Tagged: biofilm diagnostic, chronic biofilm infection, chronic wound, diabetic foot infection guidelines, diabetic foot infection treatments, diabetic foot infections, diabetic foot wounds, idsa guideline
May 27, 2012 at 5:59 am #3174
HarrisonKeymaster2 ptsIt is sad that there is no mention of these facts and learnings in this “current” press release entitled, .
My two cents:
(1) Chronic bacterial infections — which usually include polymicrobial biofilms — prevent healing;
(2) Docs in the trenches know little about them, in terms of diagnostics and treatments (wait until “discharge” to diagnose?);
(3) The IDSA does not address them (biofilms or chronic bacterial infections) publicly;
(4) Lives and limbs are saved by docs that understand biofilm diagnostics and treatments.
Again, very sad for the MILLIONS OF PEOPLE afflicted that certain influential medical societies have a denial problem of biofilms in chronic infections.
Bottom line: this omission in the guidelines causes suffering, pain, limb loss, family hardships, more medicare and social security spending, drug dependencies…
June 12, 2012 at 4:59 am #3175
This is a sad release here for a few reasons. Actually, more than a few:
– No mention of the fact that most people are in HIGH RISK groups: they have prosthetics in their body (dental fillings or implants, artificial joints (spine, knee, hip) other hardware, which are host areas to receive microbial colonization. Or they may be receiving (or be in between) cancer treatments, or on medications causing drymouth (zerostomia) putting them at even higher risks because of poor oral health. Or they may already have an oral infection in their piehole — which is likely if you are an adult American! Good gosh. Should I go on?! OK….
– No details about the nature of diagnostics tests did they use PCR? Biofilm diagnostics? Blood? Tissue? Culture diagnostics will detect 3-5% of bacteria/fungal “infections.”
– Did they only track one bug family?
– Did they track and report on blood oxygenation or INR (PTT) changes over the course of follow-up? Many post-op (dental) procedures can lead to infections that are “sub-clinical” therefore avoiding guidelines which account for acute infections — not chronic infections.
– Did they mention that endocarditis often involve biofilms? Monomicrobial? Polymicobial biofilm infections? Often involve gram negative bacteria – that originate from the oral cavity?
– No mention of patients that have “vanilla” dental procedures, like cleaning, who experience acute and/or chronic infections in their joints in the days following the dental procedures? This is not the norm by any means, but it does happen throughout the U.S.
In my opinion, this kind of press release is irresponsible: it is both misleading and incomplete.
Most Don’t Need Antibiotics Before Dental Work
By Todd Neale, Senior Staff Writer, MedPage Today
Published: June 11, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
Recommendations restricting the use of antibiotic prophylaxis before invasive dental procedures to only a handful of patient groups did not appear to increase rates of infective endocarditis caused by viridans group streptococci, researchers found.
Among 22 patients diagnosed with the infection over a 12-year period in Olmsted County, Minn., only three received the diagnosis after the restrictions were issued, according to Daniel DeSimone, MD, of the Mayo Clinic in Rochester, Minn., and colleagues.
And the rate was actually lower after the updated guidance was published than it was just prior to publication, although the declining trend did not reach statistical significance (0.77 versus 3.19 per 100,000 person-years, =0.061 for trend), the researchers reported online in .
“Nevertheless, limitations of the study, including a small annual number of infective endocarditis cases, mandate continued evaluation of incidence trends over an extended period of time, both locally and elsewhere, before concerns regarding increasing incidence of viridans group streptococci infective endocarditis related to changes in guidelines recommendations can be addressed fully,” the authors wrote.
The American Heart Association first issued formal guidelines for the use of infective endocarditis prophylaxis in patients with specific cardiovascular conditions undergoing certain dental procedures in 1955.
In 2007, the organization updated the guidance to restrict the use of antibiotic prophylaxis to a small number of at-risk patients, including those with underlying cardiac conditions conferring the highest risk of a poor outcome from infective endocarditis. Prophylaxis was no longer recommended for invasive gastrointestinal or genitourinary procedures.
To see whether the new guidance was associated with an increase in infective endocarditis caused by viridans group streptococci, which has been linked to invasive dental procedures, the researchers examined data on all definite or probable cases identified in the Rochester Epidemiology Project of Olmsted County from 1999 through 2010.
Only 22 cases were identified, resulting in sex-adjusted rates of 3.19, 2.48, and 0.77 per 100,000 person-years for the first 4 years, second 4 years, and final 4 years of the study period, respectively.
Of the three cases identified after the revised guidance was released in 2007, two had not undergone any dental procedures within 6 months of admission. The third patient had a dental procedure 2 weeks before symptom onset and had taken clindamycin 30 minutes before the procedure.
Only two of the 22 total cases were considered healthcare-associated, and the rest were classified as community-acquired.
To look at broader trends, the researchers also examined data from the Nationwide Inpatient Sample for 1999 through 2009. The number of hospital discharges for infective endocarditis caused by viridans group streptococci remained relatively stable during the study period.
The researchers acknowledged that the study was limited by the small sample size, the relatively short amount of time between the guideline revision and the end of follow-up, the mostly white study population, and the limited data on compliance with the new recommendations.
The study was supported by research grants from the Baddour Family Fund, Mayo Foundation for Medical Education and Research.
DeSimone reported that he had no conflicts of interest. His co-authors reported relationships with TyRx, UpToDate, the Massachusetts Medical Society (Journal Watch Infectious Diseases), and the American College of Physicians (PIER [Physicians’ Information and Education Resource]).
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