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Gros A, Seguy B, Bonnet G, Guettard YO, Pillois X, Prevel R, Orieux A, Ternacle J, Préau S, Lavie-Badie Y, Coupez E, Coudroy R, Marest D, Martins RP, Gruson D, Tourdias T, Boyer A. Critically ill patients with infective endocarditis, neurological complications and indication for cardiac surgery: a multicenter propensity-adjusted study. Ann Intensive Care 2024; 14:21. [PMID: 38305979 PMCID: PMC10837394 DOI: 10.1186/s13613-023-01221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/26/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The benefit-risk balance and optimal timing of surgery for severe infective endocarditis (IE) with ischemic or hemorrhagic strokes is unknown. The study aim was to compare the neurological outcome between patients receiving surgery or not. METHODS In a prospective register-based multicenter ICU study, patients were included if they met the following criteria: (i) left-sided IE with an indication for heart surgery; (ii) with cerebral complications documented by cerebral imaging before cardiac surgery; (iii) with Sequential Organ Failure Assessment score ≥ 3. Exclusion criteria were isolated right-sided IE, in-hospital acquired IE and patients with cerebral complications only after cardiac surgery. In the primary analysis, the prognostic value of surgery in term of disability at 6 month was assessed by using a propensity score-adjusted logistic regression. RESULTS 192 patients were included including ischemic stroke (74.5%) and hemorrhagic lesion (15.6%): 67 (35%) had medical treatment and 125 (65%) cardiac surgery. In the propensity score-adjusted logistic regression, a favorable 6-month neurological outcome was associated with surgery (odds ratio 13.8 (95% CI 6.2-33.7). The 1-year mortality was strongly reduced with surgery in the fixed-effect propensity-adjusted Cox model (hazard ratio 0.18; 95% CI 0.11-0.27; p < 0.001). These effects remained whether the patients received delayed surgery (n = 62/125) or not and whether they were deeply comatose (Glasgow Coma Scale ≤ 10) or not. CONCLUSIONS In critically ill IE patients with an indication for surgery and previous cerebral events, a better propensity-adjusted neurological outcome was associated with surgery compared with medical treatment.
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Affiliation(s)
- Alexandre Gros
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Benjamin Seguy
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | - Guillaume Bonnet
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | | | - Xavier Pillois
- Hôpital Cardiologique du Haut-Lévêque, LIRYC Institute, 33000, Bordeaux, France
| | - Renaud Prevel
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Arthur Orieux
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Julien Ternacle
- Soins Intensifs de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, 33000, Pessac cedex, France
| | - Sebastien Préau
- Service de Médecine Intensive Réanimation, Inserm, Institut Pasteur de Lille, U1167, University of Lille, CHU Lille, 59000, Lille, France
| | - Yoan Lavie-Badie
- Fédération de Cardiologie, Centre Expert de la Valve, CHU de Toulouse, 31000, Toulouse, France
| | - Elisabeth Coupez
- Réanimation Médicale Polyvalente, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Rémi Coudroy
- Médecine Intensive Réanimation, CHU de Poitiers, F-86000, Poitiers, France
- Groupe ALIVE, INSERM CIC 1402, Université de Poitiers, F-86000, Poitiers, France
| | - Delphine Marest
- Service d'Anesthésie-Réanimation, Hôpital Laënnec, CHU de Nantes, 44000, Nantes, France
| | - Raphaël P Martins
- Cardiologie et Maladies Vasculaires, CHU de Rennes, 35000, Rennes, France
| | - Didier Gruson
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France
| | - Thomas Tourdias
- Service de Neuroradiologie, CHU de Bordeaux, 33000, Bordeaux, France
- INSERM-U1215, Neurocentre Magendie, 33000, Bordeaux, France
| | - Alexandre Boyer
- Service de Médecine Intensive Réanimation, CHU de Bordeaux, 33000, Bordeaux, France.
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Graversen PL, Østergaard L, Voldstedlund M, Wandall-Holm MF, Smerup MH, Køber L, Fosbøl EL. Microbiological Etiology in Patients with IE Undergoing Surgery and for Patients with Medical Treatment Only: A Nationwide Study from 2010 to 2020. Microorganisms 2023; 11:2403. [PMID: 37894060 PMCID: PMC10608926 DOI: 10.3390/microorganisms11102403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 and examined the microbiological etiology of IE according to treatment choice. To identify factors associated with surgery during initial admission, we used the Aalen-Johansen estimator and an adjusted cause-specific Cox model. One-year mortality stratified by microbiological etiology and treatment choice was assessed using unadjusted Kaplan-Meier estimates and an adjusted Cox proportional hazard model. A total of 6255 patients were included, of which 1276 (20.4%) underwent surgery during admission. Patients who underwent surgery were younger (65 vs. 74 years) and less frequently had cerebrovascular disease, cardiovascular disease, diabetes, and chronic kidney disease. Patients with Staphylococcus aureus IE were less likely to undergo surgery during admission (13.6%) compared to all other microbiological etiologies. One-year mortality according to microbiological etiology in patients who underwent surgery was 7.0%, 5.3%, 5.5%, 9.6%, 13.2, and 11.2% compared with 24.2%, 19.1%, 27,6%, 25.2%, 21%, and 16.9% in patients who received medical therapy for Staphylococcus aureus, Streptococcus spp., Enterococcus spp., coagulase-negative Staphylococci, "other microbiological etiologies", and blood culture-negative infective endocarditis, respectively. Patients with IE who underwent surgery differed in terms of microbiology, more often having Streptococci than those who received medical therapy. Contrary to expectations, Staphylococcus aureus was more common among patients who received medical therapy only.
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Affiliation(s)
- Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institut, 2300 Copenhagen, Denmark;
| | - Malthe Faurschou Wandall-Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen—Rigshospitalet, 2600 Glostrup, Denmark;
| | - Morten Holdgaard Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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3
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Van Hemelrijck M, Sromicki J, Frank M, Greutmann M, Ledergerber B, Epprecht J, Padrutt M, Vogt PR, Carrel TP, Dzemali O, Mestres CA, Hasse B. Dismal prognosis of patients with operative indication without surgical intervention in active left-sided infective endocarditis. Front Cardiovasc Med 2023; 10:1223878. [PMID: 37692048 PMCID: PMC10491846 DOI: 10.3389/fcvm.2023.1223878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/28/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Around 25% of patients with left-sided infective endocarditis and operative indication do not undergo surgery. Baseline characteristics and outcomes are underreported. This study describes characteristics and outcomes of surgical candidates with surgical intervention or medical treatment only. Methods Retrospective analysis of ongoing collected data from a single-center from an observational cohort of patients with infective endocarditis (ENVALVE). Kaplan-Meier estimates for survival was calculated. Factors associated with survival were assessed using a bivariable Cox model. To adjust for confounding by indication, uni- and multivariable logistic regression for the propensity to receive surgery were adjusted. Results From January 2018 and December 2021, 154 patients were analyzed: 116 underwent surgery and 38 received medical treatment only. Surgical candidates without surgery were older (70 vs. 62 years, p = 0.001). They had higher preoperative risk profile (EuroSCORE II 14% (7.2-28.6) vs. 5.8% (2.5-20.3), p = 0.002) and more comorbidities. One patient was lost-to-follow-up. Survival analysis revealed a significant higher one-year survival rate among patients following surgery (83.7% vs. 15.3% in the non-surgical group; log-rank test <0.0001). In the final multivariable adjusted model, surgery was less likely among patients with liver cirrhosis [OR = 0.03 (95% CI 0.00-0.30)] and with hemodialysis [OR = 0.014 (95% CI 0.00-0.47)]. Conclusion Patients with left-sided infective endocarditis who do not undergo surgery despite an operative indication are older, have more comorbidities and therefore higher preoperative risk profile and a low 1-year survival. The role of the Endocarditis Team may be particularly important for the decision-making process in this specific group.
