1
|
Liaqat W, Palaiodimos L, Li W, Karamanis D, Tahir A, Tzoumas A, Nagraj S, Tiwari N, Grushko M, Kokkinidis D, Gashi E, Leider J, Coyle C, Faillace RT. Epidemiologic and clinical characteristics of infective endocarditis: a single-center retrospective study in the Bronx, New York. Infection 2022; 50:1349-1361. [PMID: 35614176 DOI: 10.1007/s15010-022-01846-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There is paucity of data on the epidemiological, microbiological, and clinical characteristics of patients admitted with infective endocarditis (IE) in the Bronx, New York. PATIENT AND METHODS We conducted a retrospective study at Jacobi Medical Center, a tertiary care hospital in the Bronx. All adult patients who were hospitalized with a primary diagnosis of new-onset IE between January 1st, 2010 and September 30th, 2020 were included. The primary outcome was in-hospital mortality. A logistic regression model was used to identify baseline variables associated with in-hospital mortality. RESULTS 182 patients were included in this analysis (female sex: 38.5%, median age: 54 years). 46 patients (25.3%) reported intravenous drug use. 153 patients (84.1%) had positive blood cultures. Staphylococcus aureus (S. aureus) was the most common isolated pathogen (45.1% of monomicrobial IE). Nearly half of the cases secondary to S. aureus were methicillin resistant Staphylococcus aureus (MRSA) (34/69). 164 patients (90.1%) were diagnosed with native valve IE. The mitral valve was involved in 32.4% of patients followed by the aortic valve (19.8%). The in-hospital mortality was 18.1%. The mortality was higher in the cohort 2010-2015 compared to the cohort 2016-2020 (22.1% vs 14.6%). Increasing age, MRSA IE, and active malignancy were the only variables found to have significant association with in-hospital death. CONCLUSION S. aureus was the most common causative agent and MRSA accounted for about half of the S. aureus IE cases. The incidence of IE in patients with intravenous drug use increased over time, while the median age decreased. The in-hospital death rate was higher in 2010-2015 compared to 2016-2020.
Collapse
Affiliation(s)
- Wasla Liaqat
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA.
- Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Weijia Li
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dimitrios Karamanis
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Department of Health Informatics, Rutgers School of Health Professions, Newark, NJ, USA
- Department of Economics, University of Peiraeus, Attica, Greece
| | - Arooj Tahir
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andreas Tzoumas
- Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sanjana Nagraj
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nidhish Tiwari
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Damianos Kokkinidis
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Eleonora Gashi
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jason Leider
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christina Coyle
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Robert T Faillace
- Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, 3N1, Suite B, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
2
|
Oberbach A, Schlichting N, Hagl C, Lehmann S, Kullnick Y, Friedrich M, Köhl U, Horn F, Kumbhari V, Löffler B, Schmidt F, Joskowiak D, Born F, Saha S, Bagaev E. Four decades of experience of prosthetic valve endocarditis reflect a high variety of diverse pathogens. Cardiovasc Res 2022; 119:410-428. [PMID: 35420122 DOI: 10.1093/cvr/cvac055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 01/18/2023] Open
Abstract
Prosthetic valve endocarditis (PVE) remains a serious condition with a high mortality rate. Precise identification of the PVE-associated pathogen/s and their virulence is essential for successful therapy, and patient survival. The commonly described PVE-associated pathogens are staphylococci, streptococci and enterococci, with Staphylococcus aureus being the most frequently diagnosed species. Furthermore, multi-drug resistance pathogens are increasing in prevalence, and continue to pose new challenges mandating a personalized approach. Blood cultures in combination with echocardiography are the most common methods to diagnose PVE, often being the only indication, it exists. In many cases, the diagnostic strategy recommended in the clinical guidelines does not identify the precise microbial agent and to frequently, false negative blood cultures are reported. Despite the fact that blood culture findings are not always a good indicator of the actual PVE agent in the valve tissue, only a minority of re-operated prostheses are subjected to microbiological diagnostic evaluation. In this review, we focus on the diversity and the complete spectrum of PVE-associated bacterial, fungal and viral pathogens in blood, and prosthetic heart valve, their possible virulence potential, and their challenges in making a microbial diagnosis. We are curious to understand if the unacceptable high mortality of PVE is associated with the high number of negative microbial findings in connection with a possible PVE. Herein, we discuss the possibilities and limits of the diagnostic methods conventionally used and make recommendations for enhanced pathogen identification. We also show possible virulence factors of the most common PVE-associated pathogens and their clinical effects. Based on blood culture, molecular biological diagnostics, and specific valve examination, better derivations for the antibiotic therapy as well as possible preventive intervention can be established in the future.
