1
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Ziegler R, Arnold H, Bertram R, Geißdörfer W, Pauschinger M, Fischlein T, Pollari F, Steinmann J. Microbiologic diagnostics and pathogen spectrum in infective endocarditis of surgically treated patients: a five-year, retrospective, monocentric study. Infection 2023; 51:1523-1530. [PMID: 37024627 DOI: 10.1007/s15010-023-02030-x] [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: 03/02/2023] [Accepted: 03/26/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE The spectrum of causative organisms in infective endocarditis (IE) has changed significantly in the last decades. Reliable pathogen detection is crucial for appropriate antimicrobial therapy for IE. The aim of the study was to evaluate the diagnostic value of microbiological methods for detecting the causative microorganism of IE and to analyze the spectrum of pathogens. METHODS A total of 224 cases (211 unique patients, some with multiple surgeries) were included into this retrospective study. Patients were diagnosed with IE according to the modified Duke criteria from January 2016 to July 2021 and underwent heart valve surgery in a tertiary hospital. Pathogen detection was performed by blood culture, microbiological culture and 16S rDNA PCR of explanted heart valve material. RESULTS A causative pathogen of IE was detected in 95.5% (n = 214) of cases. Blood cultures were positive in 83.3%, while a pathogen in the examined heart valve samples was identified in 32.6% by culture and in 88.2% by 16S rDNA PCR. A microorganism was identified by 16S rDNA PCR in 61.1% of blood culture negative cases but only in 19.4% by heart valve culture. The most common pathogens were Staphylococcus aureus (27%), viridans group streptococci (20%), enterococci (19%) and coagulase-negative staphylococci (CoNS 8%). Cutibacterium acnes (7%) was detected in prosthetic valve IE cases only. CONCLUSION Blood culture as a comparatively non-invasive and straightforward technique remains an important and reliable method for initial detection of the causative organism in IE. Diagnostic stewardship programs should broadly emphasize proper collection of blood cultures, particularly sampling prior to any antibiotic treatment. Additionally, molecular testing using 16S rDNA tissue PCR can be used with culture techniques to increase the diagnostic yield, especially in the case of a negative blood culture.
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Affiliation(s)
- Renate Ziegler
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.
| | - Hendrik Arnold
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
- Department of Hematology and Medical Oncology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Ralph Bertram
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Walter Geißdörfer
- Mikrobiologisches Institut-Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Pauschinger
- Department of Cardiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Theodor Fischlein
- Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
| | - Francesco Pollari
- Department of Cardiac Surgery, Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
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2
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Hong HL, Flurin L, Greenwood-Quaintance KE, Wolf MJ, Pritt BS, Norgan AP, Patel R. 16S rRNA Gene PCR/Sequencing of Heart Valves for Diagnosis of Infective Endocarditis in Routine Clinical Practice. J Clin Microbiol 2023; 61:e0034123. [PMID: 37436146 PMCID: PMC10446860 DOI: 10.1128/jcm.00341-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
Sequencing is increasingly used for infective endocarditis (IE) diagnosis. Here, the performance of 16S rRNA gene PCR/sequencing of heart valves utilized in routine clinical practice was compared with conventional IE diagnostics. Subjects whose heart valves were sent to the clinical microbiology laboratory for 16S rRNA gene PCR/sequencing from August 2020 through February 2022 were studied. A PCR assay targeting V1 to V3 regions of the 16S rRNA gene was performed, followed by Sanger and/or next-generation sequencing (NGS) (using an Illumina MiSeq), or reported as negative, depending on an algorithm that included the PCR cycle threshold value. Fifty-four subjects, including 40 with IE, three with cured IE, and 11 with noninfective valvular disease, were studied. Thirty-one positive results, 11 from NGS and 20 from Sanger sequencing, were generated from analysis of 16S rRNA gene sequence(s). Positivity rates of blood cultures and 16S rRNA gene PCR/sequencing of valves were 55% and 75%, respectively (P = 0.06). In those with prior antibiotic exposure, positivity rates of blood cultures and 16S rRNA gene PCR/sequencing of valves were 11% and 76%, respectively (P < 0.001). Overall, 61% of blood culture-negative IE subjects had positive valve 16S rRNA gene PCR/sequencing results. 16S rRNA gene-based PCR/sequencing of heart valves is a useful diagnostic tool for pathogen identification in patients with blood culture-negative IE undergoing valve surgery in routine clinical practice.
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Affiliation(s)
- Hyo-Lim Hong
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Laure Flurin
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Intensive Care, University Hospital of Guadeloupe, Pointe-à-Pitre, France
| | - Kerryl E. Greenwood-Quaintance
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew J. Wolf
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bobbi S. Pritt
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew P. Norgan
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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3
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Hajduczenia MM, Klefisch FR, Hopf AGM, Grubitzsch H, Stegemann MS, Pfäfflin F, Puhlmann B, Ocken M, Kretzler L, von Schöning D, Falk V, Moter A, Kikhney J. New Perspectives for Prosthetic Valve Endocarditis: Impact of Molecular Imaging by FISHseq Diagnostics. Clin Infect Dis 2023; 76:1050-1058. [PMID: 36318608 PMCID: PMC10029985 DOI: 10.1093/cid/ciac860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The microbial etiology of prosthetic valve infective endocarditis (PVE) can be difficult to identify. Our aim was to investigate the benefit of molecular imaging technique fluorescence in situ hybridization (FISH) combined with 16S rRNA-gene polymerase chain reaction (PCR) and sequencing (FISHseq) for the analysis of infected prosthetic heart valves. METHODS We retrospectively evaluated the diagnostic outcome of 113 prosthetic valves from 105 patients with suspected PVE, treated in 2003-2013 in the Department of Cardiac Surgery, Charité University Medicine Berlin. Each prosthetic valve underwent cultural diagnostics and was routinely examined by FISH combined with 16S rRNA gene PCR and sequencing. We compared classical microbiological culture outcomes (blood and valve cultures) with FISHseq results and evaluated the diagnostic impact of the molecular imaging technique. RESULTS Conventional microbiological diagnostic alone turned out to be insufficient, as 67% of preoperative blood cultures were noninformative (negative, inconclusive, or not obtained) and 67% of valve cultures remained negative. FISHseq improved the conventional cultural diagnostic methods in PVE in 30% of the cases and increased diagnostic accuracy. Of the valve culture-negative PVE cases, FISHseq succeeded in identifying the causative pathogen in 35%. CONCLUSIONS FISHseq improves PVE diagnostics, complementing conventional cultural methods. In addition to species identification, FISH provides information about the severity of PVE and state of the pathogens (eg, stage of biofilm formation, activity, and localization on and within the prosthetic material). As a molecular imaging technique, FISHseq enables the unambiguous discrimination of skin flora as contaminant or infectious agent.
