Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Continuous infusion (CI) ticarcillin-clavulanate is a potential therapeutic improvement over conventional intermittent dosing because the major pharmacodynamic (PD) predictor of efficacy of beta-lactams is the time that free drug levels exceed the MIC. This study incorporated a 6-year retrospective arm evaluating efficacy and safety of CI ticarcillin-clavulanate in the home treatment of serious infections and a prospective arm additionally evaluating pharmacokinetics (PK) and PD. In the prospective arm, steady-state serum ticarcillin and clavulanate levels and MIC testing of significant pathogens were performed. One hundred and twelve patients (median age, 56 years) were treated with a CI dose of 9.3-12.4g/day and mean CI duration of 18.0 days. Infections treated included osteomyelitis (50 patients), septic arthritis (6), cellulitis (17), pulmonary infections (12), febrile neutropenia (7), vascular infections (7), intra-abdominal infections (2), and Gram-negative endocarditis (2); 91/112 (81%) of patients were cured, 14 (13%) had partial response and 7 (6%) failed therapy. Nine patients had PICC line complications and five patients had drug adverse events. Eighteen patients had prospective PK/PD assessment although only four patients had sufficient data for a full PK/PD evaluation (both serum steady-state drug levels and ticarcillin and clavulanate MICs from a bacteriological isolate), as this was difficult to obtain in home-based patients, particularly as serum clavulanate levels were found to deteriorate rapidly on storage. Three of four patients with matched PK/PD assessment had free drug levels exceeding the MIC of the pathogen. Home CI of ticarcillin-clavulanate is a safe, effective, convenient and practical therapy and is a therapeutic advance over traditional intermittent dosing when used in the home setting.
 ...
PMID:Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections: clinical efficacy, safety, pharmacokinetics and pharmacodynamics. 1587 64

Endocarditis is uncommon in patients with cancer. The characteristics of culture-positive (CPE) and culture-negative endocarditis (CNE) in high-risk cancer patients are not known; therefore we sought to evaluate the disease characteristics in patients with endocarditis at a comprehensive cancer center. We retrospectively reviewed the transthoracic (TTE) and transesophageal (TEE) echocardiograms obtained from 654 consecutive cancer patients in whom endocarditis was suspected between 1994 and 2004. Endocarditis was confirmed in 45 (7%) of 654 patients using modified Duke University criteria based on information obtained from hospital records and computerized data systems. In 21 (95%) of 22 cases, TEE examinations were diagnostic, and 16 (42%) of 38 patients with initially nondiagnostic TTE studies had the diagnosis confirmed by TEE study; this difference between diagnostic TEE and initial nondiagnostic TTE was significant (p < 0.0001). Among the 26 (58%) patients with CPE, Staphylococcus aureus (35%) was the most common organism isolated, followed by coagulase-negative Staphylococcus species (23%). Eighteen (78%) of 23 patients with a central venous catheter had CPE, whereas only 8 (36%) of 22 patients without a central venous catheter had CPE (odds ratio [OR], 6.3; 95% confidence interval [CI], 1.69-23.53; p < 0.006). Vegetations were larger in patients with CPE than in patients with CNE (median +/- standard deviation, 10 +/- 8.8 vs. 8.7 +/- 3.9 mm). Fifteen patients (58%) with CPE and 10 (53%) with CNE had embolic complications. We note that cutaneous and septic pulmonary emboli were more common in patients with CPE than in patients with CNE (31% vs. 11% and 15% vs. 0%, respectively), whereas embolic cerebrovascular and fatal embolic coronary events were more common in patients with CNE than in those with CPE (37% vs. 12% and 21% vs. 0%, respectively; p = 0.026). The 4-week endocarditis-attributable death rate did not differ significantly between the groups (CPE, 15% vs. CNE, 32%; p = 0.28). On stepwise multivariate regression analysis, patients with neutropenia (OR, 22.52; 95% CI, 2.25-225.48; p < 0.008) and those with embolic cerebrovascular events (OR, 17.07; 95% CI, 1.63-178.45; p < 0.01) had an increased probability of death due to endocarditis. The clinical spectrums of CPE and CNE differed in these patients with cancer. In patients with CNE, embolic cerebrovascular and fatal myocardial infarction were relatively common.
 ...
PMID:Culture-positive and culture-negative endocarditis in patients with cancer: a retrospective observational study, 1994-2004. 1660 47

