Adolf Karchmer - Academia.edu (original) (raw)
Papers by Adolf Karchmer
The Journal of Thoracic and Cardiovascular Surgery, 1978
We have analyzed the daily maximum temperature (T max), mean temperature (T mearJ, and white bloo... more We have analyzed the daily maximum temperature (T max), mean temperature (T mearJ, and white blood cell count (WBC) in /89 patients during the 2 weeks following cardiac valve surgery. The /54 patients without infection had an appreciable febrile response: The mean Tmax was /0/.2°F. (38.4°C.) on the first postoperative day, and /2 percent of patients without infection had a T max of /03°F. (39.4°C.) or higher at some time postoperatively. Of all patients with Tmax of 103°F. or more only three of 22 (/4 percent) had infection. Thirty-six percent of patients without infection had at least one WBC of /5,000 per cubic millimeter or more. On the other hand, the majority of the 35 patients in whom infection was documented by prospective clinical surveillance did not have a significant elevation of temperature and WBC when compared to patients without infection; on the day infection was documented, only 37 percent had an elevated T max , 29 percent had an elevated Tmean> and 44 percent had an increased WBC. Nine patients with infection (23 percent) were essentially afebrile, with a Tmax of /00.2°F. (37.9°C.) or less. Temperature and WBC are insensitive and nonspecific signs of infection following cardiac valve surgery.
Journal of Endodontics, Apr 1, 1991
Journal of the American Podiatric Medical Association, 2013
It is important to realize that guidelines cannot always account for individual variation among p... more It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
Clinical Infectious Diseases, Oct 1, 2004
These guidelines were developed and issued on behalf of the Infectious Diseases Society of Americ... more These guidelines were developed and issued on behalf of the Infectious Diseases Society of America. a B.A.L. served as the chairman and A.R.B. served as the vice chairman of the Infectious Diseases Society of America Guidelines Committee on Diabetic Foot Infections. b Deceased.
Clinical Infectious Diseases
Background Bacillus anthracis, the causative agent for anthrax, poses a potential bioterrorism th... more Background Bacillus anthracis, the causative agent for anthrax, poses a potential bioterrorism threat and is capable of causing mass morbidity and mortality. Antimicrobials are the mainstay of postexposure prophylaxis (PEP) and treatment of anthrax. We conducted this safety review of 24 select antimicrobials to identify any new or emerging serious or severe adverse events (AEs) to help inform their risk–benefit evaluation for anthrax. Methods Twenty-four antimicrobials were included in this review. Tertiary data sources (e.g. Lactmed, Micromedex, REPROTOX) were reviewed for safety information and summarized to evaluate the known risks of these antimicrobials. PubMed was also searched for published safety information on serious or severe AEs with these antimicrobials; AEs that met inclusion criteria were abstracted and reviewed. Results A total of 1316 articles were reviewed. No consistent observations or patterns were observed among the abstracted AEs for a given antimicrobial; ther...
Circulation, 1993
The Jones criteria for guidance in the diagnosis of acute rheumatic fever were first published by... more The Jones criteria for guidance in the diagnosis of acute rheumatic fever were first published by T. Duckett Jones, MD, in 1944 and have been revised over the years by the American Heart Association. The current guidelines are an update of these criteria. For the first time, the guidelines are designed to establish the initial attack of acute rheumatic fever. Major manifestations, minor manifestations, and supporting evidence of antecedent group A streptococcal infection are discussed. These updated guidelines expand on the available tools to diagnose streptococcal pharyngitis and clarify the available antibody tests for detecting antecedent group A streptococcal infection. At the present time echocardiography without accompanying auscultatory findings is insufficient to be the sole criterion for valvulitis in acute rheumatic fever. Finally, this article addresses overdiagnosis of rheumatic fever and lists exceptions to the Jones criteria, including recurrent attacks in individuals ...