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Affiliation(s)
- Maria M Hajduczenia
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank R Klefisch
- Department of Internal Medicine and Intensive Care Medicine, Paulinen Hospital Berlin, Berlin, Germany
| | - Alexander G M Hopf
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam S Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Puhlmann
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michele Ocken
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lucie Kretzler
- Clinical Trial Unit, Clinical Study Center, Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dinah von Schöning
- Department of Microbiology, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
- Moter Diagnostics, Berlin, Germany
| | - Judith Kikhney
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
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4
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Mularoni A, Mikulska M, Barbera F, Graziano E, Medaglia AA, Di Carlo D, Monaco F, Bellavia D, Cascio A, Raffa G, Sciacca S, Luca A, Pilato M, Conaldi PG. Molecular Analysis With 16S rRNA PCR/Sanger Sequencing and Molecular Antibiogram Performed on DNA Extracted From Valve Improve Diagnosis and Targeted Therapy of Infective Endocarditis: A Prospective Study. Clin Infect Dis 2022; 76:e1484-e1491. [PMID: 35686318 PMCID: PMC9907470 DOI: 10.1093/cid/ciac452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Molecular analysis (MA) on heart valve (HV) improves the microbiologic diagnosis of infectious endocarditis (IE). The main drawback of MA is the lack of antimicrobial susceptibility information. METHODS We conducted a prospective cohort observational study of consecutive adult patients from April 2012 to May 2021 who underwent valve surgery at our hospital. The performance of MA, blood cultures (BC) and valve cultures (VC), and the diagnostic and therapeutic impact of MA were evaluated. Molecular antibiogram results were compared to culture-based antimicrobial susceptibility testing (AST). RESULTS A total of 137 patients with definite IE and 52 patients with no IE were enrolled in the study. Among IE cases BC, VC, and MA were positive in 75 (55%), 30 (22%), and 120 (88%) of IE cases, respectively. Among 62 cases of BC-negative IE (BCNE), 57 achieved diagnosis with MA. MA led to a change of antimicrobial therapy in 92% of BCNE. MA was negative in 100% of patients with no IE. Molecular antibiogram performed on 17 valve specimens that resulted positive for pathogens potential carrier of genes encoding for multidrug resistant mechanisms showed 100% concordance with AST. CONCLUSIONS MA showed a high specificity and sensitivity in etiological diagnosis of IE. Molecular antibiogram could overcome the major limitation of MA that is the lack of susceptibility testing. We advocate for the inclusion of MA among diagnostic criteria for IE and for a more extensive use of molecular antibiogram when the culture result is negative, and MA is the only positive test.
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Affiliation(s)
- Alessandra Mularoni
- Correspondence: A. Mularoni, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Ernesto Tricomi 5, 90100, Palermo, Italy ()
| | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genoa (DISSAL), Genova, Italy,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Floriana Barbera
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Elena Graziano
- Infectious Diseases Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy,Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
| | | | - Daniele Di Carlo
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesco Monaco
- Pathology Unit, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Diego Bellavia
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Palermo, Italy
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Sergio Sciacca
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Michele Pilato
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
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5
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Deppe H, Reitberger J, Behr AV, Vitanova K, Lange R, Wantia N, Wagenpfeil S, Sculean A, Ritschl LM. Oral bacteria in infective endocarditis requiring surgery: a retrospective analysis of 134 patients. Clin Oral Investig 2022; 26:4977-4985. [PMID: 35316412 PMCID: PMC9276723 DOI: 10.1007/s00784-022-04465-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/15/2022] [Indexed: 01/02/2023]
Abstract
Objectives It has been reported that bacteria associated with infective endocarditis originate from the oral cavity in 26–45% of cases. However, little is known on the counts and species of periodontal microbiota in infected heart valves. The aim of this study was to identify these aspects of periodontal microbiota in infective endocarditis and to potentially initiate a dental extraction concept for periodontally compromised teeth concerning patients requiring heart valve surgery. Materials and methods The retrospective study group consisted of tissue samples from infected heart valves of 683 patients who had undergone heart valve surgery. Before patients had undergone cardiac surgery, the following laboratory tests confirmed the occurrence of endocarditis in all patients: blood cultures, echocardiography, electrocardiography, chest X-ray, and electrophoresis of the serum proteins. The specimens were aseptically obtained and deep frozen immediately following surgery. Microbiological diagnosis included proof of germs (dichotomous), species of germs, and source of germs (oral versus other). Results Microbiota was detected in 134 (31.2%) out of 430 enrolled patients. Oral cavity was supposed to be the source in 10.4% of cases, whereas microbiota of the skin (57.5%) and gastrointestinal tract (GIT, 24.6%) were detected considerably more frequently. Moreover, periodontal bacteria belonged mostly to the Streptococci species and the yellow complex. None of the detected bacteria belonged to the red complex. Conclusion Most frequently, the skin and GIT represented the site of origin of the microbiota. Nevertheless, the oral cavity represented the source of IE in up to 10%. Consequently, it needs to be emphasized that a good level of oral hygiene is strongly recommended in all patients undergoing heart valve surgery in order to reduce the bacterial load in the oral cavity, thereby minimizing the hematogenous spread of oral microbiota. The prerequisites for conservative dental treatment versus radical tooth extraction must always be based on the patient’s cooperation, and the clinical intraoral status on a sense of proportion in view of the overall clinical situation due to the underlying cardiac disease. Clinical relevance The oral cavity is a source of oral microbiota on infected heart valves. Patients requiring heart valve surgery should always undergo a critical evaluation of dental treatment affecting periodontally compromised teeth, favoring a systematic, conservative-leaning recall.
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Affiliation(s)
- Herbert Deppe
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Julia Reitberger
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Alexandra V Behr
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Keti Vitanova
- Department of Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, 80636, Munich, Germany
| | - Nina Wantia
- Department of Microbiology, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Kirrbergerstraße Building 86, 66421, Homburg, Saar, Germany
| | - Anton Sculean
- Department of Periodontology, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Lucas M Ritschl
- Department of Oral and Maxillofacial Surgery, Technical University of Munich, Hospital "Rechts Der Isar", Ismaninger Straße 22, 81675, Munich, Germany.
