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Dobreva-Yatseva B, Nikolov F, Raycheva R, Tokmakova M. Infective Endocarditis-Predictors of In-Hospital Mortality, 17 Years, Single-Center Experience in Bulgaria. Microorganisms 2024; 12:1919. [PMID: 39338593 PMCID: PMC11434097 DOI: 10.3390/microorganisms12091919] [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: 09/04/2024] [Revised: 09/16/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
Despite enormous developments in medicine, infective endocarditis (IE) remains an ongoing issue for physicians due to increased morbidity and persistently high mortality. Our goal was to assess clinical outcomes in patients with IE and identify determinants of in-hospital mortality. Material and methods: The analysis was retrospective, single-centered, and comprised 270 patients diagnosed with IE from 2005 to 2021 (median age 65 (51-74), male 177 (65.6%). Native IE (NVIE) was observed in 180 (66.7%), prosthetic IE (PVIE) in 88 (33.6%), and cardiac device-related IE (CDRIE) in 2 (0.7%), with non-survivors having much higher rates. Healthcare-associated IE (HAIE) was 72 (26.7%), Staphylococci were the most prevalent pathogen, and the proportion of Gram-negative bacteria (GNB) non-HACEK was significantly greater in non-survivors than survivors (11 (15%) vs. 9 (4.5%), p = 0.004). Overall, 54 (20%) patients underwent early surgery, with a significant difference between dead and alive patients (3 (4.5%) vs. 51 (25.1%, p = 0.000). The overall in-hospital mortality rate was 24.8% (67). Logistic regression was conducted on the total sample (n = 270) for the period 2005-2021, as well as the sub-periods 2005-2015 (n = 119) and 2016-2021 (n = 151), to identify any differences in the trend of IE. For the overall group, the presence of septic shock (OR-83.1; 95% CI (17.0-405.2), p = 0.000) and acute heart failure (OR-24.6; 95% CI (9.2-65.0), p = 0.000) increased the risk of mortality. Early surgery (OR-0.03, 95% CI (0.01-0.16), p = 0.000) and a low Charlson comorbidity index (OR-0.85, 95% CI (0.74-0.98, p = 0.026) also lower this risk. Between 2005 and 2015, the presence of septic shock (OR 76.5, 95% CI 7.11-823.4, p = 0.000), acute heart failure (OR-11.5, 95% CI 2.9-46.3, p = 0.001), and chronic heart failure (OR-1.3, 95% CI 1.1-1.8, p = 0.022) enhanced the likelihood of a fatal outcome. Low Charlson index comorbidity (CCI) lowered the risk (OR-0.7, 95% CI 0.5-0.95, p = 0.026). For the period 2016-2021, the variable with the major influence for the model is the failure to perform early surgery in indicated patients (OR-240, 95% CI 23.2-2483, p = 0.000) followed by a complication of acute heart failure (OR-72.2, 95% CI 7.5-693.6. p = 0.000), septic shock (OR-17.4, 95% CI 2.0-150.8, p = 0.010), previous stroke (OR-9.2, 95% CI 1.4-59.4, p = 0.020) and low ejection fraction (OR-1.1, 95% CI 1.0-1.2, p = 0.004). Conclusions: Knowing the predictors of mortality would change the therapeutic approach to be more aggressive, improving the short- and long-term prognosis of IE patients.
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Affiliation(s)
- Bistra Dobreva-Yatseva
- Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University-Plovdiv, UMBAL "St. Georgi" EAD, 4000 Plovdiv, Bulgaria
| | - Fedya Nikolov
- Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University-Plovdiv, UMBAL "St. Georgi" EAD, 4000 Plovdiv, Bulgaria
| | - Ralitsa Raycheva
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University-Plovdiv, 4000 Plovdiv, Bulgaria
| | - Mariya Tokmakova
- Section of Cardiology Cardiology Clinic, First Department of Internal Medicine, Faculty of Medicine, Medical University-Plovdiv, UMBAL "St. Georgi" EAD, 4000 Plovdiv, Bulgaria
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La Canna G, Torracca L, Barbone A, Scarfò I. Unexpected Infective Endocarditis: Towards a New Alert for Clinicians. J Clin Med 2024; 13:5058. [PMID: 39274271 PMCID: PMC11396651 DOI: 10.3390/jcm13175058] [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: 06/30/2024] [Revised: 08/17/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.