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Affiliation(s)
| | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michelle Frank
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Jana Epprecht
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Maria Padrutt
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Paul R. Vogt
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Thierry P. Carrel
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Carlos-A. Mestres
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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4
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Garcia Granja PE, Lopez J, Vilacosta I, Saéz C, Cabezón G, Olmos C, Jerónimo A, Pérez JB, De Stefano S, Maroto L, Carnero M, Monguio E, Pulido P, de Miguel M, Gomez Salvador I, Carrasco-Moraleja M, San Román JA. Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile. Heart 2021; 107:1987-1994. [PMID: 34509995 DOI: 10.1136/heartjnl-2021-319661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. METHODS 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. RESULTS Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). CONCLUSIONS Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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Affiliation(s)
- Pablo Elpidio Garcia Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain .,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Lopez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Saéz
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Adrián Jerónimo
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Javier B Pérez
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Salvatore De Stefano
- Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Luis Maroto
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
| | - Paloma Pulido
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María de Miguel
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco-Moraleja
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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5
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Ahtela E, Oksi J, Vahlberg T, Sipilä J, Rautava P, Kytö V. Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland. PLoS One 2021; 16:e0254553. [PMID: 34265019 PMCID: PMC8282023 DOI: 10.1371/journal.pone.0254553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005-2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18-39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.
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Affiliation(s)
- Elina Ahtela
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Administrative Center, Hospital District of Southwest Finland, Turku, Finland
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6
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Surgery for infective endocarditis-analysis of factors affecting outcome. Indian J Thorac Cardiovasc Surg 2021; 37:381-391. [PMID: 34220021 DOI: 10.1007/s12055-021-01137-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose Despite advances in medical care, infective endocarditis (IE) has high mortality. Surgery for IE though recommended for complications of the disease is still not commonly offered due to conflicting reports in the literature. We reviewed our results of surgery for IE from the last 5 years to assess their outcome. Methods A retrospective review from a single center of consecutive patients who underwent surgery for infective endocarditis from September 2014 to December 2019 was done. Data was collected from hospital records and follow-up done up to May 2020. Outcomes evaluated were mortality, follow-up survival, and postoperative complications. Factors affecting mortality and survival were analyzed. Results Ninety-seven patients underwent surgery for IE during this period. Seventy-nine had native valve endocarditis (NVE) and 18 had prosthetic valve endocarditis (PVE). The overall postoperative mortality was 13%, with mortality for native valve endocarditis being 11% and that for prosthetic valve endocarditis being 22%, which was not statistically significant. Three-year survival for the overall group was 88.7% with 88.1% for NVE and 91.7% for PVE. Multivariate predictors of operative mortality were a high EuroSCORE II, diabetes mellitus, and the presence of Staphylococcus organism. Conclusion Surgery for infective endocarditis has a very acceptable early outcome and intermediate-term survival.
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7
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Santer D, Miazza J, Koechlin L, Gahl B, Rrahmani B, Hollinger A, Eckstein FS, Siegemund M, Reuthebuch OT. Hemoadsorption during Cardiopulmonary Bypass in Patients with Endocarditis Undergoing Valve Surgery: A Retrospective Single-Center Study. J Clin Med 2021; 10:jcm10040564. [PMID: 33546164 PMCID: PMC7913197 DOI: 10.3390/jcm10040564] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Aim of this study was to evaluate the outcomes of endocarditis patients undergoing valve surgery with the Cytosorb® hemoadsorption (HA) device during cardiopulmonary bypass. Methods: From 2009 until 2019, 241 patients had undergone valve surgery due to endocarditis at the Department of Cardiac Surgery, University Hospital of Basel. We compared patients who received HA during surgery (n = 41) versus patients without HA (n = 200), after applying inverse probability of treatment weighting. Results: In-hospital mortality, major adverse cardiac and cerebrovascular events and postoperative renal failure were similar in both groups. Demand for norepinephrine (88.4 vs. 52.8%; p = 0.001), milrinone (42.2 vs. 17.2%; p = 0.046), red blood cell concentrates (65.2 vs. 30.6%; p = 0.003), and platelets (HA vs. Control: 36.7 vs. 9.8%; p = 0.013) were higher in the HA group. In addition, a higher incidence of reoperation for bleeding (34.0 vs. 7.7 %; p = 0.011), and a prolonged length of in-hospital stay (15.2 (11.8 to 19.6) vs. 9.0 (7.1 to 11.3) days; p = 0.017) were observed in the HA group. Conclusions: No benefits of HA-therapy were observed in patients with infective endocarditis undergoing valve surgery.
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Affiliation(s)
- David Santer
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Bejtush Rrahmani
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Alexa Hollinger
- Department of Intensive Care Medicine, University Hospital Basel, 4031 Basel, Switzerland; (A.H.); (M.S.)
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| | - Friedrich S. Eckstein
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
| | - Martin Siegemund
- Department of Intensive Care Medicine, University Hospital Basel, 4031 Basel, Switzerland; (A.H.); (M.S.)
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland
| | - Oliver T. Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (D.S.); (J.M.); (L.K.); (B.G.); (B.R.); (F.S.E.)
- Correspondence: ; Tel.: +41-61-265-77-53
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8
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Ripa M, Chiappetta S, Castiglioni B, Agricola E, Busnardo E, Carletti S, Castiglioni A, De Bonis M, La Canna G, Oltolini C, Pajoro U, Pasciuta R, Tassan Din C, Scarpellini P. Impact of surgical timing on survival in patients with infective endocarditis: a time-dependent analysis. Eur J Clin Microbiol Infect Dis 2021; 40:1319-1324. [PMID: 33411176 DOI: 10.1007/s10096-020-04133-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to evaluate the impact of surgical timing on survival in patients with left-sided infective endocarditis (IE). This was a retrospective study including 313 patients with left-sided IE between 2009 and 2017. Surgery was defined as urgent (US) or early (ES) if performed within 7 or 28 days, respectively. A multivariable Cox regression analysis including US and ES as time-dependent variables was performed to assess the impact on 1-year mortality. ES was associated with a better survival (aHR 0.349, 95% CI 0.135-0.902), as US (aHR 0.262, 95% CI 0.075-0.915). ES and US were associated with a better prognosis in patients with left-sided IE.
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Affiliation(s)
- Marco Ripa
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Chiappetta
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Barbara Castiglioni
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Unit of Non-invasive Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Busnardo
- Unit of Nuclear Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Carletti
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele De Bonis
- Unit of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni La Canna
- Unit of Non-invasive Cardiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ursola Pajoro
- Unit of Nuclear Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Renée Pasciuta
- Unit of Microbiology and Virology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Tassan Din
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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9
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Kousa O, Walters RW, Saleh M, Awad D, Qasim A, Guddeti RR, Smer A. Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database. J Card Surg 2020; 35:2611-2617. [PMID: 32720363 DOI: 10.1111/jocs.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although the standard treatment of infective endocarditis (IE) is antimicrobial therapy, surgical intervention is required in some cases. However, the optimal timing of surgery remains unclear. Hence, we conducted a population-based analysis using the National Inpatient Sample (NIS) database to assess the outcomes of early versus late surgery in patients with native valve IE. METHODS We queried the NIS database for all hospitalized patients between 2006 and 2016 with a primary diagnosis of IE who had cardiac surgery. We stratified surgery as early ≤7 or late >7 days of admission. Multivariable logistic regression models were used to assess in-hospital mortality and postoperative complications. Length of stay (LOS) and total hospital cost (HC) were evaluated using multivariable log-normal regression models. RESULTS A total of 13 056 patients (57.6% in the early group and 42.4% in the late group) were included. The in-hospital mortality rate in the early group was 5.0% compared to 5.4% in the late intervention group (adjusted odds ratio, 1.20, 95% confidence interval [CI] 0.79-1.81). Overall median LOS was reduced in the early group by 48.2% (95% CI, 46.5%-49.9%, 12.4 days in the early group and 25.9 days in late group), as well as HC which was reduced in the early group by 28.3% (95% CI, 26.0%-30.6%). CONCLUSION Among patients with native valve IE who needed cardiac surgery, the time of surgical intervention did not affect the in-hospital mortality. However, early surgery was associated with significantly shorter LOS and lower HC.
