Nov 132014
 
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Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis - Analysis in the International Collaboration of Endocarditis - Prospective Cohort Study.

Clin Infect Dis. 2014 Nov 10;

Authors: Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu V, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B, on behalf of the ICE Prospective Investigators

Abstract
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 one-year all-cause mortality on patients with definite left-sided SA PVIE and no history of injection drug use.
RESULTS:  EVS was performed in74 (44.3%) of the 168 patients. One-year mortality was significantly higher among patients with SA PVIE than in patients with non-SA PVIE (48.2% vs. 32.9%, p=0.003). SA PVIE patients who underwent EVS had a significantly lower one-year mortality rate (33.8% vs. 59.1%, p=0.001).In multivariate, propensity-adjusted models, EVS was not associated with one-year mortality (RR 0.67, 95% CI 0.39 - 1.15, p=0.15).
CONCLUSIONS:  In this prospective, multinational cohort of patients with SA PVIE ,: EVS was not associated with reduced one-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.

PMID: 25389255 [PubMed - as supplied by publisher]

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Nov 062014
 
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Update on acinetobacter species: mechanisms of antimicrobial resistance and contemporary in vitro activity of minocycline and other treatment options.

Clin Infect Dis. 2014 Dec 1;59 Suppl 6:S367-73

Authors: Castanheira M, Mendes RE, Jones RN

Abstract
Among Acinetobacter species, A. baumannii and other closely related species are commonly implicated in nosocomial infections. These organisms are usually multidrug resistant (MDR), and therapeutic options to treat A. baumannii infections are very limited. Clinicians have been resorting to older antimicrobial agents to treat infections caused by MDR A. baumannii, and some of these agents have documented toxicity and/or are not optimized for the infection type to be treated. Recent clinical experience supported by antimicrobial susceptibility data suggests that minocycline has greater activity than other tetracyclines and glycylcyclines against various MDR pathogens that have limited therapeutic options available, including Acinetobacter species. An intravenous formulation of minocycline has recently become available for clinical use, and in contrast to most older tetracyclines, minocycline has high activity against Acinetobacter species. In this report, we summarized some of the characteristics of the tetracycline class, and quantified the minocycline activity against contemporary (2007-2011) isolates and its potential therapeutic role against a collection of 5477 A. baumannii and other relevant gram-negative organisms when compared directly with tetracycline, doxycycline, and other broad-spectrum antimicrobial agents. Acinetobacter baumannii strains were highly resistant to all agents tested, with the exception of minocycline (79.1% susceptible) and colistin (98.8% susceptible). Minocycline (minimum inhibitory concentration that inhibits 50% and 90% of the isolates [MIC50/90]: 1/8 µg/mL) displayed greater activity than doxycycline (MIC50/90: 2/>8 µg/mL) and tetracycline hydrochloride (HCL) (only 30.2% susceptible) against A. baumannii isolates, and was significantly more active than other tetracyclines against Burkholderia cepacia, Escherichia coli, Serratia marcescens, and Stenotrophomonas maltophilia isolates. In vitro susceptibility testing using tetracycline HCL as a surrogate for the susceptibility other tetracyclines fails to detect minocycline-susceptible isolates and the potential utility of minocycline for the treatment of many MDR A. baumannii infections and other difficult-to-treat species, where there are often limited choices of antimicrobials.

PMID: 25371512 [PubMed - in process]

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Nov 062014
 
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Bad Bugs Need Old Drugs: A Stewardship Program's Evaluation of Minocycline for Multidrug-Resistant Acinetobacter baumannii Infections.

