warfarin and Staphylococcal-Infections

The aim of this study was to report our experience and review the published data on argatroban administration during adult cardiac surgery.. The information on all reported cases of argatroban use in adults, during cardiac surgery was reviewed, including that of the patient described here. This analysis focused on patient characteristics, type of surgery, argatroban dosing schedule, monitoring of anticoagulation and outcomes.. Twenty-one cases have been reported. Fifteen patients underwent off-pump surgical procedures with the argatroban dose adjusted to maintain an activated clotting time (ACT) range between 200 and 300 s. Three intraoperative thrombi occurred in two patients when the ACT was <280 s. None had coagulopathy. Six cases reported the use of argatroban during on-pump cardiac surgery dosed to keep the ACT >400 s. Intraoperative thrombotic complications were not reported in this group; however, one clot in the pump was noted after the procedure when the ACT was between 300 and 350 s. All six cases required larger volumes of perioperative blood products and three had severe coagulopathy. Of the 21 cases, seven had an indication for continued anticoagulation following surgery. Four cases did not report further use of argatroban after surgery. Three patients received argatroban after surgery without complications. Recommendations for how to use argatroban during cardiac surgery are proposed.. Argatroban, with ACT monitoring, might be safely used for anticoagulation during cardiac surgery.

Topics: Adult; Aged; Anticoagulants; Arginine; Cardiac Surgical Procedures; Coronary Artery Bypass; Coronary Artery Bypass, Off-Pump; Drug Monitoring; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Heparin; Humans; Intra-Aortic Balloon Pumping; Intraoperative Complications; Male; Middle Aged; Mitral Valve; Pipecolic Acids; Postoperative Complications; Retrospective Studies; Staphylococcal Infections; Subclavian Vein; Sulfonamides; Thrombosis; Venous Thrombosis; Warfarin; Whole Blood Coagulation Time

A new class of diphenylurea was identified as a novel antibacterial scaffold with an antibacterial spectrum that includes highly resistant staphylococcal isolates, namely methicillin- and vancomycin-resistant Staphylococcus aureus (MRSA & VRSA). Starting with a lead compound 3 that carries an aminoguanidine functionality from one side and a n-butyl moiety on the other ring, several analogues were prepared. Considering the pharmacokinetic parameters as a key factor in structural optimization, the structure-activity-relationships (SARs) at the lipophilic side chain were rigorously examined leading to the discovery of the cycloheptyloxyl analogue 21n as a potential drug-candidate. This compound has several notable advantages over vancomycin and linezolid including rapid killing kinetics against MRSA and the ability to target and reduce the burden of MRSA harboring inside immune cells (macrophages). Furthermore, the potent anti-MRSA activity of 21n was confirmed in vivo using a Caenorhabditis elegans animal model. The present study provides a foundation for further development of diphenylurea compounds as potential therapeutic agents to address the burgeoning challenge of bacterial resistance to antibiotics.

Topics: Animals; Anti-Bacterial Agents; Caenorhabditis elegans; Carbanilides; Drug Resistance, Bacterial; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Staphylococcus aureus; Vancomycin Resistance

Topics: Adult; Anticoagulants; Combined Modality Therapy; Female; Graft Occlusion, Vascular; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Mitral Valve Insufficiency; Prosthesis Failure; Prosthesis-Related Infections; Reoperation; Staphylococcal Infections; Tricuspid Valve; Warfarin

