoxicity, toxicity overall comparison except TRAEs cloxacillin. In low quality data, potentially superior safety as across most comparisons.

Language: Английский

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