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Affiliation(s)
- Giovanni La Canna
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Lucia Torracca
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Alessandro Barbone
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Iside Scarfò
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
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Issa R, Chaaban N, Salahie A, Honnekeri B, Parizher G, Xu B. Infective Endocarditis in Patients with End-Stage Renal Disease on Dialysis: Epidemiology, Risk Factors, Diagnostic Challenges, and Management Approaches. Healthcare (Basel) 2024; 12:1631. [PMID: 39201188 PMCID: PMC11353797 DOI: 10.3390/healthcare12161631] [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: 07/14/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Infective endocarditis (IE) poses a significant clinical challenge, especially among patients with end-stage renal disease (ESRD) undergoing dialysis, and is associated with high morbidity and mortality rates. This review provides a contemporary discussion of the epidemiology, risk factors, diagnostic challenges, and management strategies for IE among ESRD patients, including a literature review of recent studies focused on this vulnerable population. The review highlights the multifactorial nature of IE risk in ESRD patients, emphasizing the roles of vascular access type, dialysis modality, and comorbid conditions. It also explores the diagnostic utility of different imaging modalities and the importance of a multidisciplinary approach in managing IE, including both medical and surgical interventions. The insights from this review aim to contribute to the improvement of patient outcomes through early recognition, appropriate antimicrobial therapy, and timely surgical intervention when necessary.
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Affiliation(s)
- Rochell Issa
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nourhan Chaaban
- Department of Cardiology, University of Toledo, Toledo, OH 43606, USA
| | - Abdullah Salahie
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bianca Honnekeri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gary Parizher
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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4
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Özcan G, Balkanay OO, Göksedef D, İpek G, Ömeroğlu SN. Late-Term Outcomes of Surgical Treatment of Infective Endocarditis. Surg Infect (Larchmt) 2024. [PMID: 38995890 DOI: 10.1089/sur.2024.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Background: This study aims to evaluate the long-term outcomes of surgical interventions in patients with infective endocarditis (IE) who underwent surgical treatment and to determine the treatment approach for new patients. Patients and Methods: We retrospectively examined the long-term results of patients who underwent surgical treatment for IE between 2007 and 2017. The evaluation included late-term outcomes of IE surgery, surgical procedures, complications, the postoperative period, and clinical findings. Results: The study included 20 patients (12 male, 8 female) with a mean age of 45.1 ± 17.25. The most common cardiac risk factors for endocarditis development were the presence of prosthetic valves and heart valve disease. In addition, non-cardiac risk factors included chronic renal failure, systemic lupus erythematosus, and pemphigus vulgaris. Preoperative and postoperative laboratory findings were compared with in terms of morbidity and mortality, revealing no significant differences. The most prevalent preoperative laboratory findings were anemia (100%), elevated CRP (100%), and leukocytosis (50%). Anemia persisted as the most common laboratory finding in the postoperative evaluation. Conclusion: Our study identified comorbid chronic medical conditions, neurological complications because of IE, postoperative impaired left ventricular function, and treatment strategies such as monotherapy as poor prognostic factors in patients who underwent surgical treatment for IE. The management of IE is observed to be complex in the presence of comorbidities and complications, adversely affecting both survival and quality of life.
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Affiliation(s)
- Gülşah Özcan
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ozan Onur Balkanay
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Deniz Göksedef
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gökhan İpek
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Suat Nail Ömeroğlu
- Department of Cardiovascular Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Reisinger M, Kachel M, George I. Emerging and Re-Emerging Pathogens in Valvular Infective Endocarditis: A Review. Pathogens 2024; 13:543. [PMID: 39057770 PMCID: PMC11279809 DOI: 10.3390/pathogens13070543] [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: 06/01/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Infective endocarditis (IE) is a microbial infection of the endocardial surface, most commonly affecting native and prosthetic valves of the heart. The epidemiology and etiology of the disease have evolved significantly over the last decades. With a growing elderly population, the incidence of degenerative valvopathies and the use of prosthetic heart valves have increased, becoming the most important predisposing risk factors. This change in the epidemiology has caused a shift in the underlying microbiology of the disease, with Staphylococci overtaking Streptococci as the main causative pathogens. Other rarer microbes, including Streptococcus agalactiae, Pseudomonas aeruginosa, Coxiella burnetti and Brucella, have also emerged or re-emerged. Valvular IE caused by these pathogens, especially Staphylococcus aureus, is often associated with a severe clinical course, leading to high rates of morbidity and mortality. Therefore, prompt diagnosis and management are crucial. Due to the high virulence of these pathogens and an increased incidence of antimicrobial resistances, surgical valve repair or replacement is often necessary. As the epidemiology and etiology of valvular IE continue to evolve, the diagnostic methods and therapies need to be progressively advanced to ensure satisfactory clinical outcomes.
