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de Alarcón A. Infective endocarditis in 21st century Spain: a persistent therapeutic challenge in a changing scenario. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:747-749. [PMID: 38701883 DOI: 10.1016/j.rec.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/07/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Seville, Spain.
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Bravo Thompson HA, Campos Herrera FA, Macías Ibiricu DA, Rodríguez Barrios SI, Vázquez Acevedo DI, Candanedo Gonzalez CA, López G, Gollini R. Factors Related to the Development of Infective Endocarditis in Hemodialysis Patients in a Third-Level Hospital in Panama. Cureus 2024; 16:e52385. [PMID: 38361669 PMCID: PMC10868654 DOI: 10.7759/cureus.52385] [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: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA). METHODOLOGY A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables. RESULTS No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur. DISCUSSION Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks. CONCLUSION Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.
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Affiliation(s)
- Harold A Bravo Thompson
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | | | | | | | | | | | - Grisel López
- Medicine, University of Panama, Panama City, PAN
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Garzón-Furné AI, Ferreiro-Marzal A, Rodríguez-Serrano F, Esteban-Molina M, García-Orta R, Moreno-Escobar E, García-Delgado M, Sevilla-Martínez M, Gómez-Luque JM, Ocete-Hita E, Rodríguez-Vázquez del Rey MDM, Nuila-Durán LM, Garrido JM. Reparación valvular en la endocarditis mitral. CIRUGIA CARDIOVASCULAR 2023. [DOI: 10.1016/j.circv.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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López Palmero S, López Zúñiga MA, Rodríguez Martínez V, Reyes Parrilla R, Alguacil Muñoz AM, Sánchez-Yebra Romera W, Martín Rico P, Poquet Catalá I, Jiménez Guardiola C, Del Pozo Pérez A, Lobato Cano R, Lazo Torres AM, López Martínez G, Díez García LF, Parrón Carreño T. Point-of-Care Ultrasound (POCUS) as an Extension of the Physical Examination in Patients with Bacteremia or Candidemia. J Clin Med 2022; 11:jcm11133636. [PMID: 35806920 PMCID: PMC9267352 DOI: 10.3390/jcm11133636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background: In general, transthoracic echocardiography (TTE) is the first diagnostic test used for patients with bacteremia or candidemia and clinical signs of Infective Endocarditis (IE). Point-of-care ultrasound (POCUS) may be used in addition to physical examination for the detection of structural heart disease and valve abnormalities. Objective: To determine the diagnostic accuracy of POCUS for the detection of signs suggestive of IE, including vegetation, valvular regurgitation, structural heart disease, hepatomegaly, splenomegaly and septic embolisms, in patients with bacteremia or candidemia. Design: Observational, cross-sectional, multicenter study using convenience sampling. Setting: Six Spanish academic hospitals. Patients: Adult patients with bacteremia or candidemia between 1 February 2018 and 31 December 2020. Measurements: The reference test, to evaluate vegetation, valvular regurgitation and structural heart disease, was transesophageal echocardiography (TEE). For patients who did not undergo TEE, transthoracic echocardiography (TTE) was considered the reference test. POCUS was performed by internists, while conventional echocardiography procedures were performed by cardiologists. Results: In 258 patients, for the detection of valvular vegetation, POCUS had sensitivity, specificity, and positive and negative predictive values of 77%, 94%, 82% and 92%, respectively. For valvular regurgitation (more than mild), sensitivity was ≥76% and specificity ≥85%. Sensitivity values for the detection of hepatomegaly and splenomegaly were 92% and 92%, respectively, while those for specificity were 96% and 98%. Conclusion: POCUS could be a valuable tool, as a complement to physical examination, at the hospital bedside for patients with bacteremia or candidemia, helping to identify signs suggestive of IE.
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Affiliation(s)
- Serafín López Palmero
- Internal Medicine Department, Torrecárdenas University Hospital, 04009 Almería, Spain; (V.R.M.); (G.L.M.); (L.F.D.G.)
