Community-acquired bacterial meningitis (CABM) is a life-threatening infection that can be complicated by neurological deficits among survivors. These outcomes have prompted interventions in prevention and treatment. These include an ever-expanding list of vaccines and adjunctive therapy, including early corticosteroid administration. Researchers conducted a prospective cohort study in the Netherlands to provide a contemporary evaluation of the disease's incidence, clinical aspects, and management. Adult (aged …
Invasive aspergillosis is a major cause of death in allogeneic stem-cell transplant recipients. Knowing that Aspergillus species can affect immune-cell
Polymicrobial right-sided infective endocarditis (IE) is a recognized syndrome, particularly among injection drug users. Despite the polymicrobial component, these patients typically have good outcomes, in part because injection drug users are often young with few comorbidities. To better characterize left-sided polymicrobial IE, researchers analyzed a prospective database of all patients with IE who were seen …
In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent viridans group streptococcal (VGS) infective endocarditis (IE) in cardiac patients undergoing invasive procedures. The 2007 guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to confer the highest risk of adverse outcome. The purpose of this update is to examine interval evidence of the acceptance and impact of the 2007 recommendations on VGS IE and, if needed, to make revisions based on this evidence.A writing group was formed consisting of experts in prevention and treatment of infective endocarditis including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, in addition to the American Heart Association. MEDLINE database searches were done for English language articles on compliance with the recommendations in the 2007 guidelines and the frequency of and morbidity or mortality from VGS IE after publication of the 2007 guidelines. Overall, there was good general awareness of the 2007 guidelines but variable compliance with recommendations. There was no convincing evidence that VGS IE frequency, morbidity, or mortality has increased since 2007.On the basis of a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines. We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Randomized controlled studies to determine whether antibiotic prophylaxis is effective against VGS IE are needed to further refine recommendations.
Clinical studies performed by us and others have found an association between slime production and strains of coagulase-negative staphylococci that infect indwelling medical devices. By serial low-speed centrifugation of broth cultures we have isolated a stable, weakly adherent strain (RP62A-NA) from a strongly adherent, slime-producing, pathogenic strain of Staphylococcus epidermidis sensu stricto (RP62A, ATCC 35984). We obtained a second strain from RP62A-NA (RP62A-NAR) by serial subculture of glass-adherent cells of RP62A-NA. All three strains had the same pattern of biochemical reactions, antimicrobial susceptibilities, and plasmid analysis. Transmission electron micrograph sections stained with the mucopolysaccharide-specific stain alcian blue demonstrated that the adherent strains RP62A and RP62A-NAR were covered with an extracellular coat of polysaccharide-rich material. In contrast, the nonadherent RP62A-NA strain lacked this external coat. All three strains were used in a mouse model of foreign body infection and a rat model of catheter-induced infective endocarditis. The adherence characteristics of isolates of RP62A and RP62A-NA recovered from experimental animals were relatively stable, although we noted a slight but a significant increase in the adherence of RP62A-NA isolates recovered from the foreign body model. The adherence characteristics of RP62A-NAR isolates recovered from infected animals were variable; in general these isolates were less adherent than the laboratory strain of RP62A-NAR. In both models the 50% infective dose (calculated by the Reed and Muench method) was three times greater for the RP62A-NA strain than for the RP62A strain. The phenotypic expression of slime production is subject to both in vitro and in vivo variation and could play a role in the pathogenesis of foreign body infection.
Infection is a potentially life-threatening complication of cardiovascular implantable electronic device (CIED) therapy. Since the large majority of these cases are due to staphylococcal species, scant data exist for CIED infections (CIEDI) due to gram-negative bacilli (GNB). We retrospectively screened our institutional device database from 1992 to 2016 to identify cases of CIEDI due to GNB. Infections within 12 weeks following implantation or last invasive device manipulation were defined as early-onset. Relapse was described as infection with the same organism despite device explantation and appropriate antimicrobial therapy, based on susceptibility results. Of the 827 CIEDI cases during the study period, only 32 (4%) were caused by GNB. Median patient age was 65 years (SD±14), and 78 % (25/32) were male. Early-onset infection was the more common presentation [53% (17/32)]. Regardless of timing of onset, the majority [75% (24/32)] presented with generator pocket infection, of whom 3 (13%) had lead erosion. Five patients presented with bloodstream infection, 4 had concomitant pocket infection, and 1 had no signs of local infection. CIED-related endocarditis was seen in 9% (3/32) of patients. Two patients had a primary infection at a different anatomical site with the same causative organism 6 months prior to presentation. The most common organisms were Pseudomonas aeruginosa (22 %, 7/32) and Serratia species (19 % 6/32). Most (94 %, 30/32) patients underwent complete device removal. Antimicrobial duration was based on infection syndrome and 50% completed therapy with an oral antibiotic. Only 2 patients had infection relapse and one of them died due to septic shock following device extraction. CIEDI due to GNB are uncommon, and most patients present with early-onset generator pocket infection. Cure is achievable with complete device removal and pathogen-directed antimicrobial therapy. For local infection, patients can be switched to oral antimicrobials, based on susceptibility data, after device explanation to complete 10 to 14 days of treatment. Infection relapse is rare. M. R. Sohail, Medtronic Inc.: Consultant and Grant Investigator, Consulting fee and Research grant; Boston Scientific: Consultant, Consulting fee
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)