Phillipe Moreillon's research while affiliated with University of Lausanne and other places

IntroductionInfective endocarditis (IE) has undergone important changes in its epidemiology worldwide.Methods The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century.ResultsIE cases from 13 European countries were included. Two periods were considered: 2000–2006 and 2008–2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern–Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49–74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p < 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period.Conclusions Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).Graphical Abstract

Objectives: A recent study showed a poorer prognosis in left-sided MSSA endocarditis treated with cloxacillin when the vancomycin MIC was ≥1.5 mg/L. We aimed to validate these results using the International Collaboration on Endocarditis cohort and to analyze whether specific genetic characteristics were associated with a high vancomycin MIC (≥1.5 mg/L) phenotype. Methods: All patients with left-sided MSSA IE treated with anti-staphylococcal beta-lactam antibiotics between 2000 and 2006 with available isolates were included. Vancomycin MIC (VAN MIC) was determined by E-test as either high (≥1.5 mg/L) or low (<1.5 mg/L). Isolates underwent spa typing to infer clonal complexes (CC) and multiplex polymerase chain reaction for identifying virulence genes. Univariate analysis was performed to evaluate the association between in-hospital and one-year mortality and vancomycin MIC phenotype. Results: 62 cases met the inclusion criteria. VAN MIC was low in 28 cases (45%) and high in 34 cases (55%). No significant differences in patient demographic data or characteristics of infection were observed between patients with IE due to high and low VAN MIC isolates. Isolates with high and low VAN MIC had similar distributions of virulence genes and clonal lineages. In-hospital and one-year mortality did not differ significantly between the two groups (32% (9/28) vs. 27% (9/34), P=0.780; and 43% (12/28) vs. 29% (10/34), P=0.298, for low and high VAN MIC, respectively). Conclusion: In this international cohort of patients with left-sided MSSA endocarditis treated with anti-staphylococcal beta-lactams, vancomycin MIC phenotype was not associated with patient demographics, clinical outcome, or virulence gene repertoire.

Staphylococcus aureus is one of the most common causative pathogens of bloodstream infections (BSIs). In approximately one-half of patients with S. aureus BSI, no portal of entry can be documented. This group of patients has a high risk of developing septic metastases. Similarly, patient populations at high risk of S. aureus BSI and BSI-associated complications include patients receiving hemodialysis, injection drug users, patients with diabetes, and patients with preexisting cardiac conditions or other comorbidities. One of the most severe complications of S. aureus BSI is infective endocarditis, and S. aureus is now the most common cause of infective endocarditis in the developed world. Patients with methicillin-resistant S. aureus BSI or infective endocarditis have higher rates of mortality, compared with patients with methicillin-susceptible S. aureus infection. Nasal carriage is the most important source of S. aureus BSI. Better eradication and control strategies, including nasal decolonization and more-active antibiotics, are needed to combat S. aureus BSIs.