Bacteremia has rarely been reported in patients receiving treatment for hepatitis C virus (HCV) infection. We describe the features and investigation of four cases of Staphylococcus aureus bacteremia occurring between 3 November 2004 and 10 January 2005 in patients on therapy for chronic HCV infection. The unusual occurrence of S. aureus bacteremia in a series of patients led to an epidemiologic investigation and molecular typing methods were employed to assess the relatedness of cases. The mean time of bacteremia onset was week 10 of HCV treatment. No patient had neutropenia previously. The average duration of bacteremia was 2.6 days and complications included acute renal failure (2/4), disseminated intravascular coagulopathy (DIC) with sepsis syndrome (1/4), septic arthritis (1/4), spinal epidural abscess (1/4) and endocarditis (1/4). Two patients were in the same weight class for dosing, but no other epidemiologic links were found. One patient admitted to intravenous drug use (IVDU) and a second was suspected of IVDU. The two other patients were cirrhotic, but had no further identifiable risk factors. All bacterial isolates were methicillin-susceptible. By pulsed-field gel electrophoresis, two cases were found to have identical bacterial strains. However, fluorescent-based amplified fragment-length polymorphism analysis demonstrated distinct band patterns in all four cases. The epidemiologic data and molecular analysis of this cluster of S. aureus bacteremia cases among patients receiving combination therapy for treatment of chronic HCV infection suggest that these cases were not related. Additionally, IVDU and cirrhosis, but not neutropenia, are identified as potential risk factors for this uncommon complication of HCV therapy.
 ...
PMID:Staphylococcus aureus bacteremia in patients receiving pegylated interferon-alpha and ribavirin for chronic hepatitis C virus infection. 1765 Feb 90

Bartonella species are important emerging zoonotic pathogens. Transmission of these organisms in nature may be much more complex than is currently appreciated. Cats can be infected with five Bartonella species, including, Bartonella henselae, Bartonella clarridgeae, Bartonella bovis, Bartonella koehlerae and Bartonella quintana. In addition to cats, numerous domestic and wild animals, including bovine, canine, human, and rodent species can serve as chronically infected reservoir hosts for various intra-erythrocytic Bartonella species. In addition, an increasing number of arthropod vectors, including biting flies, fleas, keds, lice, sandflys and potentially ticks have been implicated in the transmission of various Bartonella species to animals or human beings. In the reservoir host, Bartonella species cause chronic intra-erythrocytic and vascular endothelial infections, with a relapsing bacteremia documented in experimentally infected cats. Although the immunopathology induced by Bartonella infection requires additional study, the organisms can localize to the heart valve (endocarditis), cause granulomatous inflammation in lymph nodes, liver or spleen, induce central nervous system dysfunction with or without cerebrospinal fluid changes, and may contribute to inflammatory polyarthritis. Hematological abnormalities are infrequent, but thrombocytopenia, lymphocytosis, neutropenia, and eosinophilia have been reported in B. henselae-infected cats. Serology, PCR and culture can be used to support a diagnosis of feline bartonellosis, however, due to the high rate of sub-clinical infections among various cat populations, documenting causation in an individual cat is difficult, if not impossible. Response to treatment can be used in conjunction with serology or organism isolation to support a clinical diagnosis of feline bartonellosis. As fleas are involved in the transmission among cats, the use of acaracide products to eliminate fleas from the environment is of critical importance to decrease the risk of B. henselae transmission among cats and to humans.
 ...
PMID:Feline bartonellosis and cat scratch disease. 1829 47