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Affiliation(s)
- Omar Kousa
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Division of Clinical Research and Evaluation Science, Creighton University School of Medicine, Omaha, Nebraska
| | - Mohammed Saleh
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Dana Awad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Abdallah Qasim
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Raviteja R Guddeti
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Aiman Smer
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
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10
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Sadeghpour A, Maleki M, Movassaghi M, Rezvani L, Noohi F, Boudagh S, Ghadrdoost B, Bakhshandeh H, Alizadehasl A, Naderi N, Kamali M, Ghavidel AA, Peighambari MM, Kyavar M, Pasha H. Iranian Registry of Infective Endocarditis (IRIE): Time to relook at the guideline, regarding to regional differences. IJC HEART & VASCULATURE 2019; 26:100433. [PMID: 31737777 PMCID: PMC6849153 DOI: 10.1016/j.ijcha.2019.100433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/23/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Abstract
Aims Infective endocarditis (IE) remained a potentially fatal disease with high rate of mortality and morbidity. The epidemiology and global burden of IE are largely different between the countries. We aimed to address the epidemiological aspects of IE in a tertiary hospital in Tehran, Iran. Methods and Results Between 2006–2018, all adults patients with diagnosis of IE were enrolled in the Iranian Registry of Infective Endocarditis (IRIE). The data were analyzed using the χ2, Kolmogorov–Smirnov, and Mann–Whitney U tests. Overall, 602 patients, 407 (67.6%) men, mean age 46 ± 16 years were recruited. Positive blood culture found in 49%.The most common underlying heart diseases were: Congenital heart diseases (CHD) particularly bicuspid aortic valves (BAV) and ventricular septal defects (VSD) in 37%, followed by degenerative heart diseases :flail and mitral valve prolapse (16.3%), intravenous drug user in 12.6%, prosthetic valves in 11.1%, previous IE (8.9%), rheumatic heart diseases (RHD) in 8.4%. The most causative microorganisms were Staphylococcus aureus, Enterococci, coagulase-negative staphylococci and Streptococcus viridans. Cardiac or extra cardiac complications occurred in 56.6% of the patients. Conclusions Based on IRIE, IE occurs in the younger population in Iran with high rates of blood culture-negative IE. RHD are not the main cause of IE in Iran, CHD including BAV and VSDs, followed by prolaptic or flail mitral valve were the most common. These 2 groups can be considered a high-risk group for IE. More than half of the patients with IE had cardiac or extra cardiac complications.
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Affiliation(s)
- Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Massoud Movassaghi
- Department of Pathology and Laboratory Medicine, USC/LAC+USC Medical Center, Los Angeles, CA, USA
| | | | - Feridoun Noohi
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Boudagh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Bakhshandeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Alizadehasl
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Kamali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza A Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Kyavar
- Cardiovascular Intervention Research Center Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pasha
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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11
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Jhaveri S, Saarel EV, Stewart RD, Tan C, Komarlu R. Isolated Endocarditis of Native Pulmonary Valve in a Pediatric Patient: The Unusual within the Unusual. ACTA ACUST UNITED AC 2019; 4:69-73. [PMID: 32337393 PMCID: PMC7175791 DOI: 10.1016/j.case.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Native PV IE is extremely rare. Recurrent septic emboli from PV IE may masquerade as severe pneumonia. Failure of medical management may require surgical removal of the focus of infection. TEE is used as an adjunct to TTE to better delineate PV endocarditis.
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Affiliation(s)
- Simone Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Elizabeth V Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Robert D Stewart
- Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's, Cleveland, Ohio
| | - Carmela Tan
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rukmini Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
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12
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Pettersson GB, Hussain ST. Current AATS guidelines on surgical treatment of infective endocarditis. Ann Cardiothorac Surg 2019; 8:630-644. [PMID: 31832353 DOI: 10.21037/acs.2019.10.05] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction. For the aortic valve, use of allograft is still favored.
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Affiliation(s)
- Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Syed T Hussain
- Department of Cardiovascular and Thoracic Surgery, Northwell Health/Southside Hospital, Bay Shore, NY, USA
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13
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[Treatment of infectious endocarditis]. Presse Med 2019; 48:539-548. [PMID: 31109766 DOI: 10.1016/j.lpm.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Antibiotic treatment of infective endocarditis is part of a multidisciplinary patient management that should be conducted within an "Endocarditis team". Initial antibiotic treatment of infective endocarditis should be parenteral and comply with current international guidelines. A switch to an oral antibiotic regimen may be considered after 2weeks of successful parenteral antibiotic treatment. Aminoglycosides should no longer be used for the initial treatment of native valve Staphylococcus aureus endocarditis. Valve surgery is required in almost half of the patients.
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Cecchi E, Ciccone G, Chirillo F, Imazio M, Cecconi M, Del Ponte S, Moreo A, Faggiano P, Cialfi A, Squeri A, Enia F, Forno D, De Rosa FG, Rinaldi M, Castiglione A. Mortality and timing of surgery in the left-sided infective endocarditis: an Italian multicentre study. Interact Cardiovasc Thorac Surg 2019; 26:602-609. [PMID: 29272391 DOI: 10.1093/icvts/ivx394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/18/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Observational studies on early surgery in infective endocarditis have conflicting results. This study aims to compare the treatment strategies for early surgery (within 2 weeks of diagnosis) and late surgery/medical therapy in terms of survival among patients with the left-sided infective endocarditis. METHODS This study included patients with the left-sided infective endocarditis registered between 2006 and 2010 in the Italian Registry of Infective Endocarditis (RIEI). A Cox proportional hazards model was used to estimate the effect of these treatment strategies on overall survival and included sociodemographic and clinical characteristics associated with treatment, risk factors for mortality and early surgery as a time-dependent covariate to avoid indication and immortal time biases. RESULTS Among the 502 patients included, 184 (36.7%) underwent early surgery. Of the remaining 318 patients, 138 underwent late surgery. The early surgery group had fewer patients with comorbidities and with enterococcus as the causative microorganism, but this group had more complicated cardiac conditions. No difference in mortality risk was estimated between the treatment groups including early surgery as time-dependent variables (adjusted hazard ratio = 0.95, 95% confidence interval 0.55-1.63), while a distorted and overestimated beneficial effect of surgery was estimated considering surgery as a non-time-dependent variable (adjusted hazard ratio 0.41, 95% confidence interval 0.25-0.70). CONCLUSIONS Our study did not confirm a better overall survival in patients undergoing early surgery. However, even with the use of statistical techniques to control biases, we could not draw definitive conclusions that early surgery is not beneficial. Our results need to be assessed by randomized trials before any changes in clinical practice can be recommended.
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Affiliation(s)
- Enrico Cecchi
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, 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
| | | | | | - Angelo Squeri
- Dipartimento Cardio, Nefro-Polmonare, Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Francesco Enia
- Department of Cardiology, Cervello Hospital, Palermo, Italy
| | - Davide Forno
- Department of Cardiology, Maria Vittoria Hospital, Torino, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, University of Turin; Infectious Diseases at Amedeo di Savoia Hospital, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Molinette Hospital, University of Torino, Torino, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, Città della Salute e della Scienza di Torino and CPO Piemonte, Torino, Italy
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Witten JC, Hussain ST, Shrestha NK, Gordon SM, Houghtaling PL, Bakaeen FG, Griffin B, Blackstone EH, Pettersson GB. Surgical treatment of right-sided infective endocarditis. J Thorac Cardiovasc Surg 2018; 157:1418-1427.e14. [PMID: 30503743 DOI: 10.1016/j.jtcvs.2018.07.112] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Right-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis. METHODS From January 2002 to January 2015, 134 adults underwent surgery for right-sided infective endocarditis. Patients were grouped according to predisposing condition. Hospital outcomes, time-related death, and reoperation for infective endocarditis were analyzed. RESULTS A total of 127 patients (95%) had tricuspid valve and 7 patients (5%) pulmonary valve infective endocarditis; 66 patients (49%) had isolated right-sided infective endocarditis, and 68 patients (51%) had right- and left-sided infective endocarditis. Predisposing conditions included injection drug use (30%), cardiac implantable devices (26%), chronic vascular access (19%), and other/none (25%). One native tricuspid valve was excised, 76% were repaired or reconstructed, and 23% were replaced. Intensive care unit and postoperative hospital stays were similar among groups. Injection drug users had the best early survival (no hospital mortality), and patients with chronic vascular access had the worst late survival (18% at 5 years). Survival was worst for concomitant mitral valve versus isolated right-sided infective endocarditis or concomitant aortic valve infective endocarditis. Survival after tricuspid valve replacement was worse than after repair/reconstruction. Estimated glomerular filtration rate was the strongest risk factor for death, not predisposing condition. Eleven patients underwent 12 reoperations for infective endocarditis; more reoperations occurred in injection drug users (P = .03). CONCLUSIONS Overall outcomes after surgery are variable and affected by patient condition, not predisposing condition. Injection drug use carries a higher risk of reoperation for infective endocarditis. Earlier surgery may permit more valve repairs and improve outcomes. Whenever possible, tricuspid valve replacement should be avoided.