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6
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Ding F, Shrestha NK, Chetrit M, Verma B, Gordon S, Pettersson GB, Unai S, Griffin BP, Xu B. Clinical and Echocardiographic Characteristics of Bartonella Infective Endocarditis: An 8-Year Single-Centre Experience in the United States. Heart Lung Circ 2021; 31:350-357. [PMID: 34456130 DOI: 10.1016/j.hlc.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/20/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Infective endocarditis due to Bartonella species is rare. The clinical and echocardiographic characteristics are not well defined. We aimed to investigate the clinical and echocardiographic findings of Bartonella endocarditis in the contemporary era. METHODS The infective endocarditis (IE) registry and echocardiographic database at our institution were retrospectively analysed to evaluate the clinical and echocardiographic features of Bartonella endocarditis. RESULTS Between January 2008 and December 2015, there were 11 patients with Bartonella IE (0.84% among a total of 1,308 cases of definite IE): median age 54 (30-69) years, all male, 9 Caucasian, 10 had a history of cat exposure, 10 had a pre-existing valvulopathy including 6 patients with a prosthetic valve with prosthesis age range between 3 to 5 years and 1 patient with implantable cardioverter defibrillator (ICD). Bartonella henselae was responsible for all the cases. Echocardiographic evidence of IE was found in 6 of 11 patients on transthoracic echocardiography (TTE), and 6 of 8 on transoesophageal echocardiography (TEE). Bartonella IE was associated with significant valvular destruction and dysfunction on echocardiography. Nine (9) patients were managed surgically with excellent outcomes, including two patients who failed initial medical therapy. Two (2) patients who were managed medically had progression of valvular dysfunction. At a median follow-up of 6 months, there were no deaths attributable to IE or other cardiovascular causes. CONCLUSION In a contemporary single-centre cohort in the United States, Bartonella IE remains rare, but should be considered when pathogen could not be identified in patients with suspected IE, especially those with prosthetic valves or bicuspid aortic valve (BAV). The vast majority of patients with Bartonella IE were managed surgically with excellent outcomes.
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Affiliation(s)
- Feihong Ding
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Michael Chetrit
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Beni Verma
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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7
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Abdelhamid AA, Kobayashi T, Tholany J, Sekar P. Recurrent Cutibacterium acnes prosthetic valve endocarditis. BMJ Case Rep 2021; 14:14/7/e243878. [PMID: 34326116 PMCID: PMC8323374 DOI: 10.1136/bcr-2021-243878] [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: 11/03/2022] Open
Abstract
A 29-year-old man with a history of congenital aortic stenosis and mechanical aortic valve replacement with previous Cutibacterium acnes prosthetic valve endocarditis (PVE) presented with a 2-week history of fevers and night sweats. Transoesophageal echocardiogram revealed a 0.6 cm×0.5 cm vegetation on the mechanical aortic valve. An anaerobic blood culture became positive for C. acnes 6 days after the blood cultures were obtained. He did not have any surgical intervention. He was successfully treated with 6 weeks of ceftriaxone, followed by chronic suppression with oral doxycycline. Despite its low virulence, a growing number of C. acnes PVE cases have been reported, owing to its biofilm production. When clinical suspicion is high, extending culture incubation duration beyond the standard 5 days might be helpful. Most cases are treated with surgical repair or replacement in conjunction with antibiotics, but medical therapy alone has been documented as being successful.
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Affiliation(s)
| | - Takaaki Kobayashi
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Joseph Tholany
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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8
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Chen See J, Ly T, Shope A, Bess J, Wall A, Komanduri S, Goldman J, Anderson S, McLimans CJ, Brislawn CJ, Tokarev V, Wright JR, Lamendella R. A Metatranscriptomics Survey of Microbial Diversity on Surfaces Post-Intervention of cleanSURFACES® Technology in an Intensive Care Unit. Front Cell Infect Microbiol 2021; 11:705593. [PMID: 34354962 PMCID: PMC8330600 DOI: 10.3389/fcimb.2021.705593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/16/2022] Open
Abstract
Hospital-acquired infections (HAIs) pose a serious threat to patients, and hospitals spend billions of dollars each year to reduce and treat these infections. Many HAIs are due to contamination from workers’ hands and contact with high-touch surfaces. Therefore, we set out to test the efficacy of a new preventative technology, AIONX® Antimicrobial Technologies, Inc’s cleanSURFACES®, which is designed to complement daily chemical cleaning events by continuously preventing re-colonization of surfaces. To that end, we swabbed surfaces before (Baseline) and after (Post) application of the cleanSURFACES® at various time points (Day 1, Day 7, Day 14, and Day 28). To circumvent limitations associated with culture-based and 16S rRNA gene amplicon sequencing methodologies, these surface swabs were processed using metatranscriptomic (RNA) analysis to allow for comprehensive taxonomic resolution and the detection of active microorganisms. Overall, there was a significant (P < 0.05) global reduction of microbial diversity in Post-intervention samples. Additionally, Post sample microbial communities clustered together much more closely than Baseline samples based on pairwise distances calculated with the weighted Jaccard distance metric, suggesting a defined shift after product application. This shift was characterized by a general depletion of several microbes among Post samples, with multiple phyla also being reduced over the duration of the study. Notably, specific clinically relevant microbes, including Staphylococcus aureus, Clostridioides difficile and Streptococcus spp., were depleted Post-intervention. Taken together, these findings suggest that chemical cleaning events used jointly with cleanSURFACES® have the potential to reduce colonization of surfaces by a wide variety of microbes, including many clinically relevant pathogens.
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Affiliation(s)
- Jeremy Chen See
- Contamination Source Identification, Huntingdon, PA, United States
| | - Truc Ly
- Contamination Source Identification, Huntingdon, PA, United States
| | - Alexander Shope
- Contamination Source Identification, Huntingdon, PA, United States.,AIONX, Hershey, PA, United States
| | | | - Art Wall
- Nextflex, San Jose, CA, United States
| | | | | | - Samantha Anderson
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Christopher J McLimans
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Colin J Brislawn
- Contamination Source Identification, Huntingdon, PA, United States
| | - Vasily Tokarev
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Justin R Wright
- Contamination Source Identification, Huntingdon, PA, United States
| | - Regina Lamendella
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
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9
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Witten JC, Tan CD, Rodriguez ER, Shrestha NK, Gordon SM, Hussain ST, Apte SS, Unai S, Blackstone EH, Pettersson GB. Invasive Aortic Valve Endocarditis: Clinical and Tissue Findings from a Prospective Investigation. Ann Thorac Surg 2021; 113:535-543. [PMID: 33839129 DOI: 10.1016/j.athoracsur.2021.03.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Advanced aortic valve infective endocarditis (IE) with progression and destruction beyond the valve cusps-invasive IE-is incompletely characterized. We aimed to further characterize invasive disease extent, location, and stage and correlate macroscopic operative findings with microscopic disease patterns and progression. METHODS Forty-three patients with invasive aortic valve IE were prospectively enrolled from 8/2017 to 7/2018. Twenty-three (53%) had prosthetic valve, 2 (5%) allograft, and 18 (42%) native aortic valve IE. Surgical findings and intraoperative photography were analyzed for invasion location, extent, and stage. Surgical samples were formalin-fixed and analyzed histologically. Time course of disease and management was evaluated. RESULTS Pathogens included Staphylococcus aureus in 17 (40%). Invasion predominantly affected the non-left commissure (76%) and was circumferential in 15 (35%; 14 were prosthetic valves). Extra-aortic cellulitis was present in 29 (67%), abscess in 13 (30%), abscess cavity in 29 (67%), and pseudoaneurysm in 8 (19%); 7 (16%) had fistulae. Histopathology revealed acute inflammation, abscess formation, and lysis of connective tissue, but not myocardium or elastic tissue. Median time from onset of symptoms to antibiotics was 5 days, invasion confirmation 15 days, and surgery 37 days. S. aureus cases had a 21-day shorter time course than non-S. aureus cases. Eight patients developed new/worsening heart block. CONCLUSIONS Advanced invasive aortic valve IE demonstrates consistent gross patterns and stages correlating with histopathologic findings. Invasion results from a confluence of factors, pathogen, time, host immune response and other and primarily affects the fibrous skeleton of the heart and expands to low-pressure regions.
