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P01 INFECTIVE ENDOCARDITIS: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN AN URBAN POPULATION – ROME, ITALY. RETROSPECTIVE STUDY
Abstracts from 12th ISCVID / International Journal of Antimicrobial Agents 41S1 (2013) S1–S34
of the episodes are catheter-related, which confers a leading role to catheter-related bacteremia management, including its prevention in the hospital, but also in the outpatient setting (cuffed and tunneled catheters for hemodialysis and chemotherapy in cancer patients, anti-infective surfaces, etc.). Notably, evidence-based strategies and interventions, also known as “zero bacteremia” protocols, proved to decrease the rate of infection from 2.7 per 1000 catheter-days to 0 in 3 months and a reduction of 66% of catheter-related infection at 16 to 18 months after implementation (Provonost, NEJM 2006). Another essential pack of measures reflected on current guidelines (Bratzler, Am J Health-Syst Pharm 2013) are focused on the antimicrobial prophylaxis of cardiac device insertion procedures: valve replacement and implantation of cardiovascular electronic devices. Recent studies have confirmed that S. aureus decolonization of the anterior nares decreases the rate of surgical site infections (SSI) in many surgical patients. The data are most compelling in cardiac surgery patients. In addition to antibiotic prophylaxis, antiseptic preparation of the insertion field in a properly organized and sterile setting, accomplishing the conditions of a real operation room is indispensable for placing pacemakers and defibrillators. Notably, these measures should also be applied in generator system changes. Cephalosporins have been the most studied antimicrobials for the prevention of SSI in cardiac procedures. Both first-generation (cefazolin) and second-generation (cefamandole and cefuroxime) cephalosporins have been shown to be effective in reducing SSI in cardiac surgery. Vancomycin should be considered in patients who are colonized with MRSA or for beta-lactam-allergic patients. Finally, health-care personnel training on strict hygiene measures, effective handwashing and well-established specific protocols for each centre are called for to be generalized. This includes isolation measures for resistant microorganisms, constant revision of antimicrobial empirical treatments and ensuring homogenous accomplishment of realistic goals under strict supervision. All these measures will reduce the rate of health-care associated infections and therefore the risk of bacteremia and HCA IE.
Poster abstracts P01 INFECTIVE ENDOCARDITIS: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN AN URBAN POPULATION – ROME, ITALY. RETROSPECTIVE STUDY A. Ricciardi1 *, G.A. Chiariello1 , P. Sordillo1 , P. Nardi2 , G. Maffongelli1 , A. Pellegrino2 , N. Cesta1 , L. Chiariello2 , M. Andreoni2 . 1Infectious Disease Department, University Hospital Tor Vergata, Rome, Italy, 2 Cardiac Surgery Division, University Hospital Tor Vergata, Rome, Italy E-mail address: [email protected] Objectives: To evaluate the epidemiological and therapeutic aspects, both medical and surgical, in patients with native or prosthetic infective endocarditis. Background: Infective endocarditis (IE) still represents an important disease. The incidence of IE ranges from 3 to 10 episodes/100,000 person-years. Prosthetic valve endocarditis (PVE) is the most severe form of IE. It accounts for 10–30% of all cases of IE. Surgical treatment is used in approximately half of patients with IE because of severe complications. Yet, surgical therapy during the active phase of the disease is associated with significant risk. Methods: Between 2009 and January 2011, 45 patients were admitted at Cardiac Surgery Division or at Infectious Disease Department of Tor Vergata Hospital in Rome (Italy) with diagnosis of IE. All the data were retrospective collected. Results: The study included 45 patients with IE, 39 men and 6 women, with a mean age of 59±15 years (1 DS). The main presenting symptoms or signs were episodic fever, bacteremia or sepsis, embolism and heart failure. The diagnosis based on Duke criteria could be considered definite in 37/45 patients (82%). 21 patients had a PVE and 24 NVE. Streptococcus spp. was the most important cause of infection in patients with NVE and Staphylococcusspp. in patients with PVE. An embolic complication occurred in 17 patients (10 with PVE