- Correspondence:
| | | | - Virginia Rodríguez Martínez
- Internal Medicine Department, Torrecárdenas University Hospital, 04009 Almería, Spain; (V.R.M.); (G.L.M.); (L.F.D.G.)
| | - Raul Reyes Parrilla
- Cardiology Department, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | | | | | - Patricia Martín Rico
- Internal Medicine Department, Marina Salud Dénia Hospital, 03700 Alicante, Spain; (P.M.R.); (I.P.C.)
| | - Inmaculada Poquet Catalá
- Internal Medicine Department, Marina Salud Dénia Hospital, 03700 Alicante, Spain; (P.M.R.); (I.P.C.)
| | - Carlos Jiménez Guardiola
- Internal Medicine Department, Vega Baja Orihuela Hospital, 03314 Alicante, Spain; (C.J.G.); (A.D.P.P.)
| | - Alfonso Del Pozo Pérez
- Internal Medicine Department, Vega Baja Orihuela Hospital, 03314 Alicante, Spain; (C.J.G.); (A.D.P.P.)
| | - Ruben Lobato Cano
- Internal Medicine Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain;
| | - Ana Maria Lazo Torres
- Infectious Diseases Department, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | - Gines López Martínez
- Internal Medicine Department, Torrecárdenas University Hospital, 04009 Almería, Spain; (V.R.M.); (G.L.M.); (L.F.D.G.)
| | - Luis Felipe Díez García
- Internal Medicine Department, Torrecárdenas University Hospital, 04009 Almería, Spain; (V.R.M.); (G.L.M.); (L.F.D.G.)
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Rizk HH, Elamragy AA, Youssef GS, Meshaal MS, Samir A, ElSharkawy A, Said K, Kassem HH, Elanany MG, El-Kholy AA, Akl AS, Mahfouz SM, Sorour KA. Clinical features and outcomes of infective endocarditis in Egypt: an 11-year experience at a tertiary care facility. Egypt Heart J 2019; 71:17. [PMID: 31659524 PMCID: PMC6821432 DOI: 10.1186/s43044-019-0018-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Few data are available on the characteristics of infective endocarditis (IE) cases in Egypt. The aim of this work is to describe the characteristics and outcomes of IE patients and evaluate the temporal changes in IE diagnostic and therapeutic aspects over 11 years. RESULTS The IE registry included 398 patients referred to the Endocarditis Unit of a tertiary care facility with the diagnosis of possible or definite IE. Patients were recruited over two periods; period 1 (n = 237, 59.5%) from February 2005 to December 2011 and period 2 (n = 161, 40.5%) from January 2012 to September 2016. An electronic database was constructed to include information on patients' clinical and microbiological characteristics as well as complications and mortality. The median age was 30 years and rheumatic valvular heart disease was the commonest underlying cardiac disease (34.7%). Healthcare-associated IE affected 185 patients (46.5%) and 275 patients (69.1%) had negative blood cultures. The most common complications were heart failure (n = 148, 37.2%), peripheral embolization (n = 133, 33.4%), and severe sepsis (n = 100, 25.1%). In-hospital mortality occurred in 108 patients (27.1%). Period 2 was characterized by a higher prevalence of injection drug use-associated IE (15.5% vs. 7.2%, p = 0.008), a higher staphylococcal IE (50.0% vs. 35.7%, p = 0.038), lower complications (31.1% vs. 45.1%, p = 0.005), and a lower in-hospital mortality (19.9% vs. 32.1%, p = 0.007). CONCLUSION This Egyptian registry showed high rates of culture-negative IE, complications, and in-hospital mortality in a largely young population of patients. Improvements were noted in the rates of complications and mortality in the second half of the reporting period.
