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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 157] [Impact Index Per Article: 157.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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El-Dalati S, Cronin D, Riddell J, Shea M, Weinberg RL, Stoneman E, Patel T, Ressler K, Deeb GM. A step-by-step guide to implementing a multidisciplinary endocarditis team. Ther Adv Infect Dis 2021; 8:20499361211065596. [PMID: 34950478 PMCID: PMC8689603 DOI: 10.1177/20499361211065596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last several years multiple studies, primarily from European centers have demonstrated the clinical and outcomes benefits of multidisciplinary endocarditis teams. Despite this literature, adoption of this approach to patient care has been slower in the United States. While there is literature outlining the optimal composition of an endocarditis team, there is little information to guide providers as they attempt to transform practice from a fragmented, disjointed process to an efficient, collaborative care model. In this review, the authors will outline the steps they took to create and implement a successful multidisciplinary endocarditis team at the University of Michigan. In conjunction with existing data, this piece can be used as a resource for clinicians seeking to improve the care of patients with endocarditis at their institutions.
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Affiliation(s)
- Sami El-Dalati
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky, 740 South Limestone Street, Lexington, KY 40536, USA
| | - Daniel Cronin
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - James Riddell
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Michael Shea
- Division of Cardiology, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Richard L Weinberg
- Division of Cardiology, Department of Internal Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Stoneman
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Twisha Patel
- College of Pharmacy, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - Kirra Ressler
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
| | - George Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA
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El-Dalati S, Cronin D, Riddell J, Shea M, Weinberg RL, Washer L, Stoneman E, Perry DA, Bradley S, Burke J, Murali S, Fagan C, Chanderraj R, Christine P, Patel T, Ressler K, Fukuhara S, Romano M, Yang B, Deeb GM. The Clinical Impact of Implementation of a Multidisciplinary Endocarditis Team. Ann Thorac Surg 2021; 113:118-124. [PMID: 33662308 DOI: 10.1016/j.athoracsur.2021.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/10/2021] [Accepted: 02/16/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infectious endocarditis is associated with substantial in-hospital mortality of 15-20%. Effective management requires coordination between multiple medical and surgical subspecialties which can often lead to disjointed care. Previous European studies have identified multidisciplinary endocarditis teams as a tool for reducing endocarditis mortality. METHODS The multidisciplinary endocarditis Team was formed in May 2018. The group developed an evidence-based algorithm for management of endocarditis that was used to provide recommendations for hospitalized patients over a 1-year period. Mortality outcomes were then retroactively assessed and compared to a historical control utilizing propensity matching. RESULTS Between June 2018 and June 2019 the team provided guideline-based recommendations on 56 patients with Duke Criteria definite endocarditis and at least 1 AHA indication for surgery. The historical control included 68 patients with definite endocarditis and surgical indications admitted between July 1st, 2014 to June 30th, 2015. In-hospital mortality decreased significantly from 29.4% in 2014-2015 to 7.1% in 2018-2019 (p<0.0001). There was a non-significant increase in the rate of surgical intervention after implementation of the team (41.2% vs 55.4%; p=0.12). Propensity score matching demonstrated similar results. CONCLUSIONS Implementation of a multidisciplinary endocarditis team was associated with a significant 1-year decrease in all-cause in-hospital mortality for patients with definite endocarditis and surgical indications, in the presence of notable differences between the two studied cohorts. In conjunction with previous studies demonstrating their effectiveness, this data supports that widespread adoption of endocarditis teams in North America could improve outcomes for this patient population.
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Affiliation(s)
- Sami El-Dalati
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan.
| | - Daniel Cronin
- Department of Internal Medicine, Division of Hospital Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - James Riddell
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Michael Shea
- Department of Internal Medicine, Division of Cardiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Richard L Weinberg
- Department of Internal Medicine, Division of Cardiology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Laraine Washer
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Emily Stoneman
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - D Alexander Perry
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Suzanne Bradley
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - James Burke
- Department of Neurology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Sadhana Murali
- Department of Neurology, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Christopher Fagan
- Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Rishi Chanderraj
- Department of Internal Medicine, Division of Infectious Diseases, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Paul Christine
- Department of Internal Medicine, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Twisha Patel
- College of Pharmacy, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Kirra Ressler
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
| | - George Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine - University of Michigan, Ann Arbor, Michigan
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The Role of Coronary Catheterization with Angiography in Surgically Managed Infectious Endocarditis. Am J Med 2020; 133:1101-1104. [PMID: 31972147 DOI: 10.1016/j.amjmed.2019.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronary catheterization with angiography is often performed prior to surgical valve replacement in infectious endocarditis. There are no existing data as to whether this intervention is clinically necessary or leads to a change in surgical management. In order to determine the frequency with which coronary angiography impacts surgical management in infectious endocarditis, we conducted a retrospective review of surgically managed endocarditis cases at a tertiary care medical center. METHODS Utilizing the institutional Society of Thoracic Surgeon's database, we identified 598 patients with surgically managed endocarditis between April 29, 2011 and December 31, 2018. Patient variables were recorded, including risk factors for coronary artery disease, whether the patient received coronary angiography prior to surgery, and if the patient underwent coronary artery bypass grafting as part of their valve surgery. RESULTS There were 430 patients who received coronary catheterization with angiography prior to surgical valve replacement for infectious endocarditis, and 168 patients proceeded to surgery without coronary angiography. Nine percent of patients underwent coronary artery bypass grafting at the time of valve replacement as a result of coronary angiography findings. There was no significant difference in 30-day mortality for patients with endocarditis who underwent coronary angiography when compared with those who did not receive coronary angiography (2.6 vs 2.4%; P = 0.89). CONCLUSIONS Left heart catheterization with coronary angiography prior to surgical valve replacement leads to coronary artery bypass grafting in the minority of infective endocarditis patients.
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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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Anantha Narayanan M, Mahfood Haddad T, Kalil AC, Kanmanthareddy A, Suri RM, Mansour G, Destache CJ, Baskaran J, Mooss AN, Wichman T, Morrow L, Vivekanandan R. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart 2016; 102:950-7. [PMID: 26869640 DOI: 10.1136/heartjnl-2015-308589] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 01/14/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis. METHODS PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed. RESULTS A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts. CONCLUSION The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.
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Affiliation(s)
| | - Toufik Mahfood Haddad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andre C Kalil
- Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, Nebraska, USA
| | - Arun Kanmanthareddy
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Rakesh M Suri
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - George Mansour
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Christopher J Destache
- School of Pharmacy & Health Professions and School of Medicine, Creighton University, Omaha, Nebraska, USA
| | - Janani Baskaran
- University of Texas Southwestern at Dallas, Dallas, Texas, USA
| | - Aryan N Mooss
- Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Tammy Wichman
- Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Lee Morrow
- Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Renuga Vivekanandan
- Division of Infectious Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA
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Bin Abdulhak AA, Baddour LM, Erwin PJ, Hoen B, Chu VH, Mensah GA, Tleyjeh IM. Global and regional burden of infective endocarditis, 1990-2010: a systematic review of the literature. Glob Heart 2015; 9:131-43. [PMID: 25432123 DOI: 10.1016/j.gheart.2014.01.002] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease associated with serious complications. The GBD 2010 (Global Burden of Disease, Injuries, and Risk Factors) study IE expert group conducted a systematic review of IE epidemiology literature to inform estimates of the burden on IE in 21 world regions in 1990 and 2010. The disease model of IE for the GBD 2010 study included IE death and 2 sequelae: stroke and valve surgery. Several medical and science databases were searched for IE epidemiology studies in GBD high-, low-, and middle-income regions published between 1980 and 2008. The epidemiologic parameters of interest were IE incidence, proportions of IE patients who developed stroke or underwent valve surgery, and case fatality. Literature searches yielded 1,975 unique papers, of which 115 published in 10 languages were included in the systematic review. Eligible studies were population-based (17%), multicenter hospital-based (11%), and single-center hospital-based studies (71%). Population-based studies were reported from only 6 world regions. Data were missing or sparse in many low- and middle-income regions. The crude incidence of IE ranged between 1.5 and 11.6 cases per 100,000 people and was reported from 10 countries. The overall mean proportion of IE patients that developed stroke was 0.158 ± 0.091, and the mean proportion of patients that underwent valve surgery was 0.324 ± 0.188. The mean case fatality risk was 0.211 ± 0.104. A systematic review for the GBD 2010 study provided IE epidemiology estimates for many world regions, but highlighted the lack of information about IE in low- and middle-income regions. More complete knowledge of the global burden of IE will require improved IE surveillance in all world regions.
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Affiliation(s)
- Aref A Bin Abdulhak
- Department of Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | | | - Bruno Hoen
- Department of Infectious Diseases, Dermatology, and Internal Medicine, University Medical Center of Guadeloupe, Cedex, France
| | - Vivian H Chu
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Infectious Diseases Section, King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis. J Thorac Cardiovasc Surg 2014; 147:254-8. [DOI: 10.1016/j.jtcvs.2012.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/14/2012] [Accepted: 10/10/2012] [Indexed: 11/21/2022]
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Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A, Yun J, Pressman GS, Figueredo VM. Infective endocarditis epidemiology over five decades: a systematic review. PLoS One 2013; 8:e82665. [PMID: 24349331 PMCID: PMC3857279 DOI: 10.1371/journal.pone.0082665] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/25/2013] [Indexed: 01/04/2023] Open
Abstract
AIMS To Assess changes in infective endocarditis (IE) epidemiology over the last 5 decades. METHODS AND RESULTS We searched the published literature using PubMed, MEDLINE, and EMBASE from inception until December 2011. DATA FROM Einstein Medical Center, Philadelphia, PA were also included. Criteria for inclusion in this systematic review included studies with reported IE microbiology, IE definition, description of population studied, and time frame. Two authors independently extracted data and assessed manuscript quality. One hundred sixty studies (27,083 patients) met inclusion criteria. Among hospital-based studies (n=142; 23,606 patients) staphylococcal IE percentage increased over time, with coagulase-negative staphylococcus (CNS) increasing over each of the last 5 decades (p<0.001) and Staphylococcus aureus (SA) in the last decade (21% to 30%; p<0.05). Streptococcus viridans (SV) and culture negative (CN) IE frequency decreased over time (p<0.001), while enterococcal IE increased in the last decade (p<0.01). Patient age and male predominance increased over time as well. In subgroup analysis, SA frequency increased in North America, but not the rest of the world. This was due, in part, to an increase in intravenous drug abuse IE in North America (p<0.001). Among population-based studies (n=18; 3,477 patients) no significant changes were found. CONCLUSION Important changes occurred in IE epidemiology over the last half-century, especially in the last decade. Staphylococcal and enterococcal IE percentage increased while SV and CN IE decreased. Moreover, mean age at diagnosis increased together with male:female ratio. These changes should be considered at the time of decision-making in treatment of and prophylaxis for IE.
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Affiliation(s)
- Leandro Slipczuk
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - J. Nicolas Codolosa
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Carlos D. Davila
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Abel Romero-Corral
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Jeong Yun
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Pulmonary and Critical Care Medicine Division, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Gregg S. Pressman
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
| | - Vincent M. Figueredo
- Einstein Institute for Heart and Vascular Health, Einstein Medical Center, Philadelphia, Pennsylvania, United States of America
- Jefferson Medical College, Philadelphia, Pennsylvania, United States of America
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Takahashi H, Arif R, Kallenbach K, Tochtermann U, Karck M, Ruhparwar A. Surgical Treatment of Aortic Valve Endocarditis With Left Ventricular-Aortic Discontinuity. Ann Thorac Surg 2013; 96:72-6. [DOI: 10.1016/j.athoracsur.2013.03.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Revised: 01/13/2013] [Accepted: 03/28/2013] [Indexed: 10/26/2022]
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Iversen K, Høst N, Bruun NE, Elming H, Pump B, Christensen JJ, Gill S, Rosenvinge F, Wiggers H, Fuursted K, Holst-Hansen C, Korup E, Schønheyder HC, Hassager C, Høfsten D, Larsen JH, Moser C, Ihlemann N, Bundgaard H. Partial oral treatment of endocarditis. Am Heart J 2013; 165:116-22. [PMID: 23351813 DOI: 10.1016/j.ahj.2012.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 11/11/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines for the treatment of left-sided infective endocarditis (IE) recommend 4 to 6 weeks of intravenous antibiotics. Conversion from intravenous to oral antibiotics in clinically stabilized patients could reduce the side effects associated with intravenous treatment and shorten the length of hospital stay. Evidence supporting partial oral therapy as an alternative to the routinely recommended continued parenteral therapy is scarce, although observational data suggest that this strategy may be safe and effective. STUDY DESIGN This is a noninferiority, multicenter, prospective, randomized, open-label study of partial oral treatment with antibiotics compared with full parenteral treatment in left-sided IE. Stable patients (n = 400) with streptococci, staphylococci, or enterococci infecting the mitral valve or the aortic valve will be included. After a minimum of 10 days of parenteral treatment, stable patients are randomized to oral therapy or unchanged parenteral therapy. Recommendations for oral treatment have been developed based on minimum inhibitory concentrations and pharmacokinetic calculations. Patients will be followed up for 6 months after completion of antibiotic therapy. The primary end point is a composition of all-cause mortality, unplanned cardiac surgery, embolic events, and relapse of positive blood cultures with the primary pathogen. CONCLUSION The Partial Oral Treatment of Endocarditis study tests the hypothesis that partial oral antibiotic treatment is as efficient and safe as parenteral therapy in left-sided IE. The trial is justified by a review of the literature, by pharmacokinetic calculations, and by our own experience.
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Kim SH, Je HG, Lee SK, Kim SP. Surgical Treatment of Multivalvular Endocarditis with Ventricular Septal Defect -A case report-. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.4.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Seon Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital
| | - Hyoung-Gon Je
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital
| | - Sang-Kwon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital
| | - Sang-pil Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital
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Influence of preoperative antibiotherapy on valve culture results and outcome of endocarditis requiring surgery. J Infect 2009; 59:42-8. [DOI: 10.1016/j.jinf.2009.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/25/2009] [Accepted: 04/27/2009] [Indexed: 12/20/2022]
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