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Pascal Colson - One of the best experts on this subject based on the ideXlab platform.

  • Acute kidney injury during daptomycin versus vancomycin treatment in Cardiovascular critically ill patients: a propensity score matched analysis.
    BMC infectious diseases, 2019
    Co-Authors: Philippe Gaudard, Marine Saour, David Morquin, Hélène David, Jacob Eliet, Maxime Villiet, Jean-pierre Daures, Pascal Colson
    Abstract:

    Gram-positive organisms are a leading cause of Infection in Cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive Cardiovascular Infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. ICU patients who received either DAP or VAN, prior to or after Cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful Infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. Seventy two patients, treated for infective endocarditis, Cardiovascular foreign body Infection, or surgical site Infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39–15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for Cardiovascular procedure-related Infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.

  • Acute kidney injury during daptomycin versus vancomycin treatment in Cardiovascular critically ill patients: a propensity score matched analysis
    BMC Infectious Diseases, 2019
    Co-Authors: Philippe Gaudard, Marine Saour, David Morquin, Hélène David, Jacob Eliet, Maxime Villiet, Jean-pierre Daures, Pascal Colson
    Abstract:

    Background: Gram-positive organisms are a leading cause of Infection in Cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive Cardiovascular Infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. Methods: ICU patients who received either DAP or VAN, prior to or after Cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful Infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. Results: Seventy two patients, treated for infective endocarditis, Cardiovascular foreign body Infection, or surgical site Infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39–15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). Conclusions: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for Cardiovascular procedure-related Infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.

V.s Arakelyan - One of the best experts on this subject based on the ideXlab platform.

  • Role of 18F-FDG PET/CT in diagnosis of Cardiovascular Infection in patients after cardiac surgery
    European Heart Journal, 2020
    Co-Authors: D Pursanova, I.p Aslanidis, O.v Mukhortova, I.v Shurupova, T.a Trifonova, T.a Katunina, R.m Muratov, S.y.u Serguladze, V.a Mironenko, V.s Arakelyan
    Abstract:

    Abstract Purpose To investigate the diagnostic performance of 18F-FDG PET/CT in patients with suspected prosthetic valve infective endocarditis (IE), prosthetic aortic and intracardiac device Infection. Methods The prospective analysis included results of PET/CT examinations performed in 60 patients with fever of unknown origin after cardiac surgery (median time 29 months): valve replacement (n=26), intracardiac device implantation (n=19), both procedures (n=8), Bentall-de-Bono surgery (n=7). According to the Duke criteria most patients – 90% (54/60) – had possible (n=42) and rejected (n=12) diagnosis of IE; 6 patients had definite IE. PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175–200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=41) data: confirmed in 40 and ruled out in 20 patients. Results PET/CT results correctly confirmed the infectious process in the prosthetic valve area, aortic prosthesis or along the intracardiac device in 93% (37/40) and ruled it out in 75% (15/20) patients. False results were obtained in 13% (8/60) – positive (n=5) and negative (n=3). Thus, in the analyzed group of patients (n=60), the sensitivity, specificity and diagnostic accuracy of PET/CT with 18F-FDG in the diagnosis of IE were 93%, 75% and 83%, respectively; positive and negative predictive value – 88% and 83%. In patients with possible IE according to the Duke criteria, true PET/CT results were obtained in 86% (36/42) – positive (n=28) and negative (n=8). In 7% (4/60) of patients – the diagnosis was based only on PET/CT, while initially, according to the Duke criteria, it was rejected. In addition, in 40% (24/60) of patients of the analyzed group, whole body PET/CT revealed other than valve and device, previously unknown foci of inflammation: in the lungs (n=6), in the sternum (n=6), in the area of the native valve (n=3), in the mediastinum (n=4), other (n=13). Conclusions 18F-FDG PET/CT proved to be highly informative for the diagnosis of infectious processes in the heart and vessels in patients after cardiac surgery. The inclusion of PET/CT in the diagnostic algorithm for this category of patients reduces the number of patients with possible IE according to the Duke criteria. Funding Acknowledgement Type of funding source: None

Maureen Dillon - One of the best experts on this subject based on the ideXlab platform.

  • effects of sevelamer and calcium based phosphate binders on mortality in hemodialysis patients
    Kidney International, 2007
    Co-Authors: Wadi N Suki, R Zabaneh, J L Cangiano, Jon A Reed, Danny Fischer, L Garrett, B N Ling, Scott Chasantaber, Maureen Dillon, Andrew T Blair
    Abstract:

    Elevated serum phosphorus and calcium are associated with arterial calcification and mortality in dialysis patients. Unlike calcium-based binders, sevelamer attenuates arterial calcification but it is unknown whether sevelamer affects mortality or morbidity. In a multicenter, randomized, open-label, parallel design trial we compared sevelamer and calcium-based binders on all-cause and cause-specific mortality (Cardiovascular, Infection, and other) in prevalent hemodialysis patients. A total of 2103 patients were initially randomized to treatment and 1068 patients completed the study. All-cause mortality rates and cause-specific mortality rates were not significantly different. There was a significant age interaction on the treatment effect. Only in patients over 65 years of age was there a significant effect of sevelamer in lowering the mortality rate. There was a suggestion that sevelamer was associated with lower overall, but not Cardiovascular-linked, mortality in older patients. We suggest that further research is needed to confirm these findings.