This article describes a case of a 26-year-old man presenting with left knee pain of 1 week's duration, fever, and acute onset of shortness of breath the day of admission. An arthrocentesis of the knee joint was grossly positive for methicillin-resistant Staphylococcus aureus. A left lower extremity venous duplex showed thrombosis of the superficial femoral, popliteal, posterior tibial, peroneal, and gastrocnemius veins. Pulmonary computed tomography-angiography was positive for acute pulmonary emboli. Initial management consisted of anticoagulation, intravenous antibiotics, and 2 arthroscopic irrigation and debridement procedures. After a normal transesophageal echocardiogram, a diagnosis of septic knee-induced deep venous thrombosis (DVT) of the left lower leg with subsequent septic pulmonary emboli was established. The patient was discharged to a long-term care facility for a 6-week monitored course of intravenous antibiotics. His DVT and pulmonary emboli were managed successfully with oral warfarin. Two months after his initial presentation, the patient returned with acute worsening knee pain. A knee arthrocentesis was unremarkable; however, radiographic imaging revealed fulminant osteomyelitis of the distal femur. He has since undergone open arthrotomy with excisional irrigation and debridement and is on a chronic oral antibiotic regimen. Sparse pediatric literature has shown an association between musculoskeletal sepsis and thrombosis. Only 1 case of septic knee-induced DVT exists in the adult literature, and it was not associated with pulmonary emboli. Our case provides evidence that DVT must be considered by the treating physician as a possible and devastating complication of septic arthritis.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Arthritis, Infectious; Debridement; Femur; Humans; Injections, Intravenous; Knee Joint; Male; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Staphylococcal Infections; Therapeutic Irrigation; Venous Thrombosis; Warfarin

We report a case of a 15-year-old boy who developed multiple organ failure secondary to a sport injury leading to infection with a Panton Valentine Leukocidin (PVL) secreting Community-Acquired Methicillin Sensitive Staphylococcus Aureus (CA MSSA). Aggressive antibiotic therapy eventually led to recovery.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Anticoagulants; Athletic Injuries; Bacterial Toxins; Community-Acquired Infections; Exotoxins; Floxacillin; Humans; Leukocidins; Male; Martial Arts; Methicillin Resistance; Multiple Organ Failure; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Warfarin

Infective endocarditis is an infection of the endocardium that usually involves the valves and adjacent structures. The classical fever of unknown origin presentation represents a minority of infective endocarditis. The presented case was a 21-yearold young lady presenting with acute renal failure and fever to the emergency room. Cardiac auscultation revealed a soft S1 and 4/6 apical holosystolic murmur extended to axilla. Echocardiography showed mobile fresh vegetation under the mitral posterior leaflet. She was diagnosed as having infective endocarditis. Hemodialysis was started with antimicrobial therapy. However, because of the presence of severe mitral regurgitation with left ventricle dilatation and large mobile vegetation, mitral prosthetic mechanical valve replacement was performed. Although treated with antibiotics combined with surgery, renal functions were deteriorated and progressed to chronic renal failure.

Topics: Acute Disease; Acute Kidney Injury; Adult; Anti-Infective Agents; Anticoagulants; Disease Progression; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Kidney Failure, Chronic; Renal Dialysis; Staphylococcal Infections; Staphylococcus aureus; Warfarin

The effect of warfarin treatment on an experimental Staphylococcus epidermidis endocarditis was studied. Warfarin was found to affect both the induction and course of the infection of catheter-induced endocardial vegetations. In warfarin-treated rabbits, larger bacterial inocula were needed to induce an infection, and the degree of infection of the vegetations was also significantly lower, eventually resulting in the total elimination of the bacteria from the vegetations. Thus, warfarin treatment seems to have an inhibitory effect on the induction and development of an S. epidermidis infection of the endocardium. The results differ from previous findings in studies done with Streptococcus anguis, where warfarin was found to have no effect on the induction or course of the infection of endocardial vegetations, which suggests that different mechanisms are involved in the pathogenesis of endocarditis caused by these two species of bacteria.

Topics: Animals; Endocarditis, Bacterial; Male; Rabbits; Sepsis; Staphylococcal Infections; Staphylococcus; Warfarin

Topics: Adult; Aged; Arthritis, Rheumatoid; Cloxacillin; Female; Hematoma; Hip; Hip Dislocation; Hip Joint; Humans; Joint Prosthesis; Male; Middle Aged; Ossification, Heterotopic; Osteoarthritis; Postoperative Complications; Pulmonary Embolism; Staphylococcal Infections; Streptomycin; Surgical Wound Infection; Thromboembolism; Warfarin