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Affiliation(s)
- James C Witten
- Education Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Syed T Hussain
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery
| | | | | | | | - Faisal G Bakaeen
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery
| | - Brian Griffin
- Medicine Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery; Research Institute, Department of Quantitative Health Sciences
| | - Gösta B Pettersson
- Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery.
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16
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Long B, Koyfman A. Infectious endocarditis: An update for emergency clinicians. Am J Emerg Med 2018; 36:1686-1692. [PMID: 30001813 DOI: 10.1016/j.ajem.2018.06.074] [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] [Received: 06/01/2018] [Accepted: 06/30/2018] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Infectious endocarditis (IE) is a potentially deadly disease without therapy and can cause a wide number of findings and symptoms, often resembling a flu-like illness, which makes diagnosis difficult. OBJECTIVE This narrative review evaluates the presentation, evaluation, and management of infective endocarditis in the emergency department, based on the most current literature. DISCUSSION IE is due to infection of the endocardial surface, most commonly cardiac valves. Major risk factors include prior endocarditis (the most common risk factor), structural heart damage, IV drug use (IVDU), poor immune function (vasculitis, HIV, diabetes, malignancy), nosocomial (surgical hardware placement, poor surgical technique, hematoma development), and poor oral hygiene, and a wide variety of organisms can cause IE. Patients typically present with flu-like illness. Though fever and murmur occur in the majority of cases, they may not be present at the time of initial presentation. Other findings such as Roth spots, Janeway lesions, Osler nodes, etc. are not common. An important component is consideration of risk factors. A patient with IVDU (past or current use) and fever should trigger consideration of IE. Other keys are multiple sites of infection, poor dentition, and abnormal culture results with atypical organisms. If endocarditis is likely based on history and examination, admission for further evaluation is recommended. Blood cultures and echocardiogram are key diagnostic tests. CONCLUSIONS Emergency physicians should consider IE in the patient with flu-like symptoms and risk factors. Appropriate evaluation and management can significantly reduce disease morbidity and mortality.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
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17
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Invasiveness of left- and right-sided infective endocarditis: Does pressure explain pathology? J Thorac Cardiovasc Surg 2018; 155:62. [DOI: 10.1016/j.jtcvs.2017.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/19/2017] [Indexed: 12/26/2022]
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18
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Yombi JC, Yuma SN, Pasquet A, Astarci P, Robert A, Rodriguez HV. Staphylococcal versus Streptococcal infective endocarditis in a tertiary hospital in Belgium: epidemiology, clinical characteristics and outcome. Acta Clin Belg 2017; 72:417-423. [PMID: 28372481 DOI: 10.1080/17843286.2017.1309341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infective endocarditis (IE) is a rare but serious illness associated with a high mortality. Staphylococcus spp and Streptococcus spp are the most frequent causative pathogens. In this study, we compared the epidemiology, clinical characteristics and outcomes of patients with Staphylococcal and Streptococcal IE in a tertiary hospital. Using our institutional database 'Medical Explorer', we collected all cases of IE retrospectively between January 2005 and December 2010 at the Cliniques Universitaires Saint Luc and then focused on Staphylococcal and Streptococcal IE. Of the 212 patients with IE included in our study, Staphylococcus spp accounted for 35.9% (76/212) of the cases, Streptococcus spp for 35.4% (75/212) and the remainder 18% (61/212) of cases were caused by other pathogens. Negative blood culture IE accounted for 10.4% of all cases. Demographic and clinical characteristics such as age, gender, fever, presence of a heart murmur, heart failure, nature of the affected valve, location of the endocarditis, duration of antibiotics, length of stay and complication were not different when comparing Staphylococcal and Streptococcal IE; only mortality differed. The mortality rate was 21.4 and 6.6% (p = 0.02) for Staphylococcal and Streptococcal IE, respectively. In the multivariate analysis, age >60 years, Staphylococcal IE, presence of complications and absence of surgery were independent risk factors for mortality.
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Affiliation(s)
- Jean Cyr Yombi
- Department of Internal Medicine, Infectious Diseases, Cliniques, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sandra Nyota Yuma
- School of Biomedical Sciences, Université Catholique de Louvain, Brussels, Belgium
| | - Agnes Pasquet
- Department of Cardiovascular Medicine and Surgery, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Parla Astarci
- Department of Cardiovascular Medicine and Surgery, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Annie Robert
- Faculté de Médecine, Epidemiology, Biostatistics and operational methods unit in public health Université Catholique de Louvain, Brussels, Belgium
| | - Hector Villalobos Rodriguez
- Department of Microbiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
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Hussain ST, Witten J, Shrestha NK, Blackstone EH, Pettersson GB. Tricuspid valve endocarditis. Ann Cardiothorac Surg 2017; 6:255-261. [PMID: 28706868 PMCID: PMC5494428 DOI: 10.21037/acs.2017.03.09] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 02/16/2017] [Indexed: 12/22/2022]
Abstract
Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5-10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors. Staphylococcus aureus is the predominant causative organism in TVIE. Most patients with TVIE are successfully treated with antibiotics, however, 5-16% of RSIE cases eventually require surgical intervention. Indications and timing for surgery are less clear than for left-sided IE; surgery is primarily considered for failed medical therapy, large vegetations and septic pulmonary embolism, and less often for TV regurgitation and heart failure. Most patients with an infected prosthetic TV will require surgery. Concomitant left-sided IE has its own surgical indications. Earlier surgical intervention may potentially prevent further destruction of leaflet tissue and increase the likelihood of TV repair. Fortunately, TV debridement and repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques. Valve repair is advocated over replacement, particularly in IVDUs patients who are young, non-compliant and have a higher risk of recurrent infection and reoperation with valve replacement. Excising the valve without replacing, it is not advocated; it has been reported previously, but these patients are likely to be symptomatic, particularly in cases with septic pulmonary embolism and increased pulmonary vascular resistance. Patients with concomitant left-sided involvement have worse prognosis than those with RSIE alone, due predominantly to greater likelihood of invasion and abscess formation in left-sided IE. Patients with isolated TVIE have an operative mortality between 0-15% and excellent survival.