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Affiliation(s)
- Maximilian Reisinger
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
| | - Mateusz Kachel
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
- Center for Cardiovascular Research and Development, American Heart of Poland, 40-028 Katowice, Poland
| | - Isaac George
- Division of Cardiac, Thoracic & Vascular Surgery, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA
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Petkovic A, Menkovic N, Petrovic O, Bilbija I, Nisevic M, Radovanovic NN, Stanisavljevic D, Putnik S, Maksimovic R, Ivanovic B. Imaging in Infective Endocarditis-Current Opinions and Trends in Cardiac Computed Tomography. Diagnostics (Basel) 2024; 14:1355. [PMID: 39001245 PMCID: PMC11241025 DOI: 10.3390/diagnostics14131355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
Infective endocarditis is a rare disease with an increasing incidence and an unaltered high mortality rate, despite medical development. Imaging plays an integrative part in the diagnosis of infective endocarditis, with echocardiography as the initial diagnostic test. Research data in the utility of cardiac computed tomography (CCT) in the diagnostic algorithm of IE are rising, which indicates its importance in detection of IE-related lesion along with the exclusion of coronary artery disease. The latest 2023 European Society of Cardiology Guidelines in the management of IE classified CCT as class of recommendation I and level of evidence B in detection of both valvular and paravalvular lesions in native and prosthetic valve endocarditis. This review article provides a comprehensive and contemporary review of the role of CCT in the diagnosis of IE, the optimization of acquisition protocols, the morphology characteristics of IE-related lesions, the published data of the diagnostic performance of CCT in comparison to echocardiography as the state-of-art method, as well as the limitations and future possibilities.
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Affiliation(s)
- Ana Petkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nemanja Menkovic
- Diagnostic Department of Center of Stereotaxic Radiosurgery, Clinic of Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Olga Petrovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
| | - Ilija Bilbija
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Nisevic
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Nikola N. Radovanovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Pacemaker Center, University Clinical Center of Serbia, School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Svetozar Putnik
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Department for Cardiac Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ruzica Maksimovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
- Center of Radiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | - Branislava Ivanovic
- Cardiology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (I.B.); (N.N.R.); (S.P.); (R.M.)
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7
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Pinto PHOM, Fae IG, Oliveira GB, Duque RAS, Oliveira MVM, Barbalho LSM, Parreiras AO, Gelape FA, Cambraia FSL, Costa GL, Diamante LC, Bráulio R, Gelape CL, Teixeira-Carvalho A, Ferrari TCA, Nunes MCP. Impact of Neurological Complications on Long-Term Outcomes in Patients with Infective Endocarditis. Trop Med Infect Dis 2024; 9:132. [PMID: 38922044 PMCID: PMC11209427 DOI: 10.3390/tropicalmed9060132] [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: 04/26/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Neurological complications are frequent during the active course of infective endocarditis (IE), and they are associated with high in-hospital mortality rates. However, limited data exist on the prognostic value of these complications for late outcomes. This study aimed to assess the long-term impact of neurological complications in patients surviving an IE episode. A total of 263 consecutive IE patients admitted to a tertiary care center between 2007 and 2022 were prospectively included. Neurological complications at admission included transient ischemic attack (TIA), ischemic stroke, hemorrhagic stroke, intracerebral abscess, and meningitis. The primary outcome was a composite of overall mortality or heart valve surgery. Of the patients, 34.2% died in the hospital, leaving 173 survivors for long-term follow-up. Over a median of 3.5 years, 29 patients died, and 13 (9%) underwent cardiac surgery, resulting in an overall adverse event rate of 30%. Neurological complications independently predicted long-term adverse outcomes (hazard ratio (HR) 2.237; 95% CI 1.006-4.976), after adjusting for age, chronic kidney disease (CKD), and heart failure (HF) development. In an IE patient cohort, neurological complications at admission, which is a complication directly related to the IE process, were independent predictors of long-term outcomes.
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Affiliation(s)
- Pedro Henrique Oliveira Murta Pinto
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (P.H.O.M.P.); (I.G.F.); (G.B.O.); (T.C.A.F.)
| | - Isabela Galizzi Fae
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (P.H.O.M.P.); (I.G.F.); (G.B.O.); (T.C.A.F.)
| | - Gustavo Brandão Oliveira
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (P.H.O.M.P.); (I.G.F.); (G.B.O.); (T.C.A.F.)
| | - Roni Arley Silva Duque
- Programa de Residência Médica em Cardiologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil;
| | - Mauricio Vitor Machado Oliveira
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Luan Salvador Machado Barbalho
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - André Oliveira Parreiras
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Fernanda Alves Gelape
- Faculdade de Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias, 275, Centro, Belo Horizonte 30130-110, Minas Gerais, Brazil;
| | - Fernanda Sophya Leite Cambraia
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Guilherme Lelis Costa
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Lucas Chaves Diamante
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Renato Bráulio
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (R.B.); (C.L.G.)