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Affiliation(s)
- James C Witten
- Department of Thoracic and Cardiovascular Surgery, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carmela D Tan
- Department of Anatomic Pathology, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - E René Rodriguez
- Department of Anatomic Pathology, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nabin K Shrestha
- Department of Infectious Disease, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Suneel S Apte
- Department of Biomedical Engineering, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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10
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Kotova EO, Domonova EA, Kobalava ZD, Karaulova JL, Pisaryuk AS, Balatskiy AV, Akimkin VG. Modern trends in identification of causative agents in infective endocarditis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Advances in the diagnosis and treatment of patients with infectious endocarditis are limited by the high frequency of cases with an unknown etiology and imperfection of microbiological (cultural) methods. To overcome these problems new approaches to the identification of infectious endocarditis pathogens were introduced, which allowed achieving certain positive results. However, it should be noted that despite the wide variety of diagnostic tools currently used, there is no ideal method for etiological laboratory diagnosis of infectious endocarditis. The article discusses the features and place of immunochemical, molecular biological (MALDI-TOF MS, real-time PCR, sequencing, in situ fluorescence hybridization, metagenomic methods, etc.), immunohistochemical methods, and their advantages and limitations.
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Affiliation(s)
| | | | | | | | - A. S. Pisaryuk
- Peoples’ Friendship University of Russia (RUDN);
Moscow City Hospital named after V.V. Vinogradov
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11
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El-Dalati S, Murthy VL, Owczarczyk AB, Fagan C, Riddell J, Cinti S, Weinberg RL. Correlating cardiac F-18 FDG PET/CT results with intra-operative findings in infectious endocarditis. J Nucl Cardiol 2021; 28:289-294. [PMID: 31485962 PMCID: PMC7054131 DOI: 10.1007/s12350-019-01874-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Multiple studies have demonstrated that when incorporated with conventional imaging modalities, cardiac F-18 PET/CT can aid in diagnosis of endocarditis and improve the sensitivity of the Duke Criteria. These studies used as their gold standard the opinion of an endocarditis team and were characterized by low percentages of patients who underwent surgery. We reviewed 4 years of surgically managed IE cases where F-18 cardiac PET/CT was used to aid diagnosis. METHODS Between July 2014 and December 2018, we retrospectively reviewed 68 surgically managed endocarditis cases to identify patients who underwent pre-operative PET scans. RESULTS Fourteen patients were identified who underwent F-18 cardiac PET/CT prior to surgical intervention. Nine cases were classified as possible endocarditis by Duke Criteria and 8 involved prosthetic valves. Twelve out of fourteen scans were interpreted as suggestive of or consistent with endocarditis based on FDG uptake. Twelve positive PETs were associated with either operative findings of infection and/or positive PCR testing on the excised valve. Two patients with negative scans were found to have non-infectious mobile masses intra-operatively, negative valve cultures and negative pathology. CONCLUSION In a small cohort, F-18 FDG cardiac PET/CT correlated closely with intra-operative findings in patients with endocarditis and helped guide surgical decision-making. It could be considered for addition to the Duke Criteria in the American Heart Association endocarditis guidelines similar to European protocols.
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Affiliation(s)
- Sami El-Dalati
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
- , Ann Arbor, USA.
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Anna B Owczarczyk
- Department of Pathology, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Christopher Fagan
- Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - James Riddell
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Sandro Cinti
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Richard L Weinberg
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine - University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
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12
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Tchana-Sato V, Hans G, Frippiat F, Zekhnini I, Dulgheru R, Lavigne JP, Defraigne JO. Surgical management of Staphylococcus capitis prosthetic valve infective endocarditis: Retrospective review of a 10-year single center experience and review of the literature. J Infect Public Health 2020; 13:1705-1709. [DOI: 10.1016/j.jiph.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/21/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022] Open
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13
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The Clinical Impact of 16S Ribosomal RNA Polymerase Chain Reaction Bacterial Sequencing in Infectious Endocarditis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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From 1990 to 2020. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000850] [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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15
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Limonta S, Cambau E, Erpelding ML, Piau-Couapel C, Goehringer F, Plésiat P, Revest M, Vernet-Garnier V, Moing VL, Hoen B, Duval X, Tattevin P. Infective Endocarditis Related to Unusual Microorganisms: A Prospective Population-Based Study. Open Forum Infect Dis 2020; 7:ofaa127. [PMID: 32420404 PMCID: PMC7216922 DOI: 10.1093/ofid/ofaa127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background Increased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms. Methods We performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci. Results Of 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in >1 case: Candida albicans (n = 4), Cutibacterium acnes (n = 4), Pseudomonas aeruginosa (n = 3), Cardiobacterium hominis (n = 3), and Coxiella burnetii (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; P = .002), prosthetic valve (40.5% vs 18.1%; P = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; P = .003), and who were more often nosocomial (38.1% vs 20.2%; P = .02). Conclusions In this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition. Trial registration ORCID 0000-0003-3617-5411
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Affiliation(s)
- Silvia Limonta
- Maladies Infectieuses et Reanimation Médicale, Inserm CIC 1414, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Université Rennes 1, Rennes, France
| | - Emmanuelle Cambau
- UF Urgences Microbiologiques et Mycobactériologie, Département des Agents Infectieux, DMU BioGem APHP-Nord, Hôpital Lariboisière, Université de Paris, Inserm UMR 1137 IAME, Paris, France
| | - Marie-Line Erpelding
- Inserm, Centre Hospitalier Régional Universitaire, Université de Lorraine, CIC-1433 Epidemiologie Clinique, Nancy, France
| | | | - François Goehringer
- Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Université de Lorraine, Nancy, France
| | - Patrick Plésiat
- Bactériologie, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France
| | - Matthieu Revest
- Maladies Infectieuses et Reanimation Médicale, Inserm CIC 1414, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Université Rennes 1, Rennes, France
| | | | - Vincent Le Moing
- Maladies Infectieuses et Tropicales, Centre Hospitalo-Universitaire, Université de Montpellier, Montpellier, France
| | - Bruno Hoen
- Maladies Infectieuses et Tropicales, Centre Hospitalier Régional Universitaire, Université de Lorraine, Nancy, France
| | - Xavier Duval