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Affiliation(s)
- Syed T. Hussain
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Witten
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K. Shrestha
- Department of Infectious Disease, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
PURPOSE OF THE REVIEW Infective endocarditis (IE) is a serious disease with significant morbidity and mortality. Valve surgery is fundamental in the standard of care of selected IE patients. Indeed, valve surgery can be a lifesaving procedure in critically ill endocarditis patients. Our goal from this review is to discuss the indications of surgery in IE population and international cardiac societies' guideline recommendations. RECENT FINDINGS Though IE is an uncommon disease, its incidence is noted to be on rise in some parts of the world, and the disease is expected to continue to be a major health problem. Antimicrobials remain the mainstay of IE therapy, but as many as 50% of endocarditis patients will undergo surgical intervention. Heart failure most commonly from acute valvular insufficiency, uncontrolled and persistent infection, and recurrent embolic events are the major indications for valve surgery in IE population. Heart failure is by far the most common indication for surgery in IE patients. Despite the fact that many IE patients will require surgical interventions, most of the international societies' recommendations to perform valve surgery are based on observational studies or experts' opinion. Surgery plays a major role in the management of IE patients, and it is most commonly performed in patients with heart failure, persistent or uncontrolled infection, and recurrent emboli. Most of the current evidence supporting surgical intervention in IE patients is based on observational studies and experts' opinion. Randomized clinical trials are urgently needed to guide surgical therapy in IE.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Int. Med. E315 GH, Iowa City, IA, 52242, USA.,College of Public Health, University of Iowa, Iowa City, IA, 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, PO Box 59046, Riyadh, 11525, Saudi Arabia. .,College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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21
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Could Early Surgery Get Beneficial in Adult Patients with Active Native Infective Endocarditis? A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3459468. [PMID: 28326318 PMCID: PMC5343223 DOI: 10.1155/2017/3459468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/22/2017] [Accepted: 01/26/2017] [Indexed: 01/03/2023]
Abstract
After a thorough search through the database as PubMed database and Embase database, the clinical experimental articles have been selected out on the effects of early surgery on the treatment of active native infective endocarditis. The quality of the trials included in this study was assessed by researcher according to the Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0. A meta-analysis was carried out in terms of clinical efficacy criteria by RevMan 5.3 software. Based on the results, we cautiously conclude that early surgery used for active native infective endocarditis could reduce in-hospital mortality, follow-up mortality, and IE-related mortality.
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Salvador VBD, Chapagain B, Joshi A, Brennessel DJ. Clinical Risk Factors for Infective Endocarditis in Staphylococcus aureus Bacteremia. Tex Heart Inst J 2017; 44:10-15. [PMID: 28265207 DOI: 10.14503/thij-15-5359] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Crucial to the management of staphylococcal bacteremia is an accurate evaluation of associated endocarditis, which has both therapeutic and prognostic implications. Because the clinical presentation of endocarditis can be nonspecific, the judicious use of echocardiography is important in distinguishing patients at high risk of developing endocarditis. In the presence of high-risk clinical features, an early transesophageal echocardiogram is warranted without prior transthoracic echocardiography. The purpose of this study was to investigate the clinical risk factors for staphylococcal infective endocarditis that might warrant earlier transesophageal echocardiography and to describe the incidence of endocarditis in cases of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. A retrospective case-control study was conducted by means of chart review of 91 patients consecutively admitted to a community hospital from January 2009 through January 2013. Clinical risk factors of patients with staphylococcal bacteremia were compared with risk factors of patients who had definite diagnoses of infective endocarditis. There were 69 patients with bacteremia alone (76%) and 22 patients with endocarditis (24%), as verified by echocardiography. Univariate analysis showed that diabetes mellitus (P=0.024), the presence of an automatic implantable cardioverter-defibrillator/pacemaker (P=0.006) or a prosthetic heart valve (P=0.003), and recent hospitalization (P=0.048) were significantly associated with developing infective endocarditis in patients with S. aureus bacteremia. The incidence of methicillin-resistant and methicillin-sensitive S. aureus bacteremia was similar in the bacteremia and infective-endocarditis groups (P=0.437). In conclusion, identified high-risk clinical factors in the presence of bacteremia can suggest infective endocarditis. Early evaluation with transesophageal echocardiography might well be warranted.
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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Pericart L, Fauchier L, Bourguignon T, Bernard L, Angoulvant D, Delahaye F, Babuty D, Bernard A. Long-Term Outcome and Valve Surgery for Infective Endocarditis in the Systematic Analysis of a Community Study. Ann Thorac Surg 2016; 102:496-504. [PMID: 27131900 DOI: 10.1016/j.athoracsur.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 02/02/2016] [Accepted: 02/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Information on the long-term prognosis of patients with infective endocarditis (IE) and valve surgical procedures is scarce, and most analyses are based on registries. This study described outcomes and predictors of mortality in a cohort of consecutive patients with IE with a long-term follow-up. METHODS A total of 616 of patients with IE seen in an academic institution between 1990 and 2012 were identified and followed. The mean follow-up period was 4.8 ± 5.7 years (median, 2.6 years). RESULTS Cardiac surgical procedures were performed in 47% of the patients, among whom 77% had surgical procedures in the first 6 months. Six-month and long-term (≥6 month) mortality rates were 15% and 40%, respectively. Older age, male sex, infection in a mechanical valve, Staphylococcus aureus infection, presence of vegetation, stroke, and atrioventricular block were independent predictors of mortality, whereas Streptococcus infection was independently associated with a better prognosis. Valve surgical procedures were independently associated with a decrease in mortality: hazard ratio (HR): 0.38; 95% confidence interval (CI): 0.26 to 0.56 for surgical treatment within 45 days; HR 0.36; 95% CI: 0.22 to 0.61 for surgical treatment between 45 and 180 days; and HR: 0.42; 95% CI: 0.25 to 0.73 for surgical treatment beyond 6 months. Decrease in mortality with valve surgical procedures was found in the two subgroups of patients with definite IE (adjusted HR: 0.36; 95% CI: 0.24 to 0.54; p < 0.0001) and in those with possible IE (HR: 0.40; 95% CI: 0.24 to 0.67; p = 0.0005). CONCLUSIONS In unselected patients with IE, prognostic factors for long-term mortality were consistent with those identified in previous studies for short-term mortality. These results confirm the apparent benefit associated with valve surgical procedures on long-term prognosis.
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Affiliation(s)
- Lauriane Pericart
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France.
| | - Thierry Bourguignon
- Faculté de Médecine, Université François Rabelais, Tours, France; Service de Chirurgie Cardiaque et Thoracique, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Louis Bernard
- Faculté de Médecine, Université François Rabelais, Tours, France; Service de Maladies Infectieuses, Centre Hospitalier Universitaire Bretonneau, Tours, France
| | - Denis Angoulvant
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - François Delahaye
- Service de Cardiologie, Hospices Civils de Lyon, Université Claude-Bernard Lyon I, Lyon, France
| | - Dominique Babuty
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
| | - Anne Bernard
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France; Faculté de Médecine, Université François Rabelais, Tours, France
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Anantha Narayanan M, Mahfood Haddad T, Kalil AC, Kanmanthareddy A, Suri RM, Mansour G, Destache CJ, Baskaran J, Mooss AN, Wichman T, Morrow L, Vivekanandan R. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart 2016; 102:950-7. [PMID: 26869640 DOI: 10.1136/heartjnl-2015-308589] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/14/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis. METHODS PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed. RESULTS A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts. CONCLUSION The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.
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Affiliation(s)
| | - Toufik Mahfood Haddad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andre C Kalil
- Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, Nebraska, USA
| | - Arun Kanmanthareddy
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - George Mansour
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Christopher J Destache
- School of Pharmacy & Health Professions and School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Janani Baskaran
- University of Texas Southwestern at Dallas, Dallas, Texas, USA
| | - Aryan N Mooss
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Tammy Wichman
- Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Lee Morrow
- Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Renuga Vivekanandan
- Division of Infectious Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA
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Hemkens LG, Contopoulos-Ioannidis DG, Ioannidis JPA. Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey. BMJ 2016; 352:i493. [PMID: 26858277 PMCID: PMC4772787 DOI: 10.1136/bmj.i493] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess differences in estimated treatment effects for mortality between observational studies with routinely collected health data (RCD; that are published before trials are available) and subsequent evidence from randomized controlled trials on the same clinical question. DESIGN Meta-epidemiological survey. DATA SOURCES PubMed searched up to November 2014. METHODS Eligible RCD studies were published up to 2010 that used propensity scores to address confounding bias and reported comparative effects of interventions for mortality. The analysis included only RCD studies conducted before any trial was published on the same topic. The direction of treatment effects, confidence intervals, and effect sizes (odds ratios) were compared between RCD studies and randomized controlled trials. The relative odds ratio (that is, the summary odds ratio of trial(s) divided by the RCD study estimate) and the summary relative odds ratio were calculated across all pairs of RCD studies and trials. A summary relative odds ratio greater than one indicates that RCD studies gave more favorable mortality results. RESULTS The evaluation included 16 eligible RCD studies, and 36 subsequent published randomized controlled trials investigating the same clinical questions (with 17,275 patients and 835 deaths). Trials were published a median of three years after the corresponding RCD study. For five (31%) of the 16 clinical questions, the direction of treatment effects differed between RCD studies and trials. Confidence intervals in nine (56%) RCD studies did not include the RCT effect estimate. Overall, RCD studies showed significantly more favorable mortality estimates by 31% than subsequent trials (summary relative odds ratio 1.31 (95% confidence interval 1.03 to 1.65; I(2)=0%)). CONCLUSIONS Studies of routinely collected health data could give different answers from subsequent randomized controlled trials on the same clinical questions, and may substantially overestimate treatment effects. Caution is needed to prevent misguided clinical decision making.