Collapse
Affiliation(s)
- Andreas Oberbach
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany
| | - Nadine Schlichting
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany.,Munich Heart Alliance, Partner Site German Centre for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stefanie Lehmann
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Yvonne Kullnick
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Maik Friedrich
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Ulrike Köhl
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Friedemann Horn
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Diagnostics, Leipzig, Germany.,Institute of Clinical Immunology, University of Leipzig, Leipzig, Germany
| | - Vivek Kumbhari
- Department of Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Florida, USA
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Frank Schmidt
- Proteomics Core, Weill Cornell Medical Centre Qatar, Doha, Qatar
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Frank Born
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| | - Erik Bagaev
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
| |
Collapse
|
3
|
Guery B, Papadimitriou-Olivgeris M. Infective endocarditis, is there a goal beyond antibiotics and surgery? Eur J Intern Med 2021; 94:25-26. [PMID: 34782192 DOI: 10.1016/j.ejim.2021.10.033] [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: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Benoit Guery
- Department of Medicine, Infectious Diseases Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
| | | |
Collapse
|
4
|
Brikman S, Zoabi M, Dori G. Low diagnostic yield of funduscopy in the evaluation of a patient with suspected infective endocarditis. QJM 2020; 113:439. [PMID: 31125071 DOI: 10.1093/qjmed/hcz122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Brikman
- Department of Internal Medicine E, HaEmek Medical Center, Rabin Blvd, Afula 1834111, Israel
- Tecnion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of medicine, Efron st, Haifa 3525422, Israel
| | - M Zoabi
- Department of Internal Medicine E, HaEmek Medical Center, Rabin Blvd, Afula 1834111, Israel
| | - G Dori
- Department of Internal Medicine E, HaEmek Medical Center, Rabin Blvd, Afula 1834111, Israel
- Tecnion-Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of medicine, Efron st, Haifa 3525422, Israel
| |
Collapse
|
5
|
Mistiaen WP, Gebruers N. How to manage patients in whom malignancy and infective endocarditis are associated: a review. SCAND CARDIOVASC J 2020; 54:70-76. [PMID: 32233824 DOI: 10.1080/14017431.2019.1698762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective. Infective endocarditis (IE) is a potentially short-term lethal condition. An association with malignancy could complicate diagnostic and therapeutic decisions. The questions to be answered are: (1) which type of malignancies are encountered; (2) how often has the association between malignancy and IE been described, and (3) what are thus far the diagnostic and treatment strategies for patients with both conditions. Methods. A literature search from 2010 to 2018 has been performed with the focus on IE and cancer/malignancy/neoplasm, as well as with risk factors for adverse outcome, when cancer was included in the analysis. Results. An association between digestive, respiratory and hematologic malignancy with IE has been observed in four large databases. The most important mechanisms for this association are a "port of entry" and immune suppression. Sixteen studies dealt with the effect of short and mid-term cancer on the outcome of surgery of IE in these patients. No uniform management strategy could be identified. It seems that a malignancy does not alter the short-term outcome for IE, although referral to a tertiary cardiac center and surgical treatment are less common for patients with known malignancy. Conclusions. Although there is an association between malignancy and IE, no treatment strategy has yet been developed for these patients. Short-term outcome of IE is unaltered by cancer. In most papers, the effect of cancer on mid-term survival is only significant in a univariate analysis, without being a predictor. The results indicate that cardiac surgery for IE should not be withheld in patients in whom a treatable malignancy has been found.