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Affiliation(s)
- Hussein Hassan Rizk
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmed Adel Elamragy
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ghada Sayed Youssef
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Marwa Sayed Meshaal
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmad Samir
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Ahmed ElSharkawy
- Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Karim Said
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Hussien Heshmat Kassem
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Mervat Gaber Elanany
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Amani Ali El-Kholy
- Department of Clinical Pathology and Microbiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Al Sayed Akl
- Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Soheir M. Mahfouz
- Department of Pathology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
| | - Khaled Ali Sorour
- Department of Cardiology, Kasr Al Aini Hospital, Faculty of Medicine, Cairo University, Cairo, 11562 Egypt
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National Temporal Trend Analysis of Infective Endocarditis among Patients Infected with HIV in Spain (1997-2014): A Retrospective Study. J Clin Med 2019; 8:jcm8081167. [PMID: 31382658 PMCID: PMC6723534 DOI: 10.3390/jcm8081167] [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: 07/09/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) (PLWH) form a vulnerable population for the onset of infective endocarditis (IE). We aimed to analyze the epidemiological trend of IE, as well as its microbiological characteristics, in PLWH during the combined antiretroviral therapy era in Spain. METHODS We performed a retrospective study (1997-2014) in PLWH with data obtained from the Spanish Minimum Basic Data Set. We selected 1800 hospital admissions with an IE diagnosis, which corresponded to 1439 patients. RESULTS We found significant downward trends in the periods 1997-1999 and 2008-2014 in the rate of hospital admissions with an IE diagnosis (from 21.8 to 3.8 events per 10,000 patients/year; p < 0.001), IE incidence (from 18.2 to 2.9 events per 10,000 patients/year; p < 0.001), and IE mortality (from 23.9 to 5.5 deaths per 100,000 patient-years; p < 0.001). The most frequent microorganisms involved were staphylococci (50%; 42.7% Staphylococcus aureus and 7.3% coagulase-negative staphylococci (CoNS)), followed by streptococci (9.3%), Gram-negative bacilli (8.3%), enterococci (3%), and fungus (1.4%). During the study period, we found a downward trend in the rates of CoNS (p < 0.001) and an upward trends in streptococci (p = 0.001), Gram-negative bacilli (p < 0.001), enterococci (p = 0.003), and fungus (p < 0.001) related to IE, mainly in 2008-2014. The rate of community-acquired IE showed a significant upward trend (p = 0.001), while the rate of health care-associated IE showed a significant downward trend (p < 0.001). CONCLUSIONS The rates of hospital admissions, incidence, and mortality related to IE diagnosis in PLWH in Spain decreased from 1997 to 2014, while other changes in clinical characteristics, mode of acquisition, and pathogens occurred over this time.
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Olmos C, Vilacosta I, Fernández-Pérez C, Bernal JL, Ferrera C, García-Arribas D, Pérez-García CN, San Román JA, Maroto L, Macaya C, Elola FJ. The Evolving Nature of Infective Endocarditis in Spain: A Population-Based Study (2003 to 2014). J Am Coll Cardiol 2017; 70:2795-2804. [PMID: 29191329 DOI: 10.1016/j.jacc.2017.10.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/28/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little information exists regarding population-based epidemiological changes in infective endocarditis (IE) in Europe. OBJECTIVES This study sought to analyze temporal trends in IE in Spain from 2003 to 2014. METHODS This retrospective, population-based, temporal trend study analyzed the incidence, epidemiological and clinical characteristics, and outcome of all patients discharged from hospitals included in the Spanish National Health System with a diagnosis of IE, from January 2003 to December 2014. RESULTS Overall, 16,867 episodes of IE were identified during the study period, 66.3% in men. The rate of IE significantly increased, from 2.72 in 2003 to 3.49 per 100,000 person-years in 2014, and this rise was higher among older adults. The most frequent microorganisms were staphylococci (28.7%), followed by streptococci (20.4%) and enterococci (13.1%). Twenty-three percent of patients underwent cardiac surgery. The in-hospital mortality rate was 20.4%. Throughout the study period, the proportion of patients with previously known heart valve disease and diabetes mellitus significantly increased, whereas the prevalence of intravenous drug use decreased. Regarding microorganisms, Staphylococcus aureus and streptococci slightly declined, whereas coagulase-negative staphylococci and enterococci consistently increased over the years. In-hospital complications and cardiac surgery rates significantly increased across the years. The risk-adjusted in-hospital mortality rate diminished (0.2% per year) during the study period. CONCLUSIONS The incidence of IE episodes significantly increased over the decade of the study period, particularly among older adults. Relevant changes in clinical and microbiological profile included older patients with more comorbidity and a rise in enterococci and coagulase-negative staphylococcal infections. Adjusted mortality rates slightly declined over the study period.
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Affiliation(s)
- Carmen Olmos
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Isidre Vilacosta
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Fernández-Pérez
- Department of Preventive Medicine, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain; Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
| | - José L Bernal
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain; Management Control Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carlos Ferrera
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - J Alberto San Román
- Cardiology Department, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Valladolid, Spain
| | - Luis Maroto
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco J Elola
- Fundación Instituto para la Mejora de la Asistencia Sanitaria, Madrid, Spain
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Suárez Bagnasco M, Núñez-Gil IJ. Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects. World J Cardiol 2017; 9:620-628. [PMID: 28824792 PMCID: PMC5545146 DOI: 10.4330/wjc.v9.i7.620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/16/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To summarize the current evidence on psychological issues in thoracic aortic disease (TAD) and infective endocarditis (IE) setting.
METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, PubMed and PsycINFO, we searched full manuscripts in English and published until September 1, 2014.
RESULTS We found sixteen studies exploring psychological issues in patients with IE (six studies) and in TAD (ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE (four papers) and in TAD (eight papers). Depression and anxiety were analyzed in TAD only (five papers). Post-traumatic stress disorder was assessed in IE (one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ.
CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.
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Castillo Bernal FJ, Anguita Sánchez MP, Castillo Domínguez JC, Carrasco Ávalos F, Ruiz Ortiz M, Delgado Ortega M, Romo Peñas E, Mesa Rubio D, Suárez de Lezo Cruzconde J. [Left-sided native valve infective endocarditis: Influence of age and the presence of underlying heart disease]. Med Clin (Barc) 2016; 147:475-480. [PMID: 27692625 DOI: 10.1016/j.medcli.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/04/2016] [Accepted: 07/13/2016] [Indexed: 01/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Left-sided native valve infective endocarditis (LNVIE) epidemiology has been modified as a result of the increase in average age. The aim of our study is to analyze the influence of age and the presence of predisposing heart disease in the prognosis of these patients. METHODS We analyzed a series of 257 cases of LNVIE depending on their age (greater than or equal to 70 years old), both in the overall series and in the subgroup of patients without predisposing heart disease. RESULTS Mean age was 54.6 (18.6) years. There was an increase in the percentage of cases of older patients between 1987-2000 and 2001-2014 (9.8 vs. 34.8%, P<.001). These patients present higher prevalence of degenerative valves (50 vs. 22.8%) or not predisposing heart disease (50 vs. 39.9%), P<.001, health-care associated episodes (41.8 vs. 23.6%, P=.016), lower rate of surgery (43.7 vs. 63.8%, P=.005) and higher in-hospital mortality (39.1 vs. 20.7%, P=.003), with no differences in comorbidities. Older patients who did not have predisposing heart disease also suffered higher in-hospital mortality (47 vs. 22%, P=.01). Age greater than or equal to 70 years old is an independent predictor of mortality in patients with LNVIE (OR 2.53, 95% CI 1.24-5.15, P=.011), as in those without previous heart disease (OR 3.98, 95% CI 1.49-10.62, P=.006). CONCLUSIONS Patients of age greater than or equal to 70 years old and who suffer an LNVIE are becoming more frequent and have a worse prognosis with a lower rate of surgery and higher rates of in-hospital mortality.
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Affiliation(s)
| | | | | | | | - Martín Ruiz Ortiz
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España
| | | | - Elías Romo Peñas
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Dolores Mesa Rubio
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España
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Loureiro-Amigo J, Fernández-Hidalgo N, Pijuan-Domènech A, Dos-Subirà L, Subirana-Domènech T, Gonzàlez-Alujas T, González-López JJ, Tornos-Mas P, García-Dorado D, Almirante B. [Infective endocarditis in adult patients with congenital heart disease. Experience from a reference centre]. Enferm Infecc Microbiol Clin 2016; 34:626-632. [PMID: 26860418 DOI: 10.1016/j.eimc.2016.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/20/2015] [Accepted: 01/02/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION A growing number of patients with congenital heart disease (CHD) will reach adulthood. Infective endocarditis (IE) is a major complication in this population. The aim of this study was to describe the features of IE in adults with CHD treated in a reference centre. METHODS A retrospective review was performed on a cohort of patients over 16 years of age with CHD who presented with IE (defined by the modified Duke criteria) between 1996 and 2014. Only the first episode from each patient was considered for the descriptive analysis. RESULTS IE was observed in 27 patients. The median age at diagnosis of IE was 27.7 years, and 63% were male. Comorbidity was low (median Charlson index was 0). IE was mostly community-acquired (78%). The most frequent CHD were ventricular septal defect (33%). A repair was performed in 48% of patients, and 19% received palliative treatment. Forty-one percent of patients had some type of prosthesis. A residual defect was observed in 81%. The IE was detected in the right side of 44% of the patients. The most frequent aetiological agents were viridans group streptococci (41%) and Staphylococcus epidermidis (30%). Surgery was required to treat IE in 37% of patients. There were five re-infections and three relapses. Two patients died, both as a result of recurrence. CONCLUSIONS IE in adults with CHD occurred in young patients, and almost all of them carried some prosthetic material or a residual defect. The IE is frequently right-sided. Although surgical treatment was required in many cases, mortality was low, except in the case of relapses.