Open Forum Infectious Diseases, 2020
Background According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US popula... more Background According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US population is estimated to have diabetes mellitus (either type 1 or type 2). 1 Among patients with diabetes, there is a 15% lifetime risk of developing a foot ulcer, making it an extremely common medical problem seen in both outpatient and inpatient settings.2 In fact, Medicare spends $9–13 billion/year on diabetic foot osteomyelitis (DFO).3 Despite this high prevalence and cost, experts have not agreed on a set of diagnostic criteria for diagnosing DFO, 4 nor the optimal antibiotic management.5 For example, while traditionally diabetic foot osteomyelitis has been treated with 4–6 weeks of IV antibiotics in the United States, oral antibiotics have been shown to be effective with similar cure rates in multiple studies 6–8, non-inferior in a Cochrane review,5 and are recommended in the most recent (2012) Infectious Disease Society of America (IDSA) DFO clinical practice guidelines.9 Methods Repr...
American Journal of Health-System Pharmacy, 1987
Clinical Infectious Diseases, 2016
Background Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitali... more Background Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined. Methods We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs. Results After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicil...
International Journal of Antimicrobial Agents, 2007
ATLAS 1 and ATLAS 2 trials. Percentages shown to the right were not weighted. Conclusion: The PVL... more ATLAS 1 and ATLAS 2 trials. Percentages shown to the right were not weighted. Conclusion: The PVL gene was present in a large proportion of S. aureus isolates from cSSSI patients in the ATLAS studies. PVL status did not seem to influence the outcome of treatment. In these studies, TLV was effective in the treatment of cSSSI caused by S. aureus, including strains carrying the PVL gene. P848 Efficacy of tigecycline (TGC) compared with levofloxacin (LEV) for treating Streptococcus pneumoniae bacteraemia in patients (pts) hospitalised with community-acquired pneumonia (CAP)
Clinical Infectious Diseases, 2011
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcu... more Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
Clinical Infectious Diseases, 1994
In a double-blind randomized trial, imipenem/cilastatin (I/C; 500 mg every 6 hours) and ampicilli... more In a double-blind randomized trial, imipenem/cilastatin (I/C; 500 mg every 6 hours) and ampicillin/sulbactam (A/S; 3 g every 6 hours) were compared in regard to their efficacyfor initial empirical and definitive parenteral treatment of limb-threatening pedal infection in diabetic patients. The major endpoints of treatment were cure (resolution of soft-tissue infection), failure (inadequate improvement, necessitating a change in antibiotic therapy), and eradication (clearance of all pathogens from the wound and any bone cultures). Patients in the two treatment groups were similar in regard to the severity of diabetes; presence of neuropathy and peripheral vascular disease; site and severity of infection; pathogen isolated; and frequency of osteomyelitis (associated with 68% of the 48 A/S-treated infections and 56% of the 48 I/C-treated infections). After 5 days of empirical treatment, improvement was noted in 94% of the A/S and 98% of the I/C recipients. At the end of definitive treatment (days' duration [mean ± SD): 13 ± 6.5 [A/S), 14.8 ± 8.6 [I/C]), outcomes were similar: cure, 81% (A/S) vs. 85% (l/C); failure, 17% (A/S) vs. 13% (I/C); and eradication, 67% (A/S) vs. 75% (I/C). Treatment failures were associated with the presence of antibiotic-resistant pathogens and possible nosocomial acquisition of infections. The number of adverse events among patients in the two treatment groups was similar: 7 in the A/S group (4 had diarrhea and 3 had rash) and 9 in the I/C group (5 had diarrhea, 2 had severe nausea, 1 had rash, and 1 had seizure). Efficacyof A/S and IfC is similar for initial empirical and definitive treatment of limb-threatening pedal infection in patients with diabetes. The treatment of serious lower-limb infections in diabetics can be difficult [1, 2]. Factors such as the presence ofpolymicrobial infection, underlying or contiguous osteomyelitis, hyperglycemia, and diabetic sequelae (such as peripheral vascular disease, peripheral sensory neuropathy, and renal impairment) commonly influence their medical and surgical management. The polymicrobial nature of many infections [3-6], frequently with a mixture of aerobic and anaerobic pathogens, suggests that empirical therapy with antibiotics
Clinical Infectious Diseases, 2009
