Duration of Pre-Operative Antibiotic Treatment and Culture Results in Patients With Infective Endocarditis

Gisler, Valentin; Dürr, Sarah; Irincheeva, Irina; Limacher, Andreas; Droz, Sara; Carrel, Thierry; Englberger, Lars; Sendi, Parham

doi:10.1016/j.jacc.2020.04.075

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…Of great interest are the cases with suspected endocarditis (Table 4 ). The detected species were congruent with the literature [ 33 ]. Although the specified antibiotics might explain the negative cultures, the detected number of bacteria (based on Cp values and positive microscopy) in the specimen remained high and were therefore not contaminants.…”

Section: Discussionsupporting

confidence: 90%

“…Additionally, all three available blood cultures confirm positive PCR. The influence of the duration of treatment with antibiotics and the result of valve cultures (positive or negative) remains complex [ 33 ]. Modified Duke criteria (which do not include 16S rDNA PCR) are still widely used for the diagnosis of definite endocarditis [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…The influence of the duration of treatment with antibiotics and the result of valve cultures (positive or negative) remains complex [ 33 ]. Modified Duke criteria (which do not include 16S rDNA PCR) are still widely used for the diagnosis of definite endocarditis [ 33 ]. There is evidence that blood culture is incorrectly negative for endocarditis [ 34 ], however, with a broad range (of 2 to 71%).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of an automated DNA extraction and 16S rDNA real time PCR/sequencing diagnostic method using optimized reagents with culture during a 15-month study using specimens from sterile body sites

Egli

Risch

et al. 2022

BMC Microbiol

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Background 16S rDNA-PCR for the identification of a bacterial species is an established method. However, the DNA extraction reagents as well as the PCR reagents may contain residual bacterial DNA, which consequently generates false-positive PCR results. Additionally, previously used methods are frequently time-consuming. Here, we describe the results obtained with a new technology that uses DNA-free reagents for automated DNA extraction and subsequent real time PCR using sterile clinical specimens. Results In total, we compared 803 clinical specimens using real time PCR and culturing. The clinical specimens were mainly of orthopedic origin received at our diagnostic laboratory. In 595 (74.1%) samples, the results were concordant negative, and in 102 (12.7%) the results were concordant positive. A total of 170 (21.2%) clinical specimens were PCR-positive, of which 62 (36.5% from PCR positive, 7.7% in total) gave an additional benefit to the patient since only the PCR result was positive. Many of these 62 positive specimens were strongly positive based on crossingpoint values (54% < Cp 30), and these 62 positive clinical specimens were diagnosed as medically relevant as well. Thirty-eight (4.2%) clinical specimens were culture-positive (25 of them were only enrichment culture positive) but PCR-negative, mainly for S. epidermidis, S. aureus and C. acnes. The turnaround times for negative specimens were 4 hours (automated DNA extraction and real time PCR) and 1 working day for positive specimens (including Sanger sequencing). Melting-curve analysis of SYBR Green-PCR enables the differentiation of specific and unspecific PCR products. Using Ripseq, even mixed infections of 2 bacterial species could be resolved. Conclusions For endocarditis cases, the added benefit of PCR is obvious. The crucial innovations of the technology enable timely reporting of explicit reliable results for adequate treatment of patients. Clinical specimens with truly PCR-positive but culture-negative results represent an additional benefit for patients. Very few results at the detection limit still have to be critically examined.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison of an automated DNA extraction and 16S rDNA real time PCR/sequencing diagnostic method using optimized reagents with culture during a 15-month study using specimens from sterile body sites

Egli

Risch

et al. 2022

BMC Microbiol

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“…Investigations that have examined the association between duration of pre‐operative antibiotic therapy and positive valve cultures. Gisler et al 25 . reported that extending antibiotic therapy for more than 7 days had limited impact on enhancing sterilization of vegetations.…”

Section: Discussionmentioning

confidence: 99%

Impact of delayed device re‐implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