Leptotrichia species typically colonize the oral cavity and genitourinary tract. These anaerobic bacteria belong to the normal flora of humans and are seldom found in clinically significant specimens. However, on rare occasions, Leptotrichia has been isolated from blood cultures of patients with lesions in the oral mucosa, in particular from patients with neutropenia. These organisms should be considered potential pathogens in neutropenic patients, especially when breaks in the mucosal barriers are present through which they frequently spread to the bloodstream. Leptotrichia has also been recovered from immunocompetent persons, e.g. patients with endocarditis. Although their role in infections remains elusive and not much is known, they have been suggested as emerging pathogens. The present review deals with taxonomy, diagnosis, clinical importance, pathogenesis, host defence, infection control, and spectrum of Leptotrichia infections, and ends with a few typical case reports. Currently, six species have been validly published, but a number of yet uncultivable species exist. Molecular methods recovering uncultivable species should be used to get a real idea of their role as pathogens.
 ...
PMID:Leptotrichia species in human infections. 1853 56

Invasive candidiasis (IC) includes candidemia, disseminated candidiasis with deep organ involvement, endocarditis and meningitis. IC has an attributable mortality of 40% to 50% and is increasingly reported in intensive care units (ICUs). Candida albicans and non-albicans strains are both responsible for infections in ICUs, where empirical and targeted treatments especially need to be initially appropriate. This review synthesizes the most recent guidelines for IC and candidemia from an ICU perspective. Essentially, patients who have been previously exposed to azoles have a higher probability of being infected by azole-resistant or non-albicans strains. Infection site, illness severity, neutropenia, hemodynamic status, organ failure and concomitant drug treatments are host-related factors that influence the choice of anti-fungal treatment. In general, echinocandins are currently favored for empiric treatment of candidemia, especially in critically ill patients or those with previous azole exposure. Pharmacokinetic properties and side effects suggest that polyenes should be avoided in patients with renal failure, and that echinocandins and azoles should be avoided in patients with severe hepatic dysfunction.
 ...
PMID:Invasive candidiasis and candidemia: new guidelines. 1907

Systematic reviews and meta-analyses have put into perspective the clinical implications of in vitro synergy (Box 1). Randomized, controlled trials are the cornerstone of evidence-based medicine. The trials included in the meta-analyses described in this article are the building blocks of evidence. Individual trials, however, were individually underpowered to address the broader clinical question and relevant patient-related outcomes. On the question of combination therapy, meta-analyses have shaped the complete picture. The interactions observed in vitro have not been shown to improve patient-related outcomes. Authors of systematic reviews have the privilege of considering and selecting the clinical outcomes most relevant for the individual patient. Thus, all-cause mortality, rather than treatment failure with antibiotic modifications or infection-related mortality, has been selected for the assessment of patients who had severe gram-negative infections and febrile neutropenia. Mortality and relapse were assessed for patients who had endocarditis, and clinical and lung function scores were assessed for patients who had cystic fibrosis. The authors hope that the dissemination of these reviews will lead clinicians and researchers to consider primarily these outcomes when appraising or designing clinical research. These are the outcomes that clinicians target when treating the patient. Systematic reviews have the virtue of a broad, systematic, and explicit search. In some areas, such as the use of combination therapy to treat gram-positive infections in general, and specifically to treat endocarditis and Pseudomonas aeruginosa bacteremia, the main contribution of the reviews was to show that current practice is based on very limited clinical evidence. This finding does not refute current practice but should serve to guide future trials and opens the possibility for a different choice of therapy when standard guidelines are difficult to implement. The fact that to date no evidence has been accrued for these infections is not surprising. The clinical question of combination therapy is of no major interest to pharmaceutical companies sponsoring most trials; the infections are rare; and the study design is complex. This gap in knowledge calls for a new trial paradigm: collaborative investigator-initiated, multicenter trials. When randomized, controlled trials are unfeasible, the use of novel methods for adjustments in observational studies, such as propensity analyses using large databases, might approximate the true effect of combination therapy in a wider patient population.
 ...
PMID:Combination antimicrobial treatment versus monotherapy: the contribution of meta-analyses. 1939 9