S7
and 7 with NVE; P = 0.05). Because of persistent valve infections and despite antibiotics treatment, 17 out of 45 patients underwent surgical operation: 11 out of 17 had a PVE (64%). Cerebral embolism (P = 0.05) and type of valve (P = 0.03) were the most important mortality risk factors. Conclusions: IE still represents a cause of mortality, despite major advances in both diagnostic and therapeutic procedures. Severe complications of the infection are more common in patients with PVE. An optimal coordination between clinical and surgical physicians is needed in these difficult cases of IE. P02 AN EPIDEMIC OF INFECTIVE ENDOCARDITIS AT THE CROSSROADS OF DRUG TRAFFIC A. Demin *, V. Drobysheva. Internal Medicine Department and Endocarditis Center, Novosibirsk State Medical University, Novosibirsk, Russian Federation E-mail address: [email protected] Purpose: To analyze the recent changes in clinical picture and treatment of infective endocarditis (IE) of intravenous (i/v) drug users in Novosibirsk city. Methods: Observational cohort study conducted from 2008 through 2012 at Novosibirsk city among 300 i/v drug users (morphine, heroin, hydromorphone, codeine, methadone, fentanyl, desomorphine; average age 26.1 yrs) with IE (Duke criteria). Results: The incidence of IE increased 10-fold, reaching 150 cases per 1 mln/year – increasing share of i/v drug addicts. Etiologically the change is characterized by a reduction of streptococci and a much higher incidence of staphylococci (>70%), Gram-negative bacteria, fungi and mixed virulent organisms. In all patients the clinical course of IE was with systemic affection of internal organs of thromboembolic, microvascular and toxic genesis. Necrotic vasculitis of the lower extremities developed in 44% of patients. Eradication of staphylococci with vancomycin or daptomycin, >8 mg/kg/day for 4–6 weeks, was obtained in 85% of IE patients with replacing heart valves in 70%. Mortality at discharge was 25%, at six months 35%. Russia has now become an absolute world market for opiates in the world (20%). From Afghanistan to Russia are smuggled at least 12 tons of heroin – 3 billion single doses. Every day 100 people die from overdoses, 30,000/year. Now the probability that drug addiction hooks at least one of the children in the Russian families reaches 25%. Conclusions: IE of i/v drug addicts are a new challenge in the way of drug trafficking from Afghanistan to Europe involving Novosibirsk city area. The exponential growth of this challenge because of changes in the drug traffic, the evolution of opiods, antibiotic resistance of pathogens and bad prognosis make it necessary to draw attention of the whole society to this problem. P03 STAPHYLOCOCCUS AUREUS IN THE AETIOLOGY OF INFECTIVE ENDOCARDITIS IN SLOVAKIA DURING THE LAST SIX YEARS N. Kulkova1,4 *, M. Garabasova5 , J. Sokolova1,4 , V. Hricak3 , A. Liskova2 , V. Fischer3 , P. Kisac2 , M. Karvaj2 , E. Kalavsky2 , V. Krcmery1 , on behalf of Slovak Endocarditis Working Group. 1Laboratory of Molecular Microbiology, Slovak Tropical Institute, St. Elizabeth University, Bratislava, Slovakia, 2Department of Public Health, St. Elizabeth University, Bratislava, Slovakia, 3National Institute of Cardiovascular Disease, Bratislava, Slovakia, 4Department of Laboratory Medicine, School of Health care and Social Work, University of Trnava, Slovakia, 5 Department of Public Health, School of Health care and Social Work, University of Trnava, Slovakia E-mail address: [email protected] Objectives: In the 21st century infective endocarditis (IE) is more often an acute disease, characterized by a high rate of Staphylococcus aureus in aetiology. The aim of this study was to compare the risk factors and outcome of IE due to S. aureus (SAIE) in 2007–2012 in Slovakia. Methods: In this study we compared risk factors and outcome of SAIE in Slovakia (population about 5 million) during last six years. Thirtyfour medical centers participated in this longitudinal observation nationwide survey and 449 cases of infectious endocarditis were reported. Duke criteria were used as inclusion criteria. Chi-square