- Inserm CIC 1425, AP-HP Nord, Hôpital Bichat, Inserm UMR-1137, IAME, Centre Hospitalo-Universitaire, Université de Paris, UFR de Médecine-Bichat, Paris, France
| | - Pierre Tattevin
- Maladies Infectieuses et Reanimation Médicale, Inserm CIC 1414, Hôpital Pontchaillou, Centre Hospitalo-Universitaire, Université Rennes 1, Rennes, France
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16
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A case series of patients with Gemella endocarditis. Diagn Microbiol Infect Dis 2020; 97:115009. [PMID: 32081525 DOI: 10.1016/j.diagmicrobio.2020.115009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/11/2020] [Accepted: 01/26/2020] [Indexed: 11/21/2022]
Abstract
Gemella are gram-positive bacteria that rarely cause infective endocarditis (IE). This article summarizes the characteristics of a series of patients with Gemella IE. We identified cases of Gemella IE in patients aged >18 years old hospitalized at Cleveland Clinic between July 1, 2007, and January 1, 2018, within the institutional review board-approved Cleveland Clinic IE Registry. Clinical features were obtained by manual chart review. Thirteen cases of Gemella IE were identified and accounted for <1% of all cases of IE in the registry. Eight were native and 5 were prosthetic valve IE. All were left-sided. Sixty-nine percent had positive blood cultures for Gemella, but 31% were identified solely based on 16S rRNA polymerase chain reaction (PCR) of explanted valves with sequence identification. None had positive valve cultures. All were treated surgically and survived to hospital discharge. Gemella is a rare cause of IE, albeit likely underrecognized without utilization of valve PCR.
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17
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Clinical Practice Update on Infectious Endocarditis. Am J Med 2020; 133:44-49. [PMID: 31521667 DOI: 10.1016/j.amjmed.2019.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
Infectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity; however, advances in diagnostic imaging provide new tools for clinicians to make what can be an elusive diagnosis. There are a number of risk stratification calculators that can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement. There is a need to increase access to medication-assisted treatment for opioid use disorders in this population. Recent studies suggest that oral and depo antibiotics may be viable alternatives to conventional intravenous therapy. Additionally, shorter courses of antibiotic therapy are potentially equally efficacious in patients who are surgically managed. Given the complexities involved with their care, patients with endocarditis are best managed by multidisciplinary teams.
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18
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Pettersson GB, Hussain ST. Current AATS guidelines on surgical treatment of infective endocarditis. Ann Cardiothorac Surg 2019; 8:630-644. [PMID: 31832353 DOI: 10.21037/acs.2019.10.05] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decision-making related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction. For the aortic valve, use of allograft is still favored.
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Affiliation(s)
- Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Syed T Hussain
- Department of Cardiovascular and Thoracic Surgery, Northwell Health/Southside Hospital, Bay Shore, NY, USA
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19
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Navia JL, Elgharably H, Hakim AH, Witten JC, Haupt MJ, Germano E, Houghtaling PL, Bakaeen FG, Pettersson GB, Lytle BW, Roselli EE, Gillinov AM, Svensson LG. Long-term Outcomes of Surgery for Invasive Valvular Endocarditis Involving the Aortomitral Fibrosa. Ann Thorac Surg 2019; 108:1314-1323. [DOI: 10.1016/j.athoracsur.2019.04.119] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
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20
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Shrestha NK, Shah SY, Hussain ST, Pettersson GB, Griffin BP, Nowacki AS, Gordon SM. Association of Surgical Treatment With Survival in Patients With Prosthetic Valve Endocarditis. Ann Thorac Surg 2019; 109:1834-1843. [PMID: 31606518 DOI: 10.1016/j.athoracsur.2019.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prosthetic valve endocarditis (PVE) is a serious condition with high morbidity and mortality. This study investigated the association of surgical treatment with survival among patients with PVE. METHODS A retrospective cohort study was done of patients with PVE hospitalized over 8 years in a large referral center. Association of surgery with survival was evaluated with multivariable Cox proportional hazards regression, adjusting for propensity to be accepted for surgery, and analyzing surgery as a time-dependent covariate. Survival was also compared separately in a 1:1 propensity score-matched cohort of patients accepted for surgery and control patients consigned to nonsurgical treatment. RESULTS Of 523 patients (mean [SD] age, 61 [14] years; 370 [71%] men; 393 [75%] initially accepted for surgery), 404 ultimately underwent surgery and 119 received nonsurgical treatment alone. Surgical treatment was associated with significantly lower hazard of death in the entire cohort (hazard ratio [HR] = 0.32; 95% confidence interval [CI]: 0.22-0.48; P < .001) and in the 1:1 matched cohort (HR = 0.33; 95% CI: 0.19-0.57; P < .001). Initial acceptance for surgery was associated with significantly lower odds of in-hospital death (odds ratio [OR] = 0.26; 95% CI: 0.11-0.59; P < .001), death or readmission within 90 days (OR = 0.17; 95% CI: 0.07-0.43; P < .001), and death within 1 year (OR = 0.16; 95% CI: 0.08-0.34; P < .001). CONCLUSIONS Surgical treatment is associated with a large survival benefit in PVE. A decision to pursue nonsurgical treatment in PVE should entail close follow-up for any development of an indication for surgery.
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Affiliation(s)
- Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio.
| | - Shailee Y Shah
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Syed T Hussain
- Department of Cardiovascular and Thoracic Surgery, Southside Hospital/Northwell Health, Bayshore, New York
| | | | - Brian P Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Amy S Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
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21
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Solomon IH, Lin C, Horback KL, Kanjilal S, Rojas-Rudilla V, Brigl M, Laga AC, Lindeman NI, Padera RF. Utility of Histologic and Histochemical Screening for 16S Ribosomal RNA Gene Sequencing of Formalin-Fixed, Paraffin-Embedded Tissue for Bacterial Endocarditis. Am J Clin Pathol 2019; 152:431-437. [PMID: 31172185 DOI: 10.1093/ajcp/aqz055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES 16S ribosomal RNA (rRNA) sequencing is a powerful but expensive tool for the identification of bacteria in culture-negative endocarditis. Histologic criteria to screen formalin-fixed, paraffin-embedded (FFPE) specimens for testing are evaluated. METHODS Sixty-eight cases of infective endocarditis and controls were histologically reviewed and analyzed by 16S rRNA gene sequencing. RESULTS Sequencing identified a specific pathogenic organism in 33 (49%) of 68 cases with acute inflammation and in 0 of 10 controls (P = .004). Visualization of organisms by Gram or Grocott methenamine silver stains had the strongest association with positive sequencing, while antibiotic treatment effect and acid decalcification decreased sensitivity. Molecular identifications were concordant with blood culture results in 90% of the cases, and a positive sequencing result was obtained in approximately half of the cases with negative valve cultures. CONCLUSIONS Histologic screening criteria are extremely helpful for identifying cases likely to be positive by molecular testing and can provide significant cost savings in filtering out low-yield specimens.