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Affiliation(s)
- Jose Loureiro-Amigo
- Servicio de Medicina Interna, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Nuria Fernández-Hidalgo
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - Antonia Pijuan-Domènech
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España
| | - Laura Dos-Subirà
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España
| | - Teresa Subirana-Domènech
- Universitat Autònoma de Barcelona, Barcelona, España; Unidad Integrada de Cardiopatías Congénitas del Adolescente y del Adulto Vall d'Hebron-Sant Pau, Barcelona, España; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Teresa Gonzàlez-Alujas
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - Pilar Tornos-Mas
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - David García-Dorado
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Benito Almirante
- Universitat Autònoma de Barcelona, Barcelona, España; Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España
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Gálvez-Acebal J, Almendro-Delia M, Ruiz J, de Alarcón A, Martínez-Marcos FJ, Reguera JM, Ivanova-Georgieva R, Noureddine M, Plata A, Lomas JM, de la Torre-Lima J, Hidalgo-Tenorio C, Luque R, Rodríguez-Baño J. Influence of early surgical treatment on the prognosis of left-sided infective endocarditis: a multicenter cohort study. Mayo Clin Proc 2014; 89:1397-405. [PMID: 25178264 DOI: 10.1016/j.mayocp.2014.06.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE). PATIENTS AND METHODS A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality. RESULTS A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%). CONCLUSION This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
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Affiliation(s)
- Juan Gálvez-Acebal
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain.
| | | | - Josefa Ruiz
- Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Arístides de Alarcón
- Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain
| | | | - José M Reguera
- Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain
| | - Radka Ivanova-Georgieva
- Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Mariam Noureddine
- Infectious Diseases Unit-Internal Medicine, Costal del Sol Hospital, Marbella, Spain
| | - Antonio Plata
- Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain
| | - José M Lomas
- Infectious Diseases Unit, Juan Ramón Jiménez Hospital, Huelva, Spain
| | | | | | - Rafael Luque
- Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain
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Antimicrobial prophylaxis in dentistry. J Glob Antimicrob Resist 2014; 2:232-238. [PMID: 27873681 DOI: 10.1016/j.jgar.2014.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/08/2014] [Accepted: 05/27/2014] [Indexed: 12/19/2022] Open
Abstract
Use of antibiotics both in humans and animals runs along with effects that can contribute to the spread of antibiotic resistance. Although several available guidelines for antibiotic treatment have been published to date, clinical practice in dentistry and particularly in oral surgery is not free from controversies regarding antibiotic prophylaxis. Antibiotic coverage to prevent infectious endocarditis, joint prostheses infections or local infections requires a careful evaluation of the patient condition, associated risks and other aspects that could influence the decision. It is of great relevancy for oral surgeons and for dentists in general to know exactly what they are up against. Here we review the literature regarding prophylactic use of antimicrobials in dentistry.
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Carrasco-Chinchilla F, Sánchez-Espín G, Ruiz-Morales J, Rodríguez–Bailón I, Melero–Tejedor JM, Ivanova–Georgieva R, García–López V, Muñoz–García A, Gómez–Doblas JJ, de Teresa–Galván E. Influencia de una estrategia de alerta multidisciplinaria en la mortalidad por endocarditis infecciosa izquierda. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carrasco-Chinchilla F, Sánchez-Espín G, Ruiz-Morales J, Rodríguez-Bailón I, Melero-Tejedor JM, Ivanova-Georgieva R, García-López V, Muñoz-García A, Gómez-Doblas JJ, de Teresa-Galván E. Influence of a multidisciplinary alert strategy on mortality due to left-sided infective endocarditis. ACTA ACUST UNITED AC 2014; 67:380-6. [PMID: 24774731 DOI: 10.1016/j.rec.2013.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/16/2013] [Indexed: 12/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Mortality from left-sided infective endocarditis remains very high. The aim of this study was to assess the impact of a multidisciplinary alert strategy (AMULTEI), based on clinical, echocardiographic and microbiological findings, implemented in 2008 in a tertiary hospital. METHODS Cohort study comparing our historical data series (1996-2007) with the number of patients diagnosed with left-sided endocarditis from 2008-2011 (AMULTEI). RESULTS The AMULTEI cohort included 72 patients who were compared with 155 patients in the historical cohort. AMULTEI patients were significantly older (62.5 vs 57.9 years in the historical cohort; P=.047) and had higher comorbidity (Charlson index, 3.33 vs 2.58 in the historical cohort; P=.023). There was also a trend toward more enterococcal etiology in the AMULTEI group (20.8% vs 11.6% in the historical cohort; P=.067). In the AMULTEI group, early surgery was more frequently performed (48.6% vs 23.2%; P<.001) during hospitalization, the incidence of septic shock was significantly lower (9.7% vs 24.5%; P=.009) and there was a trend toward reductions in neurological complications (19.4% vs 29.0%; P=.25) and severe heart failure (12.5% vs 18.7%; P=.24). In-hospital mortality and mortality during the first month of follow-up were significantly lower in the AMULTEI group (16.7% vs 36.1%; P=.003). CONCLUSIONS Despite the trend toward older age and more comorbidity measured by the Charlson index, early mortality was significantly lower in patients treated with the AMULTEI strategy.
