Standardisation et prise en charge multidisciplinaire des endocardites. Stratégie du CHU de Marseille

Casalta, Jean‐Paul; Gouriet, Frédérique; Thuny, Franck; Bothelo, Elisabeth; Lépidi, Hubert; Fournier, Pierre‐Edouard; Habib, Gilbert; Guidon, C.; Collard, F.; Raoult, Didier

doi:10.1016/j.antib.2009.01.004

Cited by 4 publications

(4 citation statements)

References 47 publications

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“…To determine the effect of current antibiotic treatment on the PCR results, we analyzed the data on 245 patients with IE who were receiving antibiotic treatment at the time of surgery and the data on the 41 patients who had completed antibiotic treatment at the time of surgery. The duration of antibiotic treatment for all patients was 45 days, in accordance with the protocols used at our center [13]. Bacterial DNA was amplified from 124/153 (81%) patients receiving antibiotics for ≤15 days, from 61/92 (66.3%) patients receiving antibiotics for >15 days but who had not yet completed antibiotic treatment and in 16/41 (39%) patients who had completed antibiotic treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Most recommendations still advise combination treatment with amoxicillin and an aminoglycoside for as long as 4–6 weeks [13], [30]. However, there is no consensus regarding surgical treatment of prosthetic valve enterococcal IE.…”

Section: Discussionmentioning

confidence: 99%

“…The patients had been or were being treated with antibiotics when they had valve replacement surgery. The antibiotic treatment for all of the patients was in accordance with our protocols [13], [14]. Days of treatment with parenteral antimicrobials with more than one active antibiotic were counted.…”

Section: Methodsmentioning

confidence: 99%

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DNA Persistence and Relapses Questions on the Treatment Strategies of Enterococcus Infections of Prosthetic Valves

et al. 2012

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We used amplification of the 16S rRNA gene followed by sequencing to evaluate the persistence of bacterial DNA in explanted heart valve tissue as part of the routine work of a clinical microbiology laboratory, and we analyzed the role of this persistence in the relapses observed in our center. We enrolled 286 patients treated for infective endocarditis (IE) who had valve replacement surgery and were diagnosed according to the modified Duke’s criteria described by Li et al. from a total of 579 IE cases treated in our center. The patients were grouped based on the infecting bacteria, and we considered the 4 most common bacterial genus associated with IE separately (144 were caused by Streptococcus spp., 52 by Enterococcus spp., 58 by Staphylococcus aureus and 32 by coagulase-negative Staphylococcus). Based on our cohort, the risk of relapse in patients with enterococcal prosthetic valve infections treated with antibiotics alone was 11%. Bacterial DNA is cleared over time, but this might be a very slow process, especially with Enterococcus spp. Based on a comprehensive review of the literature performed on Medline, most reports still advise combined treatment with penicillin and an aminoglycoside for as long as 4–6 weeks, but there has been no consensus for the treatment of enterococcal infection of prostheses in IE patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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DNA Persistence and Relapses Questions on the Treatment Strategies of Enterococcus Infections of Prosthetic Valves

et al. 2012

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“…osteoarticular infections [9] or negative blood culture endocarditis [10,12,13]. Its contribution is undeniable today, despite the pitfalls inherent in the technique [14,15] and a lack of sensitivity that can be criticised [16,17].…”

Section: Introductionmentioning

confidence: 99%

Complementarity between targeted real-time specific PCR and conventional broad-range 16S rDNA PCR in the syndrome-driven diagnosis of infectious diseases

Morel

Dubourg

Prudent

et al. 2014

Eur J Clin Microbiol Infect Dis

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164

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Molecular tools have shown an added value in the diagnosis of infectious diseases, in particular for those caused by fastidious intracellular microorganisms, or in patients receiving antibiotics before sampling. If 16S rDNA amplification had been gradually implemented in microbiology laboratories, specific real-time polymerase chain reaction (PCR) would have permitted an increase in the sensitivity of molecular methods and a reduction of contamination. Herein, we report our experience in the diagnosis of infectious diseases over two years, during which 32,948 clinical samples from 18,056 patients were received from France and abroad. Among these samples, 81,476 PCRs were performed, of which 1,192 were positive. Molecular techniques detected intracellular microorganisms in 31.3 % of respiratory samples, 27.8 % of endocarditis samples and 51.9 % of adenitis samples. Excluding intracellular bacteria, 25 % of the positive samples in this series were sterile in culture. Conventional broad-range PCR permitted the identification of fastidious and anaerobic microorganisms, but specific real-time PCR showed a significant superiority in the diagnosis of osteoarticular infections, in particular for those caused by Kingella kingae and Staphylococcus aureus, and for endocarditis diagnosis, specifically when Streptococcus gallolyticus and Staphylococcus aureus were involved. The sensitivity of conventional broad-range PCR was 62.9 % concerning overall diagnoses for which both techniques had been performed. These findings should lead microbiologists to focus on targeted specific real-time PCR regarding the clinical syndrome. Finally, syndrome-driven diagnosis, which consists of testing a panel of microorganisms commonly involved for each syndrome, permitted the establishment of 31 incidental diagnoses.

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Marseille scoring system for empiric treatment of infective endocarditis

Gouriet

Tissot‐Dupont

Casalta

et al. 2018

Eur J Clin Microbiol Infect Dis

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Despite advances in medical, surgical, and critical care, infective endocarditis (IE) remains associated with considerable morbidity and mortality. We evaluated the performance of the Marseille score, including clinical data and biological tests obtained within 2 h, to identify patients at high risk of IE in order to initiate early antimicrobial treatment. This was secondarily confirmed using modified ESC criteria combined with molecular testing and fluorodeoxyglucose-positron emission tomography/computed tomography as diagnostic tools. In a prospective cohort study, we enrolled 484 patients with cardiovascular predisposition and clinical suspicion of IE from 2011 to 2013. The final diagnosis was definite IE in 123 patients and possible IE in 107. Marseille score was calculated adding one point for each present parameter (range 0-9). This score includes clinical, epidemiological (male, fever, splenomegaly, clubbing, vascular disease and stroke) and biological criteria (Leucocytes>10,000/mm3, sedimentation rate (SR) > 50/mm or C reactive protein >10 mg/L and hemoglobin <100 g/l). A score of 2 or more performed best in predicting IE in patients with predisposing heart lesions. Sensitivity was better on left-side heart lesions (94%) than on right-side heart lesions (85%) (p = 0.04) and better for valvulopathy (94%) than intra cardiac devices (84%) (p = 0.02). The predictive positive value of prosthetic valves was greater than that of native valves (p = 0.02). Using our simple Marseille score combined with our standardized diagnostic procedures would help improve IE management by focusing on early empiric treatment within 2 h of admission for patients with cardiac predisposition factors.

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Standardisation et prise en charge multidisciplinaire des endocardites. Stratégie du CHU de Marseille

Cited by 4 publications

References 47 publications

DNA Persistence and Relapses Questions on the Treatment Strategies of Enterococcus Infections of Prosthetic Valves

DNA Persistence and Relapses Questions on the Treatment Strategies of Enterococcus Infections of Prosthetic Valves

Complementarity between targeted real-time specific PCR and conventional broad-range 16S rDNA PCR in the syndrome-driven diagnosis of infectious diseases

Marseille scoring system for empiric treatment of infective endocarditis

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