| | - Cláudio Léo Gelape
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (R.B.); (C.L.G.)
| | - Andréa Teixeira-Carvalho
- Fundação Oswaldo Cruz, Instituto René-Rachou, FIOCRUZ Minas, Laboratório de Biomarcadores de Diagnóstico e Monitoração, Avenida Augusto de Lima, 1715, Barro Preto, Belo Horizonte 30190-002, Minas Gerais, Brazil;
| | - Teresa Cristina Abreu Ferrari
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (P.H.O.M.P.); (I.G.F.); (G.B.O.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
| | - Maria Carmo Pereira Nunes
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (P.H.O.M.P.); (I.G.F.); (G.B.O.); (T.C.A.F.)
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte 30130-100, Minas Gerais, Brazil; (M.V.M.O.); (L.S.M.B.); (A.O.P.); (F.S.L.C.); (G.L.C.); (L.C.D.)
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8
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Becker JB, Moisés VA, Guerra-Martín MD, Barbosa DA. Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis. Infect Prev Pract 2024; 6:100343. [PMID: 38371885 PMCID: PMC10874726 DOI: 10.1016/j.infpip.2024.100343] [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: 09/13/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
Background The prevalence of healthcare-associated infective endocarditis in Brazil is poorly known. Aim To analyze the epidemiological, clinical and microbiological characteristics, and the prognosis of healthcare-associated infective endocarditis (HAIE) compared with community-acquired infective endocarditis (CIE) and identify the associated factors with hospital mortality. Method A historical cohort study was carried out, with a data collection period from January 2009 to December 2019 at the Federal University of São Paulo. Data were collected from medical records of patients with infective endocarditis (IE) hospitalized during the study period. Patients were classified into three groups: CIE, non-nosocomial HAIE (NN-HAIE) and nosocomial HAIE (NHAIE). Results A total of 204 patients with IE were included; of these, 127 (62.3%) were cases of HAIE, of which 83 (40.7%) were NN-HAIE and 44 (21.6%) were NHAIE. Staphylococcus spp. Were the main causative agents, especially in HAIE groups (P<0.001). Streptococcus spp. were more prevalent in the CIE group (P<0.001). In-hospital mortality was 44.6%, with no differences between groups. Independent risk factors for in-hospital mortality were age ≥ 60 years (odds ratio (OR): 6.742), septic shock (OR 5.264), stroke (OR 3.576), heart failure (OR 7.296), and Intensive Care Unit admission (OR 7.768). Conclusion HAIE accounted for most cases in this cohort, with a higher prevalence of non-nosocomial infections. Staphylococcus spp. were the main causative agents. Hospital mortality was high, 44.6%, with no difference between groups.
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Affiliation(s)
| | | | | | - Dulce Aparecida Barbosa
- Federal University of São Paulo, Nursing School, Clinical and Surgical Nursing Department, Brazil
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Zolfaghari F, Peighambari MM, Kohansal E, Sadeghpour A, Moradnejad P, Shafii Z. Comparative analysis of infective endocarditis in hemodialysis versus non-hemodialysis patients in Iran: implications for clinical practice and future research. BMC Cardiovasc Disord 2024; 24:8. [PMID: 38166765 PMCID: PMC10763015 DOI: 10.1186/s12872-023-03675-0] [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: 10/09/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In hemodialysis (HD) patients, there is a larger frequency of mortality and morbidity associated with infective endocarditis (IE) as opposed to the general population. Despite the increased burden of IE in the HD population, optimal strategies for prevention and management still need to be clarified. Elucidating the distinguishing features and outcomes of IE in HD patients is crucial to guide clinical decision-making and improve prognosis in this high-risk group. However, the details of IE characteristics, specifically in HD patients in the Middle East, are limited. OBJECTIVE To compare the clinical characteristics and short-term outcomes of IE between HD and non-HD patients. METHODS A retrospective analysis was carried out on 139 patients with infective endocarditis who were referred to a tertiary cardiovascular center in Iran from 2006 to 2018. The participants were split into HD (n = 34) and non-HD (n = 105) groups. Data pertaining to demographic characteristics, comorbidities, microbiological findings, occurrence of complications, therapeutic interventions, and mortality rates during hospital stay were gathered. RESULTS Diabetes, hypertension, and congestive heart failure were observed more frequently in HD patients. HD patients were more likely than non-HD patients to have involvement of the right valve (41.2% vs. 20.9%), larger vegetation, and extracardiac emboli. In-hospital mortality was 41.2% for HD patients versus 14.3% for non-HD patients. Mortality remained high after valve surgery in HD patients (38.2% vs. 10.5% in non-HD). CONCLUSION HD patients exhibited a distinct clinical profile of IE with worse short-term outcomes, including higher mortality.