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Affiliation(s)
| | - Gemma Sánchez-Espín
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Josefa Ruiz-Morales
- Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Spain
| | | | - Jose M Melero-Tejedor
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Victoria García-López
- Unidad de Microbiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Muñoz-García
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan J Gómez-Doblas
- Unidad del Corazón, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
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Fernández-Hidalgo N, Tornos Mas P. Epidemiología de la endocarditis infecciosa en España en los últimos 20 años. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Epidemiology of infective endocarditis in Spain in the last 20 years. ACTA ACUST UNITED AC 2013; 66:728-33. [PMID: 24773679 DOI: 10.1016/j.rec.2013.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 05/01/2013] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is an uncommon disease, with an estimated incidence of 3.1 to 3.7 episodes per 100 000 inhabitants/year. The incidence is highest in elderly people. The microorganisms most frequently isolated in infective endocarditis are staphylococci and streptococci. In the last few decades, the spectrum of heart diseases predisposing to infective endocarditis has changed, since degenerative heart disease is the most common valve disease, and there are an increasing number of infective endocarditis patients without previously known valve disease. In addition, up to one-third of infective endocarditis patients become infected through contact with the health system. These patients are more frail, which leads to higher in-hospital mortality. As a result of substantial epidemiological changes, few cases of infective endocarditis can be prevented by antibiotic prophylaxis. Despite advances in medical and surgical treatment, in-hospital mortality among infective endocarditis patients is high. Nevertheless, there is room for improvement in reducing the rate of nosocomial bacteremia, the prompt diagnosis of infective endocarditis in at-risk patients, and the early identification of patients with a highest risk of complications, as well as in the creation of multidisciplinary teams for the management of this disease.
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Fernandez-Hidalgo N, Almirante B, Pahissa A. Reply to Gelfand et al and Solla. Clin Infect Dis 2013; 57:768-70. [DOI: 10.1093/cid/cit331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Goenaga Sánchez MÁ. Tratamientos antibióticos parenterales en domicilio en la endocarditis infecciosa. Situación actual. Enferm Infecc Microbiol Clin 2013; 31:272-3. [DOI: 10.1016/j.eimc.2012.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/02/2012] [Indexed: 01/04/2023]
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Fernández-Hidalgo N, Almirante B, Gavaldà J, Gurgui M, Peña C, de Alarcón A, Ruiz J, Vilacosta I, Montejo M, Vallejo N, López-Medrano F, Plata A, López J, Hidalgo-Tenorio C, Gálvez J, Sáez C, Lomas JM, Falcone M, de la Torre J, Martínez-Lacasa X, Pahissa A. Ampicillin Plus Ceftriaxone Is as Effective as Ampicillin Plus Gentamicin for TreatingEnterococcus faecalisInfective Endocarditis. Clin Infect Dis 2013; 56:1261-8. [DOI: 10.1093/cid/cit052] [Citation(s) in RCA: 207] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Almirante B, Miró JM. Retos en el tratamiento antimicrobiano de la endocarditis infecciosa. Papel de la daptomicina. Enferm Infecc Microbiol Clin 2012; 30 Suppl 1:26-32. [DOI: 10.1016/s0213-005x(12)70068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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