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Affiliation(s)
- Lars G Hemkens
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Despina G Contopoulos-Ioannidis
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California, USA Meta-Research Innovation Center at Stanford (METRICS)
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA Meta-Research Innovation Center at Stanford (METRICS) Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA
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Liang F, Song B, Liu R, Yang L, Tang H, Li Y. Optimal timing for early surgery in infective endocarditis: a meta-analysis. Interact Cardiovasc Thorac Surg 2015; 22:336-45. [PMID: 26678152 DOI: 10.1093/icvts/ivv368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/19/2015] [Indexed: 12/20/2022] Open
Abstract
To systematically review early surgery and the optimal timing of surgery in patients with infective endocarditis (IE), a search for foreign and domestic articles on cohort studies about the association between early surgery and infective endocarditis published from inception to January 2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature (CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality of the method of the included studies was assessed. Then, the meta-analysis was performed using the Stata 12.0 software. Sixteen cohort studies, including 8141 participants were finally included. The results of the meta-analysis revealed that, compared with non-early surgery, early surgery in IE lowers the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95% confidence interval (CI) (0.42, 0.77); P = 0.000, I(2) = 73.1%] and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001, I(2) = 67.4%]. Further, performing operation within 2 weeks had a more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41, 0.97); P = 0.192, I(2) = 39.4%] than non-early surgery. In different kinds of IE, we found that early surgery for native valve endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31, 0.69); P = 0.001, I(2) = 73.0%] and long-term [OR = 0.57, 95% CI (0.40, 0.81); P = 0.001, I(2) = 68.9%] mortality than the non-early surgery group. However, for prosthetic valve endocarditis (PVE), in-hospital mortality did not differ significantly [OR = 0.83, 95% CI (0.65, 1.06); P = 0.413, I(2) = 0.0%] between early and non-early surgery. We concluded that early surgery was associated with lower in-hospital and long-term mortality compared with non-early surgical treatment for IE, especially in NVE. However, the optimal timing of surgery remains unclear. Additional larger prospective clinical trials will be required to clarify the optimal timing for surgical intervention and determine its efficacy in PVE.
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Affiliation(s)
- Fuxiang Liang
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Bing Song
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Ruisheng Liu
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Liu Yang
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Hanbo Tang
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Yuanming Li
- The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
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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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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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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: 2803] [Impact Index Per Article: 311.4] [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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31
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Cheng WL, Li CW, Li MC, Lee NY, Lee CC, Ko WC. Salmonella infective endocarditis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 49:313-20. [PMID: 25882489 DOI: 10.1016/j.jmii.2015.02.659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/02/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Salmonella endocarditis is so rarely reported that its clinical features, prognosis, and optimal treatment remain unclear. In this paper, we report a female with nontyphoid Salmonella endocarditis complicated with perivalvular abscess. We also review and summarize other cases reported in the English literature. METHODS Using the key words "Salmonella", "infective endocarditis", and "mural endocarditis" to search the PubMed database, we reviewed case reports on Salmonella endocarditis published between 1976 and 2014 and case series of infective endocarditis that included at least 500 cases. RESULTS Salmonella species were rare infective endocarditis pathogens. Among 16 large case series, they accounted for less than 0.01% and up to 2.9% of bacterial endocarditis cases. From 1976 to 2014, a total of 87 cases of typhoid and nontyphoid Salmonella endocarditis were reported, which included 42 cases in 1976-1984, 30 cases in 1986-2002, and 15 cases in 2003-2014. Men predominated among the cases (58.6%), and the mean age was approximately 50-60 years. The major affected valves were the mitral valves (33.3%). Mural endocarditis was common (26.4%). Perivalvular abscess was only reported in 10.5% (6 cases) of 57 cases. The overall mortality rate was 42.5% and decreased over time from 69.0% to 13.3% during the three study periods. CONCLUSION Salmonella endocarditis, although rare, may cause purulent infections in the perivalvular area or myocardium and lead to substantial mortality.
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Affiliation(s)
- Wan-Ling Cheng
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chia-Wen Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Chi Li
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Nan-Yao Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ching-Chi Lee
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Wen-Chien Ko
- Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Gálvez-Acebal J, Almendro-Delia M, Ruiz J, de Alarcón A, Martínez-Marcos FJ, Reguera JM, Ivanova-Georgieva R, Noureddine M, Plata A, Lomas JM, de la Torre-Lima J, Hidalgo-Tenorio C, Luque R, Rodríguez-Baño J. Influence of early surgical treatment on the prognosis of left-sided infective endocarditis: a multicenter cohort study. Mayo Clin Proc 2014; 89:1397-405. [PMID: 25178264 DOI: 10.1016/j.mayocp.2014.06.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE). PATIENTS AND METHODS A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality. RESULTS A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%). CONCLUSION This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
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Affiliation(s)
- Juan Gálvez-Acebal
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain.
| | | | - Josefa Ruiz
- Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Arístides de Alarcón
- Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain
| | | | - José M Reguera
- Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain
| | - Radka Ivanova-Georgieva
- Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Mariam Noureddine
- Infectious Diseases Unit-Internal Medicine, Costal del Sol Hospital, Marbella, Spain
| | - Antonio Plata
- Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain
| | - José M Lomas
- Infectious Diseases Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | | | | | - Rafael Luque
- Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain
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Garcia DC, Nascimento R, Soto V, Mendoza CE. A rare native mitral valve endocarditis successfully treated after surgical correction. BMJ Case Rep 2014; 2014:bcr-2013-202610. [PMID: 25270154 DOI: 10.1136/bcr-2013-202610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mycobacterium abscessus and Kocuria species are rare causes of infections in humans. Endocarditis by these agents has been reported in only 11 cases. M. abscessus is a particularly resistant organism and treatment requires the association of antibiotics for a prolonged period of time. We report a case of native mitral valve bacterial endocarditis due to M. abscessus and Kocuria species in a 48-year-old man with a history of intravenous drug use. The case was complicated by a perforation of the posterior mitral valve leaflet, leading to surgical mitral valve replacement. Cultures from the blood and mitral valve disclosed M. abscessus and Kocuria species. The patient was treated for 6 months with clarithromycin, imipenem and amikacin, with resolution of symptoms. Repeated blood cultures were negative. Acid-fast staining should be done in subacute endocarditis in order to identify rapidly growing mycobacteria.