Clin Infect Dis. 2014 Dec 1;59 Suppl 6:S381-7

Authors: Goff DA, Bauer KA, Mangino JE

Abstract
BACKGROUND: Minocycline is an "old-drug" with Food and Drug Administration approval for the treatment of infection due to Acinetobacter species. The purpose of this study is to describe an Antimicrobial Stewardship Program's evaluation of minocycline for the treatment of patients with multidrug resistant A. baumannii (MDR-AB) infections.
METHODS: This study evaluated hospitalized adult patients (September 2010 through March 2013) who received minocycline intravenously (IV) for a MDR-AB infection. Clinical and microbiological outcomes were analyzed. Secondary outcomes included infection-related mortality, length of hospital stay (LOS), infection-related LOS, intensive care unit (ICU) LOS, mechanical ventilation days, and 30-day readmission.
RESULTS: A total of 55 patients received minocycline. Median age was 56 (23-85) years, 65% were male with an APACHE II score of 21 (4-41). Clinical success was achieved in 40/55 (73%) patients treated with minocycline monotherapy (n = 3) or in combination with a second active agent (n = 52). Overall 43 (78%) patients demonstrated documented or presumed microbiologic eradication. Infection-related mortality was 25%. Hospital LOS was 31 (5-132) and infection-related LOS was 16 (2-43) days. Forty-seven (85%) patients were admitted to the ICU for a LOS of 18 (2-78) days. Thirty-nine (71%) patients required mechanical ventilation for 6 (2-29) days. One patient had a 30-day readmission.
CONCLUSIONS: The response rate to minocycline monotherapy or in combination for the treatment of MDR-AB infections is encouraging as therapeutic options are limited. Prospective studies in patients with MDR-AB infections will help establish the role of minocycline alone or in combination with other antimicrobials.

PMID: 25371514 [PubMed - in process]

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Nov 062014
 
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A review of intravenous minocycline for treatment of multidrug-resistant acinetobacter infections.

Clin Infect Dis. 2014 Dec 1;59 Suppl 6:S374-80

Authors: Ritchie DJ, Garavaglia-Wilson A

Abstract
Options for treatment of multidrug-resistant (MDR) Acinetobacter baumannii infections are extremely limited. Minocycline intravenous is active against many MDR strains of Acinetobacter, and Clinical and Laboratory Standards Institute breakpoints exist to guide interpretation of minocycline susceptibility results with Acinetobacter. In addition, minocycline intravenous holds a US Food and Drug Administration indication for treatment of infections caused by Acinetobacter. There is an accumulating amount of literature reporting successful use of minocycline intravenous for treatment of serious MDR Acinetobacter infections, particularly for nosocomial pneumonia. These results, coupled with the generally favorable tolerability of minocycline intravenous, support its use as a viable therapeutic option for treatment of MDR Acinetobacter infections.

PMID: 25371513 [PubMed - in process]

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Oct 302014
 
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Advances in prevention and management of central line-associated bloodstream infections in patients with cancer.

Clin Infect Dis. 2014 Nov 15;59 Suppl 5:S340-3

Authors: Raad I, Chaftari AM

Abstract
Central lines, which are essential for treating cancer, are associated with at least 400 000 episodes of bloodstream infection in patients with cancer every year in the United States. Effective novel interventions for preventing and managing these infections include antimicrobial-coated catheters and antimicrobial lock solutions.

PMID: 25352628 [PubMed - in process]

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Oct 302014
 
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Invasive gram-positive bacterial infection in cancer patients.

Clin Infect Dis. 2014 Nov 15;59 Suppl 5:S331-4

Authors: Holland T, Fowler VG, Shelburne SA

Abstract
Systematic studies have shown that gram-positive organisms are the leading cause of invasive bacterial disease in patients with cancer. A broad range of gram-positive bacteria cause serious infections in the cancer patient with the greatest burden of disease being due to staphylococci, streptococci, and enterococci. The evolution of cancer therapy and the changing epidemiology of major gram-positive pathogens mean that ongoing efforts are needed to understand and mitigate the impact of these bacteria in patients with malignancy. The development of novel antibacterials, optimization of treatment approaches, implementation of improved vaccines, and manipulation of the microbiome are all active areas of investigation in the goal of improving the survival of the cancer patient through amelioration of the disease burden of gram-positive bacteria.

PMID: 25352626 [PubMed - in process]

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