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Salinas-Botrán A, Olmos-Blanco C, Fernández de Velasco-Pérez D, Guzmán-Carreras A, Morales-Rosas A, Gómez-Ramírez D. Dalbavancin as consolidation antibiotic treatment in infective endocarditis, cardiac implantable electronic devices infection and bacteremia: Clinical experience of 7 years. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00128-X. [PMID: 38763866 DOI: 10.1016/j.eimce.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/22/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Dalbavancin (DBV), a novel lipoglycopeptide with activity against Gram-positive bacterial infections, is approved for the treatment of acute bacterial skin and skin structure infections (ABSSSIs). It has linear dose-related pharmacokinetics allowing a prolonged interval between doses. It would be a good option for the treatment of patients with Gram-positive cardiovascular infections. METHODS Retrospective analysis of patients with cardiovascular infection (infective endocarditis, bacteremia, implantable electronic device infection) treated with DBV at Hospital Clínico San Carlos (Madrid) for 7 years (2016-2022). Patients were divided in two study groups: 1) Infective endocarditis (IE), 2) Bacteremia. Epidemiological, clinical, microbiological and therapeutic data were analyzed. RESULTS A total of 25 patients were treated with DBV for cardiovascular infection. IE was the most common indication (68%), followed by bacteremia (32%) with male predominance in both groups (64% vs 62%) and median age of 67,7 and 57,5 years, respectively. 100% of blood cultures were positive to Gram-positive microorganisms (Staphylococcus spp., Streptococcus spp. or Enterococcus spp.) in both study groups. Previously to DBV, all patients received other antibiotic therapy, both in the group of IE (median: 80 days) as in bacteremia (14,8 days). The main reason for the administration of DBV was to continue intravenous antimicrobial therapy outside the hospital in both the EI group (n = 15) and the bacteremia group (n = 8). DBV was used as consolidation therapy in a once- or twice-weekly regimen. Microbiological and clinical successes were reached in 84% of cases (n = 21), 76,4% in IE group and 100% in bacteremia group. No patient documented adverse effects during long-term dalbavancin treatment. CONCLUSION DBV is an effective and safety treatment as consolidation antibiotic therapy in IE and bacteremia produced by Gram-positive microorganisms.
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Affiliation(s)
- Alejandro Salinas-Botrán
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Carmen Olmos-Blanco
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | | | | | | | - Daniel Gómez-Ramírez
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
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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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Cabezón G, de Miguel M, López J, Vilacosta I, Pulido P, Olmos C, Jerónimo A, Pérez JB, Lozano A, Gómez I, San Román JA. Contemporary Clinical Profile of Left-Sided Native Valve Infective Endocarditis: Influence of the Causative Microorganism. J Clin Med 2023; 12:5441. [PMID: 37685509 PMCID: PMC10487562 DOI: 10.3390/jcm12175441] [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: 07/05/2023] [Revised: 08/06/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
Studies focused on the clinical profile of native valve endocarditis are scarce and outdated. In addition, none of them analyzed differences depending on the causative microorganism. Our objectives are to describe the clinical profile at admission of patients with left-sided native valve infective endocarditis in a contemporary wide series of patients and to compare them among the most frequent etiologies. To do so, we conducted a prospective, observational cohort study including 569 patients with native left-sided endocarditis enrolled from 2006 to 2019. We describe the modes of presentation and the symptoms and signs at admission of these patients and compare them among the five more frequent microbiological etiologies. Coagulase-negative Staphylococci and Enterococci endocarditis patients were the oldest (71 ± 11 years), and episodes caused by Streptococci viridans were less frequently nosocomial (4%). The neurologic, cutaneous or renal modes of presentation were more typical in Staphylococcus aureus endocarditis (28%, p = 0.002), the wasting syndrome of Streptococcus viridans (49%, p < 0.001), and the cardiac in Coagulase-negative Staphylococci, Enterococci and unidentified microorganism endocarditis (45%, 49% and 56%, p < 0.001). The clinical signs agreed with the mode of presentation. In conclusion, the modes of presentation and the clinical picture at admission were tightly associated with the causative microorganism in patients with left-sided native valve endocarditis.
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Affiliation(s)
- Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - María de Miguel
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Javier B. Pérez
- Instituto de Investigación Sanitaria del Hospital la Princesa (IIS-IP), Hospital Universitario la Princesa, 28006 Madrid, Spain
| | - Adrián Lozano
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - Itzíar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
| | - J. Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Ciber de Enfermedades Cardiovasculares (CIBERCV), 47003 Valladolid, Spain
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Cabezón G, López J, Vilacosta I, Habib G, Miró JM, Olmos C, Sarriá C, Hernandez-Meneses M, González-Juanatey C, González-Juanatey JR, Llopis J, Cuervo G, Sáez C, Gómez I, San Román JA. The three-noes right-sided infective endocarditis: An unrecognized type of right-sided endocarditis. Medicine (Baltimore) 2023; 102:e34322. [PMID: 37478259 PMCID: PMC10662813 DOI: 10.1097/md.0000000000034322] [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: 03/27/2023] [Accepted: 06/22/2023] [Indexed: 07/23/2023] Open
Abstract
The "3 noes right-sided infective endocarditis" (3no-RSIE: no left-sided, no drug users, no cardiac devices) was first described more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Eight tertiary centers with surgical facilities participated in the study. Patients with right-sided endocarditis without left sided involvement, absence of drug use history and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analyzed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. the study was comprised of 100 patients (mean age 54.1 ± 20 years, 65% male) with definite 3no-RSIE were included (selected from a total of 598 patients with RSIE of all the series, which entails a 16.7% of 3no-RSIE). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent (32% of the group of patients with previous known predisposing heart disease) and fever was the main manifestation at admission (85%). The microbiological profile was led by Staphylococci spp (52%). Vegetations were detected in 94% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, P < .001). Non-community acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. the clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery may play an important role in improving outcome.
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Affiliation(s)
| | - Javier López
- Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
| | | | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille France
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - José María Miró
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBERINFEC. Instituto de Salud Carlos III, Madrid, Spain
| | - Carmen Olmos
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | | | - José Ramón González-Juanatey
- Hospital Clínico Universitario, CIBERCV, Santiago DE Compostela, Spain
- IDIS, Insituto de Investigación Sanitaria de Santiago de Compostela
| | - Jaume Llopis
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | | | - Carmen Sáez
- Hospital Universitario La Princesa, Madrid, Spain
| | - Itziar Gómez
- Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
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Qu YF, Yang J, Wang JY, Wei B, Ye XH, Li YX, Han SL. Valve repair after infective endocarditis secondary to perforation caused by Streptococcus gordonii: A case report. World J Clin Cases 2023; 11:3822-3829. [PMID: 37383117 PMCID: PMC10294171 DOI: 10.12998/wjcc.v11.i16.3822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/24/2023] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND We report a case of infective endocarditis (IE) in a patient with congenital heart valve lesions accompanied by IE, which was diagnosed based on blood culture analysis that revealed the presence of a gram-negative bacterium, Streptococcus gordonii.
CASE SUMMARY The patient had a history of precordial valve disease diagnosed by cardiac ultrasound, as well as a 4-mo history of fever. He was subjected to comprehensive anti-infection and anti-heart failure treatment in the internal medicine department. Further examination revealed sudden dislodgement from and perforation through the aortic valve by the superfluous organisms, as well as occurrence of bacterial emboli dislodgement, which caused bacteremia and infectious shock. He recovered and was discharged from the hospital after surgical and postoperative anti-infection treatments.
CONCLUSION We review the treatment process and highlight inspirations and reflections from this case; suggest possible future changes in treatment modalities.
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Affiliation(s)
- Yi-Fan Qu
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Jun Yang
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Jun-Yu Wang
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Bing Wei
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Xing-Hua Ye
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Yi-Xuan Li
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
| | - Si-Lu Han
- Department of Emergency, Beijing Chaoyang Hospital Jingxi Branch, Beijing 100000, China
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Luo L, Huang SQ, Liu C, Liu Q, Dong S, Yue Y, Liu KZ, Huang L, Wang SJ, Li HY, Zheng S, Wu ZK. Machine Learning-Based Risk Model for Predicting Early Mortality After Surgery for Infective Endocarditis. J Am Heart Assoc 2022; 11:e025433. [PMID: 35656984 PMCID: PMC9238722 DOI: 10.1161/jaha.122.025433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The early mortality after surgery for infective endocarditis is high. Although risk models help identify patients at high risk, most current scoring systems are inaccurate or inconvenient. The objective of this study was to construct an accurate and easy‐to‐use prediction model to identify patients at high risk of early mortality after surgery for infective endocarditis. Methods and Results A total of 476 consecutive patients with infective endocarditis who underwent surgery at 2 centers were included. The development cohort consisted of 276 patients. Eight variables were selected from 89 potential predictors as input of the XGBoost model to train the prediction model, including platelet count, serum albumin, current heart failure, urine occult blood ≥(++), diastolic dysfunction, multiple valve involvement, tricuspid valve involvement, and vegetation >10 mm. The completed prediction model was tested in 2 separate cohorts for internal and external validation. The internal test cohort consisted of 125 patients independent of the development cohort, and the external test cohort consisted of 75 patients from another center. In the internal test cohort, the area under the curve was 0.813 (95% CI, 0.670–0.933) and in the external test cohort the area under the curve was 0.812 (95% CI, 0.606–0.956). The area under the curve was significantly higher than that of other ensemble learning models, logistic regression model, and European System for Cardiac Operative Risk Evaluation II (all, P<0.01). This model was used to develop an online, open‐access calculator (http://42.240.140.58:1808/). Conclusions We constructed and validated an accurate and robust machine learning–based risk model to predict early mortality after surgery for infective endocarditis, which may help clinical decision‐making and improve outcomes.
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Affiliation(s)
- Li Luo
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Sui-Qing Huang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Chuang Liu
- School of Computer Science and Technology Xidian University Xi'an P. R. China
| | - Quan Liu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shuohui Dong
- Department of General Surgery Qianfoshan HospitalShandong University Jinan P. R. China
| | - Yuan Yue
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Kai-Zheng Liu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Lin Huang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shun-Jun Wang
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Hua-Yang Li
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery Nanfang HospitalSouthern Medical University Guangzhou P. R. China
| | - Zhong-Kai Wu
- Department of Cardiac Surgery The First Affiliated Hospital of Sun Yat-sen University Guangzhou P. R. China
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Cabezón G, López J, Vilacosta I, Sáez C, García-Granja PE, Olmos C, Jerónimo A, Gutiérrez Á, Pulido P, de Miguel M, Gómez I, San Román JA. Reassessment of vegetation size as a sole indication for surgery in left-sided infective endocarditis. J Am Soc Echocardiogr 2021; 35:570-575. [PMID: 34971762 DOI: 10.1016/j.echo.2021.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Guidelines recommend surgery in left-sided infective endocarditis (LSIE) associated with large vegetations. Given that most patients who undergo surgery also have other indications (heart failure and/or uncontrolled infection), it is not settled whether surgery should be routinely recommended in patients with large vegetations but no other predictors of poor outcome. METHODS A total of 726 patients with definitive LSIE were included in our analysis. Mean age was 64.9 years, 61% were male. Multivariate analysis of all patients was performed to determine if vegetation size is related to death in LSIE. Then, patients were divided in two groups according to vegetation size: Group A (>10 mm, n=420) and group B (≤10 mm, n=306). Univariate and multivariate analyses of group A patients were carried out to identify the variables related to death in this group. Impact of surgery on mortality of group A patients without heart failure or uncontrolled local infection (n=139) was assessed. RESULTS Age, Staphylococcus aureus, perivalvular complications, heart failure, kidney failure and septic shock, but not vegetation size, were associated with death. Patients with large vegetations showed increased mortality (31.7% in group A vs 24.8% in group B, p=0.045). Group A had more valve rupture and valve regurgitation than group B, but heart failure (55% vs 53%, p=0.678), stroke (22% vs 17.0%, p=0.091), systemic embolism (39% vs 32%, p=0.074), perivalvular complication (28% vs 28%, p=0.865) or septic shock (15% vs 13%, p=0.288) were similar in both groups. In patients from group A without heart failure or uncontrolled infection mortality was similar with and without surgery (n=139; n=70 with surgery, n=69 without surgery; mortality 18.6% vs 11.6% respectively, p=0.251). CONCLUSIONS large vegetations identify patients with poor outcome in LSIE. However, surgery is not associated with a better prognosis in patients with large vegetations if they do not present with another predictor of poor outcome such as heart failure or uncontrolled infection. These findings challenge whether vegetation size alone should be an indication for surgery in LSIE.
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Affiliation(s)
- Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV).
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Pablo Elpidio García-Granja
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Ángela Gutiérrez
- Hospital Universitario la Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP) Madrid, Spain
| | - Paloma Pulido
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - María de Miguel
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - Itzíar Gómez
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain. Ciber de enfermedades cardiovasculares (CIBERCV)
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Garcia Granja PE, Lopez J, Vilacosta I, Saéz C, Cabezón G, Olmos C, Jerónimo A, Pérez JB, De Stefano S, Maroto L, Carnero M, Monguio E, Pulido P, de Miguel M, Gomez Salvador I, Carrasco-Moraleja M, San Román JA. Prognostic impact of cardiac surgery in left-sided infective endocarditis according to risk profile. Heart 2021; 107:1987-1994. [PMID: 34509995 DOI: 10.1136/heartjnl-2021-319661] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/22/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication. METHODS 605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication. RESULTS Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632). CONCLUSIONS Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
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Affiliation(s)
- Pablo Elpidio Garcia Granja
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain .,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Lopez
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Carmen Saéz
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Adrián Jerónimo
- Department of Cardiology. Instituto Cardiovascular. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Javier B Pérez
- Internal Medicine Department, Instituto de investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Madrid, Spain
| | - Salvatore De Stefano
- Department of Cardiac Surgery. Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Luis Maroto
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Emilio Monguio
- Department of Cardiac Surgery, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa (IIS-IP), Hospital Universitario La Princesa, Madrid, Spain
| | - Paloma Pulido
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - María de Miguel
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Itziar Gomez Salvador
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco-Moraleja
- Biostatistics Department, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Santos-Martínez S, Alkhodair A, Nombela-Franco L, Saia F, Muñoz-García AJ, Gutiérrez E, Regueiro A, Jimenez-Diaz VA, Rivero F, Romaguera R, Gómez-Herrero J, Rodriguez-Gabella T, Sathananthan J, Gómez Salvador I, Carrasco-Moraleja M, Rodés-Cabau J, Webb J, López J, San Román JA, Amat-Santos IJ. Transcatheter Aortic Valve Replacement for Residual Lesion of the Aortic Valve Following "Healed" Infective Endocarditis. JACC Cardiovasc Interv 2021; 13:1983-1996. [PMID: 32912458 DOI: 10.1016/j.jcin.2020.05.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the safety and mid-term efficacy of transcatheter aortic valve replacement (TAVR) in the setting of aortic valve (AV) infective endocarditis (IE) with residual lesion despite successful antibiotic treatment. BACKGROUND Patients with AV-IE presenting residual lesion despite successful antibiotic treatment are often rejected for cardiac surgery due to high-risk. The use of TAVR following IE is not recommended. METHODS This was a multicenter retrospective study across 10 centers, gathering baseline, in-hospital, and 1-year follow-up characteristics of patients with healed AV-IE treated with TAVR. Matched comparison according to sex, EuroSCORE, chronic kidney disease, left ventricular function, prosthesis type, and valve-in-valve procedure was performed with a cohort of patients free of prior IE treated with TAVR (46 pairs). RESULTS Among 2,920 patients treated with TAVR, 54 (1.8%) presented with prior AV-IE with residual valvular lesion and healed infection. They had a higher rate of multivalvular disease and greater surgical risk scores. A previous valvular prosthesis was more frequent than a native valve (50% vs. 7.5%; p < 0.001). The in-hospital and 1-year mortality rates were 5.6% and 11.1%, respectively, comparable to the control cohort. After matching, the 1-year III to IV aortic regurgitation rate was 27.9% (vs. 10%; p = 0.08) and was independently associated with higher mortality. There was only 1 case of IE relapse (1.8%); however, 18% of patients were complicated with sepsis, and 43% were readmitted due to heart failure. CONCLUSIONS TAVR is a safe therapeutic alternative for residual valvular lesion after successfully healed AV-IE. At 1-year follow-up, the risk of IE relapse was low and mortality rate did not differ from TAVR patients free of prior IE, but one-fourth presented with significant aortic regurgitation and >50% required re-admission.
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Affiliation(s)
- Sandra Santos-Martínez
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain. https://twitter.com/drassantos
| | - Abdullah Alkhodair
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Francesco Saia
- Division of Cardiology, Cardiothoracic and Vascular Department, S. Orsola Hospital, Bologna University, Bologna, Italy
| | | | - Enrique Gutiérrez
- CIBERCV, Cardiology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Ander Regueiro
- Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | | | - Rafael Romaguera
- Cardiology Department, Hospital Universitari de Bellvitge - IDIBELL, Universitat de Barcelona. Barcelona, Spain
| | | | - Tania Rodriguez-Gabella
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
| | | | | | | | | | - John Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Javier López
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
| | - J Alberto San Román
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; Cardiology Department, Hospital Clínico Universitario, CIBERCV, Valladolid, Spain.
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10
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García-Granja PE, López J, Vilacosta I, Sarriá C, Domínguez F, Ladrón R, Olmos C, Sáez C, Vilches S, García-Arribas D, Cobo-Marcos M, Ramos A, Maroto L, Gómez I, Carrasco M, García-Pavía P, San Román JA. Predictive model of in-hospital mortality in left-sided infective endocarditis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:902-909. [PMID: 31848066 DOI: 10.1016/j.rec.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Infective endocarditis (IE) is a complex disease with high in-hospital mortality. Prognostic assessment is essential to select the most appropriate therapeutic approach; however, international IE guidelines do not provide objective assessment of the individual risk in each patient. We aimed to design a predictive model of in-hospital mortality in left-sided IE combining the prognostic variables proposed by the European guidelines. METHODS Two prospective cohorts of consecutive patients with left-sided IE were used. Cohort 1 (n=1002) was randomized in a 2:1 ratio to obtain 2 samples: an adjustment sample to derive the model (n=688), and a validation sample for internal validation (n=314). Cohort 2 (n=133) was used for external validation. RESULTS The model included age, prosthetic valve IE, comorbidities, heart failure, renal failure, septic shock, Staphylococcus aureus, fungi, periannular complications, ventricular dysfunction, and vegetations as independent predictors of in-hospital mortality. The model showed good discrimination (area under the ROC curve=0.855; 95%CI, 0.825-0.885) and calibration (P value in Hosmer-Lemeshow test=0.409), which were ratified in the internal (area under the ROC curve=0.823; 95%CI, 0.774-0.873) and external validations (area under the ROC curve=0.753; 95%CI, 0.659-0.847). For the internal validation sample (observed mortality: 29.9%) the model predicted an in-hospital mortality of 30.7% (95%CI, 27.7-33.7), and for the external validation cohort (observed mortality: 27.1%) the value was 26.4% (95%CI, 22.2-30.5). CONCLUSIONS A predictive model of in-hospital mortality in left-sided IE based on the prognostic variables proposed by the European Society of Cardiology IE guidelines has high discriminatory ability.
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Affiliation(s)
- Pablo Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
| | - Fernando Domínguez
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Raquel Ladrón
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Carmen Olmos
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna, Hospital Universitario La Princesa, Madrid, Spain
| | - Silvia Vilches
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Daniel García-Arribas
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Marta Cobo-Marcos
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Antonio Ramos
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Luis Maroto
- Servicio de Cirugía Cardiaca, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Itziar Gómez
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Manuel Carrasco
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Pablo García-Pavía
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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11
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García-Granja PE, López J, Vilacosta I, Sarriá C, Domínguez F, Ladrón R, Olmos C, Sáez C, Vilches S, García-Arribas D, Cobo-Marcos M, Ramos A, Maroto L, Gómez I, Carrasco M, García-Pavía P, San Román JA. Modelo predictivo de mortalidad hospitalaria en endocarditis infecciosa izquierda. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Olmos C, Vilacosta I, López J, Sáez C, Anguita M, García-Granja PE, Sarriá C, Silva J, Álvarez-Álvarez B, Martínez-Monzonis MA, Castillo JC, Seijas J, López-Picado A, Peral V, Maroto L, San Román JA. Short-course antibiotic regimen compared to conventional antibiotic treatment for gram-positive cocci infective endocarditis: randomized clinical trial (SATIE). BMC Infect Dis 2020; 20:417. [PMID: 32546269 PMCID: PMC7298739 DOI: 10.1186/s12879-020-05132-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background Most serious complications of infective endocarditis (IE) appear in the so-called “critical phase” of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. Methods Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4–6 weeks). Sample: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. Intervention: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. Conclusions SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4–6 weeks). Trial registration ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019–003358-10.
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Affiliation(s)
- Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain.
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - Javier López
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Valladolid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | | | - Cristina Sarriá
- Servicio de Medicina Interna-Infecciosas, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Jacobo Silva
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Oviedo, Oviedo, Spain
| | - Belén Álvarez-Álvarez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - María Amparo Martínez-Monzonis
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Carlos Castillo
- Servicio de Cardiología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - José Seijas
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Amanda López-Picado
- Unidad de Investigación y Ensayos Clinicos. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Vicente Peral
- Servicio de Cardiología, Hospital Universitario de Son Espases, Palma de Mallorca, Spain
| | - Luis Maroto
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Prof. Martín Lagos s/n, 28040, Madrid, Spain
| | - J Alberto San Román
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), CIBERCV, Valladolid, Spain
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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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14
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García-Granja PE, López J, Vilacosta I, Sarriá C, Ladrón R, Olmos C, Saéz C, Gómez I, San Román JA. Surgery changes prognosis in infective endocarditis: The importance of post-surgical clinical evolution. Eur J Intern Med 2018; 55:52-56. [PMID: 29857978 DOI: 10.1016/j.ejim.2018.05.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Left-sided infective endocarditis (LSIE) bears a grim prognosis and surgery is needed in more than half of the patients to improve survival. Our hypothesis has been that clinical complications developing after surgery impact prognosis. METHODS Among 1075 consecutive episodes of LSIE, 654 (60.7%) underwent cardiac surgery. Of them, 41 patients (6.3%) died the same day of surgery, 112 (17.2%) died after the first day of surgery during hospital stay and 500 (76.5%) were successfully discharged. We compared the last two groups and performed a multivariable analysis of in-hospital mortality. RESULTS Age (OR 1.02, 95% CI 1.01-1.04), periannular complications (OR 1.9, 95% CI 1.2-3.2) renal failure after surgery (OR 2.4, 95% CI 1.3-4.4) but not before surgery, and septic shock after surgery (OR 9.6, 95% CI 5.4-17.1) but not before surgery are predictive of in-hospital death among LSIE patients who underwent cardiac surgery. CONCLUSION A thorough clinical assessment with prognostic purposes in infective endocarditis after surgery is mandatory. In-hospital mortality of patients with infective endocarditis who undergo surgery depends mainly on the clinical evolution after surgery.
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Affiliation(s)
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR). Hospital Clínico Universitario, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Raquel Ladrón
- Instituto de Ciencias del Corazón (ICICOR). Hospital Clínico Universitario, Valladolid, Spain
| | - Carmen Olmos
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Carmen Saéz
- Hospital Universitario La Princesa, Madrid, Spain
| | - Itziar Gómez
- Instituto de Ciencias del Corazón (ICICOR). Hospital Clínico Universitario, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR). Hospital Clínico Universitario, Valladolid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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15
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Wei XB, Chen XJ, Li YL, Huang JL, Chen XL, Yu DQ, Tan N, Liu YH, Chen JY, He PC. Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis. J Clin Lipidol 2017; 12:498-505. [PMID: 29339066 DOI: 10.1016/j.jacl.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE). OBJECTIVE The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients. METHODS Patients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes. RESULTS Of the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; P = .006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; P < .001). ApoA-I (area under the curve, 0.671; P < .001) and HDL-C (area under the curve, 0.672; P < .001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I <0.90 g/L and HDL-C <0.78 mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1 g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P = .023) and HDL-C (increments of 1 mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P = .015) were independently associated with long-term mortality. CONCLUSIONS ApoA-I and HDL-C were inversely associated with adverse IE prognosis.
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Affiliation(s)
- Xue-Biao Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Xiao-Jin Chen
- Department of Internal Medicine, Longnan Medicine Hospital, Ganzhou, China
| | - Yuan-Ling Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Xiao-Lan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China
| | - Yuan-Hui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
| | - Ji-Yan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
| | - Peng-Cheng He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China; Department of Cardiology, The Second People's Hospital of Nanhai District, Guangdong General Hospital's Nanhai Hospital, Foshan, China.
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16
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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: 141] [Impact Index Per Article: 20.1] [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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