351
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Pazdernik M, Kautzner J, Sochman J, Kettner J, Vojacek J, Pelouch R. Clinical manifestations of infective endocarditis in relation to infectious agents: An 8-year retrospective study. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:298-304. [PMID: 26740050 DOI: 10.5507/bp.2015.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/01/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To compare clinical complications and outcomes of infective endocarditis (IE) episodes caused by Staphylococcus aureus (S. aureus) and other most frequent aetiological agents (streptococci, enterococci, coagulase-negative staphylococci, and culture-negative IE). METHODS A total of 117 IE episodes assessed by all internal medicine services of a major teaching institution in the Czech Republic over an eight-year period were identified. RESULTS We found that S. aureus IE episodes (n = 36) were significantly more associated with systemic embolism (41.7% vs 18.5%, P = 0.01), severe sepsis/septic shock (33.3% vs 3.7%, P < 0.0001), and in-hospital mortality (33% vs 12.3%, P = 0.01). No differences in local, structural, and/or functional complications (cardiac abscess formation, impaired integrity of the valvular apparatus, conduction disturbances, or incidence of heart failure) were observed between studied groups. Long-term survival estimates were significantly improved in patients with IE caused by agents other than S. aureus (13.78 median years vs 5.48 median years, P=0.03). CONCLUSIONS IE episodes caused by S. aureus are associated with both increased short-term and long-term mortality. Of all the studied parameters, only systemic embolism and severe sepsis/septic shock predicted in-hospital mortality.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Sochman
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jan Vojacek
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
| | - Radek Pelouch
- 1st Department of Internal Medicine - Cardioangiology, Faculty Hospital in Hradec Kralove, Czech Republic
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352
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Forestier E, Fraisse T, Roubaud-Baudron C, Selton-Suty C, Pagani L. Managing infective endocarditis in the elderly: new issues for an old disease. Clin Interv Aging 2016; 11:1199-206. [PMID: 27621607 PMCID: PMC5015881 DOI: 10.2147/cia.s101902] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The incidence of infective endocarditis (IE) rises in industrialized countries. Older people are more affected by this severe disease, notably because of the increasing number of invasive procedures and intracardiac devices implanted in these patients. Peculiar clinical and echocardiographic features, microorganisms involved, and prognosis of IE in elderly have been underlined in several studies. Additionally, elderly population appears quite heterogeneous, from healthy people without past medical history to patients with multiple diseases or who are even bedridden. However, the management of IE in this population has been poorly explored, and international guidelines do not recommend adapting the therapeutic strategy to the patient's functional status and comorbidities. Yet, if IE should be treated according to current recommendations in the healthiest patients, concerns may rise for older patients who suffer from several chronic diseases, especially renal failure, and are on polypharmacy. Treating frailest patients with high-dose intravenous antibiotics during a prolonged hospital stay as recommended for younger patients could also expose them to functional decline and toxic effect. Likewise, the place of surgery according to the aging characteristics of each patient is unclear. The aim of this article is to review the recent data on epidemiology of IE and its peculiarities in the elderly. Then, its management and various therapeutic approaches that can be considered according to and beyond guidelines depending on patient comorbidities and frailty are discussed.
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Affiliation(s)
- Emmanuel Forestier
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France
- Correspondence: Emmanuel Forestier, Service de maladies infectieuses, Centre Hospitalier Métropole Savoie, BP 1125, 73011 Chambery Cedex, France, Tel +33 4 7996 5847, Fax +33 4 7996 5171, Email
| | - Thibaut Fraisse
- Acute Geriatric Department, Centre Hospitalier, Alès, France
| | | | | | - Leonardo Pagani
- Infectious Diseases Department, Centre Hospitalier Annecy-Genevois, Annecy, France
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353
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Seminari E, De Silvestri A, Ravasio V, Ludovisi S, Utili R, Petrosillo N, Castelli F, Bassetti M, Barbaro F, Grossi P, Barzaghi N, Rizzi M, Minoli L. Infective endocarditis in patients with hepatic diseases. Eur J Clin Microbiol Infect Dis 2015; 35:279-84. [PMID: 26690071 DOI: 10.1007/s10096-015-2541-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/29/2015] [Indexed: 01/04/2023]
Abstract
Few data have been published regarding the epidemiology and outcome of infective endocarditis (IE) in patients with chronic hepatic disease (CHD). A retrospective analysis of the Studio Endocarditi Italiano (SEI) database was performed to evaluate the epidemiology and outcome of CHD+ patients compared with CHD- patients. The diagnosis of IE was defined in accordance with the modified Duke criteria. Echocardiography, diagnosis, and treatment procedures were in accordance with current clinical practice. Among the 1722 observed episodes of IE, 300 (17.4 %) occurred in CHD+ patients. The cause of CHD mainly consisted of chronic viral infection. Staphylococcus aureus was the most common bacterial species in CHD+ patients; the frequency of other bacterial species (S. epidermidis, streptococci, and enterococci) were comparable among the two groups. The percentage of patients undergoing surgery for IE was 38.9 in CHD+ patients versus 43.7 in CHD- patients (p = 0.06). Complications were more common among CHD+ patients (77 % versus 65.3 %, p < 0.001); embolization (43.3 % versus 26.1 %, p < 0.001) and congestive heart failure (42 % versus 34.1 %, p = 0.01) were more frequent among CHD+ patients. Mortality was comparable (12.5 % in CHD- and 15 % in CHD+ patients). At multivariable analysis, factors associated with hospital-associated mortality were having an infection sustained by S. aureus, a prosthetic valve, diabetes and a neoplasia, and CHD. Being an intravenous drug user (IVDU) was a protective factor and was associated with a reduced death risk. CHD is a factor worsening the prognosis in patients with IE, in particular in patients for whom cardiac surgery was required.
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Affiliation(s)
- E Seminari
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - A De Silvestri
- Direzione Scientifica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - V Ravasio
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - S Ludovisi
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Utili
- Internal Medicine Section, University of Naples S.U.N., Napoli, Italy
| | - N Petrosillo
- 2nd Division of Infectious Diseases, National Institute for Infectious Diseases "Spallanzani", Roma, Italy
| | - F Castelli
- Clinica di Malattie Infettive e Tropicali, Università degli Studi di Brescia, Brescia, Italy
| | - M Bassetti
- Clinica di Malattie Infettive, AOU Santa Maria della Misericordia, Udine, Italy
| | - F Barbaro
- UO Malattie Infettive e Tropicali, Azienda Ospedaliera di Padova, Padova, Italy
| | - P Grossi
- Clinica di Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy
| | - N Barzaghi
- UO Terapia Intensiva, Cardiochirurgica, ASO S. Croce e Carle, Cuneo, Italy
| | - M Rizzi
- USC Malattie Infettive, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - L Minoli
- Clinica di Malattie Infettive, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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354
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Iung B, Doco-Lecompte T, Chocron S, Strady C, Delahaye F, Le Moing V, Poyart C, Alla F, Cambau E, Tattevin P, Chirouze C, Obadia JF, Duval X, Hoen B. Cardiac surgery during the acute phase of infective endocarditis: discrepancies between European Society of Cardiology guidelines and practices. Eur Heart J 2015; 37:840-8. [PMID: 26685134 DOI: 10.1093/eurheartj/ehv650] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/12/2015] [Indexed: 12/20/2022] Open
Abstract
AIMS Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients.
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Affiliation(s)
- Bernard Iung
- Département de Cardiologie, AP-HP, Hôpital Bichat, Université Paris-Diderot, DHU Fire, 46 rue Henri Huchard, 75018 Paris, France
| | - Thanh Doco-Lecompte
- Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Genève, Geneve, Switzerland
| | - Sidney Chocron
- Service de Chirurgie Cardiaque, Centre Hospitalier Universitaire, Besançon, France
| | - Christophe Strady
- Cabinet d'Infectiologie. Clinique Saint André-Groupe Courlancy, Reims, France
| | - François Delahaye
- Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Vincent Le Moing
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France Unité Mixte de Recherche 145 Institut de Recherche sur le Développement/Université Montpellier 1, Montpellier, France
| | - Claire Poyart
- AP-HP, Service de Bactériologie, Centre National de Référence des Streptocoques (CNR-Strep), Hôpital Cochin, Paris, France Institut Cochin, Université Paris Descartes, Faculté de médecine, CNRS (UMR 8104), Paris, France Inserm, U1016, Paris, France
| | - François Alla
- EA 4003, Université de Nancy, Nancy, France Inserm CIC 007, Nancy, France
| | - Emmanuelle Cambau
- AP-HP, Hôpital Lariboisière, Service de Bactériologie, Paris, France Université Paris Diderot, Sorbonne Paris Cité, IAME UMR1137, Paris, France
| | - Pierre Tattevin
- Unité de Soins Intensifs et de Maladies Infectieuses, Hôpital Universitaire Pontchaillou, Rennes, France
| | - Catherine Chirouze
- Maladies Infectieuses et Tropicales. Centre Hospitalier Universitaire, Besançon, France
| | - Jean-François Obadia
- Hôpital Louis Pradel, Lyon, Chirurgie Cardiothoracique et Transplantation, Bron, France
| | - Xavier Duval
- AP-HP, Centre d'Investigation Clinique Inserm 1425, Hôpital Bichat, Université Paris-Diderot, Inserm U1137, Paris, France
| | - Bruno Hoen
- Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, France Centre Hospitalier Universitaire de Pointe-à-Pitre, Inserm CIC1424, Service de Maladies Infectieuses et Tropicales, Dermatologie, Médecine Interne, Pointe-à-Pitre, France
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355
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Lamas CC, Fournier PE, Zappa M, Brandão TJD, Januário-da-Silva CA, Correia MG, Barbosa GIF, Golebiovski WF, Weksler C, Lepidi H, Raoult D. Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases. Infection 2015; 44:459-66. [PMID: 26670038 DOI: 10.1007/s15010-015-0863-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the clinical characteristics of blood culture-negative endocarditis (BCNE) and how it compares to those of blood culture-positive endocarditis (BCPE) cases and show how molecular tools helped establish the etiology in BCNE. METHODS Adult patients with definite infective endocarditis (IE) and having valve surgery were included. Valves were studied by polymerase chain reaction (PCR). Statistical analysis compared BCNE and BCPE. RESULTS One hundred and thirty-one patients were included; 53 (40 %) had BCNE. The mean age was 45 ± 16 years; 33 (62 %) were male. BCNE was community-acquired in 41 (79 %). Most patients were referred from other hospitals (38, 73 %). Presentation was subacute in 34 (65 %), with fever in 47/53 (90 %) and a new regurgitant murmur in 34/42 (81 %). Native valves were affected in 74 %, mostly left-sided. All echocardiograms showed major criteria for IE. Antibiotics were used prior to BC collection in 31/42 (74 %). Definite histological diagnosis was established for 35/50 (70 %) valves. PCR showed oralis group streptococci in 21 (54 %), S. aureus in 3 (7.7 %), gallolyticus group streptococci in 2 (5.1 %), Coxiella burnetii in 1 (2.5 %) and Rhizobium sp. in 1 (2.5 %). In-hospital mortality was 9/53 (17 %). Fever (p = 0.06, OR 4.7, CI 0.91-24.38) and embolic complications (p = 0.003, OR 3.3, CI 1.55-6.82) were more frequent in BCPE cases, while new acute regurgitation (p = 0.05, OR 0.3, CI 0.098-0.996) and heart failure (p = 0.02, OR 0.3, CI 0.13-0.79) were less so. CONCLUSIONS BCNE resulted mostly from prior antibiotics and was associated with severe hemodynamic compromise. Valve histopathology and PCR were useful in confirming the diagnosis and pointing to the etiology of BCNE.
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Affiliation(s)
- Cristiane C Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. .,Unigranrio, Rio de Janeiro, Brazil.
| | | | - Monica Zappa
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | - Didier Raoult
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
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356
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Garciarena CD, McHale TM, Watkin RL, Kerrigan SW. Coordinated Molecular Cross-Talk between Staphylococcus aureus, Endothelial Cells and Platelets in Bloodstream Infection. Pathogens 2015; 4:869-82. [PMID: 26690226 PMCID: PMC4693168 DOI: 10.3390/pathogens4040869] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/02/2015] [Indexed: 01/06/2023] Open
Abstract
Staphylococcus aureus is an opportunistic pathogen often carried asymptomatically on the human body. Upon entry to the otherwise sterile environment of the cardiovascular system, S. aureus can lead to serious complications resulting in organ failure and death. The success of S. aureus as a pathogen in the bloodstream is due to its ability to express a wide array of cell wall proteins on its surface that recognise host receptors, extracellular matrix proteins and plasma proteins. Endothelial cells and platelets are important cells in the cardiovascular system and are a major target of bloodstream infection. Endothelial cells form the inner lining of a blood vessel and provide an antithrombotic barrier between the vessel wall and blood. Platelets on the other hand travel throughout the cardiovascular system and respond by aggregating around the site of injury and initiating clot formation. Activation of either of these cells leads to functional dysregulation in the cardiovascular system. In this review, we will illustrate how S. aureus establish intimate interactions with both endothelial cells and platelets leading to cardiovascular dysregulation.
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Affiliation(s)
- Carolina D Garciarena
- Cardiovascular Infection Research Group, School of Pharmacy & Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Tony M McHale
- Cardiovascular Infection Research Group, School of Pharmacy & Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Rebecca L Watkin
- Cardiovascular Infection Research Group, School of Pharmacy & Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
| | - Steven W Kerrigan
- Cardiovascular Infection Research Group, School of Pharmacy & Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
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357
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Leroy O, Georges H, Devos P, Bitton S, De Sa N, Dedrie C, Beague S, Ducq P, Boulle-Geronimi C, Thellier D, Saulnier F, Preau S. Infective endocarditis requiring ICU admission: epidemiology and prognosis. Ann Intensive Care 2015; 5:45. [PMID: 26621197 PMCID: PMC4666184 DOI: 10.1186/s13613-015-0091-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/17/2015] [Indexed: 01/22/2023] Open
Abstract
Background Very few studies focused on patients with severe infective endocarditis (IE) and multiple complications leading to Intensive Care Unit (ICU) admission. Studied primary outcomes depended on the series and multiple prognostic factors have been identified. Our goal was to determinate characteristics of patients, in-hospital mortality and independent prognostic factors in an overall population of patients admitted to ICU for a left-sided, definite, active and severe IE. Methods Retrospective study performed in 9 ICUs during an 11-year period. Results Data of 248 patients (mean age = 62.4 ± 13.3 years; 63.7 % male) were studied. Native and prosthetic valves were involved in 195 and 53 patients, respectively. Causative pathogens, identified in 225 patients, were mainly streptococci (45.6 %) and staphylococci (43.4 %). On ICU admission, 127 patients exhibited extra-cardiac involvement. Ninety-five patients had one or more neurological complications, as followed: ischemic stroke (n = 66), cerebral hemorrhage (n = 31), meningitis (n = 16), brain abscess (n = 16), and intracranial mycotic aneurysm (n = 10). Criteria prompting to cardiac surgery appeared during ICU stay for 186 patients and between ICU and hospital discharges in 5 patients. Due to contra-indications, surgery required by IE was only performed during hospitalization in 125 patients. Moreover, surgery was considered adequate according to usual guidelines in 76 of 191 patients with indication(s) of valvular surgery: for patients with surgical procedure considered as emergency (n = 69), 17 surgical procedures underwent within the first 24 h following indication; for patients with urgent surgical indication (n = 102), surgery was performed during the first week following indication in 40 patients; finally, elective surgery (n = 20) was performed for 19 patients. During hospitalization, 103 (41.5 %) patients died. Four independent prognostic factors were identified: SAPS II > 35 (AOR = 2.604; 95 % CI: 1.320–5.136; p = 0.0058), SOFA > 8 (AOR = 3.327; 95 % CI: 1.697–6.521; p = 0.0005), IE due to methicillin resistant Staphylococcus aureus (AOR = 4.981; 95 %CI = 1.433–17.306; p = 0.0115) and native IE (AOR = 0.345; 95 % CI: 0.169–0.703; p = 0.0034). Conclusions Mortality in patients admitted to ICU for left-sided IE remains high, especially in cases of endocarditis due to methicillin resistant Staphylococcus aureus, when organ failures occur and ICU scores are high.
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Affiliation(s)
- Olivier Leroy
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Hugues Georges
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Patrick Devos
- Département de bio statistique, CHU de Lille, 59037, Lille Cedex, France.
| | - Steve Bitton
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
| | - Nathalie De Sa
- Service de Réanimation Polyvalente, Centre Hospitalier Jean Bernard, Avenue Désandrouin, 59322, Valenciennes Cedex, France.
| | - Céline Dedrie
- Service de Réanimation Polyvalente, Hôpital Victor Provost, Rue de Barbieux, 59056, Roubaix Cedex, France.
| | - Sébastien Beague
- Service de Réanimation Polyvalente, Centre Hospitalier de Dunkerque, Avenue Louis Herbeaux, 59385, Dunkirk, France.
| | - Pierre Ducq
- Service de Réanimation Polyvalente, Centre Hospitalier de Boulogne-sur-Mer, Allée Jacques Monod, 62321, Boulogne-Sur-Mer Cedex, France.
| | - Claire Boulle-Geronimi
- Service de Réanimation Polyvalente, Centre Hospitalier de Douai, Route de Cambrai, 59507, Douai Cedex, France.
| | - Damien Thellier
- Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, 135 rue du Président Coty, Tourcoing, 59200, France.
| | - Fabienne Saulnier
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
| | - Sebastien Preau
- Pôle de Réanimation, Hôpital R. Salengro, CHU de Lille, Avenue du Professeur E. Laine, 59037, Lille Cedex, France.
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Abstract
Infective endocarditis is a life-threatening disease caused by a focus of infection within the heart. For clinicians and scientists, it has been a moving target that has an evolving microbiology and a changing patient demographic. In the absence of an extensive evidence base to guide clinical practice, controversies abound. Here, we review three main areas of uncertainty: first, in prevention of infective endocarditis, including the role of antibiotic prophylaxis and strategies to reduce health care-associated bacteraemia; second, in diagnosis, specifically the use of multimodality imaging; third, we discuss the optimal timing of surgical intervention and the challenges posed by increasing rates of cardiac device infection.
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Affiliation(s)
- Thomas J Cahill
- Department of Cardiology, Oxford University Hospitals, Oxford, UK
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359
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Chan LC, Chaili S, Filler SG, Barr K, Wang H, Kupferwasser D, Edwards JE, Xiong YQ, Ibrahim AS, Miller LS, Schmidt CS, Hennessey JP, Yeaman MR. Nonredundant Roles of Interleukin-17A (IL-17A) and IL-22 in Murine Host Defense against Cutaneous and Hematogenous Infection Due to Methicillin-Resistant Staphylococcus aureus. Infect Immun 2015; 83:4427-37. [PMID: 26351278 PMCID: PMC4598415 DOI: 10.1128/iai.01061-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/28/2015] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus is the leading cause of skin and skin structure infections (SSSI) in humans. Moreover, the high frequency of recurring SSSI due to S. aureus, particularly methicillin-resistant S. aureus (MRSA) strains, suggests that infection induces suboptimal anamnestic defenses. The present study addresses the hypothesis that interleukin-17A (IL-17A) and IL-22 play distinct roles in immunity to cutaneous and invasive MRSA infection in a mouse model of SSSI. Mice were treated with specific neutralizing antibodies against IL-17A and/or IL-22 and infected with MRSA, after which the severity of infection and host immune response were determined. Neutralization of either IL-17A or IL-22 reduced T cell and neutrophil infiltration and host defense peptide elaboration in lesions. These events corresponded with increased abscess severity, MRSA viability, and CFU density in skin. Interestingly, combined inhibition of IL-17A and IL-22 did not worsen abscesses but did increase gamma interferon (IFN-γ) expression at these sites. The inhibition of IL-22 led to a reduction in IL-17A expression, but not vice versa. These results suggest that the expression of IL-17A is at least partially dependent on IL-22 in this model. Inhibition of IL-17A but not IL-22 led to hematogenous dissemination to kidneys, which correlated with decreased T cell infiltration in renal tissue. Collectively, these findings indicate that IL-17A and IL-22 have complementary but nonredundant roles in host defense against cutaneous versus hematogenous infection. These insights may support targeted immune enhancement or other novel approaches to address the challenge of MRSA infection.
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Affiliation(s)
- Liana C Chan
- Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Siyang Chaili
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Scott G Filler
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kevin Barr
- Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Huiyuan Wang
- Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Deborah Kupferwasser
- Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - John E Edwards
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yan Q Xiong
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lloyd S Miller
- Department of Dermatology, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Michael R Yeaman
- Division of Molecular Medicine, Harbor-UCLA Medical Center, Torrance, California, USA Division of Infectious Diseases, Harbor-UCLA Medical Center, Torrance, California, USA St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Temporal trends in infective endocarditis epidemiology from 2007 to 2013 in Olmsted County, MN. Am Heart J 2015; 170:830-6. [PMID: 26386808 DOI: 10.1016/j.ahj.2015.07.007] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/11/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study is to determine if there have been contemporary shifts in infective endocarditis (IE) epidemiology in our local population; an analysis of cases from 2007 to 2013 was conducted. METHODS This is a population-based review of all adults (≥18 years) residing in Olmsted County, MN, with definite or possible IE using the Rochester Epidemiology Project from January 1, 2007, to December 31, 2013. RESULTS We identified 51 cases of IE in Olmsted County, MN, between 2007 and 2013. Median age of IE cases was 68.8 years (interquartile range 55.6-76.5), and 41% were females. Age- and sex-adjusted incidence of IE was 7.4 (95% CI 5.3-9.4) cases per 100,000 person-years. From a multivariable Poisson regression model, incidence of IE did not change significantly during the study period (P = .222) but was significantly higher in males and those of older age (P < .001). The annual incidences (per 100,000 person-years) were 2.5 for Staphylococcus aureus, 1.1 for viridans group streptococci, 1.6 for Enterococcus species, and 0.8 for coagulase-negative staphylococci. Only 19.6% (10/51) of Olmsted County patients underwent valve surgery between 2007 and 2013 as compared with 44.4% (197/444) of non-Olmsted County patients treated at Mayo Clinic Rochester. CONCLUSION In this population-based study, no significant change in the overall incidence of IE in Olmsted County, MN, between 2007 and 2013 was seen, and it was similar to that seen between 1970 and 2006. Male gender and older age were associated with increased IE risk. With a lesser extent of cases attributable to viridans group streptococcal IE compared with previous years, S aureus was the predominant pathogen in IE cases during 2007 to 2013. The relatively low valve surgery rate was disparate from that reported from large, tertiary care centers (including our own) with non-population-based cohorts, which are subject to referral bias and can influence the expected characterization of IE.
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361
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Honarbakhsh S, Chowdhury M, Farooqi F, Deaner A. Syncope secondary to left ventricular outflow tract obstruction, an interesting presentation of infective endocarditis. BMJ Case Rep 2015; 2015:bcr-2015-211920. [PMID: 26392460 DOI: 10.1136/bcr-2015-211920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 74-year-old woman who presented with symptoms of fever and lethargy, associated with an episode of cardiac syncope and exertional shortness of breath (SOB). She was diagnosed with Staphylococcus aureus infective mural endocarditis (IE) and subsequent transoesophageal echocardiogram (TOE) confirmed this diagnosis. As the vegetative mass arose from the septal wall, an unusual location, it caused left ventricular outflow tract (LVOT) obstruction and therefore behaved similarly to a subaortic valvular stenosis. There were no conduction abnormalities on the ECG and no clinical or echocardiographic features of congestive heart failure. The finding of LVOT obstruction explained the unusual presentation with syncope and exertional SOB making this case unique. Owing to the large vegetative mass and thereby its high risk of septic emboli, the patient underwent successful surgical resection of the mass with resolution of the obstruction. She successfully completed intravenous antibiotics and was discharged from hospital.
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Affiliation(s)
- Shohreh Honarbakhsh
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Mohammad Chowdhury
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Fahad Farooqi
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
| | - Andrew Deaner
- Department of Cardiology, King George Hospital; Barking, Havering and Redbridge NHS Trust, London, UK
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1889] [Impact Index Per Article: 209.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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Abstract
INTRODUCTION Streptococci are a genus of Gram-positive bacteria which cause diverse human diseases. Many of these species have the potential to cause invasive infection resulting from the presence of bacteria in a normally sterile site. SOURCES OF DATA Original articles, reviews and guidelines. AREAS OF AGREEMENT Invasive infection by a streptococcus species usually causes life-threatening illness. When measured in terms of deaths, disability and cost, these infections remain an important threat to health in the UK. Overall they are becoming more frequent among the elderly and those with underlying chronic illness. New observational evidence has become available to support the use of clindamycin and intravenous immunoglobulin in invasive Group A streptococcal disease. AREAS OF CONTROVERSY Few interventions for the treatment and prevention of these infections have undergone rigorous evaluation in clinical trials. For example, the role of preventative strategies such as screening of pregnant women to prevent neonatal invasive Group B streptococcal disease needs to be clarified. FUTURE PROSPECTS Studies of invasive streptococcal disease are challenging to undertake, not least because individual hospitals treat relatively few confirmed cases. Instead clinicians and scientists must work together to build national and international networks with the aim of developing a more complete evidence base for the treatment and prevention of these devastating infections.
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Affiliation(s)
- Tom Parks
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Lucinda Barrett
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nicola Jones
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, UK
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364
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3143] [Impact Index Per Article: 349.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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365
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Bouchiat C, Moreau K, Devillard S, Rasigade JP, Mosnier A, Geissmann T, Bes M, Tristan A, Lina G, Laurent F, Piroth L, Aissa N, Duval X, Le Moing V, Vandenesch F. Staphylococcus aureus infective endocarditis versus bacteremia strains: Subtle genetic differences at stake. INFECTION GENETICS AND EVOLUTION 2015; 36:524-530. [PMID: 26318542 DOI: 10.1016/j.meegid.2015.08.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/03/2015] [Accepted: 08/23/2015] [Indexed: 11/25/2022]
Abstract
Infective endocarditis (IE)((1)) is a severe condition complicating 10-25% of Staphylococcus aureus bacteremia. Although host-related IE risk factors have been identified, the involvement of bacterial features in IE complication is still unclear. We characterized strictly defined IE and bacteremia isolates and searched for discriminant features. S. aureus isolates causing community-acquired, definite native-valve IE (n=72) and bacteremia (n=54) were collected prospectively as part of a French multicenter cohort. Phenotypic traits previously reported or hypothesized to be involved in staphylococcal IE pathogenesis were tested. In parallel, the genotypic profiles of all isolates, obtained by microarray, were analyzed by discriminant analysis of principal components (DAPC)((2)). No significant difference was observed between IE and bacteremia strains, regarding either phenotypic or genotypic univariate analyses. However, the multivariate statistical tool DAPC, applied on microarray data, segregated IE and bacteremia isolates: IE isolates were correctly reassigned as such in 80.6% of the cases (C-statistic 0.83, P<0.001). The performance of this model was confirmed with an independent French collection IE and bacteremia isolates (78.8% reassignment, C-statistic 0.65, P<0.01). Finally, a simple linear discriminant function based on a subset of 8 genetic markers retained valuable performance both in study collection (86.1%, P<0.001) and in the independent validation collection (81.8%, P<0.01). We here show that community-acquired IE and bacteremia S. aureus isolates are genetically distinct based on subtle combinations of genetic markers. This finding provides the proof of concept that bacterial characteristics may contribute to the occurrence of IE in patients with S. aureus bacteremia.
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Affiliation(s)
- Coralie Bouchiat
- Laboratoire de Bactériologie, Centre de Biologie Est, Hospices Civils de Lyon, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France; CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Karen Moreau
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France
| | - Sébastien Devillard
- Université de Lyon, Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, F-69622 Villeurbanne, France
| | - Jean-Philippe Rasigade
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Amandine Mosnier
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France
| | - Tom Geissmann
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France
| | - Michèle Bes
- Laboratoire de Bactériologie, Centre de Biologie Est, Hospices Civils de Lyon, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France; CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Anne Tristan
- Laboratoire de Bactériologie, Centre de Biologie Est, Hospices Civils de Lyon, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France; CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Gérard Lina
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Frédéric Laurent
- CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France
| | - Lionel Piroth
- Service de Maladies Infectieuses, CHU de Dijon, 14 rue Gaffarel, 21079 Dijon Cedex, France
| | - Nejla Aissa
- Laboratoire de Bactériologie, CHU de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Xavier Duval
- Centre d'Investigation Clinique, Inserm CIC 1425, IAME, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
| | - Vincent Le Moing
- Service des Maladies Infectieuses et Tropicales, CHU de Montpellier, Hôpital Gui de Chauliac, 34000 Montpellier, France
| | - François Vandenesch
- Laboratoire de Bactériologie, Centre de Biologie Est, Hospices Civils de Lyon, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France; CIRI, International Center for Infectiology Research, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR5308, 7 rue Guillaume Paradin, 69008 Lyon, France; Centre National de Référence des Staphylocoques, 59 Boulevard Louis Pinel, 69677 Bron Cedex, France.
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Loubet P, Lescure FX, Lepage L, Kirsch M, Armand-Lefevre L, Bouadma L, Lariven S, Duval X, Yazdanpanah Y, Joly V. Endocarditis due to gram-negative bacilli at a French teaching hospital over a 6-year period: clinical characteristics and outcome. Infect Dis (Lond) 2015; 47:889-95. [PMID: 26260729 DOI: 10.3109/23744235.2015.1075660] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) due to gram-negative bacilli (GNB) is rare. However, several studies described a change in the epidemiological profile of patients within the past few years. METHODS We reviewed all cases diagnosed and followed in the infectious diseases ward of a French teaching hospital in Paris between 2009 and 2014, inclusive. RESULTS Among the 17 patients with definite GNB-IE (11 male, mean age 54 years), 12 (70%) were due to non-HACEK GNB and 5 (30%) to HACEK group GNB. A prosthetic valve was involved in 10 cases (8 in non-HACEK and 2 in HACEK group). Escherichia coli (4/12 patients) and Pseudomonas aeruginosa (3/12 patients) were the most common pathogens in the first group; all the pathogens in the second group were Haemophilus spp. One-third of the patients with non-HACEK GNB had nosocomial IE, whereas injection drug use-related infections were rare (2/12). All patients with HACEK infection had at least one complication (intracardiac abscess, stroke or other systemic embolization). All patients were treated by antibiotic combination therapy during a median time of 42 days (interquartile range (IQR) = 42-42) and 10 (59%) underwent cardiac surgery. One death at 9 months was observed in the non-HACEK group. CONCLUSIONS Regarding HACEK IE, this report supports the frequent association with vascular complications. Regarding non-HACEK GNB IE, this report supports the increasing proportion of nosocomial infections. We reported a high proportion of surgery in the therapeutic management of both HACEK and non-HACEK groups associated with no in-hospital mortality.
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Affiliation(s)
- Paul Loubet
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - François-Xavier Lescure
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,b INSERM, IAME, UMR 1137 , Paris , France.,c Université Paris Diderot, IAME, UMR 1137 , Paris , France
| | | | | | - Laurence Armand-Lefevre
- b INSERM, IAME, UMR 1137 , Paris , France.,c Université Paris Diderot, IAME, UMR 1137 , Paris , France.,e Laboratoire de Bactériologie , Paris , France
| | - Lila Bouadma
- f Service de Réanimation Médicale, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Sylvie Lariven
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Xavier Duval
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France
| | - Yazdan Yazdanpanah
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,b INSERM, IAME, UMR 1137 , Paris , France.,c Université Paris Diderot, IAME, UMR 1137 , Paris , France
| | - Veronique Joly
- a From the Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Bichat-Claude Bernard , Paris , France.,b INSERM, IAME, UMR 1137 , Paris , France.,c Université Paris Diderot, IAME, UMR 1137 , Paris , France
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367
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Abramczuk E, Stępińska J, Hryniewiecki T. Twenty-Year Experience in the Diagnosis and Treatment of Infective Endocarditis. PLoS One 2015; 10:e0134021. [PMID: 26230402 PMCID: PMC4521749 DOI: 10.1371/journal.pone.0134021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/04/2015] [Indexed: 12/30/2022] Open
Abstract
Aims The aim of this study was to compare the etiology, clinical course, selected diagnostic methods and efficacy of the treatment used in patients with infective endocarditis (IE) in the nineteen eighties and nineties. Material and Methods The study group comprised 300 patients with infective endocarditis hospitalized in the Institute of Cardiology in Warsaw in the following years: from 1982 to 1987 (150 patients: 75 successive patients with IE on the prosthetic valve and 75 successive patients with IE on the native valve), as well as from 1990 to 2003 (150 patients: 75 successive patients with IE on the prosthetic valve and 75 successive patients with IE on the native valve). Results In the nineties, immunological symptoms, embolism formation and progressive heart failure were diagnosed decidedly more frequently. Early prosthetic valve endocarditis (PVE) (up to 60 days after operation) occurred significantly more frequently in the eighties. The quantity of negative blood cultures in PVE has not decreased, it is still observed in over 20% of cases. For 20 years the etiology of PVE has remained the same, the dominant pathogen remains Staphylococcus. The frequency of PVE caused by Streptococci has markedly reduced. In both the decades analyzed the etiology of native valve endocarditis (NVE) was similar. In the eighties Streptococcus was predominant. In successive years the number of infections caused by Staphylococci was the same as that caused by Streptococci. Conclusions The incidence of early PVE decreased in the nineties. More patients were treated surgically with lesser peri-operative mortality. A lower incidence of infective endocarditis on prosthetic valves caused by streptococci may signify better prophylaxis against infective endocarditis. Infective endocarditis with sterile blood cultures continues to occur frequently.
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368
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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369
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Daptomycin for the Treatment of Infective Endocarditis: Results from European Cubicin(®) Outcomes Registry and Experience (EU-CORE). Infect Dis Ther 2015; 4:283-96. [PMID: 26168988 PMCID: PMC4575291 DOI: 10.1007/s40121-015-0075-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The European Cubicin(®) Outcomes Registry and Experience (EU-CORE(SM)) was a retrospective, non-interventional, multicenter study which evaluated the safety and effectiveness of daptomycin therapy in patients with Gram-positive infections including infective endocarditis (IE). METHODS Data from the EU-CORE registry were collected for patients with IE who had received at least one dose of daptomycin between January 2006 and April 2012, across 18 countries in Europe (12), Latin America (5) and Asia (1). Clinical outcomes were assessed as success (cured or improved), failure or non-evaluable. Adverse events (AEs) were recorded during treatment and for up to 30 days post-treatment; follow-up data were collected for 2 years. RESULTS Of 6075 patients included in the EU-CORE registry, 610 were diagnosed with IE as primary infection; 149 (24.4%) right-sided IE (RIE), 414 (67.9%) left-sided IE (LIE), and 47 (7.7%) with both right- and left-sided IE (BRLIE). Overall clinical success was achieved in 80.0% of patients (RIE 88.6%, LIE 76.6% and BRLIE 82.9%). Success rates for methicillin-resistant Staphylococcus aureus (MRSA) infections were 90.9%, 71.7% and 66.6% in patients with RIE, LIE and BRLIE, respectively. The overall sustained clinical success rate in patients followed for up to 2 years was 86.7% (RIE 93.5%, LIE 88.3% and BRLIE 77.8%). AEs deemed possibly related to daptomycin in the investigator's opinion were reported in 2 (1.3%) RIE, 18 (4.3%) LIE and 1 (2.1%) BRLIE patients. There were 11 (1.8%) patients (2 with RIE, 8 with LIE and 1 with BRLIE) with AEs of creatine phosphokinase elevation reported as possibly related to daptomycin. CONCLUSION Data from this real-world clinical setting showed that daptomycin was well tolerated and effective for the treatment of LIE and BRLIE in addition to RIE caused by Gram-positive bacteria, including MRSA. Two-year follow-up data showed that a high proportion of patients had a sustained response.
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370
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Yoshioka D, Toda K, Okazaki S, Sakaguchi T, Miyagawa S, Yoshikawa Y, Sawa Y. Anemia Is a Risk Factor of New Intraoperative Hemorrhagic Stroke During Valve Surgery for Endocarditis. Ann Thorac Surg 2015; 100:16-23. [DOI: 10.1016/j.athoracsur.2015.02.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
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Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28:603-61. [PMID: 26016486 PMCID: PMC4451395 DOI: 10.1128/cmr.00134-14] [Citation(s) in RCA: 2772] [Impact Index Per Article: 308.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
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Affiliation(s)
- Steven Y C Tong
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Emily Eichenberger
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas L Holland
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Ragnarsson S, Sjögren J, Stagmo M, Wierup P, Nozohoor S. Clinical Presentation of Native Mitral Valve Infective Endocarditis Determines Long-Term Outcome after Surgery. J Card Surg 2015; 30:669-76. [DOI: 10.1111/jocs.12591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery; Skane University Hospital and Lund University; Lund Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery; Skane University Hospital and Lund University; Lund Sweden
| | - Martin Stagmo
- Department of Cardiology; Skane University Hospital and Lund University; Lund Sweden
| | - Per Wierup
- Department of Cardiothoracic Surgery; Skane University Hospital and Lund University; Lund Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery; Skane University Hospital and Lund University; Lund Sweden
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Hunter AS, Guervil DJ, Perez KK, Schilling AN, Verheyden CN, Vuong NN, Xu R. Significant publications on infectious diseases pharmacotherapy in 2013. Am J Health Syst Pharm 2015; 71:1974-88. [PMID: 25349243 DOI: 10.2146/ajhp140148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The most important articles on infectious diseases (ID) pharmacotherapy published in the peer-reviewed literature in 2013, as nominated and selected by panels of pharmacists and others with ID expertise, are summarized. SUMMARY Members of the Houston Infectious Diseases Network were asked to nominate articles published last year in prominent biomedical journals that had a major impact in the field of ID pharmacotherapy. A list of 27 nominated articles on ID-related topics in general and 26 articles specifically focused on human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) was compiled. In a national online survey conducted in January 2014, members of the Society of Infectious Diseases Pharmacists (SIDP) were asked to select from the list those articles that they felt had made the greatest contributions to the field of ID pharmacotherapy. Of 168 SIDP members surveyed, 108 (64%) and 53 (32%) participated in the selection of ID- and HIV/AIDS-related articles, respectively. Summaries of the top-ranked articles in both categories are presented. CONCLUSION Major topics explored in the top-ranked ID articles of 2013 include the use of cefepime for gram-negative infections due to AmpC or extended-spectrum β-lactamase-producing Enterobacteriaceae, optimizing antibiotic therapy through the use of extended- or continuous-infusion regimens, the use of the oral integrase inhibitor dolutegravir to combat HIV disease, and new approaches to treatment of Clostridium difficile infection and enterococcal endocarditis.
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Affiliation(s)
- Andrew S Hunter
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - David J Guervil
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands.
| | - Katherine K Perez
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Amy N Schilling
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Collin N Verheyden
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Nancy N Vuong
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
| | - Ran Xu
- Andrew S. Hunter, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. David J. Guervil, Pharm.D., is Clinical Pharmacy Specialist-Infectious Diseases, Memorial Hermann-Texas Medical Center, Houston. Katherine K. Perez, Pharm. D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases, Houston Methodist Hospital and Houston Methodist Research Institute, Houston. Amy N. Schilling, Pharm.D., BCPS, is Clinical Pharmacy Specialist-Infectious Diseases/Internal Medicine, Memorial Hermann-The Woodlands Hospital, The Woodlands, TX. Collin N. Verheyden, Pharm.D., BCPS, is Postgraduate Year 2 (PGY2) Infectious Diseases Pharmacy Resident, Michael E. DeBakey Veterans Affairs Medical Center. Nancy N. Vuong, Pharm.D., BCPS, is PGY2 Infectious Diseases Pharmacotherapy Resident, Cardinal Health and University of Houston College of Pharmacy, Houston. Ran Xu, Ph.D., Pharm.D., BCPS, is Clinical Pharmacy Manager, St. Luke's The Woodlands Hospital, The Woodlands
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Patrat-Delon S, Rouxel A, Gacouin A, Revest M, Flécher E, Fouquet O, Le Tulzo Y, Lerolle N, Tattevin P, Tadié JM. EuroSCORE II underestimates mortality after cardiac surgery for infective endocarditis. Eur J Cardiothorac Surg 2015; 49:944-51. [DOI: 10.1093/ejcts/ezv223] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/27/2015] [Indexed: 11/13/2022] Open
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Staphylococcus aureus Bloodstream Infection and Endocarditis--A Prospective Cohort Study. PLoS One 2015; 10:e0127385. [PMID: 26020939 PMCID: PMC4447452 DOI: 10.1371/journal.pone.0127385] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/15/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE). METHODS All consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France. RESULTS SAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%). CONCLUSION SAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.
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376
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Mahr A, Batteux F, Duval X. Reply. Arthritis Rheumatol 2015; 67:1408. [DOI: 10.1002/art.39047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/15/2015] [Indexed: 11/07/2022]
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Mirabel M, André R, Barsoum Mikhaïl P, Colboc H, Lacassin F, Noël B, Robert J, Nadra M, Braunstein C, Gervolino S, Marijon E, Iung B, Jouven X. Infective endocarditis in the Pacific: clinical characteristics, treatment and long-term outcomes. Open Heart 2015; 2:e000183. [PMID: 25973211 PMCID: PMC4422921 DOI: 10.1136/openhrt-2014-000183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/13/2014] [Accepted: 12/11/2014] [Indexed: 01/23/2023] Open
Abstract
Introduction Data on clinical characteristics and outcomes of infective endocarditis (IE) in the Pacific are scarce. Methods Retrospective hospital-based study in New Caledonia, a high-income country, on patients aged over 18 years with definite IE according to the modified Duke criteria (2005–2010). Results 51 patients were included: 31 (60.8%) men; median age of 52.4 years (IQR 33.0–70.0). Left-sided IE accounted for 47 (92.2%) patients: native valve IE in 34 (66.7%) and prosthetic valve IE in 13 (25.5%). The main underlying heart disease included: rheumatic valve disease in 19 (37.3%), degenerative heart valve disease in 12 (23.5%) and congenital heart disease in 6 (11.8%). Significant comorbidities (Charlson's score >3) were observed in 20 (38.7%) patients. Infection was community acquired in 43 (84.3%) patients. Leading pathogens included Staphylococcus aureus in 16 (31.4%) and Streptococcus spp in 15 (29.4%) patients. Complications were noted in 33 patients (64.7%) and 24 (47.1%) were admitted to the intensive care unit. Cardiac surgery was eventually performed in 22 of 40 (55.0%) patients with a theoretical indication. None underwent emergent cardiac surgery (ie, first 24 h); 2 (3.9%) were operated within 7 days; and 20 (39.2%) beyond 7 days. 11 (21.6%) patients died in hospital and 21 (42.9%) were dead after a median follow-up of 28.8 months (IQR 4.6–51.2). Two (3.9%) were lost to follow-up. Conclusions In New Caledonia, IE afflicts relatively young patients with rheumatic heart disease, and carries high complication and mortality rates. Access to heart surgery remains relatively limited in this remote archipelago.
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Affiliation(s)
- Mariana Mirabel
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
| | - Romain André
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France
| | - Paul Barsoum Mikhaïl
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Hester Colboc
- Department of Internal Medicine and Infectious Disease , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Flore Lacassin
- Department of Internal Medicine and Infectious Disease , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Baptiste Noël
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Jacques Robert
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Marie Nadra
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Corinne Braunstein
- Cardiology Department , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Shirley Gervolino
- Department of Bioinformatics , Hôpital Territorial de Nouvelle Calédonie , Nouméa , New Caledonia
| | - Eloi Marijon
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
| | - Bernard Iung
- Cardiology Department , Hôpital Bichat and Paris Diderot University , Paris , France
| | - Xavier Jouven
- INSERM U970, Paris Cardiovascular Research Centre-PARCC , Paris , France ; Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou , Paris , France
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Asgeirsson H, Thalme A, Kristjansson M, Weiland O. Incidence and outcome of Staphylococcus aureus endocarditis--a 10-year single-centre northern European experience. Clin Microbiol Infect 2015; 21:772-8. [PMID: 25934159 DOI: 10.1016/j.cmi.2015.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/08/2015] [Accepted: 04/20/2015] [Indexed: 11/17/2022]
Abstract
Staphylococcus aureus is a leading cause of infective endocarditis. Little has been published on the outcome and epidemiology of S. aureus endocarditis (SAE) in the twenty-first century. Our aim was to evaluate the short-term and long-term outcome of SAE in Stockholm, Sweden, and assess its incidence over time. Patients treated for SAE from January 2004 through December 2013 were retrospectively identified at the Karolinska University Hospital. Clinical data were obtained from medical records and the diagnosis was verified according to the modified Duke criteria. Of 245 SAE cases, 152 (62%) were left-sided and 120 (49%) occurred in intravenous drug users. The calculated incidence in Stockholm County was 1.56/100 000 person-years, increasing from 1.28 in 2004-08 to 1.82/100 000 person-years in 2009-13 (p 0.002). In-hospital and 1-year mortality rates were 9.0% (22/245) and 19.5% (46/236), respectively. Age (OR 1.06 per year) and female sex (OR 3.0) were independently associated with in-hospital mortality in multivariate analysis. Involvement of the central nervous system (CNS) was observed in 30 (12%) patients, and valvular surgery was performed during hospitalization in 37 (15%). In left-sided endocarditis the strongest predictors for surgery were severe valvular insufficiency (OR 8.9), lower age (OR 1.07 per year) and no intravenous drug use (OR 10.7), and for CNS involvement lower age (OR 1.04 per year). In conclusion we noted low mortality, low CNS complication rate, and low valvular surgery frequency associated with SAE in our setting. The incidence was high and increased over time. The study provides an update on the outcome and epidemiology of SAE in the twenty-first century.
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Affiliation(s)
- H Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
| | - A Thalme
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - M Kristjansson
- Department of Infectious Diseases, Landspitali University Hospital, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - O Weiland
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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Cecchi E, Chirillo F, Castiglione A, Faggiano P, Cecconi M, Moreo A, Cialfi A, Rinaldi M, Del Ponte S, Squeri A, Corcione S, Canta F, Gaddi O, Enia F, Forno D, Costanzo P, Zuppiroli A, Ronzani G, Bologna F, Patrignani A, Belli R, Ciccone G, De Rosa FG. Clinical epidemiology in Italian Registry of Infective Endocarditis (RIEI): Focus on age, intravascular devices and enterococci. Int J Cardiol 2015; 190:151-6. [PMID: 25918069 DOI: 10.1016/j.ijcard.2015.04.123] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 04/07/2015] [Accepted: 04/15/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The epidemiology of infective endocarditis (IE) is changing due to a number of factors, including aging and health related comorbidities and medical procedures. The aim of this study is to describe the main clinical, epidemiologic and etiologic changes of IE from a large database in Italy. METHODS We prospectively collected episodes of IE in 17 Italian centers from July 2007 to December 2010. RESULTS We enrolled 677 patients with definite IE, of which 24% health-care associated. Patients were male (73%) with a median age of 62 years (IQR: 49-74) and 61% had several comorbidities. One hundred and twenty-eight (19%) patients had prosthetic left side IE, 391 (58%) native left side IE, 94 (14%) device-related IE and 54 (8%) right side IE. A predisposing cardiopathy was present in 50%, while odontoiatric and non odontoiatric procedures were reported in 5% and 21% of patients respectively. Symptoms were usually atypical and precocious. The prevalent etiology was represented by Staphylococcus aureus (27%) followed by coagulase-negative staphylococci (CNS, 21%), Streptococcus viridans (15%) and enterococci (14%). CNS and enterococci were relatively more frequent in patients with intravascular devices and prosthesis and S. viridans in left native valve. Diagnosis was made by transthoracic and transesophageal echocardiography in 62% and 94% of cases, respectively. The in-hospital mortality was 14% and 1-year mortality was 21%. CONCLUSION The epidemiology is changing in Italy, where IE more often affects older patients with comorbidities and intravascular devices, with an acute onset and including a high frequency of enterococci. There were few preceding odontoiatric procedures.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Anna Castiglione
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | | | - Moreno Cecconi
- Dipartimento di Scienze Cardiologiche Mediche e Chirurgiche Azienda Ospedaliera Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Antonella Moreo
- Department of Cardiology, Niguarda Ca' Granda Hospital, Milano, Italy
| | | | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | | | - Angelo Squeri
- Dipartimento Cardio-Nefro-Polmonare, Azienda Ospedaliera - Universitaria di Parma, Parma, Italy
| | - Silvia Corcione
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | | | - Oscar Gaddi
- Department of Cardiology, Reggio Emilia Hospital, Reggio Emilia, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Piera Costanzo
- Department of Cardiology, Giovanni Bosco Hospital, Torino, Italy
| | | | | | - Flavio Bologna
- Department of Cardiology, Rimini Hospital, Rimini, Italy
| | - Anna Patrignani
- Department of Cardiology, Senigallia Hospital, Senigallia, Italy
| | - Riccardo Belli
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- SSCVD Epidemiologia Clinica e Valutativa, Città della Salute e della Scienza di Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
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Bouchiat C, Saison J, Boisset S, Flandrois JP, Issartel B, Dauwalder O, Benito Y, Jarraud S, Grando J, Boibieux A, Dumitrescu O, Delahaye F, Farhat F, Thivolet-Bejui F, Frieh JP, Vandenesch F. Nontuberculous Mycobacteria: An Underestimated Cause of Bioprosthetic Valve Infective Endocarditis. Open Forum Infect Dis 2015. [PMID: 26213691 PMCID: PMC4511745 DOI: 10.1093/ofid/ofv047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
From 2010 to 2013, 5 cases of nontuberculous mycobacteria infective endocarditis (IE), exclusively from bioprosthesis, were diagnosed in three hospitals out of 370 blood culture-negative-suspected IE. The porcine origin of this underestimated etiology is questioned. Background. Atypical mycobacteria, or nontuberculous mycobacteria (NTM), have been barely reported as infective endocarditis (IE) agents. Methods. From January 2010 to December 2013, cardiac valve samples sent to our laboratory as cases of blood culture-negative suspected IE were analyzed by 16S rDNA polymerase chain reaction (PCR). When positive for NTM, hsp PCR allowed species identification. Demographic, clinical, echocardiographic, histopathological, and Ziehl-Neelsen staining data were then collected. Results. Over the study period, 6 of 370 cardiac valves (belonging to 5 patients in 3 hospitals) were positive for Mycobacterium chelonae (n = 5) and Mycobacterium lentiflavum (n = 1) exclusively on bioprosthetic material. The 5 patients presented to the hospital for heart failure without fever 7.1–18.9 months (median 13.1 months) after biological prosthetic valve implantation. Echocardiography revealed paravalvular regurgitation due to prosthesis dehiscence in all patients. Histopathological examination of the explanted material revealed inflammatory infiltrates in all specimens, 3 of which were associated with giant cells. Gram staining and conventional cultures remained negative, whereas Ziehl-Neelsen staining showed acid-fast bacilli in all patients. Allergic etiology was ruled out by antiporcine immunoglobulin E dosages. These 5 cases occurred exclusively on porcine bioprosthetic material, revealing a statistically significant association between bioprosthetic valves and NTM IE (P < .001). Conclusions. The body of evidence confirmed the diagnosis of prosthetic IE. The statistically significant association between bioprosthetic valves and NTM IE encourages systematic Ziehl-Neelsen staining of explanted bioprosthetic valves in case of early bioprosthesis dysfunction, even without an obvious sign of IE. In addition, we strongly question the cardiac bioprosthesis conditioning process after animal sacrifice.
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Affiliation(s)
- Coralie Bouchiat
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
| | | | - Sandrine Boisset
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
| | - Jean-Pierre Flandrois
- Laboratoire de Biometrie et Biologie Evolutive , Université Lyon 1-CNRS UMR 5558 , Bâtiment Mendel, Villeurbanne
| | | | - Olivier Dauwalder
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
| | - Yvonne Benito
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
| | - Sophie Jarraud
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
| | | | | | - Oana Dumitrescu
- Laboratoire de Bactériologie, Centre Hospitalier Lyon Sud , Hospices Civils de Lyon , Pierre-Bénite
| | - François Delahaye
- Service de Cardiologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron
| | - Fadi Farhat
- Service de Chirurgie Cardiaque, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron
| | - Françoise Thivolet-Bejui
- Service d'Anatomo-Pathologie, Centre de Biologie Est , Hôpital Louis Pradel, Hospices Civils de Lyon , Bron
| | - Jean-Philippe Frieh
- Service de Chirurgie Cardiaque , Clinique du Tonkin , Villeurbanne ; Service de Chirurgie Cardiaque , Infirmerie Protestante , Caluire-et-Cuire , France
| | - François Vandenesch
- Laboratoire de Bactériologie, Centre de Biologie Est , Hospices Civils de Lyon , Bron
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381
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Heart transplantation as salvage treatment of intractable infective endocarditis. Clin Microbiol Infect 2015; 21:371.e1-4. [DOI: 10.1016/j.cmi.2014.11.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/25/2014] [Accepted: 11/27/2014] [Indexed: 11/23/2022]
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382
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Laursen ML, Gill S, Moller JE, Gustavsen PH. Healthcare-associated infective endocarditis of the pulmonary valve. BMJ Case Rep 2015; 2015:bcr-2014-207577. [PMID: 25820109 DOI: 10.1136/bcr-2014-207577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 66-year-old man with known ischaemic heart disease, diabetes mellitus and stage 4 kidney disease who was admitted to our tertiary centre with shortness of breath and atrial flutter. Transoesophageal echocardiography (TOE) was without suspicion of endocarditis. During hospitalisation, the patient suffered a nosocomial infection in a peripheral vascular catheter caused by Staphylococcus aureus. TOE after positive blood cultures revealed a new vegetation on the pulmonary valve that resolved after antibiotic treatment.
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Affiliation(s)
| | - Sabine Gill
- Department of Cardiology, Odense University Hospital, Odense C, Denmark
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383
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Mirabel M, André R, Barsoum P, Colboc H, Lacassin F, Noel B, Axler O, Phelippeau G, Braunstein C, Marijon E, Iung B, Jouven X. Ethnic disparities in the incidence of infective endocarditis in the Pacific. Int J Cardiol 2015; 186:43-4. [PMID: 25804467 DOI: 10.1016/j.ijcard.2015.03.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/17/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Mariana Mirabel
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, Paris Cardiovascular Research Center - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Romain André
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Paul Barsoum
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Hester Colboc
- Department of Infternal Medicine and Infectious Disease, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Flore Lacassin
- Department of Infternal Medicine and Infectious Disease, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Baptiste Noel
- Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Olivier Axler
- Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Gwendolyne Phelippeau
- Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Corinne Braunstein
- Cardiology Department, Hôpital Territorial de Nouvelle Calédonie, Nouméa, New Caledonia
| | - Eloi Marijon
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, Paris Cardiovascular Research Center - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Bernard Iung
- Cardiology Department, Hôpital Bichat and Paris Diderot University, Paris, France
| | - Xavier Jouven
- Assistance Publique - Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, Paris Cardiovascular Research Center - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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384
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Marks DJB, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Huggett JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF. Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJM 2015; 108:219-29. [PMID: 25223570 DOI: 10.1093/qjmed/hcu188] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) causes substantial morbidity and mortality. Patient and pathogen profiles, as well as microbiological and operative strategies, continue to evolve. The impact of these changes requires evaluation to inform optimum management and identify individuals at high risk of early mortality. AIM Identification of clinical and microbiological features, and surgical outcomes, among patients presenting to a UK tertiary cardiothoracic centre for surgical management of IE between 1998 and 2010. DESIGN Retrospective observational cohort study. METHODS Clinical, biochemical, microbiological and echocardiographic data were identified from clinical records. Principal outcomes were all-cause 28-day mortality and duration of post-operative admission. RESULTS Patients (n = 336) were predominantly male (75.0%); median age 52 years (IQR = 41-67). Most cases involved the aortic (56.0%) or mitral (53.9%) valves. Microbiological diagnoses, obtained in 288 (85.7%) patients, included streptococci (45.2%); staphylococci (34.5%); Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) organisms (3.0%); and fungi (1.8%); 11.3% had polymicrobial infection. Valve replacement in 308 (91.7%) patients included mechanical prostheses (69.8%), xenografts (24.0%) and homografts (6.2%). Early mortality was 12.2%, but fell progressively during the study (P = 0.02), as did median duration of post-operative admission (33.5 to 10.5 days; P = 0.0003). Multivariable analysis showed previous cardiothoracic surgery (OR = 3.85, P = 0.03), neutrophil count (OR = 2.27, P = 0.05), albumin (OR = 0.94, P = 0.04) and urea (OR = 2.63, P < 0.001) predicted early mortality. CONCLUSIONS This study demonstrates reduced post-operative early mortality and duration of hospital admission for IE patients over the past 13 years. Biomarkers (previous cardiothoracic surgery, neutrophil count, albumin and urea), predictive of early post-operative mortality, require prospective evaluation to refine algorithms, further improve outcomes and reduce healthcare costs associated with IE.
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Affiliation(s)
- D J B Marks
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Hyams
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C Y Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M Pavlou
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Robbins
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - C S Koo
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - G Rodger
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J F Huggett
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - J Yap
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - M B Macrae
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R H Swanton
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - A I Zumla
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
| | - R F Miller
- From the Department of Medicine, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK, Department of Cardiothoracic Surgery, Heart Hospital, London, UK, Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, UK, Department of Cardiology, The Heart Hospital, London, UK and National Institute of Health Research, Biomedical Research Centre, University College London Hospital, London, UK
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385
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Watt G, Lacroix A, Pachirat O, Baggett HC, Raoult D, Fournier PE, Tattevin P. Prospective comparison of infective endocarditis in Khon Kaen, Thailand and Rennes, France. Am J Trop Med Hyg 2015; 92:871-4. [PMID: 25646262 DOI: 10.4269/ajtmh.14-0689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/13/2014] [Indexed: 12/13/2022] Open
Abstract
Prospectively collected, contemporary data are lacking on how the features of infective endocarditis (IE) vary according to region. We, therefore, compared IE in Rennes, France and Khon Kaen, Thailand. Fifty-eight patients with confirmed IE were enrolled at each site during 2011 and 2012 using a common protocol. Compared with French patients, Thais had a lower median age (47 versus 70 years old; P < 0.001) and reported more animal contact (86% versus 21%; P < 0.001). There were more zoonotic infections among Thai than France patients (6 and 1 cases; P = 0.017) and fewer staphylococcal infections (4 versus 15 cases; P = 0.011). Underlying rheumatic heart disease was more prevalent in Thai than in French patients (31% and 4%; P = 0.001), whereas prosthetic heart valves were less prevalent (9% and 35%; P = 0.001). Our data strengthen previous observations that IE in the tropics has distinctive demographic characteristics, risk factors, and etiologies and underscore the need for improved prevention and control strategies.
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Affiliation(s)
- George Watt
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Adele Lacroix
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Orathai Pachirat
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Didier Raoult
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Pierre-Edouard Fournier
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
| | - Pierre Tattevin
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Université Rennes-1, Rennes, France; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, Georgia; Unite de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Faculte de Medicine, University of the Mediterranean, Marseille, France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, INSERM U835, Université Rennes-1, Rennes, France
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386
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Chu VH, Park LP, Athan E, Delahaye F, Freiberger T, Lamas C, Miro JM, Mudrick DW, Strahilevitz J, Tribouilloy C, Durante-Mangoni E, Pericas JM, Fernández-Hidalgo N, Nacinovich F, Rizk H, Krajinovic V, Giannitsioti E, Hurley JP, Hannan MM, Wang A. Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis. Circulation 2015; 131:131-40. [DOI: 10.1161/circulationaha.114.012461] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined.
Methods and Results—
The International Collaboration on Endocarditis–PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non–cardiac device–related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and
Staphyloccus aureus
etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE.
Conclusions—
Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period.
S aureus
IE was significantly associated with nonsurgical management.
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Affiliation(s)
- Vivian H. Chu
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Lawrence P. Park
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Eugene Athan
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Francois Delahaye
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Tomas Freiberger
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Cristiane Lamas
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Jose M. Miro
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Daniel W. Mudrick
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Jacob Strahilevitz
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Christophe Tribouilloy
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Emanuele Durante-Mangoni
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Juan M. Pericas
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Nuria Fernández-Hidalgo
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Francisco Nacinovich
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Hussien Rizk
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Vladimir Krajinovic
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Efthymia Giannitsioti
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - John P. Hurley
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Margaret M. Hannan
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
| | - Andrew Wang
- From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic–August Pi i Sunyer Biomedical
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387
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Affiliation(s)
- Younghee Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Korea
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388
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Tattevin P, Watt G, Revest M, Arvieux C, Fournier PE. Update on blood culture-negative endocarditis. Med Mal Infect 2015; 45:1-8. [PMID: 25480453 DOI: 10.1016/j.medmal.2014.11.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/04/2014] [Indexed: 12/13/2022]
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389
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Bergin SP, Holland TL, Fowler VG, Tong SYC. Bacteremia, Sepsis, and Infective Endocarditis Associated with Staphylococcus aureus. Curr Top Microbiol Immunol 2015; 409:263-296. [PMID: 26659121 DOI: 10.1007/82_2015_5001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Bacteremia and infective endocarditis (IE) are important causes of morbidity and mortality associated with Staphylococcus aureus infections. Increasing exposure to healthcare, invasive procedures, and prosthetic implants has been associated with a rising incidence of S. aureus bacteremia (SAB) and IE since the late twentieth century. S. aureus is now the most common cause of bacteremia and IE in industrialized nations worldwide and is associated with excess mortality when compared to other pathogens. Central tenets of management include identification of complicated bacteremia, eradicating foci of infection, and, for many, prolonged antimicrobial therapy. Evolving multidrug resistance and limited therapeutic options highlight the many unanswered clinical questions and urgent need for further high-quality clinical research.
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390
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Yeaman MR, Filler SG, Chaili S, Barr K, Wang H, Kupferwasser D, Hennessey JP, Fu Y, Schmidt CS, Edwards JE, Xiong YQ, Ibrahim AS. Mechanisms of NDV-3 vaccine efficacy in MRSA skin versus invasive infection. Proc Natl Acad Sci U S A 2014; 111:E5555-63. [PMID: 25489065 PMCID: PMC4280579 DOI: 10.1073/pnas.1415610111] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Increasing rates of life-threatening infections and decreasing susceptibility to antibiotics urge development of an effective vaccine targeting Staphylococcus aureus. This study evaluated the efficacy and immunologic mechanisms of a vaccine containing a recombinant glycoprotein antigen (NDV-3) in mouse skin and skin structure infection (SSSI) due to methicillin-resistant S. aureus (MRSA). Compared with adjuvant alone, NDV-3 reduced abscess progression, severity, and MRSA density in skin, as well as hematogenous dissemination to kidney. NDV-3 induced increases in CD3+ T-cell and neutrophil infiltration and IL-17A, IL-22, and host defense peptide expression in local settings of SSSI abscesses. Vaccine induction of IL-22 was necessary for protective mitigation of cutaneous infection. By comparison, protection against hematogenous dissemination required the induction of IL-17A and IL-22 by NDV-3. These findings demonstrate that NDV-3 protective efficacy against MRSA in SSSI involves a robust and complementary response integrating innate and adaptive immune mechanisms. These results support further evaluation of the NDV-3 vaccine to address disease due to S. aureus in humans.
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Affiliation(s)
- Michael R Yeaman
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and Molecular Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502; St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Scott G Filler
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Siyang Chaili
- Divisions of Infectious Diseases and Molecular Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502; St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Kevin Barr
- St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Huiyuan Wang
- Divisions of Infectious Diseases and Molecular Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502; St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Deborah Kupferwasser
- Divisions of Infectious Diseases and Molecular Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502; St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | | | - Yue Fu
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | | | - John E Edwards
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Yan Q Xiong
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
| | - Ashraf S Ibrahim
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095; Divisions of Infectious Diseases and St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502; and
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391
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Fukuchi T, Iwata K, Ohji G. Failure of early diagnosis of infective endocarditis in Japan--a retrospective descriptive analysis. Medicine (Baltimore) 2014; 93:e237. [PMID: 25501088 PMCID: PMC4602777 DOI: 10.1097/md.0000000000000237] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infective endocarditis (IE) is a severe disease with high morbidity and mortality, and these can be exacerbated by delay in diagnosis. We investigated IE diagnosis in Japan with the emphasis on the delay in diagnosis and its cause and implications. We conducted a retrospective study on 82 definite IE patients at Kobe University Hospital from April 1, 2008, through March 31, 2013. We reviewed charts of the patients for data such as causative pathogens, prescription of inappropriate antibiotic use prior to the diagnosis, existence of risk factors of IE, previous doctor's subspecialty, or duration until the diagnosis, with the primary outcome of 180-day mortality. We also qualitatively, as well as quantitatively, analyzed those cases with delay in diagnosis, and hypothesized its causes and implications. Eighty-two patients were reviewed for this analysis. The average age was 61 ± 14.5-year-old. Fifty percent of patients had known underlying risk factors for IEs, such as prosthetic heart valve (10), valvular heart disease (21), congenital heart disease (3), or cardiomyopathy (2). The median days until the diagnosis was 14 days (range 2 days to 1 year). Sixty-five percent of patients received inappropriate antibiotic before the diagnosis (53). Forty percent of causative organisms were Staphylococcus aureus (MSSA 20, MRSA 13), 32% were viridans streptococci and Streptococcus bovis, 28% were others or unknown (CNS 5, Corynebacterium 3, Cardiobacterium 1, Candida 1). Subspecialties such as General Internal Medicine (15), and Orthopedics (13) were associated with delay in diagnosis. Ten patients (12%) died during follow up, and 8 of them had been received prior inappropriate antibiotics. Significant delay in the diagnosis of IE was observed in Japan. Inappropriate antibiotics were prescribed frequently and may be associated with poor prognosis. Further improvement for earlier diagnosis of IE is needed.
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Affiliation(s)
- Takahiko Fukuchi
- From the Division of Infectious Diseases therapeutics, Department of Microbiology and Infectious Diseases, Kobe University Graduate School of Medicine, Kobe, Japan
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392
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Sunder S, Grammatico-Guillon L, Baron S, Gaborit C, Bernard-Brunet A, Garot D, Legras A, Prazuck T, Dibon O, Boulain T, Tabone X, Guimard Y, Massot M, Valery A, Rusch E, Bernard L. Clinical and economic outcomes of infective endocarditis. Infect Dis (Lond) 2014; 47:80-7. [DOI: 10.3109/00365548.2014.968608] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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393
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Mirabel M, Rattanavong S, Frichitthavong K, Chu V, Kesone P, Thongsith P, Jouven X, Fournier PE, Dance DAB, Newton PN. Infective endocarditis in the Lao PDR: clinical characteristics and outcomes in a developing country. Int J Cardiol 2014; 180:270-3. [PMID: 25482077 PMCID: PMC4323144 DOI: 10.1016/j.ijcard.2014.11.184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/02/2014] [Accepted: 11/23/2014] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Data on infective endocarditis (IE) in Southeast Asia are scarce. OBJECTIVES To describe the clinical epidemiology of IE in Lao PDR, a lower middle-income country. METHODS A single centre retrospective study at Mahosot Hospital, Vientiane. Patients aged over 1year of age admitted 2006-2012 to Mahosot Hospital with definite or possible IE by modified Duke criteria were included. RESULTS Thirty-six patients fulfilled the inclusion criteria; 33 (91.7%) had left-sided IE. Eleven (30.6%) had definite IE and 25 (69.4%) possible left-sided IE. Median age was 25years old [IQR 18-42]. Fifteen patients (41.7%) were males. Underlying heart diseases included: rheumatic valve disease in 12 (33.3%), congenital heart disease in 7 (19.4%), degenerative valve disease in 3 (8.3%), and of unknown origin in 14 (38.9%) patients. Native valve IE was present in 30 patients (83.3%), and prosthetic valve IE in 6 patients (16.7%). The most frequent pathogens were Streptococcus spp. in 7 (19.4%). Blood cultures were negative in 22 patients (61.1%). Complications included: heart failure in 11 (30.6%), severe valve regurgitation in 7 (19.4%); neurological event in 7 (19.4%); septic shock or severe sepsis in 5 (13.9%); and cardiogenic shock in 3 patients (8.3%). No patient underwent heart surgery. Fourteen (38.9%) had died by follow-up after a median of 2.1years [IQR 1-3.2]; and 3 (8.3%) were lost to follow-up. CONCLUSIONS Infective endocarditis, a disease especially of young adults and mainly caused by Streptococcus spp., was associated with rheumatic heart disease and had high mortality in Laos.
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Affiliation(s)
- Mariana Mirabel
- INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | | | - Vang Chu
- Cardiology Department, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Pany Kesone
- Cardiology Department, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Phonvilay Thongsith
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Xavier Jouven
- INSERM U970, Paris Cardiovascular Research Center PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Pierre-Edouard Fournier
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Centre National de la Recherche Scientifique-Institut de Recherche pour le Développement, Unité Mixte de Recherche 6236, Faculté de Médecine, Université de la Méditerranée, France
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
| | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Churchill Hospital, University of Oxford, Oxford, United Kingdom
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394
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Şimşek-Yavuz S, Şensoy A, Kaşıkçıoğlu H, Çeken S, Deniz D, Yavuz A, Koçak F, Midilli K, Eren M, Yekeler İ. Infective endocarditis in Turkey: aetiology, clinical features, and analysis of risk factors for mortality in 325 cases. Int J Infect Dis 2014; 30:106-14. [PMID: 25461657 DOI: 10.1016/j.ijid.2014.11.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/03/2014] [Accepted: 11/07/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE In order to define the current characteristics of infective endocarditis (IE) in Turkey, we evaluated IE cases over a 14-year period in a tertiary referral hospital. METHODS All adult patients who were hospitalized in our hospital with a diagnosis of IE between 2000 and 2013 were included in the study. Modified Duke criteria were used for diagnosis. The Chi-square test, Student's t-test, Mann-Whitney U-test, Cox and logistic regression analysis were used for the statistical analysis. RESULTS There were 325 IE cases during the study period. The mean age of the patients was 47 years. Causative microorganisms were identified in 253 patients (77.8%) and included staphylococci (36%), streptococci (19%), enterococci (7%), and Brucella spp (5%). A streptococcal aetiology was associated with younger age (<40 years) (p=0.001), underlying chronic rheumatic heart disease (CRHD) (odds ratio (OR) 3.89) or a congenital heart defect (OR 4.04), community acquisition (OR 17.93), and native valve (OR 3.68). A staphylococcal aetiology was associated with healthcare acquisition (OR 2.26) or pacemaker lead-associated endocarditis (OR 6.63) and an admission creatinine level of >1.2mg/dl (OR 2.15). Older age (>50 year) (OR 3.93), patients with perivalvular abscess (OR 9.18), being on dialysis (OR 6.22), and late prosthetic valve endocarditis (OR 3.15) were independent risk factors for enterococcal IE. Independent risk factors for mortality in IE cases were the following: being on dialysis (hazard ratio (HR) 4.13), presence of coronary artery heart disease (HR 2.09), central nervous system emboli (HR 2.33), and congestive heart failure (HR 2.15). Higher haemoglobin (HR 0.87) and platelet (HR 0.996) levels and surgical interventions for IE (HR 0. 33) were found to be protective factors against mortality. CONCLUSIONS In Turkey, IE occurs in relatively young patients and Brucella spp should always be taken into consideration as a cause of this infection. We should first consider streptococci as the causative agents of IE in young patients, those with CRHD or congenital heart valve disease, and cases of community-acquired IE. Staphylococci should be considered first in the case of pacemaker lead IE, when there are high levels of creatinine, and in cases of healthcare-associated IE. Enterococci could be the most probable causative agent of IE particularly in patients aged >50 years, those on dialysis, those with late prosthetic valve IE, and those with a perivalvular abscess. The early diagnosis and treatment of IE before complications develop is crucial because the mortality rate is high among cases with serious complications. The prevention of bacteraemia with the measures available among chronic haemodialysis patients should be a priority because of the higher mortality rate of subsequent IE among this group of patients.
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Affiliation(s)
- Serap Şimşek-Yavuz
- Istanbul University, Istanbul Medical Faculty, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey.
| | - Ayfer Şensoy
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Hulya Kaşıkçıoğlu
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiology Department, Istanbul, Turkey
| | - Sabahat Çeken
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Denef Deniz
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Atilla Yavuz
- Kartal Lutfi Kırdar Research and Education Hospital, Cardiology Department, Istanbul, Turkey
| | - Funda Koçak
- Basaksehir State Hospital, Infectious Disease and Clinical Microbiology Department, Istanbul, Turkey
| | - Kenan Midilli
- Istanbul University, Cerrahpasa Medical Faculty, Microbiology Department, Istanbul, Turkey
| | - Mehmet Eren
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiology Department, Istanbul, Turkey
| | - İbrahim Yekeler
- Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Cardiovascular Surgery Department, Istanbul, Turkey
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395
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Chirouze C, Alla F, Fowler VG, Sexton DJ, Corey GR, Chu VH, Wang A, Erpelding ML, Durante-Mangoni E, Fernández-Hidalgo N, Giannitsioti E, Hannan MM, Lejko-Zupanc T, Miró JM, Muñoz P, Murdoch DR, Tattevin P, Tribouilloy C, Hoen B. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis 2014; 60:741-9. [PMID: 25389255 DOI: 10.1093/cid/ciu871] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration on Endocarditis-Prospective Cohort Study. METHODS Participants were enrolled between June 2000 and December 2006. Cox proportional hazards modeling that included surgery as a time-dependent covariate and propensity adjustment for likelihood to receive cardiac surgery was used to evaluate the impact of EVS and 1-year all-cause mortality on patients with definite left-sided S. aureus PVIE and no history of injection drug use. RESULTS EVS was performed in 74 of the 168 (44.3%) patients. One-year mortality was significantly higher among patients with S. aureus PVIE than in patients with non-S. aureus PVIE (48.2% vs 32.9%; P = .003). Staphylococcus aureus PVIE patients who underwent EVS had a significantly lower 1-year mortality rate (33.8% vs 59.1%; P = .001). In multivariate, propensity-adjusted models, EVS was not associated with 1-year mortality (risk ratio, 0.67 [95% confidence interval, .39-1.15]; P = .15). CONCLUSIONS In this prospective, multinational cohort of patients with S. aureus PVIE, EVS was not associated with reduced 1-year mortality. The decision to pursue EVS should be individualized for each patient, based upon infection-specific characteristics rather than solely upon the microbiology of the infection causing PVIE.
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Affiliation(s)
- Catherine Chirouze
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon
| | - François Alla
- Université de Lorraine, Université Paris Descartes, Apemac, EA4360 INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | - Vance G Fowler
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Sexton
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Ralph Corey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Vivian H Chu
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew Wang
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marie-Line Erpelding
- INSERM, CIC-EC, CIE6 CHU Nancy, Pôle S2R, Epidémiologie et Evaluation Cliniques, Nancy, France
| | | | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Margaret M Hannan
- Department of Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - José M Miró
- Hospital Clinic-IDIBAPS, University of Barcelona
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - David R Murdoch
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Pontchaillou University Hospital, Rennes
| | | | - Bruno Hoen
- UMR CNRS 6249 Chrono-Environnement, Université de Franche-Comté Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Besançon Université des Antilles et de la Guyane, Faculté de Médecine Hyacinthe Bastaraud, EA 4537, Pointe-à-Pitre, Guadeloupe Service de Maladies Infectieuses et Tropicales, CIC 1424, Centre Hospitalier Universitaire, Pointe-à-Pitre, France
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396
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Benito N, Pericas JM, Gurguí M, Mestres CA, Marco F, Moreno A, Horcajada JP, Miró JM. Health Care-Associated Infective Endocarditis: a Growing Entity that Can Be Prevented. Curr Infect Dis Rep 2014; 16:439. [PMID: 25230606 DOI: 10.1007/s11908-014-0439-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infective endocarditis (IE) continues to be a serious disease with a poor prognosis and high mortality. Neither incidence rates nor mortality have decreased in recent decades. Because of this, it is important to prevent IE in patients at risk. In the past, prevention of IE has focused on antimicrobial prophylaxis, mainly for dental procedures. However, recent major changes in epidemiology, the most significant being the growing frequency and high mortality rate of health care-associated valve endocarditis (HAIE), mean that preventive strategies against IE must also change. Since intravascular catheters are the most common source of bacteremia among patients with HAIE, significant efforts must be made to minimize the risk of catheter-related bloodstream infections. Measures for preventing the infection of prosthetic valves and cardiac implantable devices at the time of implantation also need to be implemented.
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Affiliation(s)
- Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine. Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain,
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397
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Abstract
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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Affiliation(s)
- Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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398
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Maor Y, Belausov N, Ben-David D, Smollan G, Keller N, Rahav G. hVISA and MRSA endocarditis: an 8-year experience in a tertiary care centre. Clin Microbiol Infect 2014; 20:O730-6. [DOI: 10.1111/1469-0691.12498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 12/03/2013] [Accepted: 12/09/2013] [Indexed: 12/25/2022]
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399
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Infective endocarditis epidemiology and consequences of prophylaxis guidelines modifications: the dialectical evolution. Curr Infect Dis Rep 2014; 16:440. [PMID: 25233804 DOI: 10.1007/s11908-014-0440-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Historically, infective endocarditis (IE) affected patients with predisposing cardiac conditions and community-acquired bacteremia. Over the past 30 years, significant changes have occurred, regarding microorganisms, underlying valvular heart diseases, portals of entry, and patients' comorbidities. Given these epidemiological changes and unproven prophylaxis efficacy, experts in most countries currently limit antibiotic indications to patients with high-risk cardiac conditions having oral procedures and, in the UK, recommend discontinuing their use altogether. To date, no epidemiological impact on streptococcal IE incidence has been observed. Policy must now address these epidemiological modifications, focus on community-acquired and health care-associated staphylococcal bacteremia prevention, and prompt the adoption of broader and nonexclusively antibiotic-based strategies.
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400
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Hagiya H, Kokeguchi S, Ogawa H, Terasaka T, Kimura K, Waseda K, Hanayama Y, Oda K, Mori H, Miyoshi T, Otsuka F. Aortic vascular graft infection caused by Cardiobacterium valvarum: a case report. J Infect Chemother 2014; 20:804-9. [PMID: 25242585 DOI: 10.1016/j.jiac.2014.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 07/10/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Susumu Kokeguchi
- Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroko Ogawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Terasaka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kosuke Kimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koichi Waseda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihisa Hanayama
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Oda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisatoshi Mori
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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