  • Effects of sevelamer and calcium-based phosphate binders on mortality in hemodialysis patients. Commentary
    Kidney International, 2007
    Co-Authors: J. Silver, Wadi N Suki, R Zabaneh, J L Cangiano, Jon A Reed, Danny Fischer, L Garrett, B N Ling, Scott Chasan-taber, Maureen Dillon
    Abstract:

    Elevated serum phosphorus and calcium are associated with arterial calcification and mortality in dialysis patients. Unlike calcium-based binders, sevelamer attenuates arterial calcification but it is unknown whether sevelamer affects mortality or morbidity. In a multicenter, randomized, open-label, parallel design trial we compared sevelamer and calcium-based binders on all-cause and cause-specific mortality (Cardiovascular, Infection, and other) in prevalent hemodialysis patients. A total of 2103 patients were initially randomized to treatment and 1068 patients completed the study. All-cause mortality rates and cause-specific mortality rates were not significantly different. There was a significant age interaction on the treatment effect. Only in patients over 65 years of age was there a significant effect of sevelamer in lowering the mortality rate. There was a suggestion that sevelamer was associated with lower overall, but not Cardiovascular-linked, mortality in older patients. We suggest that further research is needed to confirm these findings.

Philippe Gaudard - One of the best experts on this subject based on the ideXlab platform.

  • Acute kidney injury during daptomycin versus vancomycin treatment in Cardiovascular critically ill patients: a propensity score matched analysis.
    BMC infectious diseases, 2019
    Co-Authors: Philippe Gaudard, Marine Saour, David Morquin, Hélène David, Jacob Eliet, Maxime Villiet, Jean-pierre Daures, Pascal Colson
    Abstract:

    Gram-positive organisms are a leading cause of Infection in Cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive Cardiovascular Infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. ICU patients who received either DAP or VAN, prior to or after Cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful Infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. Seventy two patients, treated for infective endocarditis, Cardiovascular foreign body Infection, or surgical site Infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39–15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for Cardiovascular procedure-related Infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.

  • Acute kidney injury during daptomycin versus vancomycin treatment in Cardiovascular critically ill patients: a propensity score matched analysis
    BMC Infectious Diseases, 2019
    Co-Authors: Philippe Gaudard, Marine Saour, David Morquin, Hélène David, Jacob Eliet, Maxime Villiet, Jean-pierre Daures, Pascal Colson
    Abstract:

    Background: Gram-positive organisms are a leading cause of Infection in Cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive Cardiovascular Infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. Methods: ICU patients who received either DAP or VAN, prior to or after Cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful Infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. Results: Seventy two patients, treated for infective endocarditis, Cardiovascular foreign body Infection, or surgical site Infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39–15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). Conclusions: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for Cardiovascular procedure-related Infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.

D Pursanova - One of the best experts on this subject based on the ideXlab platform.

  • Role of 18F-FDG PET/CT in diagnosis of Cardiovascular Infection in patients after cardiac surgery
    European Heart Journal, 2020
    Co-Authors: D Pursanova, I.p Aslanidis, O.v Mukhortova, I.v Shurupova, T.a Trifonova, T.a Katunina, R.m Muratov, S.y.u Serguladze, V.a Mironenko, V.s Arakelyan
    Abstract:

    Abstract Purpose To investigate the diagnostic performance of 18F-FDG PET/CT in patients with suspected prosthetic valve infective endocarditis (IE), prosthetic aortic and intracardiac device Infection. Methods The prospective analysis included results of PET/CT examinations performed in 60 patients with fever of unknown origin after cardiac surgery (median time 29 months): valve replacement (n=26), intracardiac device implantation (n=19), both procedures (n=8), Bentall-de-Bono surgery (n=7). According to the Duke criteria most patients – 90% (54/60) – had possible (n=42) and rejected (n=12) diagnosis of IE; 6 patients had definite IE. PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175–200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=41) data: confirmed in 40 and ruled out in 20 patients. Results PET/CT results correctly confirmed the infectious process in the prosthetic valve area, aortic prosthesis or along the intracardiac device in 93% (37/40) and ruled it out in 75% (15/20) patients. False results were obtained in 13% (8/60) – positive (n=5) and negative (n=3). Thus, in the analyzed group of patients (n=60), the sensitivity, specificity and diagnostic accuracy of PET/CT with 18F-FDG in the diagnosis of IE were 93%, 75% and 83%, respectively; positive and negative predictive value – 88% and 83%. In patients with possible IE according to the Duke criteria, true PET/CT results were obtained in 86% (36/42) – positive (n=28) and negative (n=8). In 7% (4/60) of patients – the diagnosis was based only on PET/CT, while initially, according to the Duke criteria, it was rejected. In addition, in 40% (24/60) of patients of the analyzed group, whole body PET/CT revealed other than valve and device, previously unknown foci of inflammation: in the lungs (n=6), in the sternum (n=6), in the area of the native valve (n=3), in the mediastinum (n=4), other (n=13). Conclusions 18F-FDG PET/CT proved to be highly informative for the diagnosis of infectious processes in the heart and vessels in patients after cardiac surgery. The inclusion of PET/CT in the diagnostic algorithm for this category of patients reduces the number of patients with possible IE according to the Duke criteria. Funding Acknowledgement Type of funding source: None