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Affiliation(s)
- Isaac H Solomon
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Chieyu Lin
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Katharine L Horback
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sanjat Kanjilal
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Vanesa Rojas-Rudilla
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Manfred Brigl
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Alvaro C Laga
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Robert F Padera
- Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
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Balkhair A, Al Lawati H, Al Riyami M, Alameddine T, Al Amin M, Al Adawi B. Erysipelothrix rhusiopathiae endocarditis diagnosed by broad range 16s rRNA PCR gene sequencing. IDCases 2019; 18:e00584. [PMID: 31338300 PMCID: PMC6630084 DOI: 10.1016/j.idcr.2019.e00584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 11/26/2022] Open
Abstract
Occupationally related E. rhusiopathiae endocarditis requiring valve replacement surgery. Broad range 16S rRNA PCR applied to excised valve leaflets/vegetations confirmed the presence of E. rhusiopathiae. E. rhusiopathiae should be included in the list of pathogens causing endocarditis especially when occupational setting is compatible.
Erysipelothrix rhusiopathiae (E. rhusiopathiae) is a rare occupational opportunistic Gram-positive bacillus. Infections caused by E. rhusiopathiae are principally a sequel of occupational and recreational exposures to infected animals. Infective endocarditis is a classic, albeit it infrequent, manifestation of invasive infection with this bacterium. We present a case of E. rhusiopathiae mitral valve endocarditis in a farmer with psoriasis presented with acute intractable heart failure requiring valve replacement surgery. E. rhusiopathiae was identified by 16S rRNA-based gene sequencing from culture-negative, surgically excised mitral valve leaflets.
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Affiliation(s)
- A. Balkhair
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
- Corresponding author.
| | - H. Al Lawati
- Department of Medicine, Cardiology Unit, Sultan Qaboos University Hospital, Oman
| | - M. Al Riyami
- Department of Pathology, Sultan Qaboos University Hospital, Oman
| | - T. Alameddine
- Department of Surgery, Cardiothoracic Surgery Unit, Sultan Qaboos University Hospital, Oman
| | - M. Al Amin
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - B. Al Adawi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Oman
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Cheng J, Hu H, Fang W, Shi D, Liang C, Sun Y, Gao G, Wang H, Zhang Q, Wang L, Wu H, Hu L, Chen L, Zhang J, Lee S, Wang F, Zhou Z. Detection of pathogens from resected heart valves of patients with infective endocarditis by next-generation sequencing. Int J Infect Dis 2019; 83:148-153. [DOI: 10.1016/j.ijid.2019.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022] Open
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Tkadlec J, Peckova M, Sramkova L, Rohn V, Jahoda D, Raszka D, Berousek J, Mosna F, Vymazal T, Kvapil M, Drevinek P. The use of broad-range bacterial PCR in the diagnosis of infectious diseases: a prospective cohort study. Clin Microbiol Infect 2018; 25:747-752. [PMID: 30321604 DOI: 10.1016/j.cmi.2018.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/25/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Broad-range PCR has the potential to detect virtually any bacterial species via amplification and nucleotide sequencing of a DNA region common to all bacteria. We aimed to evaluate its usefulness and clinical relevance when applied to a wide variety of primary sterile materials. METHODS A prospective study including 1370 samples (75 heart valves, 151 joint tissue samples, 230 joint aspirates, 848 whole blood samples and 66 culture-negative cerebrospinal fluid samples) were studied by using a commercial PCR system for detecting 16S rDNA (Molzym). The PCR results were compared with culture and were considered to provide added diagnostic value only if the PCR approach revealed new pathogens that were missed by culture. RESULTS The added value of PCR was evident in 173 of 555 PCR-positive samples (0.126; 0.109-0.144 (proportion from all tested samples; 95% confidence interval)), most frequently in examinations of heart valves (0.56; 0.448-0.672) and joint tissue samples (0.219; 0.153-0.284). In contrast, the lowest rate of PCR with added value was noted for blood samples, regardless of the patient cohort they had been drawn from (nononcologic patients from intensive care: 0.065; 0.043-0.087, haematooncologic children: 0.048; 0.027-0.070). Moreover, PCR missed up to 7.1% of blood culture findings (0.071; 0.048-0.095) regarded as clinically relevant, which was the second highest failure rate after joint tissue samples (0.099; 0.052-0.147). CONCLUSIONS Broad-range PCR substantially increases detection rate of pathogens, especially from heart valves and joint samples. However, a concurrent risk of false-negative PCR results justifies the need for parallel culture.
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Affiliation(s)
- J Tkadlec
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - M Peckova
- Institute of Applied Mathematics and Information Technologies, Faculty of Science, Charles University, Czech Republic
| | - L Sramkova
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - V Rohn
- Department of Cardiovascular Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - D Jahoda
- 1st Orthopaedic Department, 1st Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - D Raszka
- 1st Orthopaedic Department, 1st Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - J Berousek
- Department of Anaesthesiology and ICM, Motol University Hospital, Prague, Czech Republic
| | - F Mosna
- Department of Anaesthesiology and ICM, Motol University Hospital, Prague, Czech Republic
| | - T Vymazal
- Department of Anaesthesiology and ICM, Motol University Hospital, Prague, Czech Republic
| | - M Kvapil
- Department of Internal Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic
| | - P Drevinek
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Czech Republic.
