The Assessment of Antimicrobial Resistance in Gram-Negative and Gram-Positive Infective Endocarditis: A Multicentric Retrospective Analysis

Abstract

Background and Objectives: Multidrug-resistant microorganisms have made treating bacterial infections challenging. Resistance to antibiotics is expected to overcome efforts to produce new, effective antibacterial medication that is lifesaving in many situations. Infective endocarditis (IE) is a life-threatening infection that affects 5–15 per 100,000 patients annually and requires rapid antibiotic therapy to prevent morbidity and mortality. Materials and Methods: The present research assessed IE cases over five years, from a multicentric database, with the main objective of determining the degree of antibiotic resistance in these patients, stratified by Gram-positive and Gram-negative bacteria. Results: Bad oral hygiene was present in 58.6% of patients from the Gram-negative group (vs. 38.7% in the Gram-positive group). Non-valvular heart disease was identified in approximately 40% of all patients, and valvopathies in approximately 20%. It was observed that 37.9% of Gram-negative IE bacteria were resistant to three or more antibiotics, whereas 20.7% were susceptible. Among Gram-positive infections, S. aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics. Patients with Gram-negative IE were 4.2 times more likely to die. The mortality risk was 4 times higher when bacteria resistant to two or more antibiotics was involved and 5.7 times higher with resistance patterns to three or more antibiotics than the reference group with no antibiotic resistance. Peripheral catheters were the most common cause of multi-resistant IE, followed by heart surgery, dental procedures, and ENT interventions. Conclusions: Even though Gram-positive infections were the most frequent (83.0% of all cases), Gram-negative IE infections are substantially more deadly than Gram-positive IE infections. However, it was also observed that patients with Gram-negative infections were more likely to have underlying comorbidities, be institutionalized, and be underweight. Although the Gram-negative infections were more severe, their resistance patterns were similar to Gram-positive bacteria. As resistance patterns increase, more efforts should be made to prevent a healthcare catastrophe. At the same time, careful prophylaxis should be considered in patients at risk, including those with central catheters, undergoing dental procedures, and with poor oral hygiene.

Antibacterial Efficacy of Extraction of Salvia palaestina Bentham

“…The plates were then incubated at a temperature of 37 C for 18-24 hours for bacteria [16] . Finally, measurements were taken every two days, and the diameter of the inhibition zones was measured in millimeters (mm) using Caliber after an overnight incubation [17] .…”

Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

“…Consistent with the rapid increase in the burden of endocarditis, the frequency of antibiotic applications in endocarditis is also on the rising, leading to high levels of resistance to antibiotics are observed in global clinical practice [12]. A retrospective cohort study conducted in Romania from 2016 to 2021 with a multicentric database on endocarditis showed that among Gram-positive infections, Staphylococcus aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics [12]. However, to date there has been no comprehensive study covering all regions to estimate bacterial AMR in endocarditis, which is insu cient to understand the global burden of AMR and to identify and target the highest priority pathogens in different regions.…”

“…The burden has been increasing annually, and substantial heterogeneity between regions [10,11], with most notable increases observed in high-income regions [10]. Consistent with the rapid increase in the burden of endocarditis, the frequency of antibiotic applications in endocarditis is also on the rising, leading to high levels of resistance to antibiotics are observed in global clinical practice [12]. A retrospective cohort study conducted in Romania from 2016 to 2021 with a multicentric database on endocarditis showed that among Gram-positive infections, Staphylococcus aureus was the most commonly involved pathogen, with a multidrug-resistant pattern in 11.2% of patients, while Acinetobacter baumannii had the highest resistance pattern of all Gram-negative pathogens, with 27.4% of all samples resistant to three or more antibiotics [12].…”

Post-Severe-COVID-19 Cardiopulmonary Rehabilitation: A Comprehensive Study on Patient Features and Recovery Dynamics in Correlation with Workout Intensity

“…Numerous studies have documented the cardiopulmonary consequences of COVID-19 [ 11 , 12 , 13 ]. However, there is a relative shortage of research focusing on effective rehabilitation strategies.…”