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Nielsen ST, Hadji-Turdeghal K, Graversen PL, Østergaard L, Smerup MH, Køber L, Fosbøl EL. Early surgery to prevent embolic events in patients with infective endocarditis: a comprehensive review. J Cardiothorac Surg 2024; 19:463. [PMID: 39034421 PMCID: PMC11261816 DOI: 10.1186/s13019-024-02946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/29/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a dangerous and lethal illness with high mortality rates. One of the main indications for surgery according to the guidelines is prevention of embolic events. However, uncertainty remains concerning the timing of surgery and the effect of early surgery in combination with antibiotic therapy versus antibiotic therapy alone in IE patients with a vegetation size > 10 mm. METHODS We conducted a comprehensive review by searching the PubMed, MEDLINE, and EMbase databases. Titles and abstracts were screened, and studies of interest were selected for full-text assessment. Studies were selected for review if they met the criteria of comparing surgical treatment + antibiotic therapy to antibiotic therapy alone in patients with vegetations > 10 mm. RESULTS We found 1,503 studies through our database search; nine of these were eligible for review, with a total number of 3,565 patients. Median age was 66 years (range: 17-80) and the median percentage of male patients was 65.6% (range: 61.8 - 71.4%). There was one randomised controlled trial, one prospective study, and seven retrospective studies. Seven studies found surgery + antibiotic therapy to be associated with better outcomes in patients with IE and vegetations > 10 mm, one of them being the randomised trial [hazard ratio = 0.10; 95% confidence interval 0.01-0.82]. Two studies found surgery + antibiotic therapy was associated with poorer outcomes compared with antibiotic therapy alone. CONCLUSION Overall, data vary in quality due to low numbers and selection bias. Evidence is conflicting, yet suggest that surgery + antibiotic therapy is associated with better outcomes in patients with IE and vegetations > 10 mm for prevention of emboli. Properly powered randomised trials are warranted.
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Affiliation(s)
- Sikander Tajik Nielsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Katra Hadji-Turdeghal
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Morten Holdgaard Smerup
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, Copenhagen, 2200, Denmark.
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2
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Nappi F. Native Infective Endocarditis: A State-of-the-Art-Review. Microorganisms 2024; 12:1481. [PMID: 39065249 PMCID: PMC11278776 DOI: 10.3390/microorganisms12071481] [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: 06/06/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Native valve infective endocarditis (NVE) is a global phenomenon, defined by infection of a native heart valve and involving the endocardial surface. The causes and epidemiology of the disease have evolved in recent decades, with a doubling of the average patient age. A higher incidence was observed in patients with implanted cardiac devices that can result in right-sided infection of the tricuspid valve. The microbiology of the disease has also changed. Previously, staphylococci, which are most often associated with health-care contact and invasive procedures, were the most common cause of the disease. This has now been superseded by streptococci. While innovative diagnostic and therapeutic strategies have emerged, mortality rates have not improved and remain at 30%, which is higher than that for many cancer diagnoses. The lack of randomized trials and logistical constraints impede clinical management, and long-standing controversies such as the use of antibiotic prophylaxis persist. This state of the art review addresses clinical practice, controversies, and strategies to combat this potentially devastating disease. A multidisciplinary team will be established to provide care for patients with presumptive NVE. The composition of the team will include specialists in cardiology, cardiovascular surgery, and infectious disease. The prompt administration of combination antimicrobial therapy is essential for effective NVE treatment. Additionally, a meticulous evaluation of each patient is necessary in order to identify any indications for immediate valve surgery. With the intention of promoting a more comprehensive understanding of the procedural management of native infective endocarditis and to furnish clinicians with a reference, the current evidence for the utilization of distinct strategies for the diagnosis and treatment of NVE are presented.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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3
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Carter-Storch R, Pries-Heje MM, Povlsen JA, Christensen U, Gill SU, Hjulmand JG, Bruun NE, Elming H, Madsen T, Fuursted K, Schultz M, Christensen JJ, Rosenvinge F, Helweg-Larsen J, Fosbøl E, Køber L, Torp-Pedersen C, Tønder N, Moser C, Iversen K, Bundgaard H, Ihlemann N. Association Between Vegetation Size and Outcome in the Partial Oral Antibiotic Endocarditis Treatment Trial. Am J Cardiol 2024; 222:131-140. [PMID: 38703884 DOI: 10.1016/j.amjcard.2024.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/26/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Step-down oral antibiotic therapy is associated with a non-inferior long-term outcome compared with continued intravenous antibiotic therapy in the treatment of left-sided infective endocarditis. We aimed to analyze whether step-down oral therapy compared with continued intravenous antibiotic therapy is also associated with a non-inferior outcome in patients with large vegetations (vegetation length ≥ 10 mm) or among patients who underwent surgery before step-down oral therapy. We included patients without presence of aortic root abscess at diagnosis from the POET (Partial Oral Antibiotic Endocarditis Treatment) study. Multivariable Cox regression analyses were used to find associations between large vegetation, cardiac surgery, step-down oral therapy, and the primary end point (composite of all-cause mortality, unplanned cardiac surgery, embolic event, or relapse of positive blood cultures during follow-up). A total of 368 patients (age 68 ± 12, 77% men) were included. Patients with large vegetations (n = 124) were more likely to undergo surgery compared with patients with small vegetations (n = 244) (65% vs 20%, p <0.001). During a median 1,406 days of follow-up, 146 patients reached the primary end point. Large vegetations were not associated with the primary end point (hazard ratio 0.74, 95% confidence interval 0.47 to 1.18, p = 0.21). Step-down oral therapy was non-inferior to continued intravenous antibiotic in all subgroups when stratified by the presence of a large vegetation at baseline and early cardiac surgery. Step-down oral therapy is safe in the presence of a large vegetation at diagnosis and among patients who underwent early cardiac surgery.
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Affiliation(s)
| | | | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ulrik Christensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Sabine U Gill
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Julie Glud Hjulmand
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zeeland University Hospital, Roskilde, Denmark
| | - Hanne Elming
- Department of Cardiology, Zeeland University Hospital, Roskilde, Denmark
| | - Trine Madsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kurt Fuursted
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Martin Schultz
- Department of Cardiology, Herlev Hospital, Copenhagen, Denmark
| | - Jens J Christensen
- The Regional Department of Clinical Microbiology, Zealand University Hospital, Roskilde, Denmark
| | - Flemming Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | | | - Emil Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Niels Tønder
- Department of Cardiology, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
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4
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Álvarez-Zaballos S, Vázquez-Alen P, Muñoz P, de Alarcón A, Gutiérrez Carretero E, Álvarez-Uría A, Fariñas MC, Rodríguez-García R, Goenaga MÁ, Cuervo G, Plata-Ciezar A, Hidalgo-Tenorio C, Aldamiz-Echevarría G, Martínez-Sellés M. Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis. Int J Stroke 2024:17474930241255560. [PMID: 38708722 DOI: 10.1177/17474930241255560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE. METHODS Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. RESULTS Out of 5667 IE cases, 1125 had acute stroke (19.8%): 818 ischemic strokes (811 cardioembolic strokes (193 with hemorrhagic transformation), 4 transient ischemic attacks, 3 lacunar infarctions), 127 intracranial hemorrhages, and 27 other neurological complications (cerebral abscesses, encephalitis, and meningitis). Compared to patients without stroke, those with stroke had a similar mean age (69 years) but were more frequently female (68.2% vs 63.7%, p = 0.04) and had a higher incidence of intracardiac complications (35% vs 30%, p = 0.01), surgical indication (69.9% vs 65.9%, p = 0.001), in-hospital mortality (40.9% vs 22.0%, p < 0.001), and 1-year mortality (46.2% vs 27.9%, p < 0.001). The following variables were independently associated with stroke: mitral location (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.34-1.8, p < 0.001), vascular phenomenon (OR = 2.9, 95% CI = 2.4-3.6, p = 0.0001), acute renal failure (OR = 1.2, 95% CI = 1.0-1.4, p = 0.021), septic shock (OR = 1.3, 95% CI = 1.1-1.6, p = 0.007), sepsis (OR = 1.3, 95% CI = 1.1-1.6, p = 0.005), surgery indicated but not performed (OR = 1.4, 95% CI = 1.2-1.7, p < 0.001), community-acquired IE (OR = 1.2, 95% CI = 1-1.4, p = 0.017), and peripheral embolization (OR = 1.6, 95% CI = 1.4-1.9, p < 0.001). Stroke was an independent predictor of in-hospital (OR = 2.1, 95% CI = 1.78-2.51, p < 0.001) and 1-year mortality (hazard ratio = 1.9, 95% CI = 1.6-2.5). CONCLUSION One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.
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Affiliation(s)
- Sara Álvarez-Zaballos
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Pilar Vázquez-Alen
- Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Muñoz
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Infective Diseases, Microbiology and Parasitology Department, (UCEIMP), Hospital Virgen del Rocío Seville, Seville, Spain
- Grupo de Resistencias bacterianas y antimicrobianos (CIBERINFEC), Madrid, Spain
- Institute of Biomedicine of Seville (IBiS), Seville, Spain
- University of Seville/CSIC, Seville, Spain
| | - Encarnación Gutiérrez Carretero
- Institute of Biomedicine of Seville (IBiS), Seville, Spain
- University of Seville/CSIC, Seville, Spain
- Cardiac Surgery Service CIBERCV, Hospital Virgen del Rocío Seville, Seville, Spain
| | - Ana Álvarez-Uría
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mª Carmen Fariñas
- Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla IDIVAL, Santander, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Raquel Rodríguez-García
- Intensive Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- University of Oviedo, Oviedo, Spain
| | - Miguel Ángel Goenaga
- Infectious Diseases Department, Hospital Universitario Donosti, ISS Biodonostia, San Sebastián, Spain
| | - Guillermo Cuervo
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antonio Plata-Ciezar
- Infectious Diseases Department, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Carmen Hidalgo-Tenorio
- Internal Medicine Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Gonzalo Aldamiz-Echevarría
- Cardiac Surgery Department, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Universidad Europea, Madrid, Spain
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5
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Pham S, Heigle B, Gibbs C, Gebrehiwot WG, Pannu P. Complications of Infective Endocarditis: A Case Report of Intracerebral Hemorrhage Exacerbated by Enoxaparin. Cureus 2024; 16:e61235. [PMID: 38939272 PMCID: PMC11210433 DOI: 10.7759/cureus.61235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
Infective endocarditis (IE) can cause life-threatening intracerebral hemorrhage via the transformation of an embolic ischemic stroke. Navigating anticoagulant therapy for IE patients is challenging due to this risk. Hospitalized patients often receive anticoagulation to minimize venous thromboembolism (VTE). Those at higher VTE risk may require full anticoagulation, particularly if there is an initial suspicion of a blood clot. A timely IE diagnosis is crucial but is often delayed during inpatient stays, with the patient potentially already on anticoagulants for other conditions. Our case discusses a hemorrhagic stroke in a patient with IE while receiving therapeutic enoxaparin. Clinical signs and symptoms, echocardiographic findings, laboratory workup and microbiological data, and possibly other imaging techniques such as cerebral magnetic resonance imaging (MRI) need to be employed in a timely manner in determining endocarditis as a cause of stroke.
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Affiliation(s)
- Steven Pham
- Internal Medicine, White County Medical Center, Searcy, USA
| | | | - Connor Gibbs
- Emergency Medicine, White County Medical Center, Searcy, USA
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6
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Schuermann H, von Rennenberg R, Riegler C, Rangus I, Litmeier S, Scheitz JF, Doehner W, Audebert H, Braemswig TB, Nolte CH. Characteristics associated with occurrence of stroke in patients with infective endocarditis - a retrospective cohort study. Neurol Res Pract 2024; 6:22. [PMID: 38600573 PMCID: PMC11007977 DOI: 10.1186/s42466-024-00317-4] [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: 01/24/2024] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Stroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms. METHODS All patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité - Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke. RESULTS The study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35-4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06-6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21-8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04-0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14-0.72). CONCLUSIONS Stroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.
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Affiliation(s)
- H Schuermann
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
- Paracelsus Medical University Salzburg, Salzburg, Austria.
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - R von Rennenberg
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Riegler
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - I Rangus
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Litmeier
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J F Scheitz
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
| | - W Doehner
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
- German Heart Center of the Charite, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health-Center or Regenerative Therapies, Universitätsmedizin Berlin, Berlin, Germany
| | - H Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T B Braemswig
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
| | - C H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Universitätsmedizin Berlin, Berlin, Germany
- DZHK German Centre for Cardiovascular Research (DZHK), Partner-Site Berlin, Berlin, Germany
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7
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Ji Y, Zhuo B, Jiang T, Chen M, Xu W, Shen Y, Cheng D, Ge Y. Talaromyces marneffei endocarditis initially detected by Next Generation Sequencing: A case report. Int J Med Microbiol 2024; 314:151615. [PMID: 38394877 DOI: 10.1016/j.ijmm.2024.151615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Talaromyces marneffei (T. marneffei) is a thermal dimorphic fungus, which can cause lung or blood stream infection in patients, often life-threatening. However, endocarditis caused by T. marneffei has not been reported. For elderly patients with implanted cardiac devices or artificial valves, the prevention and treatment of infective endocarditis should not be ignored. METHODS This is a descriptive study of a T. marneffei endocarditis by joint detection of cardiac ultrasound examination, peripheral blood DNA metagenomics Next Generation Sequencing (mNGS), and in vitro culture. RESULTS We describe an 80-year-old female patient with an unusual infection of T. marneffei endocarditis. After intravenous drip of 0.2 g voriconazole twice a day for antifungal treatment, the patient showed no signs of improvement and their family refused further treatment. CONCLUSION Infective endocarditis is becoming more and more common in the elderly due to the widely use of invasive surgical procedures and implantation of intracardiac devices. The diagnosis and treatment of T. marneffei endocarditis is challenging because of its rarity. Here, we discussed a case of T. marneffei endocarditis, and emphasized the role of mNGS in early diagnosis, which is of great significance for treatment and survival rate of patients.
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Affiliation(s)
- Youqi Ji
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Bingqian Zhuo
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang 310053, China
| | - Tao Jiang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Mengyuan Chen
- Department of Laboratory Medicine, the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Wei Xu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yuhuan Shen
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China
| | - Dongqing Cheng
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China
| | - Yumei Ge
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang 310014, China; School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang 310053, China; Department of Laboratory Medicine, the Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, China; Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang 310063, China.
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8
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Papadimitriou-Olivgeris M, Guery B, Ianculescu N, Auberson D, Tozzi P, Kirsch M, Monney P. Risk of embolic events before and after antibiotic treatment initiation among patients with left-side infective endocarditis. Infection 2024; 52:117-128. [PMID: 37402113 PMCID: PMC10811187 DOI: 10.1007/s15010-023-02066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Embolic events (EEs) are a common complication of left-side infective endocarditis (IE). The aim of the present study was to identify risk factors for the occurrence of EEs before or after antibiotic treatment instauration among patients with definite or possible IE. METHODS This retro-prospective study was conducted at the Lausanne University Hospital, Lausanne, Switzerland, from January 2014 to June 2022. EEs and IE were defined according to modified Duke criteria. RESULTS A total of 441 left-side IE episodes were included (334: 76% were definite and 107; 24% possible IE). EE were diagnosed in 260 (59%) episodes; in 190 (43%) before antibiotic treatment initiation and 148 (34%) after. Central nervous system (184; 42%) was the most common site of EE. Multivariable analysis identified S. aureus (P 0.022), immunological phenomena (P < 0.001), sepsis (P 0.027), vegetation size ≥ 10 mm (P 0.003) and intracardiac abscess (P 0.022) as predictors of EEs before antibiotic treatment initiation. For EEs after antibiotic treatment initiation, multivariable analysis revealed vegetation size ≥ 10 mm (P < 0.001), intracardiac abscess (P 0.035) and prior EE (P 0.042), as independent predictors of EEs, while valve surgery (P < 0.001) was associated with lower risk for EEs. CONCLUSIONS We reported a high percentage of EEs among patients with left-side IE; vegetation size, intracardiac abscess, S. aureus and sepsis were independently associated with the occurrence of EEs. In addition to antibiotic treatment, early surgery led to further decrease in EEs incidence.
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Affiliation(s)
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland
| | - Nicoleta Ianculescu
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Denise Auberson
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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9
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Becher PM, Goßling A, Fluschnik N, Schrage B, Seiffert M, Schofer N, Blankenberg S, Kirchhof P, Westermann D, Kalbacher D. Temporal trends in incidence, patient characteristics, microbiology and in-hospital mortality in patients with infective endocarditis: a contemporary analysis of 86,469 cases between 2007 and 2019. Clin Res Cardiol 2024; 113:205-215. [PMID: 36094574 PMCID: PMC10850016 DOI: 10.1007/s00392-022-02100-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is characterized by high morbidity and mortality rates, despite recent improvements in diagnostics and treatment. We aimed to investigate incidence, clinical characteristics, and in-hospital mortality in a large-scale nationwide cohort. METHODS Using data from the German Federal Bureau of Statistics, all IE cases in Germany between 2007 and 2019 were analyzed. Logistic regression models were fitted to assess associations between clinical factors and in-hospital mortality. RESULTS In total, 86,469 patients were hospitalized with IE between 2007 and 2019. The mean age was 66.5 ± 14.7 years and 31.8% (n = 27,534/86,469) were female. Cardiovascular (CV) comorbidities were common. The incidence of IE in the German population increased from 6.3/100,000 to 10.2/100,000 between 2007 and 2019. Staphylococcus (n = 17,673/86,469; 20.4%) and streptococcus (n = 17,618/86,469; 20.4%) were the most common IE-causing bacteria. The prevalence of staphylococcus gradually increased over time, whereas blood culture-negative IE (BCNIE) cases decreased. In-hospital mortality in patients with IE was 14.9%. Compared to BCNIE, staphylococcus and Gram-negative pathogens were associated with higher in-hospital mortality. In multivariable analysis, factors associated with higher likelihood of in-hospital mortality were advanced age, female sex, CV comorbidities (e.g., heart failure, COPD, diabetes, stroke), need for dialysis or invasive ventilation, and sepsis. CONCLUSIONS In this contemporary cohort, incidence of IE increased over time and in-hospital mortality remained high (~ 15%). While staphylococcus and streptococcus were the predominant microorganisms, bacteremia with staphylococcus and Gram-negative pathogens were associated with higher likelihood of in-hospital mortality. Our results highlight the need for new preventive strategies and interventions in patients with IE.
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Affiliation(s)
- Peter Moritz Becher
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology I, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
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10
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Lee TTL, Chan SCL, Chou OHI, Lee S, Chan JSK, Liu T, Chang C, Wong WT, Lip GYH, Cheung BMY, Wai AKC, Tse G. Initiation of warfarin is associated with decreased mortality in patients with infective endocarditis: A population-based cohort study. Thromb Res 2024; 233:1-9. [PMID: 37979284 DOI: 10.1016/j.thromres.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
IMPORTANCE The use of warfarin to prevent thromboembolism in patients with infective endocarditis (IE) remains controversial due to potentially increased bleeding risks. DESIGN Population-based retrospective cohort study. PARTICIPANTS Patients aged 18 or older and diagnosed with IE in Hong Kong between January 1st, 1997 and August 31st, 2020 were included. Patients with use of any anticoagulant 30 days before IE diagnosis were excluded. Patients initiated on warfarin within 14 days of IE diagnosis and patients without warfarin use were matched for baseline characteristics using 1:1 propensity score matching. EXPOSURE Warfarin use within 14 days of IE diagnosis. MAIN OUTCOMES AND MEASURES Patients were followed up to 90 days for the outcomes of ischemic stroke, all-cause mortality, intracranial hemorrhage, and gastrointestinal bleeding. Cox regression was used to determine hazard ratios (HRs) [95 % confidence intervals (CIs)] between treatment groups. Fine-Gray competing risk regression with all-cause mortality as the competing event was performed as a sensitivity analysis. In addition to 90-day analyses, landmark analyses were performed at 30 days of follow-up. RESULTS The matched cohort consisted of 675 warfarin users (57.0 % male, age 59 ± 16 years) and 675 warfarin non-users (53.5 % male, age 61 ± 19 years). Warfarin users had a 50 % decreased 90-day risk in all-cause mortality (HR:0.50 [0.39-0.65]), without significantly different 90-day risks of ischemic stroke (HR:1.04 [0.70-1.53]), intracranial hemorrhage (HR:1.25 [0.77-2.04]), and gastrointestinal bleeding (HR:1.04 [0.60-1.78]). Thirty-day landmark analysis showed similar results. Competing risk regression showed significantly higher 30-day cumulative incidence of intracranial hemorrhage in warfarin users (sub-HR:3.34 [1.34-8.31]), but not at 90-day (sub-HR:1.63 [0.95-2.81]). Results from Fine-Gray regression were otherwise congruent with those from Cox regression. CONCLUSIONS AND RELEVANCE Warfarin initiated within 14 days of IE diagnosis was associated with significantly decreased risks of mortality but higher risks of intracranial hemorrhage, with similar risks of ischemic stroke and gastrointestinal bleeding, compared with non-use of warfarin with 14 days of IE diagnosis. KEY POINTS Question: Is warfarin, initiated within 14 days of a diagnosis of infective endocarditis (IE), efficacious and safe? FINDINGS In this propensity score-matched, population-based, prospective cohort study from Hong Kong, warfarin use within 14 days of IE diagnosis was associated with a 50 % decrease in the risk of all-cause mortality, albeit with higher risk of intracranial hemorrhage, and without significant differences in the risk of ischaemic stroke and gastrointestinal bleeding. Meaning: In patients with IE, warfarin use within 14 days of diagnosis may have mortality benefits, despite increased risks of intracranial hemorrhage.
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Affiliation(s)
- Teddy Tai Loy Lee
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China; Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Sunny Ching Long Chan
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Oscar Hou In Chou
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China; Division of Clinical Pharmacology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Sharen Lee
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Jeffrey Shi Kai Chan
- Cardiovascular Pharmacology Unit, Cardiovascular Analytics Group, PowerHealth Research Institute, Hong Kong, China.
| | - Tong Liu
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Carlin Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital and The University of Hong Kong, Hong Kong, China.
| | - Wing Tak Wong
- State Key Laboratory of Agrobiotechnology (CUHK), School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China.
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Bernard Man Yung Cheung
- Division of Clinical Pharmacology, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Abraham Ka-Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China; Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, United Kingdom; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
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11
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Flurin L, Fisher CR, Wolf MJ, Pritt BS, DeSimone DC, Patel R. Comparison of Blood-Based Shotgun and Targeted Metagenomic Sequencing for Microbiological Diagnosis of Infective Endocarditis. Open Forum Infect Dis 2023; 10:ofad546. [PMID: 38075017 PMCID: PMC10709542 DOI: 10.1093/ofid/ofad546] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
Background Shotgun and targeted metagenomic sequencing have been shown in separate studies to be potentially useful for culture-free pathogen identification in blood and/or plasma of patients with infective endocarditis (IE). However, the 2 approaches have not been directly compared. The aim of this study was to compare shotgun metagenomic sequencing with targeted metagenomic sequencing (tMGS) for organism identification in blood or plasma of patients with IE. Methods Patients with possible or definite IE were prospectively enrolled from October 2020 to July 2021. Shotgun metagenomic sequencing was performed with the Karius test, which uses microbial cell-free DNA (mcfDNA) sequencing to detect, identify, and quantitate DNA-based pathogens in plasma. tMGS was performed using a 16S ribosomal RNA (rRNA) polymerase chain reaction assay targeting the V1 to V3 regions of the 16S rRNA gene. Results were compared using the McNemar test of paired proportions. Results Samples from 34 patients were investigated. The Karius test was positive in 24/34 (71%), including 3/6 (50%) with blood culture-negative endocarditis (BCNE), which was not significantly different from the positivity rate of tMGS (P = .41). Results of the Karius test were concordant with tMGS in 75% of cases. The Karius test detected 2 cases of methicillin-resistant Staphylococcus aureus among the 7 S. aureus detections, in accordance with results of phenotypic susceptibility testing. The combination of blood cultures, the Karius test, and tMGS found a potential causative pathogen in 33/34 (97%), including 5/6 with BCNE. Conclusions The Karius test and tMGS yielded comparable detection rates; however, beyond organism identification, the Karius test generated potentially useful antibiotic resistance data.
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Affiliation(s)
- Laure Flurin
- Divisions of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, France
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Cody R Fisher
- Divisions of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J Wolf
- Divisions of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi S Pritt
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Divisions of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
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12
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Sambola A, Lozano-Torres J, Boersma E, Olmos C, Ternacle J, Calvo F, Tribouilloy C, Reskovic-Luksic V, Separovic-Hanzevacki J, Park SW, Bekkers S, Chan KL, Almaghraby A, Iung B, Lancellotti P, Habib G. Predictors of embolism and death in left-sided infective endocarditis: the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry. Eur Heart J 2023; 44:4566-4575. [PMID: 37592753 DOI: 10.1093/eurheartj/ehad507] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND AIMS Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was >10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P < .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine >2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P < .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS Prognosis after LSIE is determined by multiple factors, including vegetation size.
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Affiliation(s)
- Antonia Sambola
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Jordi Lozano-Torres
- Department of Cardiology and Research Institute, Cardiac Intensive Care Unit, University Hospital Valld'Hebron, Universitat Autònoma, CIBER Cardiovascular Diseases (CIBER-CV), P° Vall d'Hebron, 119-129, Barcelona 08035, Spain
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Cardiovascular Institute, University Medical Center Rotterdam, BOX 2040, 3000 CA, Rotterdam, The Netherlands
| | - Carmen Olmos
- Instituto cardiovascular, Hospital Clínico San Carlos, Instituto de investigación Sanitaria del Hospital Clínico San Carlos, Prof. Martín Lagos s/n, 28040 Madrid, Spain
| | - Julien Ternacle
- Department of Cardiology, SOS Endocarditis, Henri Mondor University Hospital, Creteil, France
| | - Francisco Calvo
- Department of Cardiology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | | | - Vlatka Reskovic-Luksic
- Department of Cardiovascular Diseases, School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Seung-Woo Park
- Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sebastiaan Bekkers
- Cardiovascular Research Institute Maastricht (CAARIM), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Kwan-Leung Chan
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | - Bernard Iung
- Cardiology Department, AP-HP, Hôpital Bichat, Paris, France
| | - Patrizio Lancellotti
- ANMCO Research Center, Florence, Italy
- Department of Cardiology, Heart valve Clinic, University of Liege Hospital, Liege, Belgium
| | - Gilbert Habib
- Cardiology Department, APHM, La Timone Hospital, Marseille, France
- Aix Marseille University, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
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13
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Wang A. Reducing embolic events in left-sided infective endocarditis by surgery: the earlier the better. Eur Heart J 2023; 44:4576-4578. [PMID: 37674408 DOI: 10.1093/eurheartj/ehad548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Andrew Wang
- Department of Medicine, Duke University School of Medicine, DUMC 3428, Durham, NC 27710, USA
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14
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Nappi F, Avtaar Singh SS, Jitendra V, Fiore A. Bridging Molecular and Clinical Sciences to Achieve the Best Treatment of Enterococcus faecalis Endocarditis. Microorganisms 2023; 11:2604. [PMID: 37894262 PMCID: PMC10609379 DOI: 10.3390/microorganisms11102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Enterococcus faecalis (E. faecalis) is a commensal bacterium that causes various infections in surgical sites, the urinary tract, and blood. The bacterium is becoming a significant concern because it tends to affect the elderly population, which has a high prevalence of undiagnosed degenerative valvular disease and is often subjected to invasive procedures and implanted medical devices. The bacterium's actions are influenced by specific characteristics like pili activity and biofilm formation. This resistance significantly impedes the effectiveness of numerous antibiotic therapies, particularly in cases of endocarditis. While current guidelines recommend antimicrobial therapy, the emergence of resistant strains has introduced complexity in managing these patients, especially with the increasing use of transcatheter therapies for those who are not suitable for surgery. Presentations of the condition are often varied and associated with generalised symptoms, which may pose a diagnostic challenge. We share our encounter with a case study that concerns an octogenarian who had a TAVI valve and developed endocarditis. We also conducted a literature review to identify the essential treatment algorithms for such cases.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | - Vikram Jitendra
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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15
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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16
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Rodríguez-Montolio J, Meseguer-Gonzalez D, Almeida-Zurita M, Santos-Lasaosa S. Clinical profile, antibiotic treatment, and risk of stroke in patients with infective endocarditis. Neurologia 2023; 38:603-605. [PMID: 36356906 DOI: 10.1016/j.nrleng.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/24/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - D Meseguer-Gonzalez
- Servicio de Cardiología del Hospital Clínico Universitario Lozano Blesa, Spain
| | - M Almeida-Zurita
- Servicio de Neurología del Hospital Clínico Universitario Lozano Blesa, Spain
| | - S Santos-Lasaosa
- Servicio de Neurología del Hospital Clínico Universitario Lozano Blesa, Spain
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17
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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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18
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Aoyagi S, Tobinaga S, Wada K, Nata SI, Yasunaga H. Rothia Aeria Endocarditis Complicated with Multiple Systemic Embolisms. Kurume Med J 2023; 68:259-263. [PMID: 37316288 DOI: 10.2739/kurumemedj.ms6834009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rothia aeria is part of the normal flora in the human oral cavity and rarely causes serious systemic infection in healthy hosts. We report a case of infective endocarditis of the mitral valve due to Rothia aeria. A 53-year-old man suffered a cut on his left thumb. At the time, the patient licked the wound as a conventional way to accelerate its cure. Thereafter, he developed a recurrent fever, which was temporarily lysed with treatment using an intravenous antibiotic, over a period of 2 months after the injury. On admission, the patient had no dental caries and denied any dental procedures before onset of the fever. Auscultation revealed a systolic cardiac murmur. Echocardiography showed torn chordae of the posterior mitral leaflet with a small vegetation and severe mitral regurgitation. Two sets of blood cultures were positive for Rothia aeria. Computed tomography revealed splenic and left renal infarctions but no cerebral infarction. After resolution of the inflammation by 6 weeks of penicillin treatment, mitral valve repair was successfully performed.
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Affiliation(s)
| | | | - Kumiko Wada
- Department of Cardiovascular Surgery, St. Mary's Hospital
| | - Shin-Ichi Nata
- Department of Cardiovascular Surgery, St. Mary's Hospital
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19
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Zhu X, Wang Z, Ferrari MW, Ferrari-Kuehne K, Hsi DH, Tse G, Zhou Q, Liang H, Zhang Y, Zhang J. Management of anticoagulation in patients with infective endocarditis. Thromb Res 2023; 229:15-25. [PMID: 37390524 DOI: 10.1016/j.thromres.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023]
Abstract
Infective endocarditis (IE) carries a high risk of vascular complications (e.g., cerebral embolism, intracerebral hemorrhage, and renal infarction), which are correlated with increased early and late mortality. Although anticoagulation is the cornerstone for management of thromboembolic complications, it remains controversial and challenging in patients with IE. An appropriate anticoagulation strategy is crucial to improving outcomes and requires a good understanding of the indication, timing, and regimen of anticoagulation in the setting of IE. Observational studies have shown that anticoagulant treatment failed to reduce the risk of ischemic stroke in patents with IE, supporting that IE alone is not an indication for anticoagulation. In the absence of randomized controlled trials and high-quality meta-analyses, however, current guidelines on IE were based largely on observational data and expert opinion, providing few specific recommendations on anticoagulation. A multidisciplinary approach and patient engagement are required to determine the timing and regimen of anticoagulation in patients with IE, especially in specific situations (e.g., receiving warfarin anticoagulation at the time of IE diagnosis, cerebral embolism or ischemic stroke, intracerebral hemorrhage, or urgent surgery). Collectively, individualized strategies on anticoagulation management of IE should be based on clinical evaluation, available evidence, and patient engagement, and ultimately be developed by the multidisciplinary team.
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Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, China
| | - Zhenhua Wang
- Department of Cardiology, Second Affiliated Hospital of Fujian Medical University, China
| | - Markus W Ferrari
- Clinic of Internal Medicine 1, HSK, Clinic of the City of Wiesbaden and the HELIOS Group, Germany
| | | | - David H Hsi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Gary Tse
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou Province, Affiliated Hospital of Zunyi Medical University, China
| | - Haifeng Liang
- Department of Cardiology, Fu Xing Hospital, Capital Medical University, China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
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20
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Kelesoglu Ş, Inci S, Gul M, Ozan R, Düzgün I, Tuncay A, Aktaş H, Elcik D, Kalay N. Value of increased CRP/albumin ratio in predicting embolic events in patients with infective endocarditis. Biomark Med 2023; 17:613-621. [PMID: 37812054 DOI: 10.2217/bmm-2023-0414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background: The CRP/albumin ratio (CAR), a new inflammatory marker, is associated with adverse outcomes in various cardiovascular diseases. We evaluated the effectiveness of CAR in predicting embolic events in patients diagnosed with infective endocarditis (IE). Methods: A total of 145 patients with IE were included in the study and categorized into two groups according to the presence of embolic events. We retrospectively analyzed the patients' clinical, laboratory and echocardiographic data. Results: CRP (94.2 vs 63.3; p < 0.001) and CAR (25.8 vs 15.1; p < 0.001) values were significantly higher in patients who experienced embolic events. Multivariate analysis showed that a high CAR value (odds ratio: 1.030; 95% CI: 1.000-1.060; p = 0.041) was an independent predictor of embolic events in patients with IE. Conclusion: The CAR is a cheap and easily accessible marker that can predict the development of embolic events in patients diagnosed with IE.
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Affiliation(s)
- Şaban Kelesoglu
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Sinan Inci
- Department of Cardiology, Aksaray University Faculty of Medicine, Aksaray, Türkiye
| | - Murat Gul
- Department of Cardiology, Aksaray University Faculty of Medicine, Aksaray, Türkiye
| | - Ramazan Ozan
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Ismail Düzgün
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Aydın Tuncay
- Department of Cardiovascular Surgery, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Halil Aktaş
- Department of Cardiology, Aksaray University Faculty of Medicine, Aksaray, Türkiye
| | - Deniz Elcik
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Nihat Kalay
- Department of Cardiology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
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21
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Martínez-Sellés M. Clinical profile, antibiotic treatment, and risk of stroke in patients with infective endocarditis. Neurologia 2023; 38:443. [PMID: 36064105 DOI: 10.1016/j.nrleng.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 10/14/2022] Open
Affiliation(s)
- M Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain.
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22
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Qu YF, Yang J, Wang JY, Wei B, Ye XH, Li YX, Han SL. Valve repair after infective endocarditis secondary to perforation caused by Streptococcus gordonii: A case report. World J Clin Cases 2023; 11:3822-3829. [PMID: 37383117 PMCID: PMC10294171 DOI: 10.12998/wjcc.v11.i16.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND We report a case of infective endocarditis (IE) in a patient with congenital heart valve lesions accompanied by IE, which was diagnosed based on blood culture analysis that revealed the presence of a gram-negative bacterium, Streptococcus gordonii.
CASE SUMMARY The patient had a history of precordial valve disease diagnosed by cardiac ultrasound, as well as a 4-mo history of fever. He was subjected to comprehensive anti-infection and anti-heart failure treatment in the internal medicine department. Further examination revealed sudden dislodgement from and perforation through the aortic valve by the superfluous organisms, as well as occurrence of bacterial emboli dislodgement, which caused bacteremia and infectious shock. He recovered and was discharged from the hospital after surgical and postoperative anti-infection treatments.
CONCLUSION We review the treatment process and highlight inspirations and reflections from this case; suggest possible future changes in treatment modalities.
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Affiliation(s)
- Yi-Fan Qu
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Jun Yang
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Jun-Yu Wang
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Bing Wei
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Xing-Hua Ye
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Yi-Xuan Li
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Si-Lu Han
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
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23
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Tascini C, Giuliano S, Attanasio V, Segreti L, Ripoli A, Sbrana F, Severino S, Sordelli C, Weisz SH, Zanus-Fortes A, Leanza GM, Carannante N, Di Cori A, Bongiorni MG, Zucchelli G, De Vivo S. Safety and Efficacy of a Single Procedure of Extraction and Reimplantation of Infected Cardiovascular Implantable Electronic Device (CIED) in Comparison with Deferral Timing: An Observational Retrospective Multicentric Study. Antibiotics (Basel) 2023; 12:1001. [PMID: 37370320 DOI: 10.3390/antibiotics12061001] [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: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: Infections are among the most frequent and life-threatening complications of cardiovascular implantable electronic device (CIED) implantation. The aim of this study is to compare the outcome and safety of a single-procedure device extraction and contralateral implantation versus the standard-of-care (SoC) two-stage replacement for infected CIEDs. (2) Methods: We retrospectively included 66 patients with CIED infections who were treated at two Italian hospitals. Of the 66 patients enrolled in the study, 27 underwent a single procedure, whereas 39 received SoC treatment. All patients were followed up for 12 months after the procedure. (3) Results: Considering those lost to follow-up, there were no differences in the mortality rates between the two cohorts, with survival rates of 81.5% in the single-procedure group and 84.6% in the SoC group (p = 0.075). (4) Conclusions: Single-procedure reimplantation associated with an active antibiofilm therapy may be a feasible and effective therapeutic option in CIED-dependent and frail patients. Further studies are warranted to define the best treatment regimen and strategies to select patients suitable for the single-procedure reimplantation.
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Affiliation(s)
- Carlo Tascini
- Infectious Diseases Clinic, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Simone Giuliano
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Vittorio Attanasio
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Luca Segreti
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Andrea Ripoli
- Bioengineering Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Francesco Sbrana
- Lipoapheresis Unit, Reference Center for Diagnosis and Treatment of Inherited Dyslipidemias, Fondazione Toscana "Gabriele Monasterio", Via Moruzzi 1, 56124 Pisa, Italy
| | - Sergio Severino
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Chiara Sordelli
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Sara Hana Weisz
- UOSD Cardiologia, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Agnese Zanus-Fortes
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Gabriele Maria Leanza
- Infectious Diseases Clinic, Azienda Sanitaria Universitaria del Friuli Centrale (ASUFC), 33100 Udine, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera Dei Colli, 80131 Napoli, Italy
| | - Andrea Di Cori
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Maria Grazia Bongiorni
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Giulio Zucchelli
- Second Division of Cardiology, Cardiac-Thoracic and Vascular Department, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano De Vivo
- UOC di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi Hospital, 80131 Napoli, Italy
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24
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Sharma M, Davis AP. Adding Fuel to the Fire: Infective Endocarditis and the Challenge of Cerebrovascular Complications. Curr Cardiol Rep 2023; 25:349-356. [PMID: 36971959 DOI: 10.1007/s11886-023-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE OF REVIEW Infective endocarditis is a deadly disease and made more deadly by neurologic complications. We review the cerebrovascular complications of infective endocarditis and focus our discussion on medical and surgical management. RECENT FINDINGS While management of stroke in the setting of infective endocarditis differs from standard stroke treatment, mechanical thrombectomy has proven safe and successful. Optimal timing of cardiac surgery in the setting of stroke remains an area of debate, but additional observational studies continue to add more detail to the discussion. Cerebrovascular complications in the setting of infective endocarditis remain a high stakes clinical challenge. Timing of cardiac surgery in IE complicated by stroke exemplifies these dilemmas. While more studies have suggested that earlier cardiac surgery is likely safe for those with small ischemic infarcts, there remains a need for more data defining optimal timing of surgery in all forms of cerebrovascular involvement.
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Affiliation(s)
- Malveeka Sharma
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA
| | - Arielle P Davis
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA.
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25
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Bignoto T. Infective Endocarditis: New Spectra, Same Severity. Arq Bras Cardiol 2023; 120:e20230117. [PMID: 37042880 PMCID: PMC10263453 DOI: 10.36660/abc.20230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Tiago Bignoto
- Faculdade de Medicina da Universidade de São PauloInstituto do Coração – InCorSão PauloSPBrasilInstituto do Coração – InCor - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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26
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Nitsch L, Shirvani Samani O, Silaschi M, Schafigh M, Zimmer S, Petzold GC, Kindler C, Bode FJ. Infective endocarditis and stroke: when does it bleed? A single center retrospective study. Neurol Res Pract 2023; 5:13. [PMID: 37020243 PMCID: PMC10077710 DOI: 10.1186/s42466-023-00239-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious condition with a high mortality, represents a rare cause of stroke and an increased risk of intracranial hemorrhage. In this single center study, we characterize stroke patients with IE. We were interested in risk factors for intracranial hemorrhage and outcome of patients with intracranial hemorrhage compared to patients with ischemic stroke. METHODS Patients with IE and symptomatic ischemic stroke or intracranial hemorrhage admitted to our hospital between January 2019 and December 2022 were included in this retrospective study. RESULTS 48 patients with IE and ischemic stroke or intracranial hemorrhage were identified. 37 patients were diagnosed with ischemic stroke, 11 patients were diagnosed with intracranial hemorrhage. The intracranial hemorrhage occurred within the first 12 days after admission. We identified Staphylococcus aureus detection and thrombocytopenia as risk factors for hemorrhagic complications. An increased in-hospital mortality in patients with intracranial hemorrhage (63.6% vs. 22%, p = 0.022) was found, whereas patients with ischemic stroke and patients with intracranial hemorrhage do not differ regarding favorable clinical outcome (27% vs. 27.3%, p = 1.0). 27.3% patients with intracranial hemorrhage and 43.2% patients with ischemic stroke underwent cardiac surgery. Overall, 15.7% new ischemic strokes occurred after valve reconstruction, whereas no new intracranial hemorrhage was observed. CONCLUSIONS We found an increased in-hospital mortality in patients with intracranial hemorrhage. Beside thrombocytopenia, we identified S. aureus detection as a risk factor for intracranial hemorrhage.
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Affiliation(s)
- L Nitsch
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - O Shirvani Samani
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - M Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - M Schafigh
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - S Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - G C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Kindler
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), Venusberg-Campus 1, 53127, Bonn, Germany
| | - F J Bode
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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27
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Scala I, Rizzo PA, Del Giacomo P, Bellavia S, Frisullo G, Rollo E, Brunetti V, De Gaetano Donati K, Della Marca G. Stroke and endocarditis: Reversing the point of view. A retrospective, cohort study. J Stroke Cerebrovasc Dis 2023; 32:106977. [PMID: 36657271 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
STUDY OBJECTIVES The primary objective of our study is to assess the endocarditis prevalence in patients admitted to the emergency department (ED) for a primary diagnosis of acute stroke (AS). Secondary objectives are the identification of early markers of endocarditis in AS patients and the analysis of the short-term outcome of this population. METHODS In this observational, retrospective, cohort study we enrolled consecutive adult patients with a primary diagnosis of AS admitted to the Stroke Unit or to the Neurological Intensive Care Unit of our hospital who were then discharged with a diagnosis of endocarditis. These patients were then compared with age and sex-matched controls with a diagnosis of AS and atrial fibrillation. RESULTS Endocarditis prevalence in patients admitted to the Stroke Unit or Neurological Intensive Care Unit with a primary diagnosis of AS is 1.0% (95% confidence interval 0.61-1.55). Fever on ED admission, concomitant cancer, low hemoglobin, low lymphocyte levels, a high neutrophils count and erythrocyte sedimentation levels could early differentiate among AS patients, those with endocarditis from those with atrial fibrillation. A moderate-to-severe valvular regurgitation is strongly suggestive of endocarditis. The short term-outcome is markedly worse in endocarditis patients compared to patients with atrial fibrillation, in terms of in-hospital mortality and discharge disability. CONCLUSIONS Endocarditis prevalence in patients admitted for a primary diagnosis of AS is low, but this etiology leads to a poor outcome. Some laboratory, clinical-epidemiological and echocardiographic parameters may help the physician to early recognize this condition and, consequently, to promptly start an antibiotic therapy.
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Affiliation(s)
- Irene Scala
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
| | - Pier Andrea Rizzo
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Simone Bellavia
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Giovanni Frisullo
- Dipartimento Di Scienze Dell'Invecchiamento, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Rollo
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Valerio Brunetti
- Dipartimento Di Scienze Dell'Invecchiamento, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Giacomo Della Marca
- Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy; Dipartimento Di Scienze Dell'Invecchiamento, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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28
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Gasior T, Woitek FJ, Schroth A, Abdel-Wahab M, Crusius L, Haussig S, Kiefer P, Scislo P, Huczek Z, Dabrowski M, Witkowski A, Olasinska-Wisniewska A, Grygier M, Protasiewicz M, Hudziak D, Kappert U, Holzhey D, Wojakowski W, Linke A, Mangner N. Impact of Enterococci vs. Staphylococci Induced Infective Endocarditis after Transcatheter Aortic Valve Implantation. J Clin Med 2023; 12:jcm12051817. [PMID: 36902604 PMCID: PMC10003722 DOI: 10.3390/jcm12051817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The two most common organisms found in infective endocarditis following transcatheter aortic valve implantation (TAVI-IE) are enterococci (EC-IE) and staphylococci (SC-IE). We aimed to compare clinical characteristics and outcomes of patients with EC-IE and SC-IE. METHODS TAVI-IE patients from 2007 to 2021 were included in this analysis. The 1-year mortality was the primary outcome measure of this retrospective multi-center analysis. RESULTS Out of 163 patients, 53 (32.5%) EC-IE and 69 (42.3%) SC-IE patients were included. Subjects were comparable with regard to age, sex, and clinically relevant baseline comorbidities. Symptoms at admission were not significantly different between groups, except for a lower risk for presenting with septic shock in EC-IE than SC-IE. Treatment was performed in 78% by antibiotics alone and in 22% of patients by surgery and antibiotics, with no significant differences between groups. The rate of any complication, in particular heart failure, renal failure, and septic shock during treatment for IE, was lower in EC-IE compared with SC-IE (p < 0.05). In-hospital (EC-IE: 36% vs. SC-IE: 56%, p = 0.035) and 1-year mortality (EC-IE: 51% vs. SC-IE: 70%, p = 0.009) were significantly lower in EC-IE compared with SC-IE. CONCLUSIONS EC-IE, compared with SC-IE, was associated with a lower morbidity and mortality. However, absolute numbers are high, a finding that should trigger further research in appropriate perioperative antibiotic management and improvement of early IE diagnosis in the case of clinical suspicion.
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Affiliation(s)
- Tomasz Gasior
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Felix J. Woitek
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Antonia Schroth
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University Hospital, 04289 Leipzig, Germany
| | - Lisa Crusius
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Stephan Haussig
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University Hospital, 04289 Leipzig, Germany
| | - Piotr Scislo
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, 04-628 Warsaw, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marek Grygier
- 1st Department of Cardiology, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Marcin Protasiewicz
- Institute of Heart Diseases, Wroclaw Medical University, ul. Borowska 213, 50-556 Wroclaw, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, 40-055 Katowice, Poland
| | - Utz Kappert
- Department of Cardiac Surgery, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Helios University Hospital Wuppertal, 42117 Wuppertal, Germany
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, 01307 Dresden, Germany
- Correspondence: ; Tel.: +49-351-45025297
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29
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Impact of the Duration of Postoperative Antibiotics on the Prognosis of Patients with Infective Endocarditis. Antibiotics (Basel) 2023; 12:antibiotics12010173. [PMID: 36671376 PMCID: PMC9854446 DOI: 10.3390/antibiotics12010173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Appropriate postoperative antibiotic treatment in patients with infective endocarditis (IE) reduces the risks of recurrence and mortality. However, concerns about adverse drug reactions arise due to prolonged antibiotic usage. Therefore, we compared the recurrence and mortality rates according to the duration of postoperative antibiotic therapy in patients with IE. From 2005 to 2017, we retrospectively reviewed 416 patients with IE treated at a tertiary hospital in South Korea; among these, 216 patients who underwent heart valve surgery and received appropriate antibiotics were enrolled. The patients were divided into two groups based on the duration of usage of postoperative antibiotic therapy; the duration of postoperative antibiotic therapy was more than two weeks in 156 patients (72.2%) and two weeks or less in 60 patients (27.8%). The primary endpoint was IE relapse. The secondary endpoints were 1-year IE recurrence, 1-year mortality, and postoperative complication rates. The median age was 53 (interquartile range: 38-62) years. The relapse rate of IE was 0.9% (2/216). There was no statistical difference in relapse (0.0% vs. 1.3%, p = 0.379), 1-year recurrence (1.7% vs. 1.3%, p = 0.829), or 1-year mortality (10.0% vs. 5.8%, p = 0.274) between patients with postoperative antibiotic administration of two weeks or less versus more than two weeks. The duration of postoperative antibiotic therapy did not affect the 1-year mortality rate (log-rank test, p = 0.393). In conclusion, there was no statistically significant difference in recurrence, mortality, or postoperative complications according to the duration of postoperative antibiotic therapy.
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Rodríguez-Montolio J, Meseguer-González D, Almeida-Zurita M, Santos-Lasaosa S. Réplica: Perfil clínico, tratamiento antibiótico y riesgo de ictus en pacientes con endocarditis infecciosa. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Rogiers M, Jentjens S, Guler I, Shakoor A, Herregods MC. Value of 18F-FDG pet/CT for prognostic assessment in patients with infective endocarditis. Acta Cardiol 2022; 77:900-909. [PMID: 35172690 DOI: 10.1080/00015385.2022.2040823] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND 18F-FDG PET/CT is a valuable diagnostic tool in infective endocarditis (IE). However, the prognostic value is unclear. This study aims to evaluate the prognostic performance of 18F-FDG PET/CT in native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). METHODS We retrospectively included 76 patients treated for definite IE (NVE and PVE) that underwent 18F-FDG PET/CT between January 2016 and December 2018. Clinical, echocardiographic and 18F-FDG PET/CT (pathologic valvular 18F-FDG uptake, extracardiac complications (ECC)) data were collected. The primary endpoint was defined as mortality or recurrence of IE at a one-year follow-up. RESULTS Pathologic valvular 18F-FDG uptake was detected in 32 of 57 (56.1%) patients, 30% (9/30) in NVE and 85.2% (23/27) in PVE group. Atrial fibrillation (OR 3.90, 95% CI = 1.14-16.3), prior anticoagulation treatment (OR 6.37, 95% CI = 1.89-26.7), large vegetation (≥ 10 mm) (OR 4.05, 95% CI = 1.14-16.1), perivalvular complications (OR 7.22, 95% CI = 1.68-55.1) and abscess (OR 10.9, 95% CI = 1.84-283) were associated with positive PET/CT. Extracardiac complications were found in 27 of 76 (35.5%) patients, 42.9% (18/42) in the NVE and 26.5% (9/34) in the PVE group. Pathological valvular tracer uptake (HR 1.20, 95% CI = 0.43-3.37) or extracardiac complications (HR 0.58, 95% CI = 0.21-1.62) were not associated with the occurrence of the primary endpoint. CONCLUSION Our study could not demonstrate a prognostic value of 18F-FDG PET/CT in IE, but confirms high diagnostic performance, which may compromise prognostic significance by accelerated optimal treatment because of earlier diagnostic certainty.
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Affiliation(s)
- Martijn Rogiers
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Sander Jentjens
- Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Ipek Guler
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Abdul Shakoor
- Department of Internal Medicine, Cardiology, University Hospital Oldenburg, Oldenburg, Germany
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Muacevic A, Adler JR. Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report. Cureus 2022; 14:e31837. [PMID: 36579226 PMCID: PMC9788919 DOI: 10.7759/cureus.31837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
Infective endocarditis (IE) is a common cause of embolic strokes. Early diagnosis and treatment are essential to decrease the risk of ischemic stroke and ensure appropriate treatment, particularly given the higher risk of hemorrhagic complications. Treatment is also essential to prevent other complications such as heart failure, perivalvular abscesses, or intracranial abscesses. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) may not show endocardial involvement in the early stages of IE and, rarely, some patients may lack systemic signs of infection, making the early detection of IE challenging. Multifocal ischemic strokes may be the initial manifestation of IE and warrant further workup directed at IE even if initial echocardiogram findings are negative. A high index of clinical suspicion and thorough history are of utmost importance.
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Philip J, Bond MC. Emergency Considerations of Infective Endocarditis. Emerg Med Clin North Am 2022; 40:793-808. [DOI: 10.1016/j.emc.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Optimal Timing for Cardiac Surgery in Infective Endocarditis with Neurological Complications: A Narrative Review. J Clin Med 2022; 11:jcm11185275. [PMID: 36142922 PMCID: PMC9501443 DOI: 10.3390/jcm11185275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines.
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Perfil clínico, tratamiento antibiótico y riesgo de ictus en pacientes con endocarditis infecciosa. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Infective Endocarditis in High-Income Countries. Metabolites 2022; 12:metabo12080682. [PMID: 35893249 PMCID: PMC9329978 DOI: 10.3390/metabo12080682] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.
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Béraud G, Tubiana S, Erpelding ML, Le Moing V, Chirouze C, Gorenne I, Manchon P, Tattevin P, Vernet V, Varon E, Hoen B, Duval X. Combined Bacterial Meningitis and Infective Endocarditis: When Should We Search for the Other When Either One is Diagnosed? Infect Dis Ther 2022; 11:1521-1540. [PMID: 35618954 PMCID: PMC9334461 DOI: 10.1007/s40121-022-00651-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM). Methods We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only. Results Among the 1030 included patients, we identified 42 patients with IE–BM (4.1%). Baseline characteristics of patients with IE–BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE (14/30, 46.7%). Three-month mortality was 28.6% in patients with IE–BM, 20.5% in patients with IE, and 16.6% in patients with BM. Conclusions Patients with pneumococcal IE or altered mental status during IE must be investigated for BM. Patients with S. aureus, oral and group D streptococcal or enterococcal BM, or unfavorable outcome in pneumococcal meningitis would benefit from an echocardiography. Patients with the dual infection have the worst prognosis. Their identification is mandatory to initiate appropriate treatment.
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Affiliation(s)
- Guillaume Béraud
- Médecine Interne et Maladies Infectieuses, University Hospital of Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers, France.
| | - Sarah Tubiana
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, 75018, Paris, France.,Université de Paris, IAME, INSERM, 75018, Paris, France
| | - Marie-Line Erpelding
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Vincent Le Moing
- Département de Maladies Infectieuses et Tropicales, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Catherine Chirouze
- Maladies infectieuses et tropicals, Centre Hospitalier Régional Universitaire, 25030, Besançon, France.,UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000, Besançon, France
| | - Isabelle Gorenne
- AP-HP CHU Xavier Bichat, Département d'Épidémiologie et Recherche Clinique, INSERM CIC-EC 1425, 75018, Paris, France
| | - Pauline Manchon
- AP-HP CHU Xavier Bichat, Département d'Épidémiologie et Recherche Clinique, INSERM CIC-EC 1425, 75018, Paris, France
| | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, CHU Pontchaillou, Rennes, France
| | | | - Emmanuelle Varon
- National Centre for Pneumococci, Centre Hospitalier Intercommunal Créteil, Créteil, France
| | - Bruno Hoen
- CHU de Nancy, Hôpitaux de Brabois, Service de Maladies Infectieuses et Tropicales, Vandœuvre-lès-Nancy, France
| | - Xavier Duval
- AP-HP, Hôpital Bichat, Centre d'Investigation Clinique, Inserm CIC 1425, 75018, Paris, France.,AP-HP, University Hospital of Bichat, Paris, France.,Inserm UMR-1137 IAME, Paris, France.,Paris Université, UFR de Médecine-Bichat, Paris, France
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Impact of Valve Culture Positivity on Prognosis in Patients with Infective Endocarditis Who Underwent Valve Surgery. Infect Dis Ther 2022; 11:1253-1265. [PMID: 35489001 PMCID: PMC9124244 DOI: 10.1007/s40121-022-00642-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/11/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Infective endocarditis (IE) is a severe and fatal infection with high in-hospital and overall mortality rates of approximately up to 30%. Valve culture positivity was associated with in-hospital mortality and postoperative complications; however, few studies have analyzed the relationship between valve cultures and overall mortality over a long observation period. This study aimed to compare the association of valve culture positivity with overall mortality in patients with IE who underwent valve surgery. Methods A total of 416 IE patients admitted to a tertiary hospital in South Korea from November 2005 to August 2017 were retrospectively reviewed. A total of 202 IE patients who underwent valve surgery and valve culture were enrolled. The primary endpoint was long-term overall mortality. Kaplan–Meier curve and Cox proportional hazards model were used for survival analysis. Results The median follow-up duration was 63 (interquartile range, 38–104) months. Valve cultures were positive in 22 (10.9%) patients. The overall mortality rate was 15.8% (32/202) and was significantly higher in valve culture-positive patients (36.4%, p = 0.011). Positive valve culture [hazard ratio (HR) 3.921, p = 0.002], Charlson Comorbidity Index (HR 1.181, p = 0.004), Coagulase-negative staphylococci (HR 4.233, p = 0.001), new-onset central nervous system complications (HR 3.689, p < 0.001), and new-onset heart failure (HR 4.331, p = 0.001) were significant risk factors for overall mortality. Conclusions Valve culture positivity is a significant risk factor for long-term overall mortality in IE patients who underwent valve surgery. The importance of valve culture positivity needs to be re-evaluated, as the valve culture positivity rate increases with increasing early surgical intervention.
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Silbiger JJ, Rashed E, Chen H, Wiesenfeld E, Robinson SE, Cagliostro M. Cardiac Imaging for Diagnosis and Management of Infective Endocarditis. J Am Soc Echocardiogr 2022; 35:910-924. [PMID: 35487472 DOI: 10.1016/j.echo.2022.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022]
Abstract
Imaging is central to the care of patients with infective endocarditis. While transthoracic and transesophageal echocardiography are the principle imaging techniques, additional modalities including positron emission tomography and cardiac computed tomography, and to a lesser extent intracardiac echocardiography, play an increasing role. This review discusses the role of cardiac imaging in establishing the diagnosis of endocarditis, in predicting its embolic risk and in making decisions regarding the need for and timing of surgery.
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Affiliation(s)
| | - Eman Rashed
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - Huazhen Chen
- Icahn School of Medicine at Mount Sinai, New York, N.Y
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Maheshwari R, Cordato DJ, Wardman D, Thomas P, Bhaskar SMM. Clinical outcomes following reperfusion therapy in acute ischemic stroke patients with infective endocarditis: a systematic review. J Cent Nerv Syst Dis 2022; 14:11795735221081597. [PMID: 35282315 PMCID: PMC8905057 DOI: 10.1177/11795735221081597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/02/2022] [Indexed: 01/08/2023] Open
Abstract
Background Acute ischemic stroke (AIS) is a common and fatal complication of infective endocarditis (IE); however, there is a lack of understanding regarding treatment efficacy. This systematic review aimed to evaluate the safety and efficacy of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) in IE patients experiencing AIS. Objectives The aim of this study was to perform a systematic review investigating the outcomes of AIS in IE patients receiving IVT and/or EVT as a treatment method and to evaluate the safety and efficacy of these methods of reperfusion therapy. Design A systematic review in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines was conducted. Data Sources and Methods The EMBASE, Cochrane, and PubMed databases were searched for literature published between 2005 and 2021 investigating outcomes of reperfusion therapy post-AIS in IE and non-IE patients. Descriptive statistics were used to describe the overall frequency of clinical outcomes, and groupwise comparisons were performed using Fisher’s exact test to assess the significance of groupwise differences. Results Three studies were finally included in the systematic review. A total of 13.5% of IE patients compared to 37% of non-IE patients achieved a good functional outcome (modified Rankin Scale score≤ 2) (P < .001). Furthermore, a larger percentage of the IE cohort achieved good functional outcomes after EVT (22.0%) compared to IVT (10.4%) (P = .013). The IE cohort also had a higher 3-month postreperfusion mortality rate (48.8%) compared to the non-IE cohort (24.9%) (P < .001). The rate of intracranial hemorrhage (ICH) postreperfusion was also significantly higher in the IE cohort (23.5%) than in the non-IE cohort (6.5%) (P < .001). Conclusion AIS patients with IE, treated with IVT, EVT, or a combination of the two, experience worse clinical and safety outcomes than non-IE patients. EVT yielded better functional outcomes, albeit with higher postreperfusion ICH rates, than IVT.
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Affiliation(s)
- Rohan Maheshwari
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Dennis J. Cordato
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Daniel Wardman
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Peter Thomas
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical School, The University of New South Wales (UNSW), Sydney, NSW, Australia
- Department of Neurology and Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Stroke and Neurology Research Group, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Demetriades P, Ridley P, Yazdani F, Duckett S. Challenges of remote consultations: a delayed diagnosis of aortic valve endocarditis complicated by recurrent intracranial events. BMJ Case Rep 2022; 15:e248287. [PMID: 35228247 PMCID: PMC8886389 DOI: 10.1136/bcr-2021-248287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/03/2022] Open
Abstract
Embolic events causing stroke and intracranial haemorrhage are among the most catastrophic complications of infective endocarditis (IE).A female patient presented with acute unilateral weakness following a 3-month history of fever, for which she had multiple remote consultations with her general practitioner. A brain MRI confirmed a left sided infarct with haemorrhagic transformation. Blood cultures grew Streptococcus mitis and her cardiac imaging showed an aortic valve vegetation with severe aortic regurgitation. Following 2 weeks of antibiotics she developed a new cerebral haemorrhage associated with a mycotic aneurysm which was treated with two coils. After discussions within the multidisciplinary meeting, she underwent aortic valve replacement 3 weeks later. She made a remarkable recovery and was discharged.Our case highlights the importance of face-to-face clinical review in the post-COVID era. It stresses that the management of patients with infective endocarditis and neurological complications is challenging and requires a multidisciplinary approach.
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Affiliation(s)
- Polyvios Demetriades
- Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Paul Ridley
- Cardiothoracic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Farah Yazdani
- Microbiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Simon Duckett
- Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Paras ML, Jassar AS. Vegetation size in patients with infective endocarditis: does size matter? J Am Soc Echocardiogr 2022; 35:576-578. [DOI: 10.1016/j.echo.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/26/2022]
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Murala S, Nagarajan E, Bollu PC. Infectious Causes of Stroke. J Stroke Cerebrovasc Dis 2022; 31:106274. [PMID: 35093633 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106274] [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: 07/13/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
Stroke is one of the primary causes of mortality and morbidity worldwide. It can be ischemic or hemorrhagic, and the former can be due to an in-situ thrombus or a distant embolus. Despite being a rare cause, stroke can also be caused in the setting of infection. Bacterial agents are the most common cause of stroke, among other infectious agents. Until the antibiotic era, rheumatic heart disease was a predisposing risk factor of infective endocarditis. VZV is the most common cause of strokes in pediatric and adult populations. Cryptococcus and Candida spp are the most common yeasts involved in CNS infections, especially in immunocompromised patients. In COVID-19 patients, ischemic strokes are more common than hemorrhagic strokes. In this review, we will discuss the most common infectious agents, with particular emphasis on COVID-19.
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Affiliation(s)
- Sireesha Murala
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
| | - Elanagan Nagarajan
- Department of Neurology, Erlanger Health System, University of Tennessee School of Medicine, Chattanooga, TN, United States
| | - Pradeep C Bollu
- Department of Neurology, Prisma Health, Midlands/University of South Carolina School of Medicine, Columbia, SC, United States
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Wang A, Fosbøl EL. Current recommendations and uncertainties for surgical treatment of infective endocarditis: a comparison of American and European cardiovascular guidelines. Eur Heart J 2022; 43:1617-1625. [PMID: 35029274 DOI: 10.1093/eurheartj/ehab898] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 12/13/2022] Open
Abstract
Surgery is an effective therapy in the treatment of left-sided infective endocarditis (IE) in patients for whom antibiotic treatment alone is unlikely to be curative or may be associated with ongoing risk of complications. However, the interplay between indication for surgery, its risk, and timing is complex and there continue to be challenges in defining the effects of surgery on disease-related outcome. Guidelines published by the American College of Cardiology/American Heart Association and the European Society of Cardiology provide recommendations for the use of surgery in IE, but these are limited by a low level of evidence related to predominantly observational studies with inherent selection and survival biases. Evidence to guide the timing of surgery in IE is less robust, and predominantly based on expert consensus. Delays between IE diagnosis and recognition of an IE complication as a surgical indication and transfers to surgical centres also impact surgical timing. This comparison of the two guidelines exposes areas of uncertainty and gaps in current evidence for the use of surgery in IE across different indications, particularly related to its timing and consideration of operative risk.
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Affiliation(s)
- Andrew Wang
- Duke University Hospital, DUMC 3428, Durham, NC 27710, USA
| | - Emil L Fosbøl
- University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Cabezón G, López J, Vilacosta I, Sáez C, García-Granja PE, Olmos C, Jerónimo A, Gutiérrez Á, Pulido P, de Miguel M, Gómez I, San Román JA. Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis. J Am Soc Echocardiogr 2021; 35:570-575. [PMID: 34971762 DOI: 10.1016/j.echo.2021.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guidelines recommend surgery in left-sided infective endocarditis (LSIE) associated with large vegetations. Given that most patients who undergo surgery also have other indications (heart failure and/or uncontrolled infection), it is not settled whether surgery should be routinely recommended in patients with large vegetations but no other predictors of poor outcome. METHODS A total of 726 patients with definitive LSIE were included in our analysis. Mean age was 64.9 years, 61% were male. Multivariate analysis of all patients was performed to determine if vegetation size is related to death in LSIE. Then, patients were divided in two groups according to vegetation size: Group A (>10 mm, n=420) and group B (≤10 mm, n=306). Univariate and multivariate analyses of group A patients were carried out to identify the variables related to death in this group. Impact of surgery on mortality of group A patients without heart failure or uncontrolled local infection (n=139) was assessed. RESULTS Age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure and septic shock, but not vegetation size, were associated with death. Patients with large vegetations showed increased mortality (31.7% in group A vs 24.8% in group B, p=0.045). Group A had more valve rupture and valve regurgitation than group B, but heart failure (55% vs 53%, p=0.678), stroke (22% vs 17.0%, p=0.091), systemic embolism (39% vs 32%, p=0.074), perivalvular complication (28% vs 28%, p=0.865) or septic shock (15% vs 13%, p=0.288) were similar in both groups. In patients from group A without heart failure or uncontrolled infection mortality was similar with and without surgery (n=139; n=70 with surgery, n=69 without surgery; mortality 18.6% vs 11.6% respectively, p=0.251). CONCLUSIONS large vegetations identify patients with poor outcome in LSIE. However, surgery is not associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome such as heart failure or uncontrolled infection. These findings challenge whether vegetation size alone should be an indication for surgery in LSIE.
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Affiliation(s)
- Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV).
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Pablo Elpidio García-Granja
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Ángela Gutiérrez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - María de Miguel
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Itzíar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
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Kelley RE, Kelley BP. Heart-Brain Relationship in Stroke. Biomedicines 2021; 9:biomedicines9121835. [PMID: 34944651 PMCID: PMC8698726 DOI: 10.3390/biomedicines9121835] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/17/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
The patient presenting with stroke often has cardiac-related risk factors which may be involved in the mechanism of the stroke. The diagnostic assessment is predicated on recognition of this potential relationship. Naturally, an accurate history is of utmost importance in discerning a possible cause and effect relationship. The EKG is obviously an important clue as well as it allows immediate assessment for possible cardiac arrhythmia, such as atrial fibrillation, for possible acute ischemic changes reflective of myocardial ischemia, or there may be indirect factors such as the presence of left ventricular hypertrophy, typically seen with longstanding hypertension, which could be indicative of a hypertensive mechanism for a patient presenting with intracerebral hemorrhage. For all presentations in the emergency room, the vital signs are important. An elevated body temperature in a patient presenting with acute stroke raises concern about possible infective endocarditis. An irregular-irregular pulse is an indicator of atrial fibrillation. A markedly elevated blood pressure is not uncommon in both the acute ischemic and acute hemorrhagic stroke setting. One tends to focus on possible cardioembolic stroke if there is the sudden onset of maximum neurological deficit versus the stepwise progression more characteristic of thrombotic stroke. Because of the more sudden loss of vascular supply with embolic occlusion, seizure or syncope at onset tends to be supportive of this mechanism. Different vascular territory involvement on neuroimaging is also a potential indicator of cardioembolic stroke. Identification of a cardiogenic source of embolus in such a setting certainly elevates this mechanism in the differential. There have been major advances in management of acute cerebrovascular disease in recent decades, such as thrombolytic therapy and endovascular thrombectomy, which have somewhat paralleled the advances made in cardiovascular disease. Unfortunately, the successful limitation of myocardial damage in acute coronary syndrome, with intervention, does not necessarily mirror a similar salutary effect on functional outcome with cerebral infarction. The heart can also affect the brain from a cerebral perfusion standpoint. Transient arrhythmias can result in syncope, while cardiac arrest can result in hypoxic-ischemic encephalopathy. Cardiogenic dementia has been identified as a mechanism of cognitive impairment associated with severe cardiac failure. Structural cardiac abnormalities can also play a role in brain insult, and this can include tumors, such as atrial myxoma, patent foramen ovale, with the potential for paradoxical cerebral embolism, and cardiomyopathies, such as Takotsubo, can be associated with precipitous cardioembolic events.
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Affiliation(s)
- Roger E. Kelley
- Ochsner/LSU Health Sciences Center, Department of Neurology, Shreveport, LA 71130, USA
- Correspondence:
| | - Brian P. Kelley
- Division of Cardiology, Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 27514, USA;
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Mir T, Uddin M, Qureshi WT, Regmi N, Tleyjeh IM, Saydain G. Predictors of Complications Secondary to Infective Endocarditis and Their Associated Outcomes: A Large Cohort Study from the National Emergency Database (2016-2018). Infect Dis Ther 2021; 11:305-321. [PMID: 34817839 PMCID: PMC8847467 DOI: 10.1007/s40121-021-00563-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/05/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction Literature regarding outcomes and predictors of complications secondary to infective endocarditis (IE) is limited. We aimed to study the outcomes and predictors of complications of IE. Methods Data from a national emergency department sample, which constitutes 20% sample of hospital-owned emergency departments in the USA, were analyzed for hospital visits for IE. Complications of endocarditis were obtained by using ICD codes. Multivariable generalized linear method was used to evaluate predictors of in-hospital mortality and complications. Results Out of 255,838 adult IE patients (mean age 60.3 ± 20.1 years, 48.5% females), 97,803 (38.2%) patients developed one or more major complications. The major complications were cardiovascular system complications [57,900 (22.6%)], neurologic [42,851 (16.7%)] complications, and renal [16,236 (6.4%)] complications. These included cardiogenic shock [3873 (1.5%)], septic shock [25,798 (10.1%)], acute heart failure [35,602 (14%)], systemic thromboembolism (STE) [21,390 (8.36%)], heart block [11,430 (4.47%)], in-hospital dialysis [2880 (1.1%)], and disseminated intravascular coagulation (DIC) [2704 (1.1%)]. Patients with complicated IE had risk of mortality (adjusted RR 1.12, 95% CI 1.11–1.13, p < 0.001). The complications strongly associated with mortality were septic shock (RR 1.29, 95% CI 1.27–1.30, p < 0.001), cardiogenic shock (RR 1.24, 95% CI 1.20–1.29, p < 0.001), DIC (RR 1.4, 95% CI 1.35–1.46, p < 0.001), and STE (RR 1.07, 95% CI 1.05–1.08, p < 0.001). Staphylococci were the predominant causative organisms (30.8%) among the complicated IE subgroups with higher associated mortality (42.8%). The main predictors of complications from IE were congenital heart disease, history of congestive heart failure, high Elixhauser comorbidity profile, staphylococcal infection, and fungal infections. The prevalence of cardiogenic shock increased over the study years from 1.13 to 1.98% (p-trend 0.04).
Conclusion Complicated IE is not uncommon and is associated with significant mortality. Staphylococcal infections were associated with high mortality rates. There has been an increasing trend of cardiogenic shock among IE patients across the US. Further research is needed to improve the outcomes of complicated endocarditis.
Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00563-y.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Detroit Medical Center Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA. .,Internal Medicine, Baptist Health System, 300 Taylor Road,, Montgomery, AL, 36117, USA.
| | - Mohammed Uddin
- Internal Medicine, Detroit Medical Center Wayne State University, 4201, St Antoine St., Detroit, MI, 48201, USA
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Neelambuj Regmi
- Division of Pulmonary and Critical Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia.,Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ghulam Saydain
- Division of Pulmonary and Critical Medicine, Detroit Medical Center Wayne State University, Detroit, MI, USA
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48
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Val DD, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Vendramin I, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Corriea de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:102-112. [PMID: 34688853 DOI: 10.1016/j.cjca.2021.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S aureus) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on S aureus IE after transcatheter aortic valve replacement (TAVR). METHODS Data was obtained from the Infectious Endocarditis after TAVR International Registry including patients with definite IE following TAVR from 59 centers in 11 countries. Patients were divided into two groups according to microbiological etiology (non-S aureus-IE, non-SA-IE vs. S aureus-IE, SA-IE). RESULTS SA-IE was identified in 141 out of 573 (24.6%) patients, methicillin-sensitive S aureus in most cases (115/141, 81.6%). SEV were more common than BEV in patients with early SA-IE. Major bleeding and sepsis complicating TAVR, neurological symptoms or systemic embolism at admission and IE with cardiac device involvement other than the TAVR prosthesis were associated with SA-IE (p<0.05 for all). Among IE post-TAVR patients, the likelihood of SA-IE increased from 19% in the absence of those risk factors to 84.6% if ≥3 risk factors were present. In-hospital (47.8% vs. 26.9%, p<0.001) and 2-year mortality (71.5% vs. 49.6%, p<0.001) rates were higher among SA-IE (vs. non-SA-IE) patients. Surgery at the time of index SA-IE was associated with a lower mortality rate at follow-up (HRadj: 0.46, 95% CI: 0.22-0.96, p=0.038). CONCLUSIONS SA-IE represented ∼ 25% of IE cases after TAVR and was associated with a very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA-IE and could help to orientate early antibiotic regimen selection. Surgery at index SA-IE was associated with improved outcomes, and its role should be evaluated in future studies.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA; Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes-Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Acute Ischaemic Stroke in Infective Endocarditis: Pathophysiology and Clinical Outcomes in Patients Treated with Reperfusion Therapy. IMMUNO 2021. [DOI: 10.3390/immuno1040023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Infective endocarditis in the setting of acute stroke poses a clinical challenge given the high mortality and morbidity associated with the condition. The pathophysiological mechanisms including clinical and imaging biomarkers that can provide insights into clinical trajectories of such patients are of immense interest. The current paper aims to provide a comprehensive overview of acute stroke with infective endocarditis and provide insights into various clinical factors mediating outcomes and therapeutic strategies, specifically in the setting of reperfusion therapy. Prognostic and therapeutic pathways to potentially improve functional outcomes in these patients are also discussed.
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50
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Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample. PLoS One 2021; 16:e0256757. [PMID: 34478475 PMCID: PMC8415585 DOI: 10.1371/journal.pone.0256757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use. Methods Hospitalizations of adult (≥18 years old) patients diagnosed with IE were identified in the 2016 National Inpatient Sample using ICD-10 codes. Multivariable logistic and linear regression were used to compare IE patient outcomes between those with and without pulmonary complications and to identify predictors of pulmonary complications. Interaction terms were used to assess the impact of drug-use IE (DU-IE) and pulmonary complications on inpatient outcomes. Results In 2016, there were an estimated 88,995 hospitalizations of patients diagnosed with IE. Of these hospitalizations,15,490 (17%) were drug-use related. Drug-use IE (DU-IE) had the highest odds of pulmonary complications (OR 2.97, 95% CI 2.50, 3.45). At least one pulmonary complication was identified in 6,580 (7%) of IE patients. DU-IE hospitalizations were more likely to have a diagnosis of pyothorax (3% vs. 1%, p<0.001), lung abscess (3% vs. <1%, p<0.001), and septic pulmonary embolism (27% vs. 2%, p<0.001). Pulmonary complications were associated with longer average lengths of stay (CIE 7.22 days 95% CI 6.11, 8.32), higher hospital charges (CIE 78.51 thousand dollars 95% CI 57.44, 99.57), more frequent post-discharge transfers (acute care: OR 1.37, 95% CI 1.09, 1.71; long-term care: OR 2.19, 95% CI 1.83, 2.61), and increased odds of inpatient mortality (OR 1.81 95% CI 1.39, 2.35). Conclusion and relevance IE with pulmonary complications is associated with worse outcomes. Patients with DU-IE have a particularly high prevalence of pulmonary complications that may require timely thoracic surgical intervention, likely owing to right-sided valve involvement. More research is needed to determine optimal management strategies for complications to improve patient outcomes.
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