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Affiliation(s)
- Daniel C Garcia
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Rhanderson Nascimento
- Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA
| | - Victor Soto
- Department of Cardiology, Jackson Memorial Hospital, Miami, Florida, USA
| | - Cesar E Mendoza
- Department of Cardiology, Jackson Memorial Hospital, Miami, Florida, USA
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Residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis. J Thorac Cardiovasc Surg 2014; 148:981-8.e4. [DOI: 10.1016/j.jtcvs.2014.06.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/30/2014] [Accepted: 06/04/2014] [Indexed: 12/14/2022]
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Korem M, Israel S, Gilon D, Cahan A, Moses AE, Block C, Strahilevitz J. Epidemiology of infective endocarditis in a tertiary-center in Jerusalem: a 3-year prospective survey. Eur J Intern Med 2014; 25:550-5. [PMID: 24931808 DOI: 10.1016/j.ejim.2014.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/25/2014] [Accepted: 05/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological features of infective endocarditis have changed during the last decades because of increases in the prevalence of health care exposure and of Staphylococcus aureus bloodstream infection. Consequently, the role of surgery is evolving. We aim to provide a contemporary profile of epidemiological, microbiological, and clinical features of infective endocarditis in a tertiary medical center, and identify predictors of mortality. METHODS A prospective observational cohort study of consecutive adult patients with definite endocarditis according to the modified Duke criteria. Data were collected from January 1, 2009 through October 31, 2011 following a predefined case report form designed by the ICE-PCS. RESULTS Among 70 endocarditis episodes, 25.7% involved prosthetic valves and 11.5% were device related. Forty-four percent of episodes were health-care associated. The predominant causative microorganism on native valve, prosthetic valve and device related endocarditis was Staphylococcus aureus (33.3%). Viridans group streptococci accounted for the majority of community-acquired endocarditis (36.1%). At least one complication occurred in 50% of the episodes. One third of the patients who had an indication for surgery were operated upon. Six month case fatality ratio was 40%. Sixty-five percent of patients with a contraindication to surgery died, compared with 9% and 28.5% who were treated surgically and medically, respectively. In multivariable analysis, age was a predictor of mortality. CONCLUSION Compared with other series, we observed more health-care associated endocarditis, and a higher mortality. Nearly half of all deaths were in patients who had a contraindication to surgery. Careful evaluation of contraindications to surgery is warranted.
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Affiliation(s)
- M Korem
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - S Israel
- Internal Medicine Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D Gilon
- Heart Institute and Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A Cahan
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - A E Moses
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - C Block
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel
| | - J Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Center, POB 12000, 91120 Jerusalem, Israel.
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Curlier E, Hoen B, Alla F, Selton-Suty C, Schubel L, Doco-Lecompte T, Minary L, Erpelding ML, Duval X, Chirouze C. Relationships between sex, early valve surgery and mortality in patients with left-sided infective endocarditis analysed in a population-based cohort study. Heart 2014; 100:1173-8. [DOI: 10.1136/heartjnl-2013-304916] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Yusuf SW, Sharma J, Durand JB, Banchs J. Endocarditis and myocarditis: a brief review. Expert Rev Cardiovasc Ther 2014; 10:1153-64. [DOI: 10.1586/erc.12.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Chatterjee S, Sardar P. Early surgery reduces mortality in patients with infective endocarditis: Insight from a meta-analysis. Int J Cardiol 2013; 168:3094-7. [DOI: 10.1016/j.ijcard.2013.04.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
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Mirabel M, Sonneville R, Hajage D, Novy E, Tubach F, Vignon P, Perez P, Lavoué S, Kouatchet A, Pajot O, Mekontso-Dessap A, Tonnelier JM, Bollaert PE, Frat JP, Navellou JC, Hyvernat H, Hssain AA, Timsit JF, Megarbane B, Wolff M, Trouillet JL. Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 2013; 35:1195-204. [PMID: 23964033 DOI: 10.1093/eurheartj/eht303] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess long-term outcomes and the management of critical left-sided infective endocarditis (IE) and evaluate the impact of surgery. METHODS AND RESULTS Among the 198 patients included prospectively for IE across 33 adult intensive care units (ICU) in France from 1 April 2007 to 1 October 2008, 137 (69%) were dead at a median follow-up time of 59.5 months. Characteristics significantly associated with mortality were: Sepsis-related Organ-Failure Assessment (SOFA) score at ICU admission [Hazard ratio (HR), 95% Confidence Interval (CI) of 1.43 (0.79-2.59) for SOFA 5-9; 2.01 (1.05-3.85) for SOFA 10-14; 3.53 (1.75-7.11) for SOFA 15-20; reference category SOFA 0-4; P = 0.003]; prosthetic mechanical valve IE [HR 2.01; 95% CI 1.09-3.69, P = 0.025]; vegetation size ≥15 mm [HR 1.64; 95% CI 1.03-2.63, P = 0.038]; and cardiac surgery [HR (95%CI), 0.33 (0.16-0.67) for surgery ≤1 day after IE diagnosis; 0.61 (0.29-1.26) for surgery 2-7 days after IE diagnosis; 0.42 (0.21-0.83) for surgery >7 days after IE diagnosis; reference category no surgery; P = 0.005]. One hundred and three (52%) patients underwent cardiac surgery after a median time of 6 (16) days. Independent predictors of surgical intervention on multivariate analysis were: age ≤60 years [Odds ratio (OR) 5.30; 95% CI (2.46-11.41), P < 0.01], heart failure [OR 3.27; 95% CI (1.03-10.35), P = 0.04], cardiogenic shock [OR 3.31; 95% CI (1.47-7.46), P = 0.004], septic shock [OR 0.25; 95% CI (0.11-0.59), P = 0.002], immunosuppression [OR 0.15; 95% CI (0.04-0.55), P = 0.004], and diagnosis before or within 24 h of ICU admission [OR 2.81; 95% CI (1.14-6.95), P = 0.025]. SOFA score calculated the day of surgery was the only independently associated factor with long-term mortality [HR (95% CI) 1.59 (0.77-3.28) for SOFA 5-9; 3.56 (1.71-7.38) for SOFA 10-14; 11.58 (4.02-33.35) for SOFA 15-20; reference category SOFA 0-4; P < 0.0001]. Surgical timing was not associated with post-operative outcomes. Of the 158 patients with a theoretical indication for surgery, the 58 deemed not fit had a 95% mortality rate. CONCLUSION Mortality in patients with critical IE remains unacceptably high. Factors associated with long-term outcomes are the severity of multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and surgical treatment. Up to one-third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. The strongest independent predictor of post-operative mortality is the pre-operative multiorgan failure score while surgical timing does not seem to impact on outcomes.
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Affiliation(s)
- Mariana Mirabel
- Service de Réanimation Médicale, Institut de Cardiologie, Université Paris VI-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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García-Cabrera E, Fernández-Hidalgo N, Almirante B, Ivanova-Georgieva R, Noureddine M, Plata A, Lomas JM, Gálvez-Acebal J, Hidalgo-Tenorio C, Ruíz-Morales J, Martínez-Marcos FJ, Reguera JM, de la Torre-Lima J, González ADA. Neurological Complications of Infective Endocarditis. Circulation 2013; 127:2272-84. [PMID: 23648777 DOI: 10.1161/circulationaha.112.000813] [Citation(s) in RCA: 322] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background—
The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery.
Methods and Results—
This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91),
Staphylococcus aureus
as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications;
P
<0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery).
Conclusions—
Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.