Arshad

Baddour

Lahr

et al. 2021

Pacing Clinical Electrophis

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Background Optimal timing of cardiovascular implantable electronic device (CIED) re‐implantation following device removal due to infection is undefined. Multinational guidelines reflect this and include no specific recommendation for this timing, while others have recommended waiting at least 14 days in cases of CIED related infective endocarditis (CIED‐IE). The current work seeks to clarify this issue. Methods We retrospectively reviewed institutional data at Mayo Clinic, Minnesota of patients aged ≥ 18 years who developed CIED‐IE from January 1, 1991 to February 1, 2016. CIED‐IE was defined as echocardiogram reported device lead or valvular vegetation. Regression analyses were used to relate the risk of clinical outcomes to the interval between CIED removal and re‐implantation and the location of vegetations. Results A total of 109 patients met study inclusion criteria. A majority (68.8%) of patients were men and the median age was 68.0 years. Transoesophageal echocardiogram (TEE) was performed in 95.4% of patients, with valve vegetations detected in 33.9% (n = 37). Survival analysis comparing patients in whom device re‐implantation was < 14 days vs. ≥14 days, and further categorized by those with and without valve vegetation, showed a significant difference (P = 0.028); patients with valve vegetation and reimplantation interval < 14 days had the lowest (58.7%) 12‐month survival. When adjusted for valve vegetation, longer time interval for reimplantation trended toward increased hospital length of stay (P = 0.079). Conclusion Our findings suggest that the recommended 14‐day delay between CIED extraction and re‐implantation in CIED‐IE patients is associated with a survival benefit, but longer length of hospital stay following re‐implantation.

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“…Antibiotics were selected according to the ESC guidelines [ 5 ]. The duration of antibiotic treatment was considered when one of the compounds was effective against the causative microorganism, and when the antibiotic was administered intravenously; specifically, if one of the empirically started antibiotics was susceptible to the identified strain, this was counted from the first entry date, whereas if no empirically started antibiotic was susceptible to the identified strain, this was counted from the date of change according to susceptibility [ 17 ]. Surgical intervention was recommended, based on a multidisciplinary team decision according to the American Heart Association and ESC guidelines [ 5 , 18 ].…”

Section: Methodsmentioning

confidence: 99%

Impact of Valve Culture Positivity on Prognosis in Patients with Infective Endocarditis Who Underwent Valve Surgery

Kim

Lee

et al. 2022

Infect Dis Ther

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Introduction Infective endocarditis (IE) is a severe and fatal infection with high in-hospital and overall mortality rates of approximately up to 30%. Valve culture positivity was associated with in-hospital mortality and postoperative complications; however, few studies have analyzed the relationship between valve cultures and overall mortality over a long observation period. This study aimed to compare the association of valve culture positivity with overall mortality in patients with IE who underwent valve surgery. Methods A total of 416 IE patients admitted to a tertiary hospital in South Korea from November 2005 to August 2017 were retrospectively reviewed. A total of 202 IE patients who underwent valve surgery and valve culture were enrolled. The primary endpoint was long-term overall mortality. Kaplan–Meier curve and Cox proportional hazards model were used for survival analysis. Results The median follow-up duration was 63 (interquartile range, 38–104) months. Valve cultures were positive in 22 (10.9%) patients. The overall mortality rate was 15.8% (32/202) and was significantly higher in valve culture-positive patients (36.4%, p = 0.011). Positive valve culture [hazard ratio (HR) 3.921, p = 0.002], Charlson Comorbidity Index (HR 1.181, p = 0.004), Coagulase-negative staphylococci (HR 4.233, p = 0.001), new-onset central nervous system complications (HR 3.689, p < 0.001), and new-onset heart failure (HR 4.331, p = 0.001) were significant risk factors for overall mortality. Conclusions Valve culture positivity is a significant risk factor for long-term overall mortality in IE patients who underwent valve surgery. The importance of valve culture positivity needs to be re-evaluated, as the valve culture positivity rate increases with increasing early surgical intervention.

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Duration of Pre-Operative Antibiotic Treatment and Culture Results in Patients With Infective Endocarditis

Cited by 17 publications

References 18 publications

Comparison of an automated DNA extraction and 16S rDNA real time PCR/sequencing diagnostic method using optimized reagents with culture during a 15-month study using specimens from sterile body sites

Comparison of an automated DNA extraction and 16S rDNA real time PCR/sequencing diagnostic method using optimized reagents with culture during a 15-month study using specimens from sterile body sites

Impact of delayed device re‐implantation on outcomes of patients with cardiovascular implantable electronic device related infective endocarditis

Impact of Valve Culture Positivity on Prognosis in Patients with Infective Endocarditis Who Underwent Valve Surgery

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