Guidelines for Diagnosis and Management of Infective Endocarditis in Adults

JAMA Network Open, Journal Year: 2023, Volume and Issue: 6(7), P. e2326366 - e2326366

Published: July 31, 2023

Importance Practice guidelines often provide recommendations in which the strength of recommendation is dissociated from quality evidence. Objective To create a clinical guideline for diagnosis and management adult bacterial infective endocarditis (IE) that addresses gap between evidence strength. Evidence Review This consensus statement systematic review applied an approach previously established by WikiGuidelines Group to construct collaborative guidelines. In April 2022 call new existing members was released electronically (social media email) next topic, subsequently, topics questions related IE were crowdsourced prioritized vote. For each PubMed literature searches conducted including all years languages. reported according charter: clear only when reproducible, prospective, controlled studies provided hypothesis-confirming absence such data, reviews crafted discussing risks benefits different approaches. Findings A total 51 10 countries reviewed 587 articles submitted information relevant 4 sections: establishing (9 questions); multidisciplinary teams (1 question); prophylaxis (2 treatment (5 questions). Of 17 unique questions, could be 1 question: 3 randomized trials have oral transitional therapy at least as effective intravenous (IV)–only IE. Clinical generated remaining questions. Conclusions Relevance this WikiGuideline method development, IV-only Several are underway inform other areas practice, further research needed.

Language: Английский

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Can the Future of ID Escape the Inertial Dogma of Its Past? The Exemplars of Shorter Is Better and Oral Is the New IV

Open Forum Infectious Diseases, Journal Year: 2022, Volume and Issue: 10(1)

Published: Dec. 29, 2022

Like all fields of medicine, Infectious Diseases is rife with dogma that underpins much clinical practice. In this study, we discuss 2 specific examples historical practice have been overturned recently by numerous prospective studies: traditional durations antimicrobial therapy and the necessity intravenous (IV)-only for infectious syndromes. These dogmas are based on uncontrolled case series from >50 years ago, amplified opinions eminent experts. contrast, more than 120 modern, randomized controlled trials established shorter equally effective many infections. Furthermore, 21 concordant demonstrated oral antibiotic at least as IV-only osteomyelitis, bacteremia, endocarditis. Nevertheless, practitioners in settings remain refractory to adopting these changes. It time move beyond its history opinion-based medicine truly into era evidenced-based medicine.

Language: Английский

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Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management

Life, Journal Year: 2023, Volume and Issue: 13(2), P. 377 - 377

Published: Jan. 30, 2023

Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE represented by patients underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number and intracardiac procedures associated device implantation, growing too. If bacteremia develops, infected vegetation on native/prosthetic valve or any intracardiac/intravascular may occur as final result invading microorganisms/host immune system interaction. In case suspicion, all efforts must be focused diagnosis can spread to almost organ in body. Unfortunately, might difficult require combination clinical examination, microbiological assessment echocardiographic evaluation. There need novel imaging techniques, especially cases blood culture-negative. last few years, management has changed. A multidisciplinary care team, including experts infectious diseases, cardiology cardiac surgery, namely, Endocarditis Team, highly recommended current guidelines.

Language: Английский

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Current therapies and challenges for the treatment of Staphylococcus aureus biofilm‐related infections

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy, Journal Year: 2023, Volume and Issue: 43(8), P. 816 - 832

Published: May 3, 2023

Abstract Staphylococcus aureus is a major cause of nosocomial and community‐acquired infections contributes to significant increase in morbidity mortality especially when associated with medical devices biofilm form. Biofilm structure provides pathway for the enrichment resistant persistent phenotypes S. leading relapse recurrence infection. Minimal diffusion antibiotics inside leads heterogeneity distinct physiological activity. Additionally, horizontal gene transfer between cells proximity adds challenges eradication biofilms. This narrative review focuses on biofilm‐associated caused by , impact environmental conditions formation, interactions communities, clinical that they present. Conclusively, potential solutions, novel treatment strategies, combination therapies, reported alternatives are discussed.

Language: Английский

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Antibiotic Myths for the Infectious Diseases Clinician

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(8), P. 1120 - 1125

Published: June 10, 2023

Antimicrobials are commonly prescribed and often misunderstood. With more than 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious optimal use these drugs is paramount to advancing patient care. This narrative will focus on myths relevant nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety antibiotics.

Language: Английский

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Contemporary Management ofStaphylococcus aureusBacteremia—Controversies in Clinical Practice

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(11), P. e57 - e68

Published: Aug. 22, 2023

Abstract Staphylococcus aureus bacteremia (SAB) carries a high risk for excess morbidity and mortality. Despite its prevalence, significant practice variation continues to permeate clinical management of this syndrome. Since the publication 2011 Infectious Diseases Society America (IDSA) guidelines on methicillin-resistant infections, field SAB has evolved with emergence newer diagnostic strategies therapeutic options. In review, we seek provide comprehensive overview evaluation SAB, special focus areas where highest level evidence is lacking inform best practices.

Language: Английский

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Global Differences in the Management of Staphylococcus aureus Bacteremia: No International Standard of Care

Clinical Infectious Diseases, Journal Year: 2023, Volume and Issue: 77(8), P. 1092 - 1101

Published: June 13, 2023

Abstract Background Despite being the leading cause of mortality from bloodstream infections worldwide, little is known about regional variation in treatment practices for Staphylococcus aureus bacteremia (SAB). The aim this study was to identify global management, diagnostics, and definitions SAB. Methods During a 20-day period 2022, physicians throughout world were surveyed on SAB practices. survey distributed through listservs, e-mails, social media. Results In total, 2031 71 different countries 6 continents (North America [701, 35%], Europe [573, 28%], Asia [409, 20%], Oceania [182, 9%], South [124, 6%], Africa [42, 2%]) completed survey. Management-based responses differed significantly by continent preferred methicillin-susceptible S. (MSSA) methicillin-resistant (MRSA) bacteremia, use adjunctive rifampin prosthetic material infection, oral antibiotics (P < .01 all comparisons). 18F-FDG PET/CT scans most commonly used (94%) least frequently (13%) North (51%; P .01). Although respondents defined persistent as 3–4 days positive blood cultures, ranged 2 31% European 7 38% Asian Conclusions Large practice variations exist world, reflecting paucity high-quality data absence an international standard care management

Language: Английский

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A case of stroke as a unique sign of subclinical infective endocarditis by Abiotrophia defectiva: a case report

International Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: 18(1)

Published: Jan. 17, 2025

Here we describe a patient admitted for stroke that was unexpectedly correlated with subclinical infective endocarditis attributable to rarely opportunistic pathogen, Abiotrophia defectiva. A 75-year-old man presented stroke. Transesophageal echocardiography suggested vegetation on all aortic valve cusps, despite the absence of clinical or laboratory signs infection. Surprisingly, three sets blood cultures collected without fever were positive A. Although did not exhibit classic infection during hospitalization, severity condition necessitated replacement bioprosthesis. This case underscores importance investigating origin endocarditis, even in evidence. Physicians should maintain high level suspicion, especially patients highly suggestive anamnestic characteristics.

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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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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