Collapse
Affiliation(s)
- Wilhelm P Mistiaen
- Department of Healthcare Sciences and Wellbeing, Artesis-Plantijn University of Applied Sciences, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of rehabilitation sciences and physiotherapy (REVAKI - MOVANT), University of Antwerp, Antwerp, Belgium
| | - Nick Gebruers
- Faculty of Medicine and Health Sciences, Department of rehabilitation sciences and physiotherapy (REVAKI - MOVANT), University of Antwerp, Antwerp, Belgium.,Multidisciplinary Edema Clinic, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
6
|
Mistiaen WP. A special topic in onco-cardiology: how to deal with a patient with endocarditis and malignancy. Future Cardiol 2019; 16:61-63. [PMID: 31833406 DOI: 10.2217/fca-2019-0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Wilhelm P Mistiaen
- Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Healthcare & Wellbeing, Artesis-Plantijn University of Applied Sciences, Antwerp, Belgium
| |
Collapse
|
7
|
Acute Kidney Injury After Nephrotoxic Antibiotic Therapy in Patients with Infective Endocarditis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.87617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
8
|
Liu Y, Zhang H, Liu Y, Han Q, Tang Y, Zhao L, Qiao F, Xu Z, Yu M, Yuan Z. Risk factors and short-term prognosis of preoperative renal insufficiency in infective endocarditis. J Thorac Dis 2018; 10:3679-3688. [PMID: 30069366 DOI: 10.21037/jtd.2018.06.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The incidence of postoperative complications and the in-hospital mortality rate of infective endocarditis (IE) complicated with renal insufficiency are relatively high. This study aimed to analyze the clinical features, etiological characteristics, diagnosis and treatment, and prognosis of IE with renal insufficiency and to explore the risk factors for renal damage. Methods IE patients undergoing valvular surgery between 2008 and 2017 in two cardiac centers were retrospectively analyzed. They were divided into renal insufficiency (RI) [endogenous creatinine clearance rate (Ccr) <60 mL/min/1.73 m2] and normal renal function (NRF) (Ccr ≥60 mL/min/1.73 m2) groups. The disease conditions at admission, etiology, treatment, and prognosis were compared between the two groups. Multivariate regression analysis was performed for the related factors. Results A total of 8,055 cases of valvular surgery was performed during the study period. We analyzed 401 IE patients [average age 43.9±15 years; RI, n=56 (14%); NRF, n=345 (86%)], after the exclusion of 2 patients with primary glomerulonephritis. RI patients showed higher perioperative mortality (14.3% vs. 4.5%, P=0.042) and streptococcal infection (71.4% vs. 43.8%, P=0.001) rates. The RI group was also older and had worse heart function, greater decreases in hemoglobin and platelet levels, a higher rate of prosthetic valve involvement, more cases of postoperative dialysis, and worse prognosis (all P<0.05). Binary logistic multivariate regression analysis showed that the incidence of streptococcal infection [odds ratio (OR) =4.271, 95% confidence interval (CI), 1.846-9.884; P=0.001], age ≥51 years (OR =5.138, 95% CI, 2.258-11.694; P<0.001), and New York Heart Association (NYHA) functional class III-IV (OR =10.768, 95% CI, 2.417-47.972; P=0.002) were independent risk factors for preoperative renal insufficiency. Conclusions IE patients with preoperative renal insufficiency had a high mortality rate and poor prognosis, with streptococcal infection predisposing to a higher risk of renal insufficiency. Moreover, older the age and worse heart function in IE resulted in a greater risk for renal insufficiency.
Collapse
Affiliation(s)
- Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Hang Zhang
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Yaoyang Liu
- Department of Rheumatology and Immunology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Yangfeng Tang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Libo Zhao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
| | - Min Yu
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Zhongxiang Yuan
- Department of Cardiovascular Surgery, Shanghai General Hospital, Nanjing Medical University, Shanghai 200080, China.,Department of Cardiovascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| |
Collapse
|
9
|
Gouriet F, Chaudet H, Gautret P, Pellegrin L, de Santi VP, Savini H, Texier G, Raoult D, Fournier PE. Endocarditis in the Mediterranean Basin. New Microbes New Infect 2018; 26:S43-S51. [PMID: 30402243 PMCID: PMC6205568 DOI: 10.1016/j.nmni.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/24/2018] [Accepted: 05/18/2018] [Indexed: 12/31/2022] Open
Abstract
Infective endocarditis is a severe disease with high mortality. Despite a global trend towards an increase in staphylococcal aetiologies, in older patients and a decrease in viridans streptococci, we have observed in recent studies great epidemiologic disparities between countries. In order to evaluate these differences among Mediterranean countries, we performed a PubMed search of infective endocarditis case series for each country. Data were available for 13 of the 18 Mediterranean countries. Despite great differences in diagnostic strategies, we could classify countries into three groups. In northern countries, patients are older (>50 years old), have a high rate of prosthetic valves or cardiac electronic implantable devices and the main causative agent is Staphylococcus aureus. In southern countries, patients are younger (<40 years old), rheumatic heart disease remains a major risk factor (45–93%), viridans streptococci are the main pathogens, zoonotic and arthropod-borne agents are frequent and blood culture–negative endocarditis remains highly prevalent. Eastern Mediterranean countries exhibit an intermediate situation: patients are 45 to 60 years old, the incidence of rheumatic heart disease ranges from 8% to 66%, viridans streptococci play a predominant role and zoonotic and arthropod-borne diseases, in particular brucellosis, are identified in up to 12% of cases.