Background. The safety of adding initial low-dose gentamicin to antistaphylococcal penicillins or... more Background. The safety of adding initial low-dose gentamicin to antistaphylococcal penicillins or vancomycin for treatment of suspected Staphylococcus aureus native valve endocarditis is unknown. This study evaluated the association between this practice and nephrotoxicity. Methods. We performed a prospective cohort study of safety data from a randomized, controlled trial of therapy for S. aureus bacteremia and native valve infective endocarditis involving 236 patients from 44 hospitals in 4 countries. Patients either received standard therapy (antistaphylococcal penicillin or vancomycin) plus initial low-dose gentamicin () or received daptomycin monotherapy (). We measured renal adverse events n p 116 n p 120 and clinically significant decreased creatinine clearance in patients (1) in the original randomized study arms and (2) who received any initial low-dose gentamicin either, as a study medication or р2 days before enrollment. Results. Renal adverse events occurred in 8 (7%) of 120 daptomycin recipients, 10 (19%) of 53 vancomycin recipients, and 11 (17%) of 63 antistaphylococcal penicillin recipients. Decreased creatinine clearance occurred in 9 (8%) of 113 of evaluable daptomycin recipients, 10 (22%) of 46 vancomycin recipients, and 16 (25%) of 63 antistaphylococcal penicillin recipients. An additional 21 patients received initial low-dose gentamicin р2 days before study enrollment. A total of 22% of patients who received initial low-dose gentamicin versus 8% of patients who did not receive initial low-dose gentamicin experienced decreased creatinine clearance (). Independent P p .005 predictors of a clinically significant decrease in creatinine clearance were age у65 years and receipt of any initial low-dose gentamicin. Conclusions. Initial low-dose gentamicin as part of therapy for S. aureus bacteremia and native valve infective endocarditis is nephrotoxic and should not be used routinely, given the minimal existing data supporting its benefit.
Clinical Infectious Diseases, 1994
Circulation, 1994
Long-term management of patients with Kawasaki disease should be tailored to the degree of corona... more Long-term management of patients with Kawasaki disease should be tailored to the degree of coronary arterial involvement. This committee has made recommendations for each risk level about antiplatelet and anticoagulant therapy, physical activity, follow-up assessment by a pediatric cardiologist or primary care physician, and the appropriate diagnostic procedures that may be performed to evaluate cardiac disease. The risk level for a given patient with coronary arterial involvement may change over time because of changes in coronary artery morphology. The recommendations for management presented here are intended as practical interim guidelines until additional prospective or retrospective data are compiled to define more clearly the natural history of Kawasaki disease.
Clinical Infectious Diseases
The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have ch... more The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of “typical” microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cul...
JAMA: The Journal of the American Medical Association, 1989
За последние 30 лет частота инфекционного эндокардита (ИЭ) возросла в 3 раза. Заболеваемость ИЭ р... more За последние 30 лет частота инфекционного эндокардита (ИЭ) возросла в 3 раза. Заболеваемость ИЭ регистрируется во всех странах мира, и в Российской Федерации составляет более 40 человек на 1 млн населения. Одним из частых возбудителей инфекционного эндокардита является энтерококк, который занимает третье место в структуре частоты возбудителей инфекционного эндокардита. Несмотря на появление новых групп антибактериальных препаратов, ИЭ энтерококковой этиологии остается заболеванием с высокой летальностью. Данный обзор литературы вобрал в себя результаты исследований эффективности и безопасности различных режимов антибактериальной терапии (АБТ) ИЭ, вызванного Enterococcus faecalis (E. faecalis). В обзоре проведен анализ данных зарубежных и отечественных исследований по выбору АБТ у больных с инфекционным эндокардитом, сопровождающимся энтерококковой бактериемией. Поиск литературы осуществлялся с помощью медицинских компьютерных баз данных: MEDLINE, EMBASE, eLIBRARY. В текущий обзор включали только исследования у больных ИЭ с оценкой эффективности и безопасности АБТ. По результатам 5 найденных исследований было обнаружено, что основные схемы АБТ ИЭ, вызванного E. faecalis, включают 2 бета-лактамных антибиотика, или комбинацию ампициллина с гентамицином. Летальность больных при использовании указанных схем существенно не отличается. Данные международных регистров свидетельствуют об эффективности и безопасности монотерапии даптомицином при энтерококковом эндокардите. Линезолид и даптомицин являются препаратами выбора для лечения инфекционного эндокардита, вызванного ванкомицин-резистентными энтерококками. В отечественной литературе появляются сообщения о высоком уровне резистентности штаммов энтерококков к бета-лактамным антибактериальным препаратам. Такие показатели, как длительность лихорадки, частота хирургических вмешательств на клапанах сердца, длительность бактериемии представлены не полностью в каждом из исследований, в результате чего комплексная оценка составляющих затруднительна. Основными схемами АБТ энтерококкового эндокардита являются комбинации ампициллин+цефтриаксон и ампициллин+гентамицин. Эффективность при использовании указанных схем существенно не отличается. Терапия ИЭ должна осуществляться с учетом эпидемиологической ситуации и чувствительности конкретного выделенного штамма к антибактериальному препарату.