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García-Granja PE, López J, Vilacosta I, Sarriá C, Ladrón R, Olmos C, Sáez C, Maroto L, Di Stefano S, Gómez I, San Román JA. Impact of Valve Culture in the Prognosis of Active Left-sided Infective Endocarditis. Clin Infect Dis 2018; 68:1017-1023. [DOI: 10.1093/cid/ciy684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/09/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pablo Elpidio García-Granja
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Cristina Sarriá
- Internal Medicine-Infectious Diseases, Hospital Universitario La Princesa, Madrid, Spain
| | - Raquel Ladrón
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carmen Sáez
- Internal Medicine-Infectious Diseases, Hospital Universitario La Princesa, Madrid, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Salvatore Di Stefano
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
| | - Itziar Gómez
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
| | - J Alberto San Román
- Instituto de Ciencias del Corazón, Hospital Clínico Universitario Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
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26
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Kim SL, Gordon SM, Shrestha NK. Distribution of streptococcal groups causing infective endocarditis: a descriptive study. Diagn Microbiol Infect Dis 2018; 91:269-272. [PMID: 29567126 DOI: 10.1016/j.diagmicrobio.2018.02.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to describe the distribution of streptococci causing infective endocarditis (IE). A total of 296 patients with definite IE admitted from July 2007 to December 2014 were identified, with microbial identification done by a combination of blood culture, valve culture, and valve polymerase chain reaction (PCR). The overall distribution of streptococci was 76% viridans (n = 224), 17% pyogenic (50), 6% nutritionally variant (17), and 2% anaerobic (5). Sixty-three (21%) viridans group streptococci were not identified further. The distribution of the remaining 161 viridans group streptococci was Streptococcus mitis group 61%, S. bovis group 15%, S. mutans group 13%, S. anginosus group 9%, and S. salivarius group 1%. Of the 50 pyogenic streptococci, 78% were S. agalactiae and 16% were S. dysgalactiae. PCR was significantly more sensitive than culture in identifying streptococci in excised heart valves.
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Affiliation(s)
- So Lim Kim
- Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Avenue, G21, Cleveland, OH 44195, USA.
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Avenue, G21, Cleveland, OH 44195, USA.
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27
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Added diagnostic value and impact on antimicrobial therapy of 16S rRNA PCR and amplicon sequencing on resected heart valves in infective endocarditis: a prospective cohort study. Clin Microbiol Infect 2017. [DOI: 10.1016/j.cmi.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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28
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Abstract
Infective endocarditis is an endovascular infection usually caused by bacteria. Mortality rate is still approximately 20 %. To improve patients' prognosis by implementation of current diagnostic and therapeutic evidence, the European Society of Cardiology published an updated version of the guidelines for management of infective endocarditis in 2015. It strengthens the role of imaging modalities like PET/CT for detection of infectious foci when echocardiography remains negative and highlights the use of modern tests for identification of possible pathogens. New diagnostic criteria were introduced to integrate these methods for improved diagnostic sensitivity. Complicated cases should be treated in reference centers with on-site cardiac surgery. The antibiotic and early surgical management should be discussed in a multidisciplinary endocarditis team. A few years ago, the indication for endocarditis prophylaxis was limited to high-risk patients. These recommendations were confirmed in current guidelines.
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Affiliation(s)
- B Plicht
- Klinik für Kardiologie, Klinikum Westfalen, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Deutschland.
| | - A Lind
- Medizinische Universitätsklinik II, Kardiologie und Angiologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
| | - R Erbel
- Klinik für Kardiologie, Universitätsklinikum Essen, Essen, Deutschland
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Abstract
Infective endocarditis is life-threatening; identification of the underlying etiology informs optimized individual patient management. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing (i.e., Q fever serology, Bartonella serology) in culture-negative cases. Histopathology and molecular diagnostics (e.g., 16S rRNA gene PCR/sequencing, Tropheryma whipplei PCR) may be applied to resected valves to aid in diagnosis. Herein, we summarize recent knowledge in this area and propose a microbiologic and pathological algorithm for endocarditis diagnosis.
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30
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Banzon J, Rehm S, Gordon S, Hussain S, Pettersson G, Shrestha N. Propionibacterium acnes endocarditis: a case series. Clin Microbiol Infect 2017; 23:396-399. [DOI: 10.1016/j.cmi.2016.12.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/25/2016] [Indexed: 01/12/2023]
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31
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 260] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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32
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Banzon JM, Hussain ST, Gordon SM, Pettersson GB, Butler RS, Shrestha NK. Aminoglycosides for Surgically Treated Enterococcal Endocarditis. Semin Thorac Cardiovasc Surg 2017; 28:331-338. [PMID: 28043440 DOI: 10.1053/j.semtcvs.2016.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/11/2022]
Abstract
Aminoglycosides are a mainstay of treatment for enterococcal infective endocarditis. However, the benefit of adding aminoglycosides to cell wall-active agents after surgery is unclear. The aim of this study was to determine if adjunctive aminoglycoside treatment after surgery for enterococcal endocarditis leads to better outcomes. We included patients who underwent surgery for enterococcal endocarditis at our institution between July 2007 and July 2014. Treatment was defined as at least 1 dose of an aminoglycoside after surgery. Propensity to receive aminoglycosides was calculated in a model that included age, native vs prosthetic valve endocarditis, chronic kidney disease, high-level aminoglycoside resistance, metastatic infection, invasive disease, positive valve culture, and creatinine on the day of surgery. A multivariable Cox proportional hazards model was used to compare the primary outcome of death, adjusted for propensity to receive aminoglycosides, among patients who did and did not receive aminoglycosides. A total of 108 patients were identified of whom 37 (34%) received at least 1 dose of an aminoglycoside after surgery, with a median duration of 5 days (interquartile range: 2.5-10). In the multivariable model, patients treated with adjunctive aminoglycoside therapy had better survival than those treated with a cell wall-active agent alone, although the difference did not reach statistical significance (hazard ratio = 0.65, 95% CI: 0.32-1.33). The survival difference was consistently present in subgroups stratified by all-purpose refined diagnosis-related group mortality risk, and with varying definitions of aminoglycoside therapy. In conclusion, antibiotic monotherapy with a cell wall-active agent after surgery for enterococcal endocarditis may be inferior to combination therapy including an aminoglycoside.
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Affiliation(s)
- Jona M Banzon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert S Butler
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Nabin K Shrestha
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio.
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33
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Brandão TJD, Januario-da-Silva CA, Correia MG, Zappa M, Abrantes JA, Dantas AMR, Golebiovski W, Barbosa GIF, Weksler C, Lamas CC. Histopathology of valves in infective endocarditis, diagnostic criteria and treatment considerations. Infection 2016; 45:199-207. [PMID: 27771866 DOI: 10.1007/s15010-016-0953-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/11/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is a severe disease. Pathogen isolation is fundamental so as to treat effectively and reduce morbidity and mortality. Blood and valve culture and histopathology (HP) are routinely employed for this purpose. Valve HP is the gold standard for diagnosis. OBJECTIVES To determine the sensitivity and specificity of clinical criteria for IE (the modified Duke and the St Thomas' minor modifications, STH) of blood and valve culture compared to valve HP, and to evaluate antibiotic treatment duration. METHODS Prospective case series of patients, from 2006 to 2014 with surgically treated IE. Statistical analysis was done by the R software. RESULTS There were 136 clinically definite episodes of IE in 133 patients. Mean age ± SD was 43 ± 15.6 years and IE was left sided in 81.6 %. HP was definite in 96 valves examined, which were used as gold standard. Sensitivity of blood culture was 61 % (CI 0.51, 0.71) and of valve culture 15 % (CI 0.07, 0.26). The modified Duke criteria were 65 % (CI 0.55, 0.75) sensitive and 33 % specific, while the STH's sensitivity was 72 % (CI 0.61, 0.80) with similar specificity. In multivariate analysis and logistic regression, the only variable with statistical significance was duration of antibiotic therapy postoperatively. CONCLUSIONS Valve HP had high sensitivity and valve culture low sensitivity in the diagnosis of IE. The STH's criteria were more sensitive than the modified Duke criteria. Valve HP should guide duration of postoperative antibiotic treatment.
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Affiliation(s)
- Tatiana J D Brandão
- Heart Valve Disease Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | - Marcelo G Correia
- Biostatistics Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Monica Zappa
- Pathology Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Jaime A Abrantes
- Microbiology Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Angela M R Dantas
- Microbiology Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Wilma Golebiovski
- Heart Valve Disease Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | - Clara Weksler
- Heart Valve Disease Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- Heart Valve Disease Department, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. .,Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro and Unigranrio, Rio de Janeiro, Brazil. .,Valvular Disease Department, Instituto Nacional de Cardiologia, 8th Floor, Rua das Laranjeiras 375, Laranjeiras, Rio de Janeiro, RJ, CEP 22240-006, Brazil.
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34
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Patel R. New Developments in Clinical Bacteriology Laboratories. Mayo Clin Proc 2016; 91:1448-1459. [PMID: 27552910 PMCID: PMC5786463 DOI: 10.1016/j.mayocp.2016.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 12/20/2022]
Abstract
There are a number of changes underway in modern clinical bacteriology laboratories. Panel-based molecular diagnostics are now available for numerous applications, including, but not limited to, detection of bacteria and select antibacterial resistance markers in positive blood culture bottles, detection of acute gastroenteritis pathogens in stool, and detection of selected causes of acute meningitis and encephalitis in the cerebrospinal fluid. Today, rapid point-of-care nucleic acid amplification tests are bringing the accuracy of sophisticated molecular diagnostics closer to patients. A proteomic technology, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, is enabling rapid, accurate, and cost-effective identification of bacteria, as well as fungi, recovered in cultures. Laboratory automation, common in chemistry laboratories, is now available for clinical bacteriology laboratories. Finally, there are several technologies under development, such as rapid phenotypic antimicrobial susceptibility testing, whole-genome sequencing, and metagenomic analysis for the detection of bacteria in clinical specimens. It is helpful for clinicians to be aware of the pace of new development in their bacteriology laboratory to enable appropriate test ordering, to enable test interpretation, and to work with their laboratories and antimicrobial stewardship programs to ensure that new technology is implemented to optimally improve patient care.
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Affiliation(s)
- Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.
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35
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Comparison of PCR-Electrospray Ionization Mass Spectrometry with 16S rRNA PCR and Amplicon Sequencing for Detection of Bacteria in Excised Heart Valves. J Clin Microbiol 2016; 54:2825-2831. [PMID: 27629895 DOI: 10.1128/jcm.01240-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/02/2016] [Indexed: 12/27/2022] Open
Abstract
Identification of the causative pathogen of infective endocarditis (IE) is crucial for adequate management and therapy. A broad-range PCR-electrospray ionization mass spectrometry (PCR-ESI-MS) technique was compared with broad-spectrum 16S rRNA PCR and amplicon sequencing (16S rRNA PCR) for the detection of bacterial pathogens in 40 heart valves obtained from 34 definite infective endocarditis patients according to the modified Duke criteria and six nonendocarditis patients. Concordance between the two molecular techniques was 98% for being positive or negative, 97% for concordant identification up to the genus level, and 77% for concordant identification up to the species level. Sensitivity for detecting the causative pathogen (up to the genus level) in excised heart valves was 88% for 16S rRNA PCR and 85% for PCR-ESI-MS; the specificity was 83% for both methods. The two molecular techniques were significantly more sensitive than valve culture (18%) and accurately identified bacteria in excised heart valves. In eight patients with culture-negative IE, the following results were obtained: concordant detection of Coxiella burnetii (n = 2), Streptococcus gallolyticus (n = 1), Propionibacterium acnes (n = 1), and viridans group streptococci (n = 1) by both molecular tests, detection of P. acnes by PCR-ESI-MS whereas the 16S rRNA PCR was negative (n = 1), and a false-negative result by both molecular techniques (n = 2). In one case of IE caused by viridans streptococci, PCR-ESI-MS was positive for Enterococcus spp. The advantages of PCR-ESI-MS compared to 16S rRNA PCR are its automated workflow and shorter turnaround times.
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Affiliation(s)
- B Cherie Millar
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK
| | - Gilbert Habib
- Aix-Marseille Université, Marseille, France Cardiology Department, APHM, La Timone Hospital, Marseille, France
| | - John E Moore
- Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK
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Elgharably H, Hussain ST, Shrestha NK, Blackstone EH, Pettersson GB. Current Hypotheses in Cardiac Surgery: Biofilm in Infective Endocarditis. Semin Thorac Cardiovasc Surg 2016; 28:56-9. [DOI: 10.1053/j.semtcvs.2015.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 12/21/2022]
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38
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Early Bioprosthetic Valve Failure: Mechanistic Insights via Correlation between Echocardiographic and Operative Findings. J Am Soc Echocardiogr 2015; 28:1131-48. [DOI: 10.1016/j.echo.2015.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/22/2022]
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39
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Delayed diagnosis of Q fever endocarditis in a rheumatoid arthritis patient. IDCases 2015; 2:94-6. [PMID: 26793469 PMCID: PMC4712205 DOI: 10.1016/j.idcr.2015.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/14/2015] [Indexed: 12/23/2022] Open
Abstract
Chronic Q fever caused by Coxiella burnetii is uncommon in the United States and is most often associated with infective endocarditis. We present a 52-year-old woman with a history of aortic valve replacement and rheumatoid arthritis treated with Etanercept with chronic Q fever manifesting as prosthetic valve infective endocarditis. Explanted valve tissue showed organisms confirmed to be C. burnetii by PCR (polymerase chain reaction) sequencing. She subsequently reported consumption of unpasteurized cow milk which was the likely source of C. burnetii. She continues to do well 6 months after valve replacement on oral doxycycline and hydroxychloroquine.
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40
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Hicks GL. Invited commentary. Ann Thorac Surg 2015; 99:37. [PMID: 25555933 DOI: 10.1016/j.athoracsur.2014.07.019] [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] [Received: 07/15/2014] [Revised: 07/15/2014] [Accepted: 07/21/2014] [Indexed: 11/19/2022]
Affiliation(s)
- George L Hicks
- Division of Cardiothoracic Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY14642.
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