Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.

Background: Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances.

Diseases Transmitted by Birds.

Although many people these days actually work very hard at leisure time activities, diseases are most commonly acquired from birds during the course of work in the usual sense of the term, not leisure. However, travel for pleasure to areas where the diseases are highly endemic puts people at risk of acquiring some of these bird-related diseases (for example, histoplasmosis and arbovirus infections), as does ownership of birds as pets (psittacosis).

Community-acquired culture-negative endocarditis: clinical characteristics and risk factors for mortality.

Objectives: We studied the clinical characteristics, in-hospital mortality, and long-term prognosis of patients with culture-negative endocarditis.

Methods: In total, 221 episodes of definite endocarditis were studied (2004-2009). We compared the clinical, laboratory, and echocardiography characteristics and the survival rates of patients with culture-negative and culture-positive endocarditis.

Treatment of complicated urinary tract infections with an emphasis on drug-resistant gram-negative uropathogens.

Complicated urinary tract infection is a challenging infection, since cure is difficult and either persistence or recurrence is common. The challenge is frequently increased because complicated urinary tract infection is often caused by gram-negative bacilli resistant to multiple antimicrobial drugs. In this review, we approach the therapy of complicated urinary tract infection with an emphasis on those caused by antimicrobial drug-resistant gram-negative uropathogens.

Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association.

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus.

A summary of the update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.

Background: The purpose of this statement is to update the recommendations by the American Heart Association (AHA) for cardiovascular implantable electronic device (CIED) infections and their management, which were last published in 2003.

Methods And Results: The AHA commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections and highlight areas of needed research. The recommendations in this statement reflect analyses of relevant literature, to include recent advances in our understanding of the epidemiology, risk factors, microbiology, management and prevention of CIED infections.

Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.

Despite improvements in cardiovascular implantable electronic device (CIED) design, application of timely infection control practices, and administration of antibiotic prophylaxis at the time of device placement, CIED infections continue to occur and can be life-threatening. This has prompted the study of all aspects of CIED infections. Recognizing the recent advances in our understanding of the epidemiology, risk factors, microbiology, management, and prevention of CIED infections, the American Heart Association commissioned this scientific statement to educate clinicians about CIED infections, provide explicit recommendations for the care of patients with suspected or established CIED infections, and highlight areas of needed research.

Pharmacokinetics and pharmacodynamics of antibacterial agents.

This article reviews pharmacodynamics of antibacterial drugs, which can be used to optimize treatment strategies, prevent emergence of resistance and rationalize the determination of antimicrobial susceptibility. Important pharmacodynamic concepts include the requirements for bactericidal therapy for endocarditis and meningitis, for synergistic combinations to treat enterococcal endocarditis or to shorten the course of antimicrobial therapy, for obtaining maximal plasma concentration/minimal inhibitory concentration (MIC) ratios that are greater than 10 or 24 hour-area under the plasma concentration curve (AUC)/MIC ratios that are greater than 100-125 for concentration-dependent agents against gram-negative bacilli and 25-35 against Streptococcus pneumoniae, and for obtaining percent of time that drug levels are greater than the MIC that is at least 40% to 50% of the dosing interval for time-dependent agents.

Community-associated methicillin-resistant Staphylococcus aureus: reconsideration of therapeutic options.

Methicillin resistance, long recognized as characteristic of nosocomial Staphylococcus aureus, has increasingly been identified in community-acquired strains in the past 15 years. The genotypes of community-associated methicillin-resistant S. aureus (MRSA) are different from nosocomial strains, and unlike nosocomial strains, they have a distinctive methicillin-resistance chromosomal cassette (designated type IV), are usually susceptible to multiple classes of antimicrobials other than beta-lactams, carry a distinctive virulence factor (the Panton-Valentine leukocidin), cause mainly skin and soft tissue infection and less frequently, necrotizing pneumonia, and involve predominantly children and young adults.

Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

Background: Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.

Methods And Results: A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease.

Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association.

Background: Kawasaki disease is an acute self-limited vasculitis of childhood that is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. Coronary artery aneurysms or ectasia develop in approximately 15% to 25% of untreated children and may lead to ischemic heart disease or sudden death.

Methods And Results: A multidisciplinary committee of experts was convened to revise the American Heart Association recommendations for diagnosis, treatment, and long-term management of Kawasaki disease.

Pharmacodynamics of antimicrobial drugs.

Knowledge of the antimicrobial pharmacodynamic characteristics of a drug (inhibition of growth, rate and extent of bactericidal action, and postantibiotic effect) provides a more rational basis for determination of optimal dosing regimens in terms of the dose and the dosing interval. This article reviews concepts of antimicrobial pharmacodynamics, the effect of pharmacodynamics on the emergence of resistant bacterial subpopulations, and the development of pharmacodynamic breakpoints for use in the design of trials of these drugs and in treatment of infected patients.

Regional occurrence of plasmid-mediated SHV-7, an extended-spectrum beta-lactamase, in Enterobacter cloacae in Philadelphia Teaching Hospitals.

Although the production of extended-spectrum beta-lactamases (ESBLs) by Klebsiella pneumoniae and Escherichia coli is an emerging problem, limited data are available regarding the frequency of ESBL production in other organisms. We provide the only description of regional occurrence of SHV-7 in Enterobacteriaceae other than E. coli or K.