ABSTRACT
OBJECTIVE: One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS: Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS: Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS: We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.
Subject(s)
Endocarditis , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Aged , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Endocarditis/drug therapy , Hospitals, University , Humans , Microbial Sensitivity Tests , Retrospective Studies , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcus aureusABSTRACT
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Subject(s)
Humans , Female , Aged , Biological Clocks/radiation effects , Heart Block/complications , Heart Block , Risk Factors , Asthenia/complications , Asthenia/etiology , Electrocardiography/instrumentation , Electrocardiography/methods , Dementia/complications , Obesity/complicationsABSTRACT
Objetivo. El tratamiento antibiótico recomendado para la endocarditis infecciosa (EI) tiene un nivel de evidencia bajo. Nuestro objetivo fue comprobar si la adherencia a las recomendaciones de la Sociedad Europea de Cardiología (ESC) se relaciona con una menor morbimortalidad intrahospitalaria de la enfermedad. Métodos. Estudio retrospectivo de 162 casos de EI diagnosticados entre 2005 y 2014. Se realizó un análisis de propensity score matching para determinar el efecto del tratamiento en la mortalidad intrahospitalaria. Resultados. No hubo diferencias en cuanto a complicaciones de la enfermedad entre los grupos de tratamiento. La mortalidad intrahospitalaria fue del 29,2% cuando el tratamiento fue ajustado a las guías, y del 28,2% cuando no lo fue (OR=1,048; IC95%: 0,442-2,484; p=0,916). Conclusión. El uso de las guías de la ESC no parece traducirse en una reducción de la morbimortalidad intrahospitalaria por EI cuando se compara con regímenes de tratamiento antibiótico alternativos (AU)
Objective. The antibiotic treatment recommended for infectious endocarditis (IE) has a low level of evidence. Our objective was to determine whether compliance with the recommendations of the European Society of Cardiology (ESC) was related to lower inhospital morbidity and mortality for this disease. Methods. A retrospective study was conducted on 162 cases of IE diagnosed between 2005 and 2014. A propensity score-matching analysis was performed to determine the effect of treatment on hospital mortality. Results. There were no differences in terms of disease complications between the treatment groups. Hospital mortality was 29.2% when the treatment was adjusted to the guidelines and 28.2% when the treatment was not adjusted (OR=1.048; 95%CI: 0.442-2.484; P=.916). Conclusion. The use of the ESC guidelines does not appear to translate into a reduction in hospital morbidity and mortality due to IE when compared with alternative antibiotic treatment regimens (AU)
Subject(s)
Humans , Male , Female , Endocarditis, Non-Infective/blood , Cardiology/education , Spain , Anti-Bacterial Agents/administration & dosage , Heart Failure/genetics , Intracranial Embolism/blood , Renal Insufficiency/metabolism , Renal Insufficiency/pathology , Endocarditis, Non-Infective/pathology , Cardiology/methods , Retrospective Studies , Anti-Bacterial Agents/metabolism , Heart Failure/metabolism , Intracranial Embolism/complications , Renal Insufficiency/complications , Renal Insufficiency/diagnosisABSTRACT
OBJECTIVE: The antibiotic treatment recommended for infectious endocarditis (IE) has a low level of evidence. Our objective was to determine whether compliance with the recommendations of the European Society of Cardiology (ESC) was related to lower inhospital morbidity and mortality for this disease. METHODS: A retrospective study was conducted on 162 cases of IE diagnosed between 2005 and 2014. A propensity score-matching analysis was performed to determine the effect of treatment on hospital mortality. RESULTS: There were no differences in terms of disease complications between the treatment groups. Hospital mortality was 29.2% when the treatment was adjusted to the guidelines and 28.2% when the treatment was not adjusted (OR=1.048; 95%CI: 0.442-2.484; P=.916). CONCLUSION: The use of the ESC guidelines does not appear to translate into a reduction in hospital morbidity and mortality due to IE when compared with alternative antibiotic treatment regimens.