of the episodes are catheter-related, which confers a leading role to catheter-related bacteremia management, including its prevention in the hospital, but also in the outpatient setting (cuffed and tunneled catheters for hemodialysis and chemotherapy in cancer patients, anti-infective surfaces, etc.). Notably, evidence-based strategies and interventions, also known as “zero bacteremia” protocols, proved to decrease the rate of infection from 2.7 per 1000 catheter-days to 0 in 3 months and a reduction of 66% of catheter-related infection at 16 to 18 months after implementation (Provonost, NEJM 2006). Another essential pack of measures reflected on current guidelines (Bratzler, Am J Health-Syst Pharm 2013) are focused on the antimicrobial prophylaxis of cardiac device insertion procedures: valve replacement and implantation of cardiovascular electronic devices. Recent studies have confirmed that S. aureus decolonization of the anterior nares decreases the rate of surgical site infections (SSI) in many surgical patients. The data are most compelling in cardiac surgery patients. In addition to antibiotic prophylaxis, antiseptic preparation of the insertion field in a properly organized and sterile setting, accomplishing the conditions of a real operation room is indispensable for placing pacemakers and defibrillators. Notably, these measures should also be applied in generator system changes. Cephalosporins have been the most studied antimicrobials for the prevention of SSI in cardiac procedures. Both first-generation (cefazolin) and second-generation (cefamandole and cefuroxime) cephalosporins have been shown to be effective in reducing SSI in cardiac surgery. Vancomycin should be considered in patients who are colonized with MRSA or for beta-lactam-allergic patients. Finally, health-care personnel training on strict hygiene measures, effective handwashing and well-established specific protocols for each centre are called for to be generalized. This includes isolation measures for resistant microorganisms, constant revision of antimicrobial empirical treatments and ensuring homogenous accomplishment of realistic goals under strict supervision. All these measures will reduce the rate of health-care associated infections and therefore the risk of bacteremia and HCA IE.
Poster abstracts P01 INFECTIVE ENDOCARDITIS: EPIDEMIOLOGICAL AND THERAPEUTIC ASPECTS IN AN URBAN POPULATION – ROME, ITALY. RETROSPECTIVE STUDY A. Ricciardi1 *, G.A. Chiariello1 , P. Sordillo1 , P. Nardi2 , G. Maffongelli1 , A. Pellegrino2 , N. Cesta1 , L. Chiariello2 , M. Andreoni2 . 1Infectious Disease Department, University Hospital Tor Vergata, Rome, Italy, 2 Cardiac Surgery Division, University Hospital Tor Vergata, Rome, Italy E-mail address: [email protected] Objectives: To evaluate the epidemiological and therapeutic aspects, both medical and surgical, in patients with native or prosthetic infective endocarditis. Background: Infective endocarditis (IE) still represents an important disease. The incidence of IE ranges from 3 to 10 episodes/100,000 person-years. Prosthetic valve endocarditis (PVE) is the most severe form of IE. It accounts for 10–30% of all cases of IE. Surgical treatment is used in approximately half of patients with IE because of severe complications. Yet, surgical therapy during the active phase of the disease is associated with significant risk. Methods: Between 2009 and January 2011, 45 patients were admitted at Cardiac Surgery Division or at Infectious Disease Department of Tor Vergata Hospital in Rome (Italy) with diagnosis of IE. All the data were retrospective collected. Results: The study included 45 patients with IE, 39 men and 6 women, with a mean age of 59±15 years (1 DS). The main presenting symptoms or signs were episodic fever, bacteremia or sepsis, embolism and heart failure. The diagnosis based on Duke criteria could be considered definite in 37/45 patients (82%). 21 patients had a PVE and 24 NVE. Streptococcus spp. was the most important cause of infection in patients with NVE and Staphylococcusspp. in patients with PVE. An embolic complication occurred in 17 patients (10 with PVE