Pediatric Infectious Disease Journal, 2012
The Journal of Thoracic and Cardiovascular Surgery, 1978
We have analyzed the daily maximum temperature (T max), mean temperature (T mearJ, and white bloo... more We have analyzed the daily maximum temperature (T max), mean temperature (T mearJ, and white blood cell count (WBC) in /89 patients during the 2 weeks following cardiac valve surgery. The /54 patients without infection had an appreciable febrile response: The mean Tmax was /0/.2°F. (38.4°C.) on the first postoperative day, and /2 percent of patients without infection had a T max of /03°F. (39.4°C.) or higher at some time postoperatively. Of all patients with Tmax of 103°F. or more only three of 22 (/4 percent) had infection. Thirty-six percent of patients without infection had at least one WBC of /5,000 per cubic millimeter or more. On the other hand, the majority of the 35 patients in whom infection was documented by prospective clinical surveillance did not have a significant elevation of temperature and WBC when compared to patients without infection; on the day infection was documented, only 37 percent had an elevated T max , 29 percent had an elevated Tmean> and 44 percent had an increased WBC. Nine patients with infection (23 percent) were essentially afebrile, with a Tmax of /00.2°F. (37.9°C.) or less. Temperature and WBC are insensitive and nonspecific signs of infection following cardiac valve surgery.
Journal of Endodontics, Apr 1, 1991
Journal of the American Podiatric Medical Association, 2013
It is important to realize that guidelines cannot always account for individual variation among p... more It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
Clinical Infectious Diseases, Oct 1, 2004
These guidelines were developed and issued on behalf of the Infectious Diseases Society of Americ... more These guidelines were developed and issued on behalf of the Infectious Diseases Society of America. a B.A.L. served as the chairman and A.R.B. served as the vice chairman of the Infectious Diseases Society of America Guidelines Committee on Diabetic Foot Infections. b Deceased.
Clinical Infectious Diseases
Background Bacillus anthracis, the causative agent for anthrax, poses a potential bioterrorism th... more Background Bacillus anthracis, the causative agent for anthrax, poses a potential bioterrorism threat and is capable of causing mass morbidity and mortality. Antimicrobials are the mainstay of postexposure prophylaxis (PEP) and treatment of anthrax. We conducted this safety review of 24 select antimicrobials to identify any new or emerging serious or severe adverse events (AEs) to help inform their risk–benefit evaluation for anthrax. Methods Twenty-four antimicrobials were included in this review. Tertiary data sources (e.g. Lactmed, Micromedex, REPROTOX) were reviewed for safety information and summarized to evaluate the known risks of these antimicrobials. PubMed was also searched for published safety information on serious or severe AEs with these antimicrobials; AEs that met inclusion criteria were abstracted and reviewed. Results A total of 1316 articles were reviewed. No consistent observations or patterns were observed among the abstracted AEs for a given antimicrobial; ther...
