1
|
Ardeshna A, Gupta S, Rossouw PE, Valiathan M. Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2. Dent Clin North Am 2024; 68:707-724. [PMID: 39244252 DOI: 10.1016/j.cden.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.
Collapse
Affiliation(s)
- Anil Ardeshna
- Department of Orthodontics, Rutgers School of Dental Medicine, Newark, NJ, USA.
| | - Sumit Gupta
- Private Practice, Rak Dental Care & Implant Centre, Ras Al Khaimah, United Arab Emirates
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, University of Rochester, Eastman Institute for Oral Health
| | - Manish Valiathan
- Department of Orthodontics, Case Western Reserve University, 9601 Chester Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
2
|
Imazio M. The 2023 new European guidelines on infective endocarditis: main novelties and implications for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:718-726. [PMID: 38916201 PMCID: PMC11365601 DOI: 10.2459/jcm.0000000000001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/13/2024] [Accepted: 05/19/2024] [Indexed: 06/26/2024]
Abstract
The 2023 European Society of Cardiology (ESC) guidelines for the management of infective endocarditis update the previous 2015 guidelines with main novelties in five areas: (1) antibiotic prevention for high-risk patients, and prevention measures for intermediate-risk and high-risk patients; (2) diagnosis with emphasis on multimodality imaging to assess cardiac lesions of infective endocarditis' (3) antibiotic therapy allowing an outpatient antibiotic treatment for stabilized, uncomplicated cases; (4) cardiac surgery with an emphasis on early intervention without delay for complicated cases; and (5) shared management decision by the endocarditis team. Most evidence came from observational studies and expert opinions. The guidelines strongly support a patient-centred approach with a shared decision process by a multidisciplinary team that should be implemented either in tertiary referral centres, becoming heart valve centres, and referral centres. A continuous sharing of data is warranted in the hospitals' network between heart valve centres, which are used for referrals for complicated cases of infective endocarditis, and referral centres, which should be able to manage uncomplicated cases of infective endocarditis.
Collapse
Affiliation(s)
- Massimo Imazio
- Department of Medicine (DMED), University of Udine
- Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy
| |
Collapse
|
3
|
Quintero-Martinez JA, Hindy JR, Michelena HI, DeSimone DC, Baddour LM. Infective Endocarditis in Patients With Bicuspid Aortic Valves: Unique Clinical and Microbiologic Features. Heart Lung Circ 2024; 33:1484-1491. [PMID: 39153949 DOI: 10.1016/j.hlc.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE Patients with bicuspid aortic valves (BAV) are at increased risk of infective endocarditis (IE). Information of the clinical presentation and the microbiology of BAV-associated IE, however, is limited. Therefore, our study aimed to characterise the clinical features native valve endocarditis (NVE) in the setting of BAV and compared them to patients with prosthetic valve endocarditis (PVE) following BAV replacement. METHODS Adult patients with BAV or history of BAV with aortic valve replacement (AVR) and a definite or possible IE diagnosis within the Mayo Clinic Enterprise (USA) from January 2008 to December 2021, were included. BAV was confirmed by trans-oesophageal echocardiography. IE was defined according to the modified Duke criteria and only an initial episode was included. Statistical analyses were performed to compare clinical characteristics, microbiology, and IE complications. RESULTS Overall, 161 patients with BAV and IE (NVE [n=60], 37.3%) and PVE [n=101, 62.7%) were included. Mean age±SD was 56.5±16.1 years, and 139 (86.3%) patients were males. PVE patients were older (p<0.01) and had a higher rate of hypertension (p<0.01), chronic heart failure (p<0.01), chronic kidney disease (p<0.01), and perivalvular abscess (p<0.01). BAV patients with NVE had a higher prevalence of isolated mitral valve IE (p<0.01), moderate to severe aortic valve regurgitation (p<0.01) and combined aortic with mitral valve IE (p<0.01). Streptococcus mitis was the most common pathogen in NVE (30.0%) while Staphylococcus aureus was the most common in PVE (15.8%). CONCLUSIONS Patients with BAV are at risk of both NVE and PVE. Each syndrome has unique clinical features, including microbiologic findings, that should be appreciated in IE diagnosis and management.
Collapse
Affiliation(s)
- Juan A Quintero-Martinez
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Joya-Rita Hindy
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA
| | - Hector I Michelena
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Rochester, MN, USA; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| |
Collapse
|
4
|
Epprecht J, Ledergerber B, Frank M, Greutmann M, van Hemelrijck M, Ilcheva L, Padrutt M, Stadlinger B, Özcan M, Carrel T, Hasse B. Increase in Oral Streptococcal Endocarditis Among Moderate-Risk Patients: Impact of Guideline Changes on Endocarditis Prevention. JACC. ADVANCES 2024; 3:101266. [PMID: 39290812 PMCID: PMC11406034 DOI: 10.1016/j.jacadv.2024.101266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/20/2024] [Accepted: 08/06/2024] [Indexed: 09/19/2024]
Abstract
Background The well-established connection between oral bacteria and infective endocarditis (IE) has prompted discussions about using antibiotic prophylaxis (AP) before invasive dental procedures. In 2007/2008, guidelines restricted AP from moderate and high-risk to exclusively high-risk patients. Objectives The authors aimed to assess whether the proportion of oral streptococcal IE increased in moderate-risk patients using University Hospital Zurich data from 2000 to 2022. Methods Adult IE patients were categorized into risk groups based on European Society of Cardiology and Swiss guidelines. The investigation focused on analyzing the proportion of oral streptococcal IE across different risk groups in two distinct periods (1: 2000-2008; 2: 2009-2022). Logistic regression models, adjusted for various factors, were employed. Results Of 752 IE cases, 163 occurred in period 1, and 589 in period 2. Oral streptococci caused 22% of cases. Proportions of streptococcal IE in period 1 versus period 2 were 24% versus 16% in high-risk, 24% versus 39% in moderate-risk, 33% versus 7% in low-/unknown-risk, and 18% versus 14% in no-risk patients. Compared to the other risk groups, the moderate-risk group had a 22% higher chance of oral streptococcal IE in period 2. After multivariable adjustment, moderate-risk patients had twice the risk of oral streptococcal IE compared to period 1 (OR: 2.59 [95% CI: 1.16-5.81]). Among moderate-risk conditions, congenital valve anomalies were associated with oral streptococcal IE (unadjusted OR: 2.52 [95% CI: 1.71-3.71]). Conclusions Oral streptococcal IEs increased in the moderate-risk group of patients after the AP guideline change. Exploring the potential necessity for expanding AP indications to certain patient groups with congenital valve anomalies may be warranted.
Collapse
Affiliation(s)
- Jana Epprecht
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Maria Padrutt
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Masticatory Disorders and Dental Biomaterials, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Barbara Hasse
- Department of Infectious Disease and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Cusumano JA, Kalogeropoulos AP, Le Provost M, Gallo NR, Levine SM, Inzana T, Papamanoli A. The emerging challenge of Enterococcus faecalis endocarditis after transcatheter aortic valve implantation: time for innovative treatment approaches. Clin Microbiol Rev 2024:e0016823. [PMID: 39235238 DOI: 10.1128/cmr.00168-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
SUMMARYInfective endocarditis (IE) is a life-threatening infection that has nearly doubled in prevalence over the last two decades due to the increase in implantable cardiac devices. Transcatheter aortic valve implantation (TAVI) is currently one of the most common cardiac procedures. TAVI usage continues to exponentially rise, inevitability increasing TAVI-IE. Patients with TAVI are frequently nonsurgical candidates, and TAVI-IE 1-year mortality rates can be as high as 74% without valve or bacterial biofilm removal. Enterococcus faecalis, a historically less common IE pathogen, is the primary cause of TAVI-IE. Treatment options are limited due to enterococcal intrinsic resistance and biofilm formation. Novel approaches are warranted to tackle current therapeutic gaps. We describe the existing challenges in treating TAVI-IE and how available treatment discovery approaches can be combined with an in silico "Living Heart" model to create solutions for the future.
Collapse
Affiliation(s)
- Jaclyn A Cusumano
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York, USA
| | - Andreas P Kalogeropoulos
- Renaissance School of Medicine Division of Cardiology, Stony Brook University, Stony Brook, New York, USA
| | - Mathieu Le Provost
- School of Engineering, Computer Science and Artificial Intelligence, Long Island University, Brooklyn, New York, USA
| | - Nicolas R Gallo
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York, USA
- School of Engineering, Computer Science and Artificial Intelligence, Long Island University, Brooklyn, New York, USA
| | | | - Thomas Inzana
- College of Veterinary Medicine, Long Island University, Brooklyn, New York, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Stony Brook University Medical Center, Stony Brook, New York, USA
| |
Collapse
|
6
|
Nagiub M, Fares M, Ganigara M, Ullah S, Hsieh N, Jaquiss R, Dillenbeck J, Hussain T. Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective Endocarditis. Pediatr Cardiol 2024; 45:1267-1274. [PMID: 36534136 DOI: 10.1007/s00246-022-03069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnosis of infective endocarditis (IE) can be challenging due to negative blood cultures and diagnostic limitations of various imaging modalities. Transesophageal echocardiography (TEE) is the gold standard imaging modality for visualization of valvular vegetations. However, due to the anterior location of the pulmonary valve, post-surgical changes, and sedation requirement, TEE can be challenging in the pediatric population. The aim of this study was to assess the value of Cardiac CT (CCT) for diagnosis of IE in children and young adults with congenital heart disease (CHD). METHODS This is a single-center retrospective study of pediatric patients with CHD and diagnosis of IE who underwent CCT from 2018 to 2022. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic/CCT findings, and blood culture results. In addition, modified Duke criteria (MDC) for the diagnosis of IE were applied with and without CCT findings as the diagnostic imaging criterion. RESULTS Fourteen patients were included in this study with a median age of 11 years old. Nine patients were female. Ten patients had IE of the RV-PA conduit and four patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. After including CCT findings, 11 patients (79%) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings/pseudoaneurysms in 5 patients each and prosthetic valve perforation/prosthetic valve leak in one patient each. CONCLUSIONS This study reinforces the complimentary role of CCT to echocardiography in the work-up and diagnosis of IE in patients with CHD. With further improvement in lowering radiation exposure, CCT may have a key role in the diagnostic work-up of endocarditis and could be implemented in the diagnostic criteria of IE.
Collapse
Affiliation(s)
| | - Munes Fares
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sana Ullah
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
7
|
Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet 2024; 404:377-392. [PMID: 39067905 DOI: 10.1016/s0140-6736(24)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
First described more than 350 years ago, infective endocarditis represents a global health concern characterised by infections affecting the native or prosthetic heart valves, the mural endocardium, a septal defect, or an indwelling cardiac device. Over recent decades, shifts in causation and epidemiology have been observed. Echocardiography remains pivotal in the diagnosis of infective endocarditis, with alternative imaging modalities gaining significance. Multidisciplinary management requiring expertise of cardiologists, cardiovascular surgeons, infectious disease specialists, microbiologists, radiologists and neurologists, is imperative. Current recommendations for clinical management often rely on observational studies, given the limited number of well conducted randomised controlled trials studying infective endocarditis due to the rarity of the disease. In this Seminar, we provide a comprehensive overview of optimal clinical practices in infective endocarditis, highlighting key aspects of pathophysiology, pathogens, diagnosis, management, prevention, and multidisciplinary approaches, providing updates on recent research findings and addressing remaining controversies in diagnostic accuracy, prevention strategies, and optimal treatment.
Collapse
Affiliation(s)
- Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Aortic Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B K S Sastry
- Department of Cardiology, Renova Century Hospital, Hyderabad, Telangana, India
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|
8
|
Jesus A, Lopes M, Martins P, Pires A. A Case Report of Acute Infective Endocarditis Caused by Aggregatibacter aphrophilus Involving the Tricuspid Valve. Cureus 2024; 16:e64412. [PMID: 39130966 PMCID: PMC11317068 DOI: 10.7759/cureus.64412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
We report a case of a 16-year-old male with tricuspid valve infective endocarditis caused by Aggregatibacter aphrophilus and complicated by pulmonary septic embolisms. Multiple antimicrobial therapy was unsuccessful and surgical management was required. In this report, the authors highlight the importance of a high index of suspicion regarding the diagnosis of endocarditis and its possible complications.
Collapse
Affiliation(s)
- Ana Jesus
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
| | - Manuela Lopes
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
| | - Paula Martins
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
- Pediatric Cardiology, Faculdade de Medicina da Universidade de Coimbra, Coimbra, PRT
| | - António Pires
- Pediatric Cardiology, Unidade Local de Saúde de Coimbra, Hospital Pediátrico, Coimbra, PRT
- Pediatric Cardiology, Faculdade de Medicina da Universidade de Coimbra, Coimbra, PRT
| |
Collapse
|
9
|
Meena DS, Kumar D, Kumar B, Bohra GK, Midha N, Garg MK. Clinical characteristics and outcomes in pseudomonas endocarditis: a systematic review of individual cases : Systematic review of pseudomonas endocarditis. Infection 2024:10.1007/s15010-024-02311-z. [PMID: 38856808 DOI: 10.1007/s15010-024-02311-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND The landscape of Pseudomonas infective endocarditis (IE) is evolving with the widespread use of cardiac implantable devices and hospital-acquired infections. This systematic review aimed to evaluate the emerging risk factors and outcomes in Pseudomonas IE. METHODS A literature search was performed in major electronic databases (PubMed, Scopus, and Google Scholar) with appropriate keywords and combinations till November 2023. We recorded data for risk factors, diagnostic and treatment modalities. This study is registered with PROSPERO, CRD42023442807. RESULTS A total of 218 cases (131 articles) were included. Intravenous drug use (IDUs) and prosthetic valve endocarditis (PVE) were major risk factors for IE (37.6% and 22%). However, the prosthetic valve was the predominant risk factor in the last two decades (23.5%). Paravalvular complications (paravalvular leak, abscess, or pseudoaneurysm) were described in 40 cases (18%), and the vast majority belonged to the aortic valve (70%). The mean time from symptom onset to presentation was 14 days. The incidence of difficult-to-treat resistant (DTR) pseudomonas was 7.4%. Valve replacement was performed in 57.3% of cases. Combination antibiotics were used in most cases (77%), with the aminoglycosides-based combination being the most frequently used (66%). The overall mortality rate was 26.1%. The recurrence rate was 11.2%. Almost half of these patients were IDUs (47%), and most had aortic valve endocarditis (76%). CONCLUSIONS This review highlights the changing epidemiology of Pseudomonas endocarditis with the emergence of prosthetic valve infections. Acute presentation and associated high mortality are characteristic of Pseudomonas IE and require aggressive diagnostic and therapeutic approach.
Collapse
Affiliation(s)
- Durga Shankar Meena
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India.
| | - Deepak Kumar
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Bhuvanesh Kumar
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Gopal Krishana Bohra
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Naresh Midha
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| | - Mahendra Kumar Garg
- Division of Infectious Diseases, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, 342005, India
| |
Collapse
|
10
|
Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, O'Gara PT, Baddour LM. Endocarditis, invasive dental procedures, and antibiotic prophylaxis efficacy in US Medicaid patients. Oral Dis 2024; 30:1591-1605. [PMID: 37103475 DOI: 10.1111/odi.14585] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/27/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Antibiotic prophylaxis is recommended before invasive dental procedures to prevent endocarditis in those at high risk, but supporting data are sparse. We therefore investigated any association between invasive dental procedures and endocarditis, and any antibiotic prophylaxis effect on endocarditis incidence. SUBJECTS AND METHODS Cohort and case-crossover studies were performed on 1,678,190 Medicaid patients with linked medical, dental, and prescription data. RESULTS The cohort study identified increased endocarditis incidence within 30 days of invasive dental procedures in those at high risk, particularly after extractions (OR 14.17, 95% CI 5.40-52.11, p < 0.0001) or oral surgery (OR 29.98, 95% CI 9.62-119.34, p < 0.0001). Furthermore, antibiotic prophylaxis significantly reduced endocarditis incidence following invasive dental procedures (OR 0.20, 95% CI 0.06-0.53, p < 0.0001). Case-crossover analysis confirmed the association between invasive dental procedures and endocarditis in those at high risk, particularly following extractions (OR 3.74, 95% CI 2.65-5.27, p < 0.005) and oral surgery (OR 10.66, 95% CI 5.18-21.92, p < 0.0001). The number of invasive procedures, extractions, or surgical procedures needing antibiotic prophylaxis to prevent one endocarditis case was 244, 143 and 71, respectively. CONCLUSIONS Invasive dental procedures (particularly extractions and oral surgery) were significantly associated with endocarditis in high-risk individuals, but AP significantly reduced endocarditis incidence following these procedures, thereby supporting current guideline recommendations.
Collapse
Affiliation(s)
- Martin H Thornhill
- Unit of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
- Department Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | | | - Frank Yoon
- IBM Watson Health, Ann Arbor, Michigan, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, UK
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Peter B Lockhart
- Department Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
11
|
Amri M, Tamir EM, Drighil A, Habbal R. An infective endocarditis complicated by multiple septic emboli: case report. Egypt Heart J 2024; 76:19. [PMID: 38340179 DOI: 10.1186/s43044-024-00451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Owing to challenges associated with heart failure and cardiac embolism, infectious endocarditis emerges as a critical pathology characterized by elevated mortality and morbidity rates. Our case stands out as a rare instance of endocarditis involving multisystem embolization, with a successful outcome. CASE PRESENTATION We present the case of an 81-year-old man whose admission was further complicated by various septic emboli affecting the brain (manifesting as a brain abscess and ischemic stroke), spleen (resulting in splenic infarction), and spinal cord. The patient received a diagnosis of infective endocarditis affecting the native mitral valve. Following prompt medical and surgical intervention, the overall progression was favorable despite encountering several challenges. CONCLUSIONS This case is notable for its detailed description and analysis of the multiple embolic events. More importantly, it underscores the significance of timely surgical intervention and the collaborative approach of a heart team in the face of complicated endocarditis marked by numerous septic emboli. Despite the typically grim prognosis associated with such cases, the outcomes emphasize the positive impact of timely surgery on prognosis.
Collapse
Affiliation(s)
- Meriam Amri
- Cardiology Department, CHU Ibn Rochd, Casablanca, Morocco.
| | - El Mehdi Tamir
- Cardiology Department, CHU Ibn Rochd, Casablanca, Morocco
| | | | - Rachida Habbal
- Cardiology Department, CHU Ibn Rochd, Casablanca, Morocco
| |
Collapse
|
12
|
Kwan TN, Brieger D, Chow V, Ng ACT, Kwan G, Hyun K, Sy R, Kritharides L, Ng ACC. Healthcare exposures and associated risk of endocarditis after open-heart cardiac valve surgery. BMC Med 2024; 22:61. [PMID: 38331876 PMCID: PMC10854101 DOI: 10.1186/s12916-024-03279-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/31/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE). METHODS In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis. RESULTS In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002). CONCLUSIONS The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.
Collapse
Affiliation(s)
- Timothy N Kwan
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - David Brieger
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Vincent Chow
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Arnold Chin Tse Ng
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gemma Kwan
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Karice Hyun
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Raymond Sy
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Leonard Kritharides
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia
| | - Austin Chin Chwan Ng
- Department of Cardiology, Concord Hospital, The University of Sydney, 1 Hospital Road, Concord, NSW, 2139, Australia.
| |
Collapse
|
13
|
Edavaloth P, Gandham N, Mirza S. The Duke-International Society for Cardiovascular Infectious Diseases Infective Endocarditis Criteria 2023: Better, but Still Room for Modifications. J Glob Infect Dis 2024; 16:40-41. [PMID: 38680754 PMCID: PMC11045156 DOI: 10.4103/jgid.jgid_193_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 05/01/2024] Open
Affiliation(s)
- Preethy Edavaloth
- Department of Microbiology, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Nageswari Gandham
- Department of Microbiology, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| | - Shahzad Mirza
- Department of Microbiology, Dr. D. Y. Patil Medical College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
| |
Collapse
|
14
|
Grambow-Velilla J, Mahida B, Benali K, Deconinck L, Chong-Nguyen C, Cimadevilla C, Duval X, Iung B, Rouzet F, Hyafil F. Prognosis and follow-up of patients with prosthetic valve endocarditis treated conservatively in relation to WBC-SPECT imaging. J Nucl Cardiol 2023; 30:2633-2643. [PMID: 37430176 DOI: 10.1007/s12350-023-03335-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/08/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Our objective was to evaluate in patients with prosthetic valve endocarditis (PVE) treated conservatively, the prognostic value of white blood cell (WBC) signal intensity on SPECT and to describe the evolution of the WBC signal under antibiotics. METHODS Patients with PVE treated conservatively and positive WBC-SPECT imaging were identified retrospectively. Signal intensity was classified as intense if equal to or higher, or mild if lower, than the liver signal. Clinical, biological, imaging and follow-up information were collected from medical files. RESULTS Among 47 patients, WBC signal was classified as intense in 10 patients and as mild, in 37. The incidence of the primary composite endpoint (death, late cardiac surgery, or relapse) was significantly higher in patients with intense vs. mild signal (90% vs. 11%). Twenty-five patients underwent a second WBC-SPECT imaging during follow-up. The prevalence of WBC signal decreased progressively from 89% between 3 and 6 weeks to 42% between 6 and 9 weeks and 8% more than 9 weeks after initiation of antibiotics. CONCLUSIONS In patients with PVE treated conservatively, intense WBC signal was associated with poor outcome. WBC-SPECT imaging appears as an interesting tool for risk stratification and to monitor locally the efficacy of antibiotic treatment.
Collapse
Affiliation(s)
- Julia Grambow-Velilla
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France
| | - Besma Mahida
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Khadija Benali
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Laurene Deconinck
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Claire Cimadevilla
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Xavier Duval
- Department of Infectious Diseases, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Department of Cardiac Surgery, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
- Center for Clinical Investigation, AP-HP, Bichat University Hospital, University of Paris-CIté, 75018, Paris, France
| | - Bernard Iung
- Department of Cardiology, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, AP-HP, Bichat University Hospital, University of Paris-Cité, 75018, Paris, France
| | - Fabien Hyafil
- Department of Nuclear Medicine, AP-HP, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
- INSERM U970, European Hospital Georges-Pompidou, University of Paris-Cité, 75015, Paris, France.
| |
Collapse
|
15
|
Friedlander AH, Couto-Souza PH. Recent infective endocarditis research findings suggest dentists prescribe prophylactic antibiotics for patients having a bicuspid aortic valve or mitral valve prolapse. Med Oral Patol Oral Cir Bucal 2023; 28:e567-e571. [PMID: 37330961 PMCID: PMC10635622 DOI: 10.4317/medoral.25984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND The scientific validity of the European Society of Cardiology's (ESC) infective endocarditis (IE) guidelines limiting provision of prophylactic antibiotics (AP) only to patients having cardiac anomalies (e.g., prosthetic valves) believed to place them at "high risk" of adverse events when undergoing high risk dental procedures (HRDP) is unclear. MATERIAL AND METHODS A systematic review of studies conducted between 2017 and 2022 and catalogued in the PubMed database was undertaken to ascertain if this edict was associated with changes in IE incidence, development of infection in unprotected cardiac anomalies, developing infection and resultant adverse clinical outcomes. RESULTS Retrieved were 19 published manuscripts, however of these, 16 were excluded because they did not bare upon the issues of concern. Among the three studies eligible for review were those in the Netherlands, Spain, and England. The results of the Dutch study denoted a significant increase in the incidence of IE cases over the projected historical trend (rate ratio: 1327, 95% CI 1.205-1.462; p<0.001) after the introduction of the ESC guidelines. The findings from the Spanish study evidenced the uniquely high in-hospital IE associated fatality rates suffered by patients having bicuspid aortic valves (BAV); 5.6% or mitral valve prolapse (MVP); 10%. The British study provided evidence that the incidence of fatal IE infection was significantly greater among an "intermediate risk" cohort of patients, (a group likely including those with BAC and MVP for which the ESC guidelines don't recommend AP), than among "high risk" patients (P = 0.002). CONCLUSIONS Patients having either a BAV or MVP are at significant risk of developing IE and suffering serious sequelae including death. The ESC guidelines must reclassify these specific cardiac anomalies into the "high risk" category so that AP are recognized as being needed prior to provision of HRDP.
Collapse
Affiliation(s)
- A-H Friedlander
- Department of Dentistry, School of Medicine and Life Sciences Pontifícia Universidade Católica do Paraná Imaculada Conceição Street, 1155, Prado Velho, Curitiba Zip Code: 80215-901, Paraná, Brazil
| | | |
Collapse
|
16
|
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
17
|
Hirayama K, Kanda N, Hashimoto H, Yoshimoto H, Goda K, Mitsutake N, Hatakeyama S. The five-year trends in antibiotic prescription by dentists and antibiotic prophylaxis for tooth extraction: a region-wide claims study in Japan. J Infect Chemother 2023; 29:965-970. [PMID: 37343923 DOI: 10.1016/j.jiac.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Antimicrobial stewardship in dentistry and antibiotic prophylaxis for tooth extraction have been areas of concern in Japan, with limited research available. METHODS This cross-sectional study utilized the regional health insurance claims database in Japan to examine antibiotic prescription trends by dentists, including antibiotic regimens, timing of prescription, and days of supply for prophylactic antibiotic use during tooth extraction. Antibiotic prophylaxis for patients with prosthetic heart valves was also investigated. FINDINGS Antibiotic prescriptions by dentists decreased by 7% in 2019 compared to those in 2015, with third-generation cephalosporins still accounting for 48.5% in 2019. Amoxicillin prescription increased 3.9 times in 2019, although it only accounted for 8.4% of all antibiotic prescriptions. In 2019, amoxicillin was prescribed for 17.1% of all prophylactic antibiotics associated with tooth extraction, and 80% of prophylactic antibiotics were prescribed for 3 days or more, with 85% prescribed on the day of the procedure. However, only 60-70% of patients with prosthetic heart valves received antibiotic prophylaxis. INTERPRETATION Despite the increasing trend after the implementation of the National Action Plan on antimicrobial resistance, the proportion of amoxicillin prescriptions in dentistry remains low. Antimicrobial stewardship issues related to long-term prescription and timing of administration of prophylactic antibiotics for tooth extraction should be addressed. Dentists must recognize the risks associated with high-risk patients with prosthetic heart valves who require antibiotic prophylaxis, and physicians providing valve replacement therapy should inform patients of the requirement for prophylaxis before invasive dental procedures.
Collapse
Affiliation(s)
- Kaho Hirayama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Naoki Kanda
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan
| | - Hideki Hashimoto
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan; Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Kazuo Goda
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | | | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
| |
Collapse
|
18
|
Lockhart PB, Chu V, Zhao J, Gohs F, Thornhill MH, Pihlstrom B, Mougeot FB, Rose GA, Sun YP, Napenas J, Munz S, Farrehi PM, Sollecito T, Sankar V, O'Gara PT. Oral hygiene and infective endocarditis: a case control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:333-342. [PMID: 37085335 DOI: 10.1016/j.oooo.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine if oral hygiene is associated with infective endocarditis (IE) among those at moderate risk for IE. STUDY DESIGN This is a case control study of oral hygiene among hospitalized patients with IE (cases) and outpatients with heart valve disease but without IE (controls). The primary outcome was the mean dental calculus index. Secondary outcomes included other measures of oral hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization of blood culture bacterial species in case participants. RESULTS The 62 case participants had 53% greater mean dental calculus index than the 119 control participants (0.84, 0.55, respectively; difference = 0.29, 95% CI: 0.11, 0.48; P = .002) and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference = 0.18, 95% CI: 0.01.0.36; P = .043). Overall, cases reported fewer dentist and dental hygiene visits (P = .013) and fewer dental visits in the 12 weeks before enrollment than controls (P = .007). Common oral bacteria were identified from blood cultures in 27 of 62 cases (44%). CONCLUSIONS These data provide evidence to support and strengthen current American Heart Association guidance that those at risk for IE can reduce potential sources of IE-related bacteremia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures.
Collapse
Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA.
| | - Vivian Chu
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Jing Zhao
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Frank Gohs
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Martin H Thornhill
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA; Department of Oral and Maxillofacial Medicine, Oral Surgery and Oral Pathology, University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Bruce Pihlstrom
- Department of Developmental and Surgical Sciences, University of Minnesota, School of Dentistry, Minneapolis, MN, USA
| | - Farah Bahrani Mougeot
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, Microbiome Research Laboratory, Charlotte, NC, USA
| | | | - Yee-Ping Sun
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel Napenas
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA
| | - Stephanie Munz
- Department of Oral & Maxillofacial Surgery/Hospital Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Peter M Farrehi
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vidya Sankar
- Division of Oral Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic Sciences, Tufts University School of Dentistry, Boston, MA, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
19
|
Eerdekens GJ, Van Beersel D, Rex S, Gewillig M, Schrijvers A, Al Tmimi L. The patient with congenital heart disease in ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:421-436. [PMID: 37938087 DOI: 10.1016/j.bpa.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
The number of patients with congenital heart disease (CHD) undergoing ambulatory surgery is increasing. Deciding whether a CHD patient is suitable for an ambulatory procedure is still challenging. Several factors must be considered, including the type of planned procedure, the complexity of the underlying pathology, the American Society of Anesthesiologists' Physical Status classification of the patient, and other patient-specific factors, including comorbidity, chronic complications of CHD, medication, coagulation disorders, and issues related to the presence of a pacemaker (PM) or cardioverter-defibrillator. Numerous studies reported higher perioperative mortality and morbidity rates in surgical patients with CHD than non-CHD patients. However, most of these studies were conducted in a cohort of hospitalized patients and may not reflect the ambulatory setting. The current review aims to provide the anesthesiologist with an overview and practical recommendations on selecting and managing a CHD patient scheduled for an ambulatory procedure.
Collapse
Affiliation(s)
- Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Dieter Van Beersel
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - An Schrijvers
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.
| | - Layth Al Tmimi
- Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000, Leuven, Belgium.
| |
Collapse
|
20
|
Brida M, Balint HO, Bence A, Panfile E, Prokšelj K, Kačar P, Lebid IH, Šimkova I, Bobocka K, Meidrops K, Strenge A, Perčin L, Kapleriene L, Gumbiene L, Tomkiewicz-Pająk L, Komar M, Roos-Hesselink JW, Gatzoulis MA, Diller GP. Infective endocarditis in adults with congenital heart disease: Contemporary management and related outcomes in Central and South-Eastern European region. Int J Cardiol 2023; 377:45-50. [PMID: 36638916 DOI: 10.1016/j.ijcard.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/28/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Infective endocarditis (IE) remains major cause of morbidity and mortality in adult congenital heart disease (ACHD). Limited data exists on ACHD with IE in Central and South-Eastern European (CESEE) countries. The aim of this study is to characterize contemporary management and assess outcomes of ACHD with IE in CESEE region. METHODS Data on ACHD patients with IE from 9 tertiary centres in 9 different CESEE countries between 2015 and 2020 was included. Baseline demographics, clinical presentation, indication for surgery, outcomes, hospital and all-cause-1-year mortality were studied. RESULTS A total of 295 ACHD patients (mean age 40 ± 14 years) with IE were included. Median time from symptoms onset to establishing diagnosis was 25 (11-59) days. The majority of patients (203, 68.8%) received previous empiric oral antibiotic therapy. The highest incidence of IE was observed on native and left sided valves, 194(65.8%) and 204(69.2%), respectively. More than half had a vegetation size ≥10 mm (164, 55.6%); overall 138 (46.8%) had valve complications and 119 (40.3%) had heart failure. In-hospital mortality was 26 (8.8%). CONCLUSION There is clear delay in establishing IE diagnosis amongst ACHD patients in CESEE countries. Adequate diagnosis is hampered by common prescription of empiric antibiotics before establishing formal diagnosis. Hence, patients commonly present with associated complications requiring surgery. Hospital treatment and survival are, nevertheless, comparable to other Western European countries. Improved awareness and education of patients and medical profession regarding IE preventive measures, risks, signs, and symptoms are urgently needed. Empiric antibiotic prescription before blood cultures are taken must be omitted.
Collapse
Affiliation(s)
- Margarita Brida
- Department of Medical Rehabilitation, Medical Faculty, University of Rijeka, Croatia; Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK.
| | - Hajnalka Olga Balint
- Department of Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - András Bence
- Department of Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary; Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - Elena Panfile
- Republican Clinical Hospital, Cardiosurgery department Chisinau, Republic of Moldova
| | - Katja Prokšelj
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Polona Kačar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1000 Ljubljana, Slovenia
| | - Ihor H Lebid
- Ukrainian Children's Cardiac Center, Kyiv, Ukraine
| | - Iveta Šimkova
- ACHD Centre, Department of Cardiology and Angiology of Medical Faculty, Medical University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Katarina Bobocka
- ACHD Centre, Department of Cardiology and Angiology of Medical Faculty, Medical University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Kristians Meidrops
- Riga Stradins University, 16 Dzirciema Street, Riga LV-1007, Latvia; Pauls Stradins Clinical University Hospital, Centre of Cardiac Surgery, 13 Pilsonu Street, Riga LV-1002, Latvia
| | - Agnese Strenge
- Pauls Stradins Clinical University Hospital, Latvian Center of Cardiology, 13 Pilsonu Street, Riga LV-1002, Latvia
| | - Luka Perčin
- Department of Cardiovascular Medicine, University Hospital Centre Zagreb, Croatia
| | - Lina Kapleriene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lina Gumbiene
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Lidia Tomkiewicz-Pająk
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Monika Komar
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | | | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton & Harefield Hospitals, Guys & St Thomas's NHS Trust, London, UK
| | - Gerhard-Paul Diller
- Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
| | | |
Collapse
|
21
|
Filip C, Vasile CM, Nicolae G, Margarint I, Popa L, Bizubac M, Ganea G, Rusu M, Murzi B, Balgradean M, Cirstoveanu C. Gemella sanguinis Infective Endocarditis-Challenging Management of an 8-Year-Old with Duchenne Dystrophy and Undiagnosed Congenital Heart Disease: A Case Report. Antibiotics (Basel) 2023; 12:antibiotics12040706. [PMID: 37107068 PMCID: PMC10135002 DOI: 10.3390/antibiotics12040706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023] Open
Abstract
Congenital heart disease (CHD) remains a predisposing cardiac condition for infective endocarditis (IE). Case report: We present the case of 8-year-old boy with no known pre-existing cardiac disease diagnosed with infective endocarditis (IE) with Gemella sanguinis. After admission, he underwent transthoracic echocardiography (TTE), which revealed the presence of Shone syndrome with a bicuspid valve, mitral parachute valve and severe aortic coarctation. He developed a paravalvular aortic abscess with severe aortic regurgitation and left ventricle (LV) systolic dysfunction for which he required a complex surgical intervention after six weeks of antibiotic treatment, consisting of Ross operation and coarctectomy, with a complicated postoperative course, cardiac arrest and ECMO support for five days. The evolution was slow and favorable, with no significant residual valvular lesions. However, persistent LV systolic dysfunction and increased muscle enzymes required further investigation to establish a genetic diagnosis of Duchenne disease. As Gemella is not considered a frequent pathogen of IE, no current guidelines refer specifically to it. Additionally, the predisposing cardiac condition of our patient is not currently classified as "high-risk" for IE; this is not considered an indication for IE prophylaxis in the current guidelines. Conclusion: This case illustrates the importance of accurate bacteriological diagnosis in infective endocarditis and poses concerns regarding the necessity of IE prophylaxis in "moderate risk" cardiac conditions such as congenital valvular heart disease, especially aortic valve malformations.
Collapse
Affiliation(s)
- Cristina Filip
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Corina Maria Vasile
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Department of Pediatric and Adult Congenital Cardiology, University Hospital of Bordeaux, 33600 Bordeaux, France
| | - Georgiana Nicolae
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Irina Margarint
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiovascular Surgery, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Loredana Popa
- Department of Pediatric Nephrology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bizubac
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Gabriela Ganea
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mihaela Rusu
- Department of Pediatric Cardiology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
- Ph.D. School Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bruno Murzi
- Fondazione Toscana "Gabriele Monasterio", 56126 Pisa, Italy
| | - Mihaela Balgradean
- Department of Pediatrics, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Nephrology, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| | - Catalin Cirstoveanu
- Department of Neonatal Intensive Care, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Neonatal Intensive Care Unit, "M.S. Curie" Children's Clinical Hospital, 041451 Bucharest, Romania
| |
Collapse
|
22
|
Mohd Yunus SS, Nabil S, Rashdi MF, Nazimi AJ, Nordin R, Tan HL, Maskon O, Che Hassan HH, Khaithir TMN, Abdul Aziz AF, Ng YG, Ismail RY, Ramli R. Perception Regarding the NICE Guideline on Antibiotic Prophylaxis against Infective Endocarditis Following Dental Procedures: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:696. [PMID: 37107058 PMCID: PMC10135055 DOI: 10.3390/antibiotics12040696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
This study explores the opinions of Malaysian clinical specialists on the antibiotic prophylaxis against infective endocarditis (IE) as described in the 2008 National Institute for Health and Care Excellence (NICE) guideline. This cross-sectional study was performed from September 2017 to March 2019. The self-administered questionnaire comprised two sections: background information of the specialists and their opinions on the NICE guideline. The questionnaire was distributed to 794 potential participants, and 277 responded (response rate of 34.9%). In general, 49.8% of the respondents believed that clinicians should adhere to the guideline, although the majority of oral and maxillofacial surgeons (54.5%) actually disagreed with this view. The dental procedures that were perceived as presented moderate-to-high risk for IE were minor surgery for an impacted tooth with a recent episode of infection, dental implant surgery, periodontal surgery and dental extraction in patients with poor oral hygiene. The cardiac conditions that were strongly recommended for antibiotic prophylaxis were severe mitral valve stenosis or regurgitation and previous IE. Less than half of Malaysian clinical specialists agreed with the changes in the 2008 NICE guideline, contributing to their insistence that antibiotic prophylaxis is still needed for high-risk cardiac conditions and selected invasive dental procedures.
Collapse
Affiliation(s)
- Siti Salmiah Mohd Yunus
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Syed Nabil
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Muhd Fazlynizam Rashdi
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Abd Jabar Nazimi
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rifqah Nordin
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Huann Lan Tan
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Oteh Maskon
- Department of Medicine (Cardiology Unit), Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 56000, Malaysia
| | - Hamat H. Che Hassan
- Department of Medicine (Cardiology Unit), Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 56000, Malaysia
| | - Tzar Mohd Nizam Khaithir
- Department of Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 56000, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 56000, Malaysia
| | - Yee Guan Ng
- Department of Environmental Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Malaysia
| | - Ridwan Yeop Ismail
- Department of Oral & Maxillofacial Surgery, Hospital Tuanku Fauziah, Kangar 01000, Malaysia
| | - Roszalina Ramli
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur 50300, Malaysia
- Department of Oral & Maxillofacial Surgery, Hospital Canselor Tuanku Muhriz (HCTM), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| |
Collapse
|
23
|
Dayer MJ, Thornhill M, Baddour LM. Antibiotic prophylaxis for patients at risk of infective endocarditis: an increasing evidence base? THE BRITISH JOURNAL OF CARDIOLOGY 2023; 30:6. [PMID: 37705833 PMCID: PMC10495760 DOI: 10.5837/bjc.2023.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Around 100 years ago, the first link between infective endocarditis (IE) and dental procedures was hypothesised; shortly after, physicians began to use antibiotics in an effort to reduce the risk of developing IE. Whether invasive dental procedures are linked to the development of IE, and antibiotic prophylaxis (AP) is effective, have since remained topics of controversy. This controversy, in large part, has been due to the lack of prospective randomised clinical trial data. From this suboptimal position, guideline committees representing different societies and countries have struggled to reach an optimal position on whether AP use is needed for invasive dental procedures (or other procedures) and in whom. We present the findings from an investigation involving a large US patient database, published earlier this year, by Thornhill and colleagues. The work featured the use of both a cohort and case-crossover design and demonstrated there was a significant temporal association between invasive dental procedures and development of IE in high-IE-risk patients. Furthermore, the study showed that AP use was associated with a reduced risk of IE. Additional data, also published this year, from a separate study using nationwide hospital admissions data from England by Thornhill's group, showed that certain dental and non-dental procedures were significantly associated with the subsequent development of IE. Two other investigations have reported similar concerns for non-dental invasive procedures and risk of IE. Collectively, the results of this work support a re-evaluation of the current position taken by the National Institute for Health and Care Excellence (NICE) and other organisations that are responsible for publishing practice guidelines.
Collapse
Affiliation(s)
- Mark J Dayer
- Consultant Cardiologist Somerset NHS Foundation Trust, Musgrove Park Hospital, Musgrove Park, Taunton, Somerset, TA1 5DA
| | - Martin Thornhill
- Professor of Translational Research in Dentistry Unit of Oral & Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, 19 Claremont Crescent, Broomhall, Sheffield, S10 2TA
| | - Larry M Baddour
- Professor, Division of Public Health, Infectious Diseases, and Occupational Health Departments of Medicine and Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
24
|
Infective endocarditis in a cohort of adult CHD patients. Cardiol Young 2023; 33:190-195. [PMID: 35241206 DOI: 10.1017/s1047951122000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND CHD increases the risk of infective endocarditis due to the substrate of prosthetic materials and residual lesions. However, lesion-specific and mortality risks data are lacking. We sought to analyse clinical course and mortality of infective endocarditis in a cohort of adult CHD. METHODS Retrospective analysis of all cases of proven and probable infective endocarditis (Duke's criteria) followed in our adult CHD clinic between 1970 and August, 2021. Epidemiological, clinical and imaging data were analysed. Predictors of surgical treatment and mortality were assessed using regression analysis. RESULTS During a mean follow-up of 15.8 ± 10.9 years, 96 patients had 105 infective endocarditis episodes, half with previous cardiac surgery (corrective or palliative). The most frequent diagnoses were: ventricular septal defect, bicuspid aortic valve, Tetralogy of Fallot and pulmonary atresia. The site of infection was identified by echocardiography in 82 episodes (91%), most frequently in aortic (n = 27), tricuspid (n = 15), and mitral (n = 13) valves. Blood cultures were positive in 79% of cases, being streptococci (n = 29) and staphylococci (n = 23) the predominant pathogens. Surgery was necessary in 40% and the in-hospital mortality was 10.5%, associated with heart failure (p < 0.001; OR 13.5) and a non-surgical approach (p = 0.003; OR 5.06). CONCLUSIONS In an adult CHD cohort, infective endocarditis was more frequent in patients with ventricular septal defect and bicuspid aortic valves, which contradicts the current guidelines that excludes them from prophylaxis. Surgical treatment is often required and mortality remains substantial. Prevention of this serious complication should be one of the major tasks in the care of adults with CHD.
Collapse
|
25
|
Thornhill MH, Crum A, Campbell R, Stone T, Lee EC, Bradburn M, Fibisan V, Dayer M, Prendergast BD, Lockhart P, Baddour L, Nicoll J. Temporal association between invasive procedures and infective endocarditis. Heart 2023; 109:223-231. [PMID: 36137742 PMCID: PMC9872236 DOI: 10.1136/heartjnl-2022-321519] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/02/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Antibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis recommendations ceased in the mid-2000s for all but those at high IE risk undergoing invasive dental procedures. We aimed to quantify any association between IPs and IE. METHODS All 14 731 IE hospital admissions in England between April 2010 and March 2016 were identified from national admissions data, and medical records were searched for IP performed during the 15-month period before IE admission. We compared the incidence of IP during the 3 months immediately before IE admission (case period) with the incidence during the preceding 12 months (control period) to determine whether the odds of developing IE were increased in the 3 months after certain IP. RESULTS The odds of IE were increased following permanent pacemaker and defibrillator implantation (OR 1.54, 95% CI 1.27 to 1.85, p<0.001), extractions/surgical tooth removal (OR 2.14, 95% CI 1.22 to 3.76, p=0.047), upper (OR 1.58, 95% CI 1.34 to 1.85, p<0.001) and lower gastrointestinal endoscopy (OR 1.66, 95% CI 1.35 to 2.04, p<0.001) and bone marrow biopsy (OR 1.76, 95% CI 1.16 to 2.69, p=0.039). Using an alternative analysis, bronchoscopy (OR 1.33, 95% CI 1.06 to 1.68, p=0.049) and blood transfusions/red cell/plasma exchange (OR 1.2, 95% CI 1.07 to 1.35, p=0.012) were also associated with IE. CONCLUSIONS This study identifies a significant association between specific IPs (permanent pacemaker and defibrillator implantation, dental extraction, gastrointestinal endoscopy and bronchoscopy) and subsequent IE that warrants re-evaluation of current antibiotic prophylaxis recommendations to prevent IE in high IE risk individuals.
Collapse
Affiliation(s)
- Martin H Thornhill
- Department of Oral & Maxillofacial Medicine, Surgery and Pathology, The University of Sheffield School of Clinical Dentistry, Sheffield, UK .,Department of Oral Medicine/Oral & Maxillofacial Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Annabel Crum
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Richard Campbell
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Tony Stone
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Ellen C Lee
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Mike Bradburn
- CTRU, University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Veronica Fibisan
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| | - Mark Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, Somerset, UK
| | | | - Peter Lockhart
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Larry Baddour
- Departments of Medicine and Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jon Nicoll
- The University of Sheffield School of Health and Related Research, Sheffield, UK
| |
Collapse
|
26
|
Celestin B, Habensus EI, Tubiana S, Préau M, Millot S, Lescure FX, Kerneis C, Para M, Duval X, Iung B. Determinants of adherence to oral hygiene prophylaxis guidelines in patients with previous infective endocarditis. Arch Cardiovasc Dis 2023; 116:176-182. [PMID: 36797077 DOI: 10.1016/j.acvd.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/15/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by low incidence but high mortality. Patients with a history of IE are at highest risk. Adherence to prophylaxis recommendations is poor. We sought to identify determinants of adherence to oral hygiene guidelines on IE prophylaxis in patients with a history of IE. METHODS Using data from the cross-sectional, single-centre POST-IMAGE study, we analysed demographic, medical and psychosocial factors. We defined patients as adherent to prophylaxis if they declared going to the dentist at least annually and brushing their teeth at least twice a day. Depression, cognitive status and quality of life were assessed using validated scales. RESULTS Of 100 patients enrolled, 98 completed the self-questionnaires. Among these, 40 (40.8%) were categorized as adherent to prophylaxis guidelines, and were less likely to be smokers (5.1% vs. 25.0%; P=0.02) or have symptoms of depression (36.6% vs. 70.8%; P<0.01) or cognitive decline (0% vs. 15.5%; P=0.05). Conversely, they had higher rates of: valvular surgery since the index IE episode (17.5% vs. 3.4%; P=0.04), searching for information on IE (61.1% vs. 46.3%, P=0.05), and considering themselves as adherent to IE prophylaxis (58.3% vs. 32.1%; P=0.03). Tooth brushing, dental visits and antibiotic prophylaxis were correctly identified as measures to prevent IE recurrence in 87.7%, 90.8% and 92.8% of patients, respectively, and did not differ according to adherence to oral hygiene guidelines. CONCLUSIONS Self-reported adherence to secondary oral hygiene guidelines on IE prophylaxis is low. Adherence is unrelated to most patient characteristics, but to depression and cognitive impairment. Poor adherence appears related more to a lack of implementation rather than insufficient knowledge. Assessment of depression may be considered in patients with IE.
Collapse
Affiliation(s)
- Bettia Celestin
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; Université Paris-Cité, 75018 Paris, France
| | - Emila Ilic Habensus
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Sarah Tubiana
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Marie Préau
- Social Research Group (GRePS UR4163), Lumière Lyon 2 University, 69007 Lyon, France
| | - Sarah Millot
- Département de Médecine et Chirurgie Orale, Hospices Civils de Lyon, Université Lyon 1, 69002 Lyon, France
| | - François-Xavier Lescure
- Université Paris-Cité, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France; Infectious Disease Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Caroline Kerneis
- Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marylou Para
- Université Paris-Cité, 75018 Paris, France; Cardiac Surgery Department, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Xavier Duval
- Inserm 1425, Centre of Clinical Investigations, Bichat Hospital, AP-HP, 75018 Paris, France; UMR 1137 IAME, Université Paris-Cité, 75018 Paris, France
| | - Bernard Iung
- Université Paris-Cité, 75018 Paris, France; Cardiology Department, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | |
Collapse
|
27
|
Cimmino G, Bottino R, Formisano T, Orlandi M, Molinari D, Sperlongano S, Castaldo P, D’Elia S, Carbone A, Palladino A, Forte L, Coppolino F, Torella M, Coppola N. Current Views on Infective Endocarditis: Changing Epidemiology, Improving Diagnostic Tools and Centering the Patient for Up-to-Date Management. Life (Basel) 2023; 13:life13020377. [PMID: 36836734 PMCID: PMC9965398 DOI: 10.3390/life13020377] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Infective endocarditis (IE) is a rare but potentially life-threatening disease, sometimes with longstanding sequels among surviving patients. The population at high risk of IE is represented by patients with underlying structural heart disease and/or intravascular prosthetic material. Taking into account the increasing number of intravascular and intracardiac procedures associated with device implantation, the number of patients at risk is growing too. If bacteremia develops, infected vegetation on the native/prosthetic valve or any intracardiac/intravascular device may occur as the final result of invading microorganisms/host immune system interaction. In the case of IE suspicion, all efforts must be focused on the diagnosis as IE can spread to almost any organ in the body. Unfortunately, the diagnosis of IE might be difficult and require a combination of clinical examination, microbiological assessment and echocardiographic evaluation. There is a need of novel microbiological and imaging techniques, especially in cases of blood culture-negative. In the last few years, the management of IE has changed. A multidisciplinary care team, including experts in infectious diseases, cardiology and cardiac surgery, namely, the Endocarditis Team, is highly recommended by the current guidelines.
Collapse
Affiliation(s)
- Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: or ; Tel.: +39-0815664141
| | - Roberta Bottino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Tiziana Formisano
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Massimiliano Orlandi
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Daniele Molinari
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Simona Sperlongano
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Pasquale Castaldo
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Saverio D’Elia
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Andreina Carbone
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Alberto Palladino
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Lavinia Forte
- Cardiology Unit, Azienda Ospedaliera Universitaria Luigi Vanvitelli, 80138 Napoli, Italy
| | - Francesco Coppolino
- Department of Women, Child and General and Specialized Surgery, Section of Anaesthesiology, University of Campania Luigi Vanvitelli, Piazza Miraglia 2, 80138 Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, Section of Cardiac Surgery and Heart Transplant, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 81100 Caserta, Italy
| |
Collapse
|
28
|
Bergadà-Pijuan J, Frank M, Boroumand S, Hovaguimian F, Mestres CA, Bauernschmitt R, Carrel T, Stadlinger B, Ruschitzka F, Zinkernagel AS, Kouyos RD, Hasse B. Antibiotic prophylaxis before dental procedures to prevent infective endocarditis: a systematic review. Infection 2023; 51:47-59. [PMID: 35972680 PMCID: PMC9879842 DOI: 10.1007/s15010-022-01900-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE. METHODS We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol. RESULTS The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered. CONCLUSIONS Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.
Collapse
Affiliation(s)
- Judith Bergadà-Pijuan
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Boroumand
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frédérique Hovaguimian
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland ,Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Carlos A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Robert Bauernschmitt
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernd Stadlinger
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S. Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Roger D. Kouyos
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| |
Collapse
|
29
|
Carrillo SA, Duenas H, Blaney C, Eisner M, Nandi D, McConnell PI. Surgical outcomes of infective endocarditis in pediatrics: Moving the needle to a contemporary, multidisciplinary approach. J Thorac Cardiovasc Surg 2023; 165:275-284. [PMID: 35537892 DOI: 10.1016/j.jtcvs.2022.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is an uncommon disease in children that, when present, is accompanied by significant morbidity and mortality. The presence of congenital heart disease often complicates management. The aim of the present study is to describe the characteristics and outcomes of children undergoing surgery for IE. METHODS A retrospective chart review from 2004 to 2020 was conducted to identify consecutive patients younger than age 20 years with IE undergoing surgery. RESULTS A total of 94 patients with IE were identified, of whom 47 underwent surgery at a median age of 16.7 years. Thirty-one patients (65.95%) had congenital heart disease. Vegetation and embolic phenomena occurred in 41 and 29 patients (87.23% and 61.7%), respectively, with the brain as most common location (57.1%). Native valve involvement had a greater tendency to embolize (P < .001). Staphylococcus spp was the most common organism (49%). The mitral valve was the most affected (31.9%). Seven (14.9%) patients had multivalvar involvement and valve replacement was the most common procedure performed (37 patients; 78.7%). There were 3 operative deaths (6.4%). Median length of hospital stay was 21 days. Risk factors for prolonged hospital stay were time to surgery in days (P < .001) and native valvar involvement (P = .05). Five patients (10.6%) had postoperative recurrent IE. Survival at 1 and 5 years was 93.6% and 89.4%, respectively. CONCLUSIONS Children with IE can undergo surgery with acceptable results. The morbidity, but not mortality, is driven by embolic complications. Staphylococcus spp and native valve involvement are significant risk factors. VIDEO ABSTRACT.
Collapse
Affiliation(s)
- Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio.
| | - Helen Duenas
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio
| | - Cristin Blaney
- The Ohio State University, Columbus, Ohio; Division of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Mariah Eisner
- The Ohio State University, Columbus, Ohio; Biostatistics Resource, Nationwide Children's Hospital, Columbus, Ohio
| | - Deipanjan Nandi
- The Ohio State University, Columbus, Ohio; Division of Cardiology, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Patrick I McConnell
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio; The Ohio State University, Columbus, Ohio
| |
Collapse
|
30
|
Chen Y, Chen D, Liu H, Zhang CG, Song LL. Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report. World J Clin Cases 2022; 10:13418-13425. [PMID: 36683620 PMCID: PMC9850991 DOI: 10.12998/wjcc.v10.i36.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/21/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.
CASE SUMMARY We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.
CONCLUSION A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.
Collapse
Affiliation(s)
- Yu Chen
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Dian Chen
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Hao Liu
- Department of Pathology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Chen-Guang Zhang
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Lin-Lin Song
- Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| |
Collapse
|
31
|
Kim JY, Park SJ, Lee SH, Seo GH, Jang SW. Risk of infective endocarditis associated with invasive dental procedures in patients with cardiac rhythm devices. Europace 2022; 24:1967-1972. [PMID: 35696285 DOI: 10.1093/europace/euac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The incidence of infective endocarditis related to cardiac implantable electronic devices (CIEDs) has gradually increased. The risk associated with dental procedures in patients with CIED implantation and the need for prevention of infective endocarditis remain unclear. The present study investigated the incidence and risk of infective endocarditis associated with invasive dental procedures in patients with CIEDs. METHODS AND RESULTS We analysed a nationwide population-based cohort of patients with CIEDs who underwent dental procedures. We performed a self-controlled case series analysis and evaluated the incidence rate ratio of infective endocarditis 3 months after dental procedures. Of a total of 62 019 patients who underwent CIED implantation, 32 536 patients underwent at least one dental procedure during follow-up, and the mean number of dental procedures was 3.4 per patient. They were 152 infections with an incidence of 445 per 100 000 person-years in the dental procedure period and 500 events at an incidence of 255 per 100 000 person-years in the non-dental procedure period. The CIED-related infective endocarditis in the dental procedure period occurred significantly more frequently than during non-dental procedure periods (odds ratio, 1.75; 95% confidence interval, 1.48-2.05; P < 0.001). The mean time interval from dental procedure to infective endocarditis was 59.6 ± 47.3 days. CONCLUSION Invasive dental procedures are associated with an increased risk of infective endocarditis in those who underwent CIED implantation. Appropriate preventive therapy might be needed in these patients.
Collapse
Affiliation(s)
- Ju Youn Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hwa Lee
- Department of Dentistry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gi Hyeon Seo
- Health Insurance Review and Assessment Service, 60, Hyeoksin-ro, Wonju-si, Gangwon-do, Republic of Korea
| | - Sung-Won Jang
- Division of Cardiology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
32
|
Wang F, Zhou Z, Teng J, Sun Y, You Y, Su Y, Hu Q, Liu H, Cheng X, Shi H, Yang C, Ye J. The clinical pattern differentiates ANCA-positive infective endocarditis patients from ANCA-associated vasculitis patients: a 23 years' retrospective cohort study in China and follow-ups. Clin Rheumatol 2022; 41:3439-3449. [PMID: 35906495 PMCID: PMC9562078 DOI: 10.1007/s10067-022-06313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/26/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Patients with infective endocarditis (IE) may present rheumatic manifestations concurrent with various autoantibodies and thus mimic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). This study aims to characterize the specific features in a long-term cohort of ANCA-positive IE patients and to perform comparative analysis with primary AAV patients. METHODS We performed a retrospective thorough review of 475 consecutive IE patients over 23 years, identifying 22 patients positive for proteinase 3 and/or myeloperoxidase and 36 treatment-naïve AAV patients. The clinical, laboratory, and follow-up data were collected to perform comparative analysis. RESULTS Our study illustrated that ANCA-positive IE patients were younger and had a shorter duration than AAV patients. Pulmonary lesions, ENT signs, peripheral neuropath, and proteinuria were more commonly seen in AAV patients, while heart valve involvement, spleen enlargement, and cerebral hemorrhage were more typical for IE patients (all p < 0.05). Besides, ANCA-positive IE patients presented a higher level of PR3-ANCA but lower C3 (both p < 0.05). Hyperleukocytosis and thrombocytopenia were more frequently found in AAV patients (both p < 0.05). No significant difference was noticed in the survival rate. CONCLUSIONS Our study urges the early differential diagnosis of IE in ANCA-positive patients. It supports the claim that ANCA-positive IE patients and AAV patients do not share the same clinical spectrum. Echocardiography, serological profiles, and evaluation of multi-organ involvement might be required to improve diagnostic accuracy. Key Points •Early differential diagnosis of ANCA-positive IE from AAV is challenging even for expert rheumatologists. •Our study is so far one of the largest to include 22 ANCA-positive IE patients in one single center and spanning over 23 years. It is also the first study to include both ANCA-positive IE patients and AAV patients in one center. •Our study aides to identify a clinical picture to differentiate ANCA-Positive IE Patients from AAV Patients.
Collapse
Affiliation(s)
- Fan Wang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yijun You
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China.
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China.
| |
Collapse
|
33
|
Thornhill MH, Gibson TB, Yoon F, Dayer MJ, Prendergast BD, Lockhart PB, O'Gara PT, Baddour LM. Antibiotic Prophylaxis Against Infective Endocarditis Before Invasive Dental Procedures. J Am Coll Cardiol 2022; 80:1029-1041. [PMID: 35987887 DOI: 10.1016/j.jacc.2022.06.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) is recommended to prevent infective endocarditis (IE) in those at high IE risk, but there are sparse data supporting a link between IDPs and IE or AP efficacy in IE prevention. OBJECTIVES The purpose of this study was to investigate any association between IDPs and IE, and the effectiveness of AP in reducing this. METHODS We performed a case-crossover analysis and cohort study of the association between IDPs and IE, and AP efficacy, in 7,951,972 U.S. subjects with employer-provided Commercial/Medicare-Supplemental coverage. RESULTS Time course studies showed that IE was most likely to occur within 4 weeks of an IDP. For those at high IE risk, case-crossover analysis demonstrated a significant temporal association between IE and IDPs in the preceding 4 weeks (OR: 2.00; 95% CI: 1.59-2.52; P = 0.002). This relationship was strongest for dental extractions (OR: 11.08; 95% CI: 7.34-16.74; P < 0.0001) and oral-surgical procedures (OR: 50.77; 95% CI: 20.79-123.98; P < 0.0001). AP was associated with a significant reduction in IE incidence following IDP (OR: 0.49; 95% CI: 0.29-0.85; P = 0.01). The cohort study confirmed the associations between IE and extractions or oral surgical procedures in those at high IE risk and the effect of AP in reducing these associations (extractions: OR: 0.13; 95% CI: 0.03-0.34; P < 0.0001; oral surgical procedures: OR: 0.09; 95% CI: 0.01-0.35; P = 0.002). CONCLUSIONS We demonstrated a significant temporal association between IDPs (particularly extractions and oral-surgical procedures) and subsequent IE in high-IE-risk individuals, and a significant association between AP use and reduced IE incidence following these procedures. These data support the American Heart Association, and other, recommendations that those at high IE risk should receive AP before IDP.
Collapse
Affiliation(s)
- Martin H Thornhill
- Unit of Oral and Maxillofacial Medicine Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom; Department of Oral Medicine, Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA.
| | | | - Frank Yoon
- IBM Watson Health, Ann Arbor, Michigan, USA
| | - Mark J Dayer
- Department of Cardiology, Somerset Foundation Trust, Taunton, Somerset, United Kingdom
| | | | - Peter B Lockhart
- Department of Oral Medicine, Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| |
Collapse
|
34
|
Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
| | | |
Collapse
|
35
|
Cheng X, Meng J, Chen Y, Zhang F. Analysis of Clinical Features and Outcomes of Infective Endocarditis with Very Large Vegetations: A Retrospective Observational Study from 2016 to 2022. Rev Cardiovasc Med 2022; 23:264. [PMID: 39076637 PMCID: PMC11266946 DOI: 10.31083/j.rcm2308264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 07/31/2024] Open
Abstract
Background Cases of infective endocarditis (IE) with > 30 mm vegetations are rare and are associated with high mortality. Clinical experience, clear therapeutic standards, and outcome evidence about these cases are still lacking. Methods Detailed clinical data from patients suffering from IE complicated with > 30 mm vegetations were collected from a hospital medical record system. Age- and sex-matched IE cases with 10-20 mm vegetations were used as a control group. Results Twenty-two patients with > 30 mm IE vegetations confirmed by biopsy and transthoracic echocardiography (TTE) were included. Thirteen (59.0%) patients had basic cardiac diseases, mainly congenital heart disease (CHD), rheumatic heart disease, and device-related issues. Fever (81.8%), heart murmur (86.4%), heart failure (86.4%), and embolism (50.0%) were common clinical manifestations and complications. TTE showed the diameter of vegetations was 34.5 (30.0-39.8) mm. The vegetations were usually accompanied by severe valvular regurgitation and pulmonary hypertension, and were most often located in the mitral valve (38.4%). Laboratory examinations indicated anemia, hypoalbuminemia, heart failure and inflammation. The rate of positive blood culture was 68.2%. Streptococcus viridans was the most frequent pathogen (26.7%). All individuals underwent vegetectomy and valve replacement or repair surgery, within 2 days of diagnosis. Compared with 10-20 mm vegetations group, > 30 mm vegetations group had more complicated basic cardiac diseases, more special microbial infection, higher levels of procalcitonin (PCT) and D-dimer, more common heart failure and embolism. They received more biological valve replacements, and had longer intensive care unit length of stay (ICU-LOS). A few patients developed significant postoperative adverse events, including intracerebral hemorrhage (ICH), septic shock, and new symptomatic thrombosis. Re-exploratory thoracotomy was performed in two cases. All patients survived during 6-month follow-up without IE recurrence in > 30 mm vegetations group, while there was one death and one recurrence in the 10-20 mm vegetations group. Conclusions For IE complicated with > 30 mm vegetations, clinical characteristics are diverse and vegetations on TTE are prone to misdiagnosis as thrombus or tumors. This article also emphasizes the use of > 30 mm IE vegetations as an independent indication for early surgery to improve prognosis.
Collapse
Affiliation(s)
- Xiaoyun Cheng
- Department of Pulmonary and Critical Care Medicine, Xiangya Hospital of Central South University, 410000 Changsha, Hunan, China
- Hunan Key Laboratory of Organ Fibrosis, 410000 Changsha, Hunan, China
| | - Jie Meng
- Hunan Key Laboratory of Organ Fibrosis, 410000 Changsha, Hunan, China
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, 410000 Changsha, Hunan, China
| | - Yanqiu Chen
- Department of Anesthesiology, Xiangya Hospital of Central South University, 410000 Changsha, Hunan, China
| | - Fan Zhang
- Department of Anesthesiology, Xiangya Hospital of Central South University, 410000 Changsha, Hunan, China
| |
Collapse
|
36
|
Niazi SA, Bakhsh A. Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:931. [PMID: 35888650 PMCID: PMC9319780 DOI: 10.3390/medicina58070931] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023]
Abstract
The 'Focal Infection Era in Dentistry' in the late 19th and early 20th century resulted in widespread implementation of tooth extraction and limited the progress of endodontics. The theory proposed that bacteria and toxins entrapped in dentinal tubules could disseminate systemically to remote body parts, resulting in many types of degenerative systemic diseases. This theory was eventually refuted due to anecdotal evidence. However, lately there has been increased interest in investigating whether endodontic disease could have an impact on general health. There are reviews that have previously been carried out on this subject, but as new data have emerged since then, this review aims to appraise the available literature investigating the dynamic associations between apical periodontitis, endodontic treatment, and systemic health. The available evidence regarding focal infection theory, bacteraemia and inflammatory markers was appraised. The review also collated the available research arguing the associations of apical periodontitis with cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome and autoimmune disorders, along with the effect of statins and immunomodulators on apical periodontitis prevalence and endodontic treatment prognosis. There is emerging evidence that bacteraemia and low-grade systemic inflammation associated with apical periodontitis may negatively impact systemic health, e.g., development of cardiovascular diseases, adverse pregnancy outcomes, and diabetic metabolic dyscontrol. However, there is limited information supporting the effect of diabetes mellitus or autoimmune disorders on the prevalence and prognosis post endodontic treatment. Furthermore, convincing evidence supports that successful root canal treatment has a beneficial impact on systemic health by reducing the inflammatory burden, thereby dismissing the misconceptions of focal infection theory. Although compelling evidence regarding the association between apical periodontitis and systemic health is present, further high-quality research is required to support and establish the benefits of endodontic treatment on systemic health.
Collapse
Affiliation(s)
- Sadia Ambreen Niazi
- Department of Endodontics, Centre of Oral Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, Guy’s Dental Hospital, King’s College London, London SE1 9RT, UK
| | - Abdulaziz Bakhsh
- Department of Restorative Dentistry, Faculty of Dentistry, Umm Al-Qura University, Makkah 24381, Saudi Arabia;
| |
Collapse
|
37
|
Thornhill MH, Crum A, Rex S, Campbell R, Stone T, Bradburn M, Fibisan V, Dayer MJ, Prendergast BD, Lockhart PB, Baddour LM, Nicholl J. Infective endocarditis following invasive dental procedures: IDEA case-crossover study. Health Technol Assess 2022; 26:1-86. [PMID: 35642966 DOI: 10.3310/nezw6709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infective endocarditis is a heart infection with a first-year mortality rate of ≈ 30%. It has long been thought that infective endocarditis is causally associated with bloodstream seeding with oral bacteria in ≈ 40-45% of cases. This theorem led guideline committees to recommend that individuals at increased risk of infective endocarditis should receive antibiotic prophylaxis before undergoing invasive dental procedures. However, to the best of our knowledge, there has never been a clinical trial to prove the efficacy of antibiotic prophylaxis and there is no good-quality evidence to link invasive dental procedures with infective endocarditis. Many contend that oral bacteria-related infective endocarditis is more likely to result from daily activities (e.g. tooth brushing, flossing and chewing), particularly in those with poor oral hygiene. OBJECTIVE The aim of this study was to determine if there is a temporal association between invasive dental procedures and subsequent infective endocarditis, particularly in those at high risk of infective endocarditis. DESIGN This was a self-controlled, case-crossover design study comparing the number of invasive dental procedures in the 3 months immediately before an infective endocarditis-related hospital admission with that in the preceding 12-month control period. SETTING The study took place in the English NHS. PARTICIPANTS All individuals admitted to hospital with infective endocarditis between 1 April 2010 and 31 March 2016 were eligible to participate. INTERVENTIONS This was an observational study; therefore, there was no intervention. MAIN OUTCOME MEASURE The outcome measure was the number of invasive and non-invasive dental procedures in the months before infective endocarditis-related hospital admission. DATA SOURCES NHS Digital provided infective endocarditis-related hospital admissions data and dental procedure data were obtained from the NHS Business Services Authority. RESULTS The incidence rate of invasive dental procedures decreased in the 3 months before infective endocarditis-related hospital admission (incidence rate ratio 1.34, 95% confidence interval 1.13 to 1.58). Further analysis showed that this was due to loss of dental procedure data in the 2-3 weeks before any infective endocarditis-related hospital admission. LIMITATIONS We found that urgent hospital admissions were a common cause of incomplete courses of dental treatment and, because there is no requirement to record dental procedure data for incomplete courses, this resulted in a significant loss of dental procedure data in the 2-3 weeks before infective endocarditis-related hospital admissions. The data set was also reduced because of the NHS Business Services Authority's 10-year data destruction policy, reducing the power of the study. The main consequence was a loss of dental procedure data in the critical 3-month case period of the case-crossover analysis (immediately before infective endocarditis-related hospital admission), which did not occur in earlier control periods. Part of the decline in the rate of invasive dental procedures may also be the result of the onset of illness prior to infective endocarditis-related hospital admission, and part may be due to other undefined causes. CONCLUSIONS The loss of dental procedure data in the critical case period immediately before infective endocarditis-related hospital admission makes interpretation of the data difficult and raises uncertainty over any conclusions that can be drawn from this study. FUTURE WORK We suggest repeating this study elsewhere using data that are unafflicted by loss of dental procedure data in the critical case period. TRIAL REGISTRATION This trial is registered as ISRCTN11684416. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 28. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Martin H Thornhill
- Academic Unit of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Department of Oral Medicine, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | - Annabel Crum
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Saleema Rex
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tony Stone
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Veronica Fibisan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mark J Dayer
- Department of Cardiology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - Peter B Lockhart
- Department of Oral Medicine, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
38
|
Citro R, Chan KL, Miglioranza MH, Laroche C, Benvenga RM, Furnaz S, Magne J, Olmos C, Paelinck BP, Pasquet A, Piper C, Salsano A, Savouré A, Park SW, Szymański P, Tattevin P, Vallejo Camazon N, Lancellotti P, Habib G. Clinical profile and outcome of recurrent infective endocarditis. Heart 2022; 108:1729-1736. [PMID: 35641178 DOI: 10.1136/heartjnl-2021-320652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/03/2022] [Indexed: 11/04/2022] Open
Abstract
AIMS Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). METHODS Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. RESULTS 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. CONCLUSIONS In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.
Collapse
Affiliation(s)
- Rodolfo Citro
- Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Campania, Italy .,IRCCS Neurological Institute of Southern Italy Neuromed, Pozzilli, Molise, Italy
| | - Kwan-Leung Chan
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Marcelo Haertel Miglioranza
- Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil.,Mae de Deus Hospital, Porto Alegre, Brazil.,Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cécile Laroche
- EurObservational Research Progamme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Rossella Maria Benvenga
- Cardiothoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Campania, Italy
| | - Shumaila Furnaz
- Department of Research, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Julien Magne
- Department of Cardiology, University Hospital Centre of Limoges, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculté de Médecine de Limoges, Limoges, France
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Bernard P Paelinck
- Cardiac Surgery Department, Antwerp University Hospital, Edegem, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc Pôle de Recherche Cardiovasculaire (CARD) Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain, Brussels, Belgium
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, DISC Department, Genoa, Italy
| | - Arnaud Savouré
- Cardiology Department, University Hospital of Rouen, Rouen, France
| | - Seung Woo Park
- Heart Stroke Vascular Institute, Sungkyunkwan University School of Medicine, Samsung Medical Center, Gangnam-Gu, Seoul, The Republic of Korea
| | - Piotr Szymański
- Noninvasive Cardiovascular Diagnostic Department, Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, Poland and Center for Postgraduate Medical Education, Warsaw, Poland
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Nuria Vallejo Camazon
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Patrizio Lancellotti
- Department of Cardiology and Cardiovascular Surgery, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy.,Anthea Hospital, Bari, Italy
| | - Gilbert Habib
- Service de Cardiologie, Insuffisance Cardiaque et Valvulopathie, Hôpital de la Timone, Marseille, France
| | | |
Collapse
|
39
|
Sebastian SA, Co EL, Mehendale M, Sudan S, Manchanda K, Khan S. Challenges and Updates in the Diagnosis and Treatment of Infective Endocarditis. Curr Probl Cardiol 2022; 47:101267. [DOI: 10.1016/j.cpcardiol.2022.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
|
40
|
Sousa C, Pinto FJ. Infective Endocarditis: Still More Challenges Than Convictions. Arq Bras Cardiol 2022; 118:976-988. [PMID: 35613200 PMCID: PMC9368884 DOI: 10.36660/abc.20200798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
After fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.
Collapse
Affiliation(s)
- Catarina Sousa
- Centro Cardiovascular Universidade de LisboaFaculdade de MedicinaUniversidade de LisboaLisboaPortugalCentro Cardiovascular Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa – Portugal
- Serviço de CardiologiaCentro Hospitalar Barreiro MontijoBarreiroPortugalServiço de Cardiologia, Centro Hospitalar Barreiro Montijo (CHBM), Barreiro – Portugal
| | - Fausto J. Pinto
- Centro Cardiovascular Universidade de LisboaFaculdade de MedicinaUniversidade de LisboaLisboaPortugalCentro Cardiovascular Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Lisboa – Portugal
- Departamento Coração e VasosCentro Hospitalar e Universitário Lisboa NorteLisboaPortugalDepartamento Coração e Vasos, Centro Hospitalar e Universitário Lisboa Norte (CHULN), Lisboa – Portugal
| |
Collapse
|
41
|
Bianchini S, Nicoletti L, Monaco S, Rigotti E, Corbelli A, Colombari A, Auriti C, Caminiti C, Conti G, De Luca M, Donà D, Galli L, Garazzino S, Inserra A, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Piacentini G, Pietrasanta C, Principi N, Puntoni M, Simonini A, Tesoro S, Venturini E, Staiano A, Caramelli F, Gargiulo GD, Esposito S. Peri-Operative Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Cardiac and Thoracic Surgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:554. [PMID: 35625198 PMCID: PMC9137830 DOI: 10.3390/antibiotics11050554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023] Open
Abstract
Surgical site infections (SSIs) represent a potential complication of surgical procedures, with a significant impact on mortality, morbidity, and healthcare costs. Patients undergoing cardiac surgery and thoracic surgery are often considered patients at high risk of developing SSIs. This consensus document aims to provide information on the management of peri-operative antibiotic prophylaxis for the pediatric and neonatal population undergoing cardiac and non-cardiac thoracic surgery. The following scenarios were considered: (1) cardiac surgery for the correction of congenital heart disease and/or valve surgery; (2) cardiac catheterization without the placement of prosthetic material; (3) cardiac catheterization with the placement of prosthetic material; (4) implantable cardiac defibrillator or epicardial pacemaker placement; (5) patients undergoing ExtraCorporal Membrane Oxygenation; (6) cardiac tumors and heart transplantation; (7) non-cardiac thoracic surgery with thoracotomy; (8) non-cardiac thoracic surgery using video-assisted thoracoscopy; (9) elective chest drain placement in the pediatric patient; (10) elective chest drain placement in the newborn; (11) thoracic drain placement in the trauma setting. This consensus provides clear and shared indications, representing the most complete and up-to-date collection of practice recommendations in pediatric cardiac and thoracic surgery, in order to guide physicians in the management of the patient, standardizing approaches and avoiding the abuse and misuse of antibiotics.
Collapse
Affiliation(s)
- Sonia Bianchini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Laura Nicoletti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Sara Monaco
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | - Erika Rigotti
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (A.C.); (A.C.); (G.P.)
| | - Agnese Corbelli
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (A.C.); (A.C.); (G.P.)
| | - Annamaria Colombari
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (A.C.); (A.C.); (G.P.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Maia De Luca
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (M.D.L.); (L.L.)
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Pediatric Infectious Diseases Unit, Meyer’s Children Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Silvia Garazzino
- Pediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, 10122 Turin, Italy;
| | - Alessandro Inserra
- General Surgery Department, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (M.D.L.); (L.L.)
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy;
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (G.P.); (A.S.)
| | - Nicola Petrosillo
- Infectious Disease and Infection Control Unit, Campus Bio-Medico, Medicine University Hospital, 00128 Rome, Italy;
| | - Giorgio Piacentini
- Pediatric Clinic, Azienda Ospedaliera Universitaria Integrata, 37134 Verona, Italy; (E.R.); (A.C.); (A.C.); (G.P.)
| | - Carlo Pietrasanta
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | | | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, 43126 Parma, Italy; (C.C.); (M.P.)
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Simonetta Tesoro
- Division of Anesthesia, Analgesia, and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, 06129 Perugia, Italy;
| | - Elisabetta Venturini
- Pediatric Infectious Diseases Unit, Meyer’s Children Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Annamaria Staiano
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy; (G.P.); (A.S.)
| | - Fabio Caramelli
- General and Pediatric Anesthesia and Intensive Care Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (S.B.); (L.N.); (S.M.)
| | | |
Collapse
|
42
|
Gronert BJ, Yitzhak B, Nelson JS, Bender KS. Preparation of children with heart disease for diagnostic and therapeutic procedures requiring anesthesia. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
43
|
Sex-Specific Risk Factors for Short- and Long-Term Outcomes after Surgery in Patients with Infective Endocarditis. J Clin Med 2022; 11:jcm11071875. [PMID: 35407487 PMCID: PMC8999412 DOI: 10.3390/jcm11071875] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Surgery for infective endocarditis (IE) is associated with considerable mortality and it is controversial whether the female gender is predictive for a worse outcome. This large single-center study investigated the impact of sex on outcomes after surgery for IE. (2) Methods: 413 patients (25.4% female) were included into this retrospective observational study. Univariate and multivariable analyses identified sex-specific risk factors for 30 day and late mortality. Survival was estimated by the Kaplan-Meier-method. (3) Results: Women presented more often with mitral valve infection (p = 0.039). Men presented more frequently with previous endocarditis (p = 0.045), coronary heart disease (p = 0.033), and aortic valve infection (p = 0.005). Blood transfusion occurred more frequently intraoperatively in women (p < 0.001), but postoperatively in men (p = 0.015) and men had a longer postoperative stay (p = 0.046). Women showed a higher 30 day mortality than men (p = 0.007) and female gender was predictive for 30 day mortality (OR 2.090). Late survival showed no sex-specific difference (p = 0.853), and the female gender was not an independent predictor for late mortality (p = 0.718). Risk factors for early and late mortality showed distinct sex-specific differences such as increased preoperative CRP level in women and culture-negative IE in men.
Collapse
|
44
|
Shati AA. Dentists' knowledge and practices about infective endocarditis antibiotics prophylaxis among children in aseer region, Southwestern Saudi Arabia. Niger J Clin Pract 2022; 25:123-129. [PMID: 35170436 DOI: 10.4103/njcp.njcp_651_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Infective endocarditis (IE) is a disease endangering human lives. Therefore, several prophylactic measures are required to improve the protection of endocarditis-prone patients from bacteremia resulting from various dental actions. These measures range from developing the dental hygiene to trials of different antimicrobial agents. Objectives To examine the knowledge and practices of dentists in Aseer Region, Saudi Arabia, regarding antibiotic prophylaxis against IE. Design Cross-sectional study. Setting Aseer Region, Saudi Arabia. Patients and Methods The participants were interviewed at their workplaces and the data collection sheet was constructed based on the guidelines of the American Heart Association/American College of Cardiology (AHA/ACC, 2017). Main Outcome Measures The examination of the data gathered was calculated using Statistical Package for Social Sciences (SPSS, version 25) such as to test the significance of variation in dentists' mean knowledge scores as per their personal characteristics. An output with P values <0.05 was statistically significant. Sample Size 182 Dentists. Results Dentists' mean knowledge score was 17.5 ± 3.7 (out of 24). The least correct responses regarding dental procedures that require prophylactic antibiotics were "root canal treatment" (30.8%). Regarding cardiac conditions that require prophylactic antibiotics, dentists' least correct responses were "heart failure" (50%). Dentists' mean knowledge scores differed significantly according to their age groups (P = 0.032), nationality (P = 0.002), education/qualification (P = 0.002). Mean knowledge scores differed significantly according to dentists' years of experience (P = 0.018) and sources of information (P < 0.001). Amoxicillin was the most regularly recommended antibiotic (90.7%), while 86.8% correctly stated 30--60 min. before the procedure as the time for prophylactic antibiotic administration. Conclusions The knowledge of dentists in Aseer Region regarding the use of preventive drugs for the control and prevention of IE is suboptimal. The inclusion of the latest AHA guidelines into the dentistry curricula is highly recommended. Limitations Outcome are simultaneously assessed.
Collapse
Affiliation(s)
- Ayed A Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha, Saudi Arabia
| |
Collapse
|
45
|
Allen G, Brooke A. Devising a pro forma for dental screening of patients before invasive cardiac surgery. Br Dent J 2022; 232:151-154. [PMID: 35149804 DOI: 10.1038/s41415-022-3881-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
Certain types of invasive cardiac surgery can place patients at risk of developing infective endocarditis from dental pathology or dental treatment. University Hospital Bristol and Weston NHS Foundation Trust is the regional centre for cardiac surgery in the South West of the UK and is part of the South Wales and South West Congenital Heart Disease Network. As part of this network, the Special Care Dental Department within Bristol Dental Hospital provides dental screening for patients pending invasive cardiac surgery. These are conducted to identify dental pathology in individuals who will be at risk of infective endocarditis, so where possible, they are rendered dentally fit before their surgery.Presented is the information that led to the creation of a screening pro forma, for the dental assessment of patients before invasive cardiac surgery, suitable for use in primary or secondary care. This was produced following an audit, to ensure that along with identifying sources of dental pathology, the dental screening is also documenting the risk of dental pathology and modifiable risk factors. This enables tailored preventative advice which is important to help reduce a patient's lifetime risk of infective endocarditis from dental pathology. Other information used to help develop the pro forma taken from the audit, regional and national guidance is also discussed.
Collapse
Affiliation(s)
- Gemma Allen
- Specialty Registrar in Special Care Dentistry, Bristol Dental Hospital, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - Anthony Brooke
- Consultant in Special Care Dentistry, Bristol Dental Hospital, University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
46
|
Cahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Ludman P, Hildick-Smith DJR, Redwood SR, Prendergast BD. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart 2022; 108:639-647. [DOI: 10.1136/heartjnl-2021-320080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/20/2021] [Indexed: 01/22/2023] Open
Abstract
ObjectiveTo define the incidence and risk factors for infective endocarditis (IE) following surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsAll patients who underwent first SAVR or TAVI in England between 2007 and 2016 were identified from the NICOR databases. Hospital admissions with a primary diagnosis of IE were identified by linkage with the NHS Hospital Episode Statistics database. Approval was obtained from the NHS Research Ethics Committee.Results2057 of 91 962 patients undergoing SAVR developed IE over a median follow-up of 53.9 months—an overall incidence of 4.81 [95% CI 4.61 to 5.03] per 1000 person-years. Correspondingly, 140 of 14 195 patients undergoing TAVI developed IE over a median follow-up of 24.5 months—an overall incidence of 3.57 [95% CI 3.00 to 4.21] per 1000 person-years. The cumulative incidence of IE at 60 months was higher after SAVR than after TAVI (2.4% [95% CI 2.3 to 2.5] vs 1.5% [95% CI 1.3 to 1.8], HR 1.60, p<0.001). Across the entire cohort, SAVR remained an independent predictor of IE after multivariable adjustment. Risk factors for IE included younger age, male sex, atrial fibrillation, and dialysis.ConclusionsIE is a rare complication of SAVR and TAVI. In our population, the incidence of IE was higher after SAVR than after TAVI.
Collapse
|
47
|
Naso F, Calafiore AM, Gaudino M, Zilla P, Haverich A, Colli A, Melder RJ, Gandaglia A. Polyphenols could be Effective in Exerting a Disinfectant-Like Action on Bioprosthetic Heart Valves, Counteracting Bacterial Adhesiveness. CARDIOLOGY AND CARDIOVASCULAR MEDICINE 2022; 6:487-492. [PMID: 36303878 PMCID: PMC9601395 DOI: 10.26502/fccm.92920287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of infective endocarditis in patients with bioprosthetic heart valves is over 100 times that of the general population with S. aureus recognized as the causative organism in approximately 1/3 of cases. In this study, (1) the microbicidal and virucidal effect of a polyphenolic solution was carefully evaluated. The same solution was then adopted for the treatment of a commercial bioprosthetic heart valve model for (2) the assessment of inhibition of S. aureus adhesiveness. METHODS (1) the viability of 9 microorganisms strains (colony-forming units) and the infectivity degree of 3 viral strains (cellular infection capacity) were evaluated after suspension in the polyphenolic solution. (2) Leaflets from a treated and untreated commercial surgical valve model were incubated with a known concentration of S. aureus. After incubation, the leaflets were homogenized and placed in specific culture media to quantify the bacterial load. RESULTS (1) The polyphenolic solution proved to be effective in eliminating microorganisms strains guaranteeing the killing of at least 99.9%. The effectiveness is particularly relevant against M. chelonae (99.999%). (2) The polyphenol-based treatment resulted in the inhibition of the S. aureus adhesiveness by 96% concerning untreated samples. CONCLUSIONS The data suggest an interesting protective effect against infections and bacterial adhesiveness by a polyphenolic-based solution. Further studies will plan to extend the panel of microorganisms for the evaluation of the anti-adhesive effect; however, the use of optimized polyphenolic blends could lead to the development of new treatments capable to make transcatheter-valve substitutes more resistant to infection.
Collapse
Affiliation(s)
- Filippo Naso
- Biocompatibility Innovation SRL, Este, Padua, Italy
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, USA
| | - Peter Zilla
- Christian Barnard Department of Cardiothoracic Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andrea Colli
- Cardiac Surgery Unit, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | | | | |
Collapse
|
48
|
Sato M, Yamana H, Ono S, Ishimaru M, Matsui H, Yasunaga H. Trends in prophylactic antibiotic use for tooth extraction from 2015 to 2018 in Japan: An analysis using a health insurance claims database. J Infect Chemother 2021; 28:504-509. [PMID: 34973876 DOI: 10.1016/j.jiac.2021.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/30/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION To describe patterns in antibiotic prophylaxis for tooth extraction following the 2016 Japanese National Action Plan on Antimicrobial Resistance. METHODS Using a health insurance claims database, we retrospectively identified tooth extraction visits by patients aged ≥18 years from September 2015 to August 2018 and classified patients as undergoing extraction of a fully impacted or horizontally impacted mandibular wisdom tooth, being at risk of infective endocarditis or surgical site infection, or being at low risk. Antibiotic use and type of antibiotics prescribed on the day of tooth extraction were evaluated across the study period, with stratification by tooth extraction category and facility type (hospital or dental clinic). RESULTS We identified 662,435 patients with tooth extraction. The mean age was 42.7 years, and 57% were male. Twelve percent underwent wisdom tooth extraction, 32% were high risk, and 10% visited hospitals. The proportion of antibiotic use was 83% overall and 82% among low-risk patients. This proportion remained similar throughout the study period. A shift from third-generation cephalosporins to amoxicillin was observed from 2015 to 2018: the proportion prescribed third-generation cephalosporins decreased from 58% to 34% in hospitals and from 57% to 56% in clinics, and the proportion prescribed amoxicillin increased from 16% to 37% in hospitals and from 6% to 10% in clinics. CONCLUSIONS The pattern of prophylactic antibiotic use for tooth extraction gradually changed after the initiation of the National Action Plan. Further efforts are required to reduce potentially inappropriate prescriptions for low-risk patients, especially in dental clinics.
Collapse
Affiliation(s)
- Misuzu Sato
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Sachiko Ono
- Department of Eat-loss Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Miho Ishimaru
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| |
Collapse
|
49
|
Wilson WR, Gewitz M, Lockhart PB, Bolger AF, DeSimone DC, Kazi DS, Couper DJ, Beaton A, Kilmartin C, Miro JM, Sable C, Jackson MA, Baddour LM. Adapted from: Prevention of Viridans Group Streptococcal Infective Endocarditis: A Scientific Statement From the American Heart Association. J Am Dent Assoc 2021; 152:886-902.e2. [PMID: 34711348 DOI: 10.1016/j.adaj.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2007, the American Heart Association published updated evidence-based guidelines on the recommended use of antibiotic prophylaxis to prevent viridans group streptococcal (VGS) infective endocarditis (IE) in cardiac patients undergoing invasive procedures. The 2007 guidelines significantly scaled back the underlying conditions for which antibiotic prophylaxis was recommended, leaving only 4 categories thought to confer the highest risk of adverse outcome. The purpose of this update is to examine interval evidence of the acceptance and impact of the 2007 recommendations on VGS IE and, if needed, to make revisions based on this evidence. METHODS AND RESULTS A writing group was formed consisting of experts in prevention and treatment of infective endocarditis including members of the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, in addition to the American Heart Association. MEDLINE database searches were done for English language articles on compliance with the recommendations in the 2007 guidelines and the frequency of and morbidity or mortality from VGS IE after publication of the 2007 guidelines. Overall, there was good general awareness of the 2007 guidelines but variable compliance with recommendations. There was no convincing evidence that VGS IE frequency, morbidity, or mortality has increased since 2007. CONCLUSIONS On the basis of a review of the available evidence, there are no recommended changes to the 2007 VGS IE prevention guidelines. We continue to recommend VGS IE prophylaxis only for categories of patients at highest risk for adverse outcome while emphasizing the critical role of good oral health and regular access to dental care for all. Randomized controlled studies to determine whether antibiotic prophylaxis is effective against VGS IE are needed to further refine recommendations.
Collapse
|
50
|
Maser M, Radke RM. Infektiöse Endokarditis bei Erwachsenen mit angeborenen Herzfehlern. AKTUELLE KARDIOLOGIE 2021. [DOI: 10.1055/a-1587-9918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungErwachsene Patienten mit angeborenen Herzfehlern (EMAH) sind eine größer werdende
Patientengruppe, die eine lebenslange Begleitung und Behandlung benötigt. Eine der wichtigsten
Komplikationen bei EMAH-Patienten ist die infektiöse Endokarditis.Die Echokardiografie hat sowohl bei der Diagnosesicherung als auch beim Erkennen von
Komplikationen und im Follow-up eine ganz zentrale Bedeutung. Computer- und
Positronenemissionstomografie werden zur Beurteilung von implantierten Fremdmaterial zunehmend
eingesetzt. Eine antibiotische Therapie erfolgt zunächst empirisch und später auf den
individuellen Erreger zugeschnitten. Zurzeit wird die Antibiotikaprophylaxe nur den Patienten
mit deutlich erhöhtem Endokarditisrisiko vor den zahnärztlichen Eingriffen mit dem höchsten
Risiko empfohlen.
Collapse
Affiliation(s)
- Maarja Maser
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| | - Robert Matthias Radke
- Klinik für Kardiologie III: Angeborene Herzfehler (EMAH) und Klappenerkrankungen, Universitätsklinikum Münster, Münster, Deutschland
| |
Collapse
|