S7
and 7 with NVE; P = 0.05). Because of persistent valve infections and despite antibiotics treatment, 17 out of 45 patients underwent surgical operation: 11 out of 17 had a PVE (64%). Cerebral embolism (P = 0.05) and type of valve (P = 0.03) were the most important mortality risk factors. Conclusions: IE still represents a cause of mortality, despite major advances in both diagnostic and therapeutic procedures. Severe complications of the infection are more common in patients with PVE. An optimal coordination between clinical and surgical physicians is needed in these difficult cases of IE. P02 AN EPIDEMIC OF INFECTIVE ENDOCARDITIS AT THE CROSSROADS OF DRUG TRAFFIC A. Demin *, V. Drobysheva. Internal Medicine Department and Endocarditis Center, Novosibirsk State Medical University, Novosibirsk, Russian Federation E-mail address: [email protected] Purpose: To analyze the recent changes in clinical picture and treatment of infective endocarditis (IE) of intravenous (i/v) drug users in Novosibirsk city. Methods: Observational cohort study conducted from 2008 through 2012 at Novosibirsk city among 300 i/v drug users (morphine, heroin, hydromorphone, codeine, methadone, fentanyl, desomorphine; average age 26.1 yrs) with IE (Duke criteria). Results: The incidence of IE increased 10-fold, reaching 150 cases per 1 mln/year – increasing share of i/v drug addicts. Etiologically the change is characterized by a reduction of streptococci and a much higher incidence of staphylococci (>70%), Gram-negative bacteria, fungi and mixed virulent organisms. In all patients the clinical course of IE was with systemic affection of internal organs of thromboembolic, microvascular and toxic genesis. Necrotic vasculitis of the lower extremities developed in 44% of patients. Eradication of staphylococci with vancomycin or daptomycin, >8 mg/kg/day for 4–6 weeks, was obtained in 85% of IE patients with replacing heart valves in 70%. Mortality at discharge was 25%, at six months 35%. Russia has now become an absolute world market for opiates in the world (20%). From Afghanistan to Russia are smuggled at least 12 tons of heroin – 3 billion single doses. Every day 100 people die from overdoses, 30,000/year. Now the probability that drug addiction hooks at least one of the children in the Russian families reaches 25%. Conclusions: IE of i/v drug addicts are a new challenge in the way of drug trafficking from Afghanistan to Europe involving Novosibirsk city area. The exponential growth of this challenge because of changes in the drug traffic, the evolution of opiods, antibiotic resistance of pathogens and bad prognosis make it necessary to draw attention of the whole society to this problem. P03 STAPHYLOCOCCUS AUREUS IN THE AETIOLOGY OF INFECTIVE ENDOCARDITIS IN SLOVAKIA DURING THE LAST SIX YEARS N. Kulkova1,4 *, M. Garabasova5 , J. Sokolova1,4 , V. Hricak3 , A. Liskova2 , V. Fischer3 , P. Kisac2 , M. Karvaj2 , E. Kalavsky2 , V. Krcmery1 , on behalf of Slovak Endocarditis Working Group. 1Laboratory of Molecular Microbiology, Slovak Tropical Institute, St. Elizabeth University, Bratislava, Slovakia, 2Department of Public Health, St. Elizabeth University, Bratislava, Slovakia, 3National Institute of Cardiovascular Disease, Bratislava, Slovakia, 4Department of Laboratory Medicine, School of Health care and Social Work, University of Trnava, Slovakia, 5 Department of Public Health, School of Health care and Social Work, University of Trnava, Slovakia E-mail address: [email protected] Objectives: In the 21st century infective endocarditis (IE) is more often an acute disease, characterized by a high rate of Staphylococcus aureus in aetiology. The aim of this study was to compare the risk factors and outcome of IE due to S. aureus (SAIE) in 2007–2012 in Slovakia. Methods: In this study we compared risk factors and outcome of SAIE in Slovakia (population about 5 million) during last six years. Thirtyfour medical centers participated in this longitudinal observation nationwide survey and 449 cases of infectious endocarditis were reported. Duke criteria were used as inclusion criteria. Chi-square