Circulation, 1993
The Jones criteria for guidance in the diagnosis of acute rheumatic fever were first published by... more The Jones criteria for guidance in the diagnosis of acute rheumatic fever were first published by T. Duckett Jones, MD, in 1944 and have been revised over the years by the American Heart Association. The current guidelines are an update of these criteria. For the first time, the guidelines are designed to establish the initial attack of acute rheumatic fever. Major manifestations, minor manifestations, and supporting evidence of antecedent group A streptococcal infection are discussed. These updated guidelines expand on the available tools to diagnose streptococcal pharyngitis and clarify the available antibody tests for detecting antecedent group A streptococcal infection. At the present time echocardiography without accompanying auscultatory findings is insufficient to be the sole criterion for valvulitis in acute rheumatic fever. Finally, this article addresses overdiagnosis of rheumatic fever and lists exceptions to the Jones criteria, including recurrent attacks in individuals ...
Open Forum Infectious Diseases, 2020
Background According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US popula... more Background According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US population is estimated to have diabetes mellitus (either type 1 or type 2). 1 Among patients with diabetes, there is a 15% lifetime risk of developing a foot ulcer, making it an extremely common medical problem seen in both outpatient and inpatient settings.2 In fact, Medicare spends $9–13 billion/year on diabetic foot osteomyelitis (DFO).3 Despite this high prevalence and cost, experts have not agreed on a set of diagnostic criteria for diagnosing DFO, 4 nor the optimal antibiotic management.5 For example, while traditionally diabetic foot osteomyelitis has been treated with 4–6 weeks of IV antibiotics in the United States, oral antibiotics have been shown to be effective with similar cure rates in multiple studies 6–8, non-inferior in a Cochrane review,5 and are recommended in the most recent (2012) Infectious Disease Society of America (IDSA) DFO clinical practice guidelines.9 Methods Repr...
American Journal of Health-System Pharmacy, 1987
Clinical Infectious Diseases, 2016
Background Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitali... more Background Diabetic foot ulcers (DFUs) threaten limbs and prompt hospitalization. After hospitalization, remote-site invasive systemic infection related to DFU (DFU-ISI) may occur. The characteristics of DFU-ISIs and their effect on mortality risk have not been defined. Methods We conducted a retrospective cohort study of 819 diabetic patients hospitalized for treatment of 1212 unique DFUs during a 9-year period. We defined the index ulcer as that present at the first (index) DFU admission to our hospital. We defined DFU-ISI as a nonfoot infection that occurred after the index hospitalization and was caused by a microorganism concomitantly or previously cultured from the index ulcer. We determined the frequency, risk factors, and mortality risk associated with DFU-ISIs. Results After 1212 index DFU hospitalizations, 141 patients had 172 DFU-ISIs. Of the initial 141 DFU-ISIs, 64% were bacteremia, 13% deep abscesses, 10% pneumonia, 7% endocarditis, and 6% skeletal infections. Methicil...