Today, mycotic infections in immunocompromised patients are mainly caused by Candida spp. and Aspergillus spp. The patients most sensitive to these infections are those with some kind of cell-mediated immunity quantitative or qualitative alteration (i.e., blood-related cancer, primary or secondary neutropenia, immunosuppressive disease or therapy, etc.). Candida infection in the immunosupressed patient comprises a wide range of serious diseases such as candidemia, chronic disseminated candididasis, endocarditis, meningitis and endophthalmitis. Therefore, infection by Candida spp. is considered secondary to the technological and medical advances which extend the life of patients with chronic diseases.
 ...
PMID:[Fungal (Candida) infections in the immunocompromised pediatric patient]. 1953 73

Bacillus species are biofilm-forming organisms that are associated with Bacillus catheter-related bloodstream infections (CRBSIs). The optimal treatment of Bacillus CRBSIs is not known. Therefore, in the current study, we determined the role of long-term central venous catheter (CVC) removal and treatment with vancomycin compared with other agents in Bacillus CRBSIs by retrospectively reviewing the medical records of cancer patients with Bacillus bacteremia who had been treated at our institution from December 1990 to March 2008. True bacteremia was defined as a positive blood culture (>15 colony-forming units/mL) with signs and symptoms of infection (such as fever and chills). Bacillus CRBSI was defined in accordance with the Infectious Diseases Society of America guidelines as probable or definite. There were 94 Bacillus bacteremia episodes, 93 of which (99%) were Bacillus CRBSIs (28% definite and 71% probable). Neutropenia during bacteremia occurred in 29%. Almost all bacteremia patients (99%) had been treated with antibiotics; 63% had received vancomycin. Sepsis with hypotension occurred in 6%, and endocarditis in 1%. Bacillus isolates were susceptible to linezolid (100%), vancomycin (98%), tetracycline (77%), and rifampin (67%). All 4 recurrences occurred in patients in whom the CVC had not been removed (12%), whereas no recurrences occurred in patients whose CVC had been removed (p = 0.028). Patient outcome, in terms of fever and hospitalization duration after the infection, was similar in patients who had received < or =10 days of systemic antibiotics compared with patients who had received >10 days. In conclusion, catheter retention in patients with Bacillus CRBSIs is associated with a significantly higher recurrence rate. If the CVC is retained, treatment with non-vancomycin antibiotics is associated with significantly shorter hospitalization duration after the infection, which may be because glycopeptide antibiotics have poor activity against bacilli embedded in biofilm.
 ...
PMID:Management of Bacillus bacteremia: the need for catheter removal. 2082 12

Linezolid has demonstrated activity against antibiotic-susceptible and antibiotic-resistant aerobic Gram-positive cocci. The availability of intravenous and oral formulations, with near 100% bioavailability of the latter, is hoped to facilitate the management of multiply drug-resistant Gram-positive infections. Linezolid was approved for clinical use in the United States in April 2000 and has subsequently been approved in other countries for the management of community-acquired and nosocomial pneumonia, complicated and uncomplicated skin and soft-tissue infections, and infections caused by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, including cases with concurrent bacteremia. Additional studies have demonstrated potential use in febrile cancer patients with neutropenia, and case reports have documented some efficacy in the management of infective endocarditis, tuberculosis, nocardiosis, and in anaerobic infections. Given the potential for significantly increased use of linezolid, a thorough review and update of its tolerability and safety profile is warranted.
 ...
PMID:Linezolid: a review of safety and tolerability. 1994 18


<< Previous 1 2 3 4 5 6 Next >>