ABSTRACT
BACKGROUND: Ceftobiprole is approved in Europe for treatment of community-acquired pneumonia and non-ventilator-associated hospital-acquired pneumonia (HAP) in adults. Real-world data are limited. METHODS: This multi-centre, observational, ambispective investigator-initiated study was undertaken in Italy from January 2018 to December 2019 in order to evaluate the use of ceftobiprole in a real-world setting. RESULTS: Overall, 195 patients from 10 centres were evaluated (68% retrospectively). Male sex was prevalent (n=121, 62%). Median age was 67 [interquartile range (IQR) 53-75] years. Median Charlson Comorbidity Index score was 5 (IQR 3-7). The most common indication was pneumonia (151/195, 77%), especially HAP. Other uses were skin and soft tissue infections (5%), endocarditis (4%) and bone infections (4%). Ceftobiprole was usually an empiric choice (65%), in combination with other drugs (66%) and as second-line therapy (58%). A causative agent was found in 39% of cases. A diagnosis of sepsis was made in 59 cases (30%). Success in the clinically evaluable population (excluding 12 cases due to isolation of pathogens outside ceftobiprole's spectrum of activity) was obtained in 79% of cases, with all-cause mortality of 20%. On multi-level analysis, three predictors were positively associated with clinical success: male gender, pneumonia and detection of causal agent. Sepsis was a negative predictor. Nine factors were independently associated, favourably or unfavourably, with fatal outcome. CONCLUSIONS: Ceftobiprole is a safe and effective therapeutic choice, even in a real-world setting. More data are needed to establish its efficacy in patients with sepsis.
Subject(s)
Cross Infection , Pneumonia , Sepsis , Adult , Humans , Male , Middle Aged , Aged , Anti-Bacterial Agents/therapeutic use , Retrospective Studies , Cross Infection/drug therapy , Cephalosporins/therapeutic use , Pneumonia/drug therapy , Italy , Sepsis/drug therapyABSTRACT
BACKGROUND: European Society of Cardiology 2015 guidelines approved 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) as a useful diagnostic imaging technique in prosthetic valve endocarditis (PVE) and recent evidence seems to suggest a role of nuclear imaging in the follow-up of cardiovascular infections, but nowadays there are no sufficient data available. CASE SUMMARY: A 67-year-old male presented with fever, weight loss, and fatigue. His medical history included ulcerative colitis and a previous Bentall-De Bono surgical procedure in 2014. A previous recent hospitalization to a small community hospital did not reveal a clear aetiology for the fever: transeosophageal echocardiography showed dubious peri-prosthetic tissue alterations, interpreted as post-surgical fibrosis; consequently, the patient was discharged with steroid therapy. At admission in our ward, we repeated transoesophageal echocardiography that confirmed the peri-prosthetic alterations. Moreover, 18F-FDG PET/CT showed two hypermetabolic areas, one around the prosthetic tube in the aortic bulb and the other in relation with the prosthetic aortic valve. Serological test was positive for Coxiella burnetii infection with consequent beginning of a targeted antimicrobial therapy with oral doxicycline and hydroxychloroquine. Echocardiography, serology, and 18F-FDG PET/CT follow-up demonstrated a progressive response to treatment and clinical conditions of the patient gradually improved. DISCUSSION: According to guidelines, 18F-FDG PET/CT can be used in ambiguous PVE to improve diagnostic accuracy of standard techniques. In this case, 18F-FDG PET/CT combined with echocardiography and serological tests is used not only to better define diagnosis but also for treatment response monitoring during follow-up.