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Affiliation(s)
- Emilio García-Cabrera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Nuria Fernández-Hidalgo
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Benito Almirante
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Radka Ivanova-Georgieva
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Mariam Noureddine
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Antonio Plata
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Jose M. Lomas
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Juan Gálvez-Acebal
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Carmen Hidalgo-Tenorio
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Josefa Ruíz-Morales
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Francisco J. Martínez-Marcos
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Jose M. Reguera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Javier de la Torre-Lima
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Arístides de Alarcón González
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
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Zauner F, Glück T, Salzberger B, Ehrenstein B, Beutel G, Robl F, Hanses F, Birnbaum D, Linde HJ, Audebert F. Are histopathological findings of diagnostic value in native valve endocarditis? Infection 2013; 41:637-43. [PMID: 23378292 DOI: 10.1007/s15010-013-0404-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/03/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Optimal management of infective endocarditis (IE) depends on the early detection of IE-causing pathogens and on appropriate antimicrobial and surgical therapy. The current guidelines of the European Society of Cardiology (ESC) recommend histopathological examination as the gold standard for diagnosing IE Habib et al. (Eur Heart J 30:2369-2413, 2005). We hypothesize that histopathological findings do not provide additional information relevant to clinical decision-making. METHODS We retrospectively reviewed a cohort of patients who had undergone surgery for native valve endocarditis (NVE) at the University Hospital Regensburg between September 1994 and February 2005. All episodes of intraoperatively confirmed endocarditis during this period were included in the study. Data were retrieved from surgical records, microbiological and histopathological reports, and medical files of the treating as well as admitting hospital. Pathogens were correlated with the site of manifestation of the affected heart valve and with clinical and histopathological findings. RESULTS A total of 163 episodes of NVE were recorded and entered into our study for analysis. The valves affected were the aortic valve (45 %), the mitral valve (28 %), the aortic and mitral valve (22 %), and other valves (5 %). IE-causing pathogens were Staphylococcus aureus (22 %), viridans streptococci (18 %), enterococci (10 %), streptococci other than Streptococcus viridans (9 %), coagulase-negative staphylococci (5 %), miscellaneous pathogens (4 %), and culture-negative endocarditis (33 %). Infection with S. aureus was associated with high rates of sepsis, septic foci, and embolic events, while patients with enterococcal IE showed the highest rate of abscesses. Mortality rate in all subgroups was low without significant differences. However, histopathological findings correlated poorly with the pathogen involved and showed only few significant associations that were without clinical relevance. CONCLUSIONS The clinical presentation of IE depends on the pathogen involved. Among the episodes of NVE examined, the histopathological examination of resected heart valves did not show any pathogen-specific morphological patterns and therefore did not provide any additional information of clinical value. Based on our findings, we recommend complementary cultures of the resected materials (valve tissue, thrombotic material, pacer wire) and implementation of molecular diagnostic methods (e.g., broad-range PCR amplification techniques) instead of histopathological analyses of resected valve tissue.
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Affiliation(s)
- F Zauner
- Department of Internal Medicine I, Department of Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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Malhotra A, Prendergast BD. Evaluating treatment options for patients with infective endocarditis: when is it the right time for surgery? Future Cardiol 2012; 8:847-61. [DOI: 10.2217/fca.12.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infective endocarditis remains a life-threatening condition with an unchanging incidence and mortality of nearly 30% at 1 year. Surgery is required in 25–50% of acute infections and 20–40% of patients during convalescence. Operative procedures are often technically challenging and high-risk, often due to coexistent multisystem disease. However, international guidelines provide clear indications for surgical intervention, which are applicable for the majority of patients. These are not, however, supported by particularly robust clinical evidence and decision-making often needs to be tailored to the advancing age of the overall patient cohort, the presence of multisystem disease, comorbidities, prior antibiotic therapy of varying duration and the availability of surgical expertise. Native valve endocarditis will be the initial focus of this article, along with subgroups including prosthetic valve endocarditis. We present the treatment options for patients with infective endocarditis, evaluate the evidence-base that supports current clinical practice and attempt to provide an insight and subsequent recommendations for the timing of surgery.
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Affiliation(s)
- Aneil Malhotra
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Bernard D Prendergast
- Department of Cardiology, The John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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Miranda-Montero S, Rodríguez-Esteban M, Álvarez-Acosta L, Lubillo-Montenegro S, Pérez-Hernández H, Llorens-León R. Endocarditis infecciosa en la Unidad de Medicina Intensiva. Med Intensiva 2012; 36:460-6. [DOI: 10.1016/j.medin.2012.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Revised: 02/02/2012] [Accepted: 02/03/2012] [Indexed: 10/28/2022]
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Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys. J Am Coll Cardiol 2012; 59:1968-76. [PMID: 22624837 DOI: 10.1016/j.jacc.2012.02.029] [Citation(s) in RCA: 257] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/10/2012] [Accepted: 02/14/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate temporal trends in infective endocarditis (IE) incidence and clinical characteristics after 2002 French IE prophylaxis guideline modifications. BACKGROUND There are limited data on changes in the epidemiology of IE since recent guidelines recommended restricting the indications of antibiotic prophylaxis of IE. METHODS Three 1-year population-based surveys were conducted in 1991, 1999, and 2008 in 3 French regions totaling 11 million inhabitants age ≥20 years. We prospectively collected IE cases from all medical centers and analyzed age- and sex-standardized IE annual incidence trends. RESULTS Overall, 993 expert-validated IE cases were analyzed (323 in 1991; 331 in 1999; and 339 in 2008). IE incidence remained stable over time (95% confidence intervals given in parentheses/brackets): 35 (31 to 39), 33 (30 to 37), and 32 (28 to 35) cases per million in 1991, 1999, and 2008, respectively. Oral streptococci IE incidence did not increase either in the whole patient population (8.1 [6.4 to 10.1], 6.3 [4.8 to 8.1], and 6.3 [4.9 to 8.0] in 1991, 1999, and 2008, respectively) or in patients with pre-existing native valve disease. The increased incidence of Staphylococcus aureus IE (5.2 [3.9 to 6.8], 6.8 [5.3 to 8.6], and 8.2 [6.6 to 10.2]) was not significant in the whole patient population (p = 0.228) but was significant in the subgroup of patients without previously known native valve disease (1.6 [0.9 to 2.7], 3.7 [2.6 to 5.1], and 4.1 [3.0 to 5.6]; p = 0.012). CONCLUSIONS Scaling down antibiotic prophylaxis indications was not associated with an increased incidence of oral streptococcal IE. A focus on avoidance of S. aureus bacteremia in all patients, including those with no previously known valve disease, will be required to improve IE prevention.
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Clinical predictors of in-hospital death and early surgery for infective endocarditis: results of CArdiac Disease REgistration (CADRE), a nation-wide survey in Japan. Int J Cardiol 2012; 167:2688-94. [PMID: 22805554 DOI: 10.1016/j.ijcard.2012.06.117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/30/2012] [Accepted: 06/24/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND The benefit of early surgery for IE is yet to be determined in non-Western countries. We conducted this study to evaluate the role of early surgery in infective endocarditis (IE) in Japan. METHODS IE admissions in Japan were prospectively registered using a nation-wide WEB-based registration system (CArdiac Disease REgistration, CADRE). The impact of early surgery on in-hospital mortality was assessed in native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Risk factors for in-hospital death were assessed by multiple logistic regression analysis. The propensity score for early surgery was calculated to adjust the impact of early surgery. RESULTS From September 2006 to May 2009, 348 NVE and 81 PVE were registered. In NVE, early surgery was preferable in every quartile stratified with the propensity score and the summary odds ratio (OR) and 95% confidence interval (CI) was 0.12 (0.05-0.31). The predictors of in-hospital death were Staphylococcus aureus infection (OR 3.5, 95% CI 1.26-9.7), heart failure (OR 6.74, 95% CI 2.43-18.7) and early surgery (OR 0.07, 95% CI 0.03-0.2). In PVE, the predictors of in-hospital death were age (OR 1.09, 95% CI 1.01-1.18), S. aureus infection (OR 5.8, 95% CI 1.4-24.01) and heart failure (OR 7.44, 95% CI 1.81-30.67), whereas early surgery was not (OR 0.51, 95% CI 0.12-2.16). CONCLUSION Early surgery for NVE is associated with improved survival in a wide range of clinical subgroups in Japan. In PVE a survival benefit of early surgery is not clear.
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Abstract
Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.
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Affiliation(s)
- Franck Thuny
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France
| | - Dominique Grisoli
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Frederic Collart
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France.
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Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg 2011; 142:836-842.e1. [DOI: 10.1016/j.jtcvs.2011.01.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 12/15/2010] [Accepted: 01/24/2011] [Indexed: 11/19/2022]
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Evans CF, Gammie JS. Surgical Management of Mitral Valve Infective Endocarditis. Semin Thorac Cardiovasc Surg 2011; 23:232-40. [DOI: 10.1053/j.semtcvs.2011.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2011] [Indexed: 12/11/2022]
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Surgical treatment for infective endocarditis in elderly patients. J Infect 2011; 63:131-8. [DOI: 10.1016/j.jinf.2011.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/04/2011] [Accepted: 05/29/2011] [Indexed: 11/17/2022]
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