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Hoerr V, Franz M, Pletz MW, Diab M, Niemann S, Faber C, Doenst T, Schulze PC, Deinhardt-Emmer S, Löffler B. S. aureus endocarditis: Clinical aspects and experimental approaches. Int J Med Microbiol 2018. [PMID: 29526448 DOI: 10.1016/j.ijmm.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease, caused by septic vegetations and inflammatory foci on the surface of the endothelium and the valves. Due to its complex and often indecisive presentation the mortality rate is still about 30%. Most frequently bacterial microorganisms entering the bloodstream are the underlying origin of the intracardiac infection. While the disease was primarily restricted to younger patients suffering from rheumatic heart streptococci infections, new at risk categories for Staphylococcus (S.) aureus infections arose over the last years. Rising patient age, increasing drug resistance, intensive treatment conditions such as renal hemodialysis, immunosuppression and long term indwelling central venous catheters but also the application of modern cardiac device implants and valve prosthesis have led to emerging incidences of S. aureus IE in health care settings and community. The aetiologic change has impact on the pathophysiology of IE, the clinical presentation and the overall patient management. Despite intensive research on appropriate in vitro and in vivo models of IE and gained knowledge about the fundamental mechanisms in the formation of bacterial vegetations and extracardiac complications, improved understanding of relevant bacterial virulence factors and triggered host immune responses is required to help developing novel antipathogenic treatment strategies and pathogen specific diagnostic markers. In this review, we summarize and discuss the two main areas affected by the changing patient demographics and provide first, recent knowledge about the pathogenic strategies of S. aureus in the induction of IE, including available experimental models of IE used to study host-pathogen interactions and diagnostic and therapeutic targets. In a second focus we present diagnostic (imaging) regimens for patients with S. aureus IE according to current guidelines as well as treatment strategies and surgical recommendations.
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Affiliation(s)
- V Hoerr
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - M Franz
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Niemann
- Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany
| | - C Faber
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A16, 48149 Münster, Germany
| | - T Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - P C Schulze
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Deinhardt-Emmer
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - B Löffler
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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Abstract
The staphylococci comprise a diverse genus of Gram-positive, nonmotile commensal organisms that inhabit the skin and mucous membranes of humans and other mammals. In general, staphylococci are benign members of the natural flora, but many species have the capacity to be opportunistic pathogens, mainly infecting individuals who have medical device implants or are otherwise immunocompromised. Staphylococcus aureus and Staphylococcus epidermidis are major sources of hospital-acquired infections and are the most common causes of surgical site infections and medical device-associated bloodstream infections. The ability of staphylococci to form biofilms in vivo makes them highly resistant to chemotherapeutics and leads to chronic diseases. These biofilm infections include osteomyelitis, endocarditis, medical device infections, and persistence in the cystic fibrosis lung. Here, we provide a comprehensive analysis of our current understanding of staphylococcal biofilm formation, with an emphasis on adhesins and regulation, while also addressing how staphylococcal biofilms interact with the immune system. On the whole, this review will provide a thorough picture of biofilm formation of the staphylococcus genus and how this mode of growth impacts the host.
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Sarsam S, Kaspar G, David S, Zughaib M. Early Detection of Subclinical Aortic Valve Endocarditis with the CardioMEMS Heart Failure System. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:665-668. [PMID: 28611348 PMCID: PMC5478220 DOI: 10.12659/ajcr.903071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Male, 79 Final Diagnosis: Infective endocarditis Symptoms: Leg edema Medication: — Clinical Procedure: — Specialty: Cardiology
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Affiliation(s)
- Sinan Sarsam
- Department of Cardiology, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA
| | - Georgy Kaspar
- Department of Cardiology,, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA
| | - Shukri David
- Department of Cardiology,, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA
| | - Marcel Zughaib
- Department of Cardiology, Providence Hospital and Medical Centers, Michigan State University, Southfield, MI, USA
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González-Castillo J, Candel FJ, Julián-Jiménez A. [Antibiotics and timing in infectious disease in the emergency department]. Enferm Infecc Microbiol Clin 2012; 31:173-80. [PMID: 22409951 DOI: 10.1016/j.eimc.2012.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 01/09/2023]
Abstract
Infectious diseases, besides being a major cause of mortality in developing countries, are one of the main reasons for consultation in emergency medicine. In the last few years, there have been numerous published studies on the importance of starting antibiotic treatment at an early stage in the Emergency Department. However, this issue is of great controversy, owing to some contradictory studies as well as the implications this may have on the pressure of the patient care. This review is presents a summary of the scientific evidence published in this regard, and makes some recommendations based on this published evidence to improve the initial management of patients with an infection; a question of great importance as it can reduce mortality in some specific situations.
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