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Tong K, Luo H, Dai H, Huang W. Infective Endocarditis Due to High-Level Gentamicin-Resistant Enterococcus faecalis Complicated Multisystemic Complications in an Elderly Patient. Infect Drug Resist 2024; 17:2329-2335. [PMID: 38882654 PMCID: PMC11179648 DOI: 10.2147/idr.s448612] [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: 11/08/2023] [Accepted: 05/21/2024] [Indexed: 06/18/2024] Open
Abstract
The escalating incidence of infective endocarditis (IE) caused by aminoglycoside-resistant Enterococcus is a growing concern for clinicians. This issue is particularly pronounced in elderly patients, who face an elevated risk of renal damage during antibiotic treatment, thereby limiting available pharmacological options. Furthermore, elderly patients often present with multiple comorbidities, leading to heightened mortality rates. In this article, we present a case involving an elderly male patient who sought medical attention on two separate occasions due to inflammation of the lower extremities and lumbosacral pain. Subsequent diagnosis revealed infective endocarditis (IE) caused by high-level gentamicin-resistant Enterococcus faecalis through blood culture and echocardiography. The patient also experienced peripheral and cerebral arterial embolism, secondary spine infection, and subsequent heart failure, highlighting the severity of the clinical situation. Following an initial 10-day course of vancomycin and ceftriaxone therapy, the patient developed renal impairment, necessitating a switch to bactericidal therapy with ampicillin in combination with ceftriaxone. Additionally, aortic valve replacement was performed during this period. Ultimately, the patient achieved clinical remission. This case underscores the critical importance of prompt and accurate diagnosis, appropriate antibiotic selection, and timely surgical intervention in enhancing the prognosis of elderly patients with IE.
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Affiliation(s)
- Kexin Tong
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Huating Luo
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Haifeng Dai
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Wenxiang Huang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
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Dobreva-Yatseva B, Nikolov F, Raycheva R, Tokmakova M. Infective Endocarditis-Characteristics and Prognosis According to the Affected Valves. Microorganisms 2024; 12:987. [PMID: 38792816 PMCID: PMC11123953 DOI: 10.3390/microorganisms12050987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) continues to be a disease with high mortality despite medical advances. OBJECTIVE The objective of this study was to investigate the characteristics and prognosis of IE according to the affected valves. MATERIALS AND METHODS This study was retrospective and single-centered, and it included 270 patients with a diagnosis of IE, for the period 2005-2021, who received treatment at the University Hospital "St. Georgi" in Plovdiv, Bulgaria. RESULTS Single-valve IE (SIE) was found in 82.6% (n-223), multivalvular IE (MIE) in 16.66% (n = 45) and device IE (CDRIE) in 0.74% (n = 2) of patients. The most commonly affected valve was the aortic valve, in 44.8% (n = 121). The predominant multivalvular involvement was aortic-mitral valves (AV-MV) (13.7%, n = 37). The patients with tricuspid valve (TV) IE were significantly younger, at 39 (30) years, and were more frequently male (80.8%). Mortality was higher in MIE than in SIE (31.1% vs. 23.8%) and was the highest in multivalve aortic-tricuspid (AV-TV) IE (75%). Early surgery was performed most in AV-MV IE, in 29.7% (n = 11). The Charlson comorbidity index (CCI) was significantly higher in MV 4 (4) and AV 3 (3) vs. TV IE 1 (5) (p = 0.048 and p = 0.011, respectively). Septic shock occurred most frequently in AV-TV involvement (75%; p = 0.0001). The most common causative agents were of the Staphylococcus group. Staphylococcus aureus more often affected TV alone (46.2%, n = 124) vs. AV (9.9%, n = 14; p = 0.0001) and vs. MV (22.6%, n = 17; p = 0.022); Staphylococcus coagulase-negative (CNG) was the prevalent cause of MV IE (22.7%, n = 17) vs. AV-MV (2.7%, n = 1; p = 0.007). Streptococci were represented in a low percentage and only in left-sided IE, more frequently in AV-MV (18.9%, n = 7) vs. AV (6.6%, n = 8; p = 0.025). CONCLUSIONS The aortic valve is the most frequently affected valve, as single-valve IE or as multivalve AV-MV, with the predominant causative agents being of the Staphylococcus group. AV-TV IE has the worst prognosis, with the most common complication of septic shock and the highest in-hospital mortality.
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Affiliation(s)
- Bistra Dobreva-Yatseva
- First Department of Internal Medicine, Section of Cardiology, Cardiology Clinic, Faculty of Medicine, Medical University—Plovdiv, UMBAL “St. Georgi” EAD, 4002 Plovdiv, Bulgaria; (F.N.); (M.T.)
| | - Fedya Nikolov
- First Department of Internal Medicine, Section of Cardiology, Cardiology Clinic, Faculty of Medicine, Medical University—Plovdiv, UMBAL “St. Georgi” EAD, 4002 Plovdiv, Bulgaria; (F.N.); (M.T.)
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University—Plovdiv, 4002 Plovdiv, Bulgaria;
| | - Mariya Tokmakova
- First Department of Internal Medicine, Section of Cardiology, Cardiology Clinic, Faculty of Medicine, Medical University—Plovdiv, UMBAL “St. Georgi” EAD, 4002 Plovdiv, Bulgaria; (F.N.); (M.T.)
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Dayer MJ, Quintero-Martinez JA, Thornhill MH, Chambers JB, Pettersson GB, Baddour LM. Recent Insights Into Native Valve Infective Endocarditis: JACC Focus Seminar 4/4. J Am Coll Cardiol 2024; 83:1431-1443. [PMID: 38599719 DOI: 10.1016/j.jacc.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 04/12/2024]
Abstract
This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group. New pathogens were designated as typical, and findings on computed tomography imaging were included as diagnostic criteria. It is now recognized that a multidisciplinary approach to care is vital, and the role of an "endocarditis team" is highlighted. Recent studies have suggested that a transition from intravenous to oral antibiotics in selected patients may be reasonable, and the role of long-acting antibiotics is discussed. It is also now clear that an aggressive surgical approach can be life-saving in some patients. Finally, results of several recent studies have suggested there is an association between dental and other invasive procedures and an increased risk of developing infective endocarditis. Moreover, data indicate that antibiotic prophylaxis may be effective in some scenarios.
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Affiliation(s)
- Mark J Dayer
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland; Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
| | - Juan A Quintero-Martinez
- Department of Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Martin H Thornhill
- Department of Oral and Maxillofacial Medicine, Surgery and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, United Kingdom
| | - John B Chambers
- Emeritus Professor of Clinical Cardiology at Guy's and St Thomas' NHS Trust, London, United Kingdom, and Kings College, London, United Kingdom
| | | | - Larry M Baddour
- Department of Medicine and Department of Cardiovascular Medicine, Division of Public Health, Infectious Diseases and Occupational Health, Mayo Clinic, Rochester, Minnesota, USA
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Santos DAM, Siciliano RF, Besen BAMP, Strabelli TMV, Sambo CT, Milczwski VDM, Goldemberg F, Tarasoutchi F, Vieira MLC, Paixão MR, Gualandro DM, Accorsi TAD, Pomerantzeff PMA, Mansur AJ. Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades. J Infect Public Health 2024; 17:712-718. [PMID: 38484416 DOI: 10.1016/j.jiph.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. METHODS Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978-1988, 1989-1999, 2000-2010 and 2011-2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. FINDINGS Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulase-negative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted in-hospital mortality from 34% to 25% (p = 0.019). INTERPRETATION In the 44 years studied, there was an increase in the mean age of patients, healthcare-related, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.
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Affiliation(s)
- Diego Augusto Medeiros Santos
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Rinaldo Focaccia Siciliano
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Tania Mara Varejão Strabelli
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio Trevelin Sambo
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor de Medeiros Milczwski
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flora Goldemberg
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Milena Ribeiro Paixão
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Menosi Gualandro
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alfredo José Mansur
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Miao H, Zhang Y, Zhang Y, Zhang J. Update on the epidemiology, diagnosis, and management of infective endocarditis: A review. Trends Cardiovasc Med 2024:S1050-1738(24)00001-X. [PMID: 38199513 DOI: 10.1016/j.tcm.2024.01.001] [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] [Received: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/12/2024]
Abstract
Despite advancements in the diagnosis and treatment of infective endocarditis (IE), the burden of IE has remained relatively high over the past decade. With an ageing population and an increasing proportion of healthcare-associated IE, the epidemiology of IE has undergone significant changes. Staphylococcus aureus has evolved as the most common causative microorganism, even in most low- and middle-income countries. Several imaging modalities and novel microbiological tests have emerged to facilitate the diagnosis of IE. Outpatient parenteral antibiotic treatment and oral step-down antibiotic treatment have become new trends for the management of IE. Early surgical intervention, particularly within seven days, should be considered in cases of IE with appropriate surgical indications. We comprehensively review the updated epidemiology, microbiology, diagnosis, and management of IE.
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Affiliation(s)
- Huanhuan Miao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Yuhui Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Yuqing Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Jian Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China.
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Damasco PV, Solórzano VEF, Fortes NRQ, Setta DXDB, da Fonseca AG, Perez MCA, Jazbick JC, Gonçalves-Oliveira J, Horta MAP, de Lemos ERS, Fortes CQ. Trends of Infective Endocarditis at Two Teaching Hospitals: A 12-Year Retrospective Cohort Study in Rio de Janeiro, Brazil. Trop Med Infect Dis 2023; 8:516. [PMID: 38133448 PMCID: PMC10747105 DOI: 10.3390/tropicalmed8120516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. METHODS This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. FINDINGS The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). INTERPRETATION In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.
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Affiliation(s)
- Paulo Vieira Damasco
- Escola de Medicina e Cirurgia, Departamento de Doenças Infecciosas e Parasitárias, Universidade do Federal do Estado do Rio de Janeiro—UNIRIO, Rio de Janeiro 20271-062, Brazil
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | | | - Natália Rodrigues Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro—UFRJ, Rio de Janeiro 21941-617, Brazil; (N.R.Q.F.); (C.Q.F.)
| | - Daniel Xavier de Brito Setta
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Aloysio Guimaraes da Fonseca
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Mario Castro Alvarez Perez
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - João Carlos Jazbick
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (HUPE/UERJ), Rio de Janeiro 20551-030, Brazil; (D.X.d.B.S.); (A.G.d.F.); (M.C.A.P.); (J.C.J.)
| | - Jonathan Gonçalves-Oliveira
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Marco Aurélio Pereira Horta
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Elba Regina Sampaio de Lemos
- Laboratório de Hantaviroses e Rickettsioses, Instituto Oswaldo Cruz (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil; (J.G.-O.); (M.A.P.H.)
| | - Claudio Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro—UFRJ, Rio de Janeiro 21941-617, Brazil; (N.R.Q.F.); (C.Q.F.)
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Jorge MS, Rodrigues AJ, Vicente WVA, Evora PRB. Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital. Arq Bras Cardiol 2023; 120:e20220608. [PMID: 36946858 DOI: 10.36660/abc.20220608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/14/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves. OBJECTIVE This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo-Brazil. METHOD Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020. RESULTS The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis. CONCLUSION For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.
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Affiliation(s)
- Marcelo Serafim Jorge
- Departamento de Cirurgia e Anatomia - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Alfredo J Rodrigues
- Departamento de Cirurgia e Anatomia - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Walter Vilella A Vicente
- Departamento de Cirurgia e Anatomia - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP - Brasil
| | - Paulo Roberto B Evora
- Departamento de Cirurgia e Anatomia - Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP - Brasil
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Kobalava ZD, Kotova EO. [Global and national trends in the evolution of infective endocarditis]. KARDIOLOGIIA 2023; 63:3-11. [PMID: 36749195 DOI: 10.18087/cardio.2023.1.n2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023]
Abstract
For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.
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Affiliation(s)
- Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - E O Kotova
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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