Collapse
Affiliation(s)
| | - H Chaudet
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France
| | - P Gautret
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France
| | - L Pellegrin
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France.,Forces Centre for Epidemiology and Public Health, French Forces Health Services, France
| | - V P de Santi
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France.,Forces Centre for Epidemiology and Public Health, French Forces Health Services, France
| | - H Savini
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France.,Military Teaching Hospital Laveran, Department of Infectious Diseases and Tropical Medicine, French Forces Health Services, Marseille, France
| | - G Texier
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France.,Forces Centre for Epidemiology and Public Health, French Forces Health Services, France
| | | | - P-E Fournier
- UMR VITROME, Aix-Marseille Université, IRD, Service de Santé des Armées, Assistance Publique-Hôpitaux de Marseille, Institut Hospitalo-Universitaire Méditerranée-Infection, France
| |
Collapse
|
10
|
Mistiaen WP. What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review. SCAND CARDIOVASC J 2018; 52:58-68. [DOI: 10.1080/14017431.2018.1433318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wilhelm P. Mistiaen
- Faculty of Medicine & Health Sciences, Department of Rehabilitation Sciences and Physiotherapy Antwerp, University of Antwerp, Antwerp, Belgium
- Department of Healthcare & Wellbeing, Artesis-Plantijn University College of Antwerp, Antwerp, Belgium
| |
Collapse
|
11
|
Zhu W, Zhang Q, Zhang J. The changing epidemiology and clinical features of infective endocarditis: A retrospective study of 196 episodes in a teaching hospital in China. BMC Cardiovasc Disord 2017; 17:113. [PMID: 28482820 PMCID: PMC5422999 DOI: 10.1186/s12872-017-0548-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/28/2017] [Indexed: 12/19/2022] Open
Abstract
Background Infective endocarditis is an uncommon but life-threatening infectious disease. To our knowledge, current investigations of the characteristics of infective endocarditis in our region are scarce. In this study, we aimed to investigate the changes in the epidemiology and clinical features of infective endocarditis. Methods A retrospective analysis of clinical data was performed using 196 infective endocarditis cases diagnosed between June 2004 and December 2012 at The First Affiliated Hospital of China Medical University. A comparative analysis of clinical risk factors was also included. Results The mean age of the patient cohort was 43.5 (29.0–55.8) years old. Of the 196 cases studied, 128 cases (65.3%) were left native valve infective endocarditis, 13 cases (6.6%) were left prosthetic valve infective endocarditis, and 47 cases (24%) were right valve infective endocarditis. In addition to natural valve endocarditis, many patients also exhibited various types of cardiopathy: 72 cases (36.7%) had congenital cardiovascular malformations, 37 cases (18.9%) had idiopathic mitral valve prolapse and 31 cases (15.8%) had no significant cardiac disease. The primary clinical manifestations that were observed included 168 cases with fever (85.7%), 131 cases with anemia (66.8%), 114 cases with hematuria (58.2%) and 58 cases with splenomegaly (29.6%). Positive blood cultures were detected in 96 cases (49%); the most commonly detected organism was Streptococcus viridans (41 cases; 42.7%), followed by 18 cases (18.8%) of Staphylococcus aureus and 10 cases (10.4%) of Enterococcus. With respect to risk factors, infection with Staphylococcus aureus or gram-negative bacilli (OR = 18.81, 95%CI = 2.39–148.2), congestive heart failure (OR = 8.854, 95%CI = 1.34–54.7), diabetes (OR = 7.224, 95%CI = 1.17–44.7) and age ≥ 60 years (OR = 6.861, 95%CI = 0.94–50.1) were major prognostic risk factors. Conclusion Infective endocarditis is more common than previously believed, but there are regional differences with respect to the epidemiological and clinical characteristics of infective endocarditis, and its etiology is diverse and complicated. Our study of the clinically diagnosed cases of infective endocarditis verified the regional characteristics of infective endocarditis using a straightforward retrospective analysis. The geographic variations we observed in the study will be of important value to clinical diagnosis in our region.
Collapse
Affiliation(s)
- Wan Zhu
- Department of Nosocomial Infection Control, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Northern Street, Shenyang, Liaoning, 110001, China
| | - Qian Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Northern Street, Shenyang, Liaoning, 110001, China
| | - Jingping Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, No. 155 Nanjing Northern Street, Shenyang, Liaoning, 110001, China.
| |
Collapse
|
12
|
Goenaga Sánchez MÁ, Kortajarena Urkola X, Bouza Santiago E, Muñoz García P, Verde Moreno E, Fariñas Álvarez MC, Teira Cobo R, Pericás Pulido JM, de Alarcón González A, Sousa Regueiro D, Ruiz Morales J, Rodríguez-Álvarez RJ, Antorrena Miranda I, Iribarren Loyarte JA. Aetiology of renal failure in patients with infective endocarditis. The role of antibiotics. Med Clin (Barc) 2017; 149:331-338. [PMID: 28431897 DOI: 10.1016/j.medcli.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/23/2017] [Accepted: 03/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The possible renal toxicity of certain antibiotics (AB) is well known. The objective of our work is to know the possible effect of AB treatments in the development of renal failure (RF) in patients with infective endocarditis (IE). MATERIAL AND METHOD Collection from a national multi-centre registry of collection on renal function, both prior and its impairment, if any, during the treatment of IE and in relation to possible causative factors, including the use of AB. RESULTS Between 2008 and 2012, 1,853 episodes of IE reported from 26 Spanish centres were analysed. Of these, 21.6% had prior RF. They developed new RF or impairment of renal function in 38.7% of the cases. In patients with prior RF, impairment was more frequent (64 vs. 31.7%, P<.001). Overall, patients with RF were older (70.6 vs. 67 years, P<.01), had more comorbidities (Charlson index 5 vs. 4, P<.01), and IE by Staphylococcus aureus (32.1 vs. 16.5%, P<.01). Potentially nephrotoxic AB use was only associated with RF in patients without prior RF (aminoglycosides: OR=1.47 [95% CI 1.096-1.988], P=.010; aminoglycosides with vancomycin: OR=1.49 [95% CI 1.069-2.09], P=.019). CONCLUSIONS In patients without prior RF, the use of nephrotoxic AB is associated with impairment of renal function. In patients with RF prior to the IE episode, impairment of renal function was more frequent but appears to be more related to the severity of infection.
Collapse
Affiliation(s)
| | - Xabier Kortajarena Urkola
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Guipúzcoa, España
| | - Emilio Bouza Santiago
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Patricia Muñoz García
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Eduardo Verde Moreno
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Carmen Fariñas Álvarez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, España
| | - Ramón Teira Cobo
- Servicio de Medicina Interna, Hospital Sierrallana, Torrelavega, Santander, España
| | - Juan Manuel Pericás Pulido
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | - Arístides de Alarcón González
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Virgen del Rocío and Virgen Macarena, Sevilla, España
| | - Dolores Sousa Regueiro
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Josefa Ruiz Morales
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, Málaga, España
| | | | | | | | | |
Collapse
|
13
|
Abstract
Background: Acquired heart diseases (AHDs) are present from childhood to old age, and the frequency of pathology differs according to age and the geographical region of the patients. The aim of this study was to document the echocardiographic patterns of AHDs in our setting. Materials and Methods: Retrospective analysis of echocardiographic diagnosis of AHD was done for age, sex, and echocardiographic pattern. Results: There were 190 diagnoses in the 163 patients with 27 patients having a double diagnosis, consisting of 88 (54%) males and 75 (46%) females. The mean age was 50.4 years (age range 9-85 years). Ten types of acquired heart pathologies were identified and they included hypertensive heart disease in 49.47%, rheumatic heart disease in 26.32%, cardiomyopathy in 11.05%, endomyocardial fibrosis in 4.74%, and pericarditis in 3.68%. Others were cor pulmonale, pulmonary hypertension, intracardiac thrombi, left atrial myxoma and degenerative heart disease which accounted for the remaining 4.74%. Conclusion: This study identifies 10 types of AHDs among the study population. The huge impact of hypertensive heart disease and rheumatic heart disease is a big indicator pointing to the existence of a sub-optimal level of healthcare in the country.
Collapse
Affiliation(s)
- Eyo Effiong Ekpe
- Department of Surgery, Cardiothoracic Surgery Unit, University of Uyo, University of Uyo Teaching Hospital, Akwa Ibom, Nigeria
| | - Mandu C Ikpe
- Department of Radiology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
| | - Idongesit Umoh
- Department of Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
| |
Collapse
|