International Journal of Antimicrobial Agents, 2007
ATLAS 1 and ATLAS 2 trials. Percentages shown to the right were not weighted. Conclusion: The PVL... more ATLAS 1 and ATLAS 2 trials. Percentages shown to the right were not weighted. Conclusion: The PVL gene was present in a large proportion of S. aureus isolates from cSSSI patients in the ATLAS studies. PVL status did not seem to influence the outcome of treatment. In these studies, TLV was effective in the treatment of cSSSI caused by S. aureus, including strains carrying the PVL gene. P848 Efficacy of tigecycline (TGC) compared with levofloxacin (LEV) for treating Streptococcus pneumoniae bacteraemia in patients (pts) hospitalised with community-acquired pneumonia (CAP)
Clinical Infectious Diseases, 2011
Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcu... more Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
Clinical Infectious Diseases, 1994
In a double-blind randomized trial, imipenem/cilastatin (I/C; 500 mg every 6 hours) and ampicilli... more In a double-blind randomized trial, imipenem/cilastatin (I/C; 500 mg every 6 hours) and ampicillin/sulbactam (A/S; 3 g every 6 hours) were compared in regard to their efficacyfor initial empirical and definitive parenteral treatment of limb-threatening pedal infection in diabetic patients. The major endpoints of treatment were cure (resolution of soft-tissue infection), failure (inadequate improvement, necessitating a change in antibiotic therapy), and eradication (clearance of all pathogens from the wound and any bone cultures). Patients in the two treatment groups were similar in regard to the severity of diabetes; presence of neuropathy and peripheral vascular disease; site and severity of infection; pathogen isolated; and frequency of osteomyelitis (associated with 68% of the 48 A/S-treated infections and 56% of the 48 I/C-treated infections). After 5 days of empirical treatment, improvement was noted in 94% of the A/S and 98% of the I/C recipients. At the end of definitive treatment (days' duration [mean ± SD): 13 ± 6.5 [A/S), 14.8 ± 8.6 [I/C]), outcomes were similar: cure, 81% (A/S) vs. 85% (l/C); failure, 17% (A/S) vs. 13% (I/C); and eradication, 67% (A/S) vs. 75% (I/C). Treatment failures were associated with the presence of antibiotic-resistant pathogens and possible nosocomial acquisition of infections. The number of adverse events among patients in the two treatment groups was similar: 7 in the A/S group (4 had diarrhea and 3 had rash) and 9 in the I/C group (5 had diarrhea, 2 had severe nausea, 1 had rash, and 1 had seizure). Efficacyof A/S and IfC is similar for initial empirical and definitive treatment of limb-threatening pedal infection in patients with diabetes. The treatment of serious lower-limb infections in diabetics can be difficult [1, 2]. Factors such as the presence ofpolymicrobial infection, underlying or contiguous osteomyelitis, hyperglycemia, and diabetic sequelae (such as peripheral vascular disease, peripheral sensory neuropathy, and renal impairment) commonly influence their medical and surgical management. The polymicrobial nature of many infections [3-6], frequently with a mixture of aerobic and anaerobic pathogens, suggests that empirical therapy with antibiotics
Clinical Infectious Diseases, 2009
Background. The safety of adding initial low-dose gentamicin to antistaphylococcal penicillins or... more Background. The safety of adding initial low-dose gentamicin to antistaphylococcal penicillins or vancomycin for treatment of suspected Staphylococcus aureus native valve endocarditis is unknown. This study evaluated the association between this practice and nephrotoxicity. Methods. We performed a prospective cohort study of safety data from a randomized, controlled trial of therapy for S. aureus bacteremia and native valve infective endocarditis involving 236 patients from 44 hospitals in 4 countries. Patients either received standard therapy (antistaphylococcal penicillin or vancomycin) plus initial low-dose gentamicin () or received daptomycin monotherapy (). We measured renal adverse events n p 116 n p 120 and clinically significant decreased creatinine clearance in patients (1) in the original randomized study arms and (2) who received any initial low-dose gentamicin either, as a study medication or р2 days before enrollment. Results. Renal adverse events occurred in 8 (7%) of 120 daptomycin recipients, 10 (19%) of 53 vancomycin recipients, and 11 (17%) of 63 antistaphylococcal penicillin recipients. Decreased creatinine clearance occurred in 9 (8%) of 113 of evaluable daptomycin recipients, 10 (22%) of 46 vancomycin recipients, and 16 (25%) of 63 antistaphylococcal penicillin recipients. An additional 21 patients received initial low-dose gentamicin р2 days before study enrollment. A total of 22% of patients who received initial low-dose gentamicin versus 8% of patients who did not receive initial low-dose gentamicin experienced decreased creatinine clearance (). Independent P p .005 predictors of a clinically significant decrease in creatinine clearance were age у65 years and receipt of any initial low-dose gentamicin. Conclusions. Initial low-dose gentamicin as part of therapy for S. aureus bacteremia and native valve infective endocarditis is nephrotoxic and should not be used routinely, given the minimal existing data supporting its benefit.
Clinical Infectious Diseases, 1994
Circulation, 1994
Long-term management of patients with Kawasaki disease should be tailored to the degree of corona... more Long-term management of patients with Kawasaki disease should be tailored to the degree of coronary arterial involvement. This committee has made recommendations for each risk level about antiplatelet and anticoagulant therapy, physical activity, follow-up assessment by a pediatric cardiologist or primary care physician, and the appropriate diagnostic procedures that may be performed to evaluate cardiac disease. The risk level for a given patient with coronary arterial involvement may change over time because of changes in coronary artery morphology. The recommendations for management presented here are intended as practical interim guidelines until additional prospective or retrospective data are compiled to define more clearly the natural history of Kawasaki disease.
Clinical Infectious Diseases
The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have ch... more The microbiology, epidemiology, diagnostics, and treatment of infective endocarditis (IE) have changed significantly since the Duke Criteria were published in 1994 and modified in 2000. The International Society for Cardiovascular Infectious Diseases (ISCVID) convened a multidisciplinary Working Group to update the diagnostic criteria for IE. The resulting 2023 Duke-ISCVID IE Criteria propose significant changes, including new microbiology diagnostics (enzyme immunoassay for Bartonella species, polymerase chain reaction, amplicon/metagenomic sequencing, in situ hybridization), imaging (positron emission computed tomography with 18F-fluorodeoxyglucose, cardiac computed tomography), and inclusion of intraoperative inspection as a new Major Clinical Criterion. The list of “typical” microorganisms causing IE was expanded and includes pathogens to be considered as typical only in the presence of intracardiac prostheses. The requirements for timing and separate venipunctures for blood cul...
JAMA: The Journal of the American Medical Association, 1989
За последние 30 лет частота инфекционного эндокардита (ИЭ) возросла в 3 раза. Заболеваемость ИЭ р... more За последние 30 лет частота инфекционного эндокардита (ИЭ) возросла в 3 раза. Заболеваемость ИЭ регистрируется во всех странах мира, и в Российской Федерации составляет более 40 человек на 1 млн населения. Одним из частых возбудителей инфекционного эндокардита является энтерококк, который занимает третье место в структуре частоты возбудителей инфекционного эндокардита. Несмотря на появление новых групп антибактериальных препаратов, ИЭ энтерококковой этиологии остается заболеванием с высокой летальностью. Данный обзор литературы вобрал в себя результаты исследований эффективности и безопасности различных режимов антибактериальной терапии (АБТ) ИЭ, вызванного Enterococcus faecalis (E. faecalis). В обзоре проведен анализ данных зарубежных и отечественных исследований по выбору АБТ у больных с инфекционным эндокардитом, сопровождающимся энтерококковой бактериемией. Поиск литературы осуществлялся с помощью медицинских компьютерных баз данных: MEDLINE, EMBASE, eLIBRARY. В текущий обзор включали только исследования у больных ИЭ с оценкой эффективности и безопасности АБТ. По результатам 5 найденных исследований было обнаружено, что основные схемы АБТ ИЭ, вызванного E. faecalis, включают 2 бета-лактамных антибиотика, или комбинацию ампициллина с гентамицином. Летальность больных при использовании указанных схем существенно не отличается. Данные международных регистров свидетельствуют об эффективности и безопасности монотерапии даптомицином при энтерококковом эндокардите. Линезолид и даптомицин являются препаратами выбора для лечения инфекционного эндокардита, вызванного ванкомицин-резистентными энтерококками. В отечественной литературе появляются сообщения о высоком уровне резистентности штаммов энтерококков к бета-лактамным антибактериальным препаратам. Такие показатели, как длительность лихорадки, частота хирургических вмешательств на клапанах сердца, длительность бактериемии представлены не полностью в каждом из исследований, в результате чего комплексная оценка составляющих затруднительна. Основными схемами АБТ энтерококкового эндокардита являются комбинации ампициллин+цефтриаксон и ампициллин+гентамицин. Эффективность при использовании указанных схем существенно не отличается. Терапия ИЭ должна осуществляться с учетом эпидемиологической ситуации и чувствительности конкретного выделенного штамма к антибактериальному препарату.
Pediatric Infectious Disease Journal, 2012