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Affiliation(s)
- Fereshteh Zolfaghari
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | - Mohammad Mehdi Peighambari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, University of Medical Sciences, Tehran, Iran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | | | - Pardis Moradnejad
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran
| | - Zahra Shafii
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali- Asr Ave, Tehran, 1995614331, Iran.
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Bravo Thompson HA, Campos Herrera FA, Macías Ibiricu DA, Rodríguez Barrios SI, Vázquez Acevedo DI, Candanedo Gonzalez CA, López G, Gollini R. Factors Related to the Development of Infective Endocarditis in Hemodialysis Patients in a Third-Level Hospital in Panama. Cureus 2024; 16:e52385. [PMID: 38361669 PMCID: PMC10868654 DOI: 10.7759/cureus.52385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Venous access for hemodialysis (HD) makes patients more susceptible to transient bacteremia, predisposing them to the development of infective endocarditis (IE). Among the risk factors observed in this population are temporary access to HD, hypoalbuminemia, diabetes mellitus, female gender, anemia, and colonization by methicillin-resistant Staphylococcus aureus (MRSA). METHODOLOGY A retrospective case-control study with a one-to-two ratio was carried out on patients with chronic kidney disease (CKD) undergoing renal replacement therapy with at least one vascular access for HD at Complejo Hospitalario Dr. Arnulfo Arias Madrid (CHDrAAM) from 2010 to 2020. Sociodemographic variables, past medical history, and data on current HD were studied. The odds ratio (OR) and adjusted odds ratio (aOR) were calculated for the collected variables. RESULTS No statistically significant differences between the groups were observed in sociodemographic variables. In terms of past medical history, the cases showed a predominance of coronary disease (47.6% vs 4.8%; OR: 37.27), valvular disease (23.8% vs 0%), and heart failure (33.3% vs 4.8%; OR: 10). In the cases, the use of a temporary catheter was more prevalent (61.9% vs 33.3%; OR: 3.25), and subclavian access was more frequently recorded (28.6% vs 2.4%; OR: 14.4). A short duration of venous access (<30 days) was found in a greater proportion of cases (23.8% vs 4.8%; OR: 6.25). The main pathogen isolated was S. aureus (33.3%), and the most affected valve was the aortic valve (59.1%). Fever was found in 100% of the reported cases, and up to 47.6% presented with a recent murmur. DISCUSSION Similar to previous studies conducted in other countries, we identified a history of pre-existing valve disease, the use of a temporary catheter, and recent venous access as risk factors. Contrary to what has been reported in the literature, this study did not find female sex, diabetes mellitus, and hypoalbuminemia as risks. CONCLUSION Factors such as a history of coronary artery disease, heart failure, preexisting valvular disease, the use of a temporary catheter, subclavian venous access, and short duration of venous access (<30 days) were identified as risk factors for the development of IE in patients with CKD on HD.
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Affiliation(s)
- Harold A Bravo Thompson
- Internal Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | | | | | | | | | | | - Grisel López
- Medicine, University of Panama, Panama City, PAN
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Cao C, Herath J. Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium. Acad Forensic Pathol 2023; 13:101-109. [PMID: 38298547 PMCID: PMC10825462 DOI: 10.1177/19253621231214442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/22/2023] [Indexed: 02/02/2024]
Abstract
Introduction Infective endocarditis (IE) is an infectious disorder of the innermost lining of the heart that can be fatal if left untreated. Infective endocarditis can spread beyond the endocardium into the myocardium and cause arrhythmias and myocardial wall rupture. Individuals with a history of intravenous drug use are at increased risk of developing IE and are at higher risk of dying, given their limited access to health care and adherence to treatment. Methods A medicolegal autopsy was performed on a 30-year-old woman with a history of intravenous drug use and recent assault after a hospital admission during which she did not survive resuscitation. Results The cause of death was found to be myocardial rupture in the setting of transmural IE. Postmortem imaging showed hemopericardium which was identified grossly with valvular vegetations in the heart. A ventricular wall defect along with transmural abscess formation was identified. Perimortem toxicology was positive for fentanyl, methamphetamine, and benzoylecgonine, a metabolite of cocaine. Postmortem blood cultures were positive for coagulase-negative Staphylococci, Staphylococcus aureus, Candida tropicalis, and Viridians group Streptococci. Postmortem tissue cultures taken from the heart was positive for Candida glabrata and Streptococcus mitis. Discussion The decedent had significant risk factors for IE, such as intravenous drug use and a prior admission to hospital for IE. The organisms identified on culture are in-keeping with the gross findings of IE and the terminal event of myocardial rupture was likely the result of tissue damage resulting from IE.
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Affiliation(s)
- Cathy Cao
- Cathy Cao, MD, MSc, Ontario Forensic
Pathology Service & Department of Laboratory Medicine and Pathobiology,
University of Toronto, Toronto, Ontario, Canada,
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12
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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: 259] [Impact Index Per Article: 259.0] [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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13
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Stahl A, Havers-Borgersen E, Østergaard L, Petersen JK, Bruun NE, Weeke PE, Kristensen SL, Voldstedlund M, Køber L, Fosbøl EL. Hemodialysis and its impact on patient characteristics, microbiology, cardiac surgery, and mortality in infective endocarditis. Am Heart J 2023; 264:106-113. [PMID: 37271357 DOI: 10.1016/j.ahj.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Patients with chronic renal failure on hemodialysis carry a significant risk of infective endocarditis (IE), but data on whether these patients differ from other patients with IE in terms of comorbidity, microbiology, rates of surgery and mortality are sparse. METHODS Using Danish nationwide registries, all patients with IE diagnosed between February 1, 2010, and May 14, 2018 were identified and categorized into a "hemodialysis group" and a "non-hemodialysis group." Patient groups were compared by comorbidities, microbiological etiology, cardiac surgery, and mortality. Risk factors associated with mortality were assessed in multivariable Cox regression analysis. RESULTS In total, 4,366 patients with IE were included with 226 (5.2%) patients in the hemodialysis group. Patients in the hemodialysis group were younger (66.0 years [IQR 53.8-74.9] vs 72.2 years [IQR 62.2-80.0]), had more comorbidities and were surgically treated less often (10.6% vs 20.8%), compared with patients from the nonhemodialysis group. Staphylococcus aureus was more than twice as prevalent (58.0% vs 26.5%). No difference in in-hospital mortality was found between the 2 groups (20.8% vs 18.5%), but 1- and 5-year mortality were significantly higher in the hemodialysis group than in the nonhemodialysis group (37.7% vs 17.7% and 72.1% vs 42.5%, respectively). In adjusted analysis, hemodialysis was associated with higher 1-year (HR = 2.71, 95% CI 2.07-3.55) and 5-year mortality (HR = 2.72, 95% CI 2.22-3.34) CONCLUSIONS: Patients with IE on chronic hemodialysis were younger, had more comorbidity, a higher prevalence of Staphylococcus aureus IE, and a higher mortality than patients without hemodialysis.
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Affiliation(s)
- Anna Stahl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | | | - Lauge Østergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jeppe K Petersen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Peter E Weeke
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Søren L Kristensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institute, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
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14
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Wang Q, Qiu J, Huang JL, Jiang M, Lu JQ, Wu D, Wei XB, Yu DQ. Prognostic Value of Blood Urea Nitrogen for Short-Term Mortality in Patients with Infective Endocarditis. Infect Dis Ther 2023; 12:2353-2366. [PMID: 37751020 PMCID: PMC10600074 DOI: 10.1007/s40121-023-00867-1] [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: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Blood urea nitrogen (BUN) is a metabolic product validated to be an independent risk factor in the prognosis of several diseases. However, the prognostic value of BUN in patients with infective endocarditis (IE) remains unevaluated. METHODS A total of 1371 patients with a diagnosis of IE were included and divided into four groups according to BUN (mmol/L) at admission: < 3.5 (n = 343), 3.5-4.8 (n = 343), 4.8-6.8 (n = 341), and ≥ 6.8 (n = 344). Restricted cubic spline was used to assess the association of BUN with in-hospital mortality. Multivariate analysis was performed to identify the independent risk factors for adverse outcomes. RESULTS The in-hospital mortality reached 7.4%, while the 6-month mortality was 9.8%. The restricted cubic spline plot exhibited an approximately linear relationship between BUN and in-hospital mortality. Receiver operating characteristics curve analysis showed that the optimal cut-off of BUN for predicting in-hospital death was 6.8 mmol/L. Kaplan-Meier analysis showed that patients with BUN > 6.8 mmol/L had a higher 6-month mortality than other groups (log rank = 97.9, P < 0.001). Multivariate analysis indicated that BUN > 6.8 mmol/L was an independent predictor indicator for both in-hospital [adjusted odds ratio (aOR) = 2.365, 95% confidence interval (CI) 1.292-4.328, P = 0.005] and 6-month mortality [adjusted hazard ratio (aHR) = 2.171, 95% CI 1.355-3.479, P = 0.001]. CONCLUSIONS BUN is suitable for independently predicting short-term mortality in patients with IE.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jia Qiu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Mei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jun-Quan Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Di Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Xue-Biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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15
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Haddad SF, Lahr BD, Patarroyo SS, Chesdachai S, Kies KD, O’Horo JC, DeSimone DC, Sendi P, Baddour LM. Bloodstream Infection Due to Coagulase-Negative Staphylococci: Impact of Species on Prevalence of Infective Endocarditis. Antibiotics (Basel) 2023; 12:1453. [PMID: 37760749 PMCID: PMC10525567 DOI: 10.3390/antibiotics12091453] [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: 08/10/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Coagulase-negative staphylococci (CoNS) are an important group of organisms that can cause bloodstream infection (BSI) and infective endocarditis (IE). The prevalence of IE in patients with BSI due to different CoNS species, however, has received limited attention; (2) Methods: A retrospective study of adults with monomicrobial CoNS BSI who had undergone echocardiography and a risk factor analysis was done to determine the most common CoNS species that cause definite IE; (3) Results: 247 patients with CoNS BSI were included in the investigation; 49 (19.8%) had definite IE, 124 (50.2%) possible IE, and 74 (30.0%) BSI only. The latter two entities were grouped in one category for further analysis. The most common species in CoNS BSI was Staphylococcus epidermidis (79.4%) and most patients (83.2%) had possible IE/BSI only. 59.1% of patients with BSI due to S. lugdunensis had definite IE. The majority of CoNS were healthcare-associated/nosocomial bacteremia. Multivariable analysis demonstrated that valve disease (p = 0.002) and a foreign cardiovascular material (p < 0.001) were risk factors associated with definite IE. Patients with S. lugdunensis BSI had an 8-fold higher risk of definite IE than did those with S. epidermidis BSI and nearly a 13-fold higher risk than did patients with BSI due to other species of CoNS (p = 0.002); (4) Conclusions: The prevalence of definite IE in patients with BSI due to different CoNS species was significant. CoNS bacteremia, particularly with S. lugdunensis, confers a significant risk of IE, particularly in patients with a valve disease or intravascular foreign body material and should not be immediately dismissed as a contaminant.
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Affiliation(s)
- Sara F. Haddad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
| | - Brian D. Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Sebastian Santos Patarroyo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
| | - Kami D. Kies
- Clinical Microbiology Core Laboratory, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA;
| | - John C. O’Horo
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel C. DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, 3001 Bern, Switzerland
| | - Larry M. Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA; (S.S.P.)
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA
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Elderia A, Kiehn E, Djordjevic I, Gerfer S, Eghbalzadeh K, Gaisendrees C, Deppe AC, Kuhn E, Wahlers T, Weber C. Impact of Chronic Kidney Disease and Dialysis on Outcome after Surgery for Infective Endocarditis. J Clin Med 2023; 12:5948. [PMID: 37762889 PMCID: PMC10532068 DOI: 10.3390/jcm12185948] [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: 08/02/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) carries a heavy burden of morbidity and mortality in chronic kidney disease (CKD) and hemodialysis (HD) patients. We investigated the risk factors, pathognomonic profile and outcomes of surgically treated IE in CKD and HD patients. We preoperatively identified patients with CKD under hemodialysis (HD group) and compared them with patients without hemodialysis (Non-HD group). Furthermore, we divided the cohort into four groups according to the underlying stage of CKD, with a subsequent outcome analysis. Between 2009 and 2018, 534 Non-HD and 58 HD patients underwent surgery for IE at our institution. The median age was 65.1 [50.6-73.6] and 63.2 [53.4-72.8] years in the Non-HD and HD groups, respectively (p = 0.861). The median EuroSCORE II was 8.0 [5.0-10.0] vs. 9.5 [7.0-12.0] in the Non-HD vs. HD groups (p = 0.004). Patients without CKD had a mortality rate of 5.6% at 30 days and 15.5% at 1 year. Mortality rates proportionally rose with the severity of CKD. Among HD patients, 30-day and 1-year mortality rates were 38.1% and 75.6%, respectively (p < 0.001). Staphylococcus aureus IE was significantly more frequent in the HD group (p = 0.006). In conclusion, outcomes after surgery for IE correlated with the severity of the underlying CKD, with HD patients exhibiting the most unfavorable results. Pre-existing CKD and staphylococcus aureus infection were independent risk factors for 1-year mortality.
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Affiliation(s)
- Ahmed Elderia
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany; (E.K.); (I.D.); (S.G.); (K.E.); (C.G.); (A.-C.D.); (E.K.); (T.W.)
| | | | | | | | | | | | | | | | | | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany; (E.K.); (I.D.); (S.G.); (K.E.); (C.G.); (A.-C.D.); (E.K.); (T.W.)
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Alonso-Menchén D, Bouza E, Valerio M, de Alarcón A, Gutiérrez-Carretero E, Miró JM, Goenaga-Sánchez MÁ, Plata-Ciézar A, González-Rico C, López-Cortés LE, Rodríguez Esteban MÁ, Martínez-Marcos FJ, Muñoz P. Non-nosocomial Healthcare-Associated Infective Endocarditis: A Distinct Entity? Data From the GAMES Series (2008-2021). Open Forum Infect Dis 2023; 10:ofad393. [PMID: 37564744 PMCID: PMC10411035 DOI: 10.1093/ofid/ofad393] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Indexed: 08/12/2023] Open
Abstract
Background Patients who acquire infective endocarditis (IE) following contact with the healthcare system, but outside the hospital, are classified as having non-nosocomial healthcare-associated IE (HCIE). Our aim was to characterize HCIE and establish whether its etiology, diagnosis, and therapeutic approach suggest it should be considered a distinct entity. Methods This study retrospectively analyzes data from a nationwide, multicenter, prospective cohort including consecutive cases of IE at 45 hospitals across Spain from 2008 to 2021. HCIE was defined as IE detected in patients in close contact with the healthcare system (eg, patients receiving intravenous treatment, hemodialysis, or institutionalized). The prevalence and main characteristics of HCIE were examined and compared with those of community-acquired IE (CIE) and nosocomial IE (NIE) and with literature data. Results IE was diagnosed in 4520 cases, of which 2854 (63%) were classified as CIE, 1209 (27%) as NIE, and 457 (10%) as HCIE. Patients with HCIE showed a high burden of comorbidities, a high presence of intravascular catheters, and a predominant staphylococcal etiology, Staphylococcus aureus being identified as the most frequent causative agent (35%). They also experienced more persistent bacteremia, underwent fewer surgeries, and showed a higher mortality rate than those with CIE (32.4% vs 22.6%). However, mortality in this group was similar to that recorded for NIE (32.4% vs 34.9%, respectively, P = .40). Conclusions Our data do not support considering HCIE as a distinct entity. HCIE affects a substantial number of patients, is associated with a high mortality, and shares many characteristics with NIE.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Respiratorias (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville, University of Seville/CSIC (Consejo Superior de Investigaciones Científicas), Seville, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Service, University Hospital Virgen del Rocío, Institute of Biomedicine of Seville, University of Seville/CSIC(Consejo Superior de Investigaciones Científicas), Seville, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - José M Miró
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases Service, Hospital Clínic–IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), University of Barcelona, Barcelona, Spain
| | | | - Antonio Plata-Ciézar
- Servicio de Enfermedades Infecciosas Hospital Regional Universitario de Málaga, IBIMA (Instituto de Investigación Biomédica de Málaga), Málaga, Spain
| | - Claudia González-Rico
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla–IDIVAL (Instituto de Investigación Marqués de Valdecilla), Santander, Spain
| | - Luis Eduardo López-Cortés
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena, Institute of Biomedicine of Seville, University of Seville/CSIC (Consejo Superior de Investigaciones Científicas), Seville, Spain
| | | | | | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Medicine Department, Universidad Complutense de Madrid, Madrid, Spain
- CIBER (Centro de Investigación Biomédica en Red) de Enfermedades Respiratorias (CB06/06/0058), Instituto de Salud Carlos III, Madrid, Spain
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Mousa A, Ghazy A, Kakhktsyan T, Chepenko K, Young K. Staphylococcus lugdunensis Infective Endocarditis With Mitral Valve Vegetations in a Hemodialysis Patient With Recurrent Arteriovenous Fistula Cannulation: A Case Report. Cureus 2023; 15:e39853. [PMID: 37404404 PMCID: PMC10314977 DOI: 10.7759/cureus.39853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Infective endocarditis is a severe medical condition that occurs when the endocardium of the heart gets infected by different microorganisms, including coagulase-negative staphylococci such as Staphylococcus lugdunensis. The source of infection is often related to procedures done in the groin area, such as femoral catheterization for cardiac catheterization, vasectomy, or central line placement in an already infected mitral or aortic valve. Herein, we are discussing a case of a 55-year-old female with a past medical history of end-stage renal disease on hemodialysis with a history of recurrent cannulation of her arteriovenous (AV) fistula. She presented with fever, myalgia, and generalized weakness, and was later found to have Staphylococcus lugdunensis bacteremia and infective endocarditis with mitral valve vegetations, for which the patient was transferred to the mitral valve specialized center for mitral valve replacement. This case acts as a reminder to consider recurrent cannulation of the AV fistula as one of the potential ports of entry of Staphylococcus lugdunensis to the body.
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Affiliation(s)
- Aliaa Mousa
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Ahmed Ghazy
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Tigran Kakhktsyan
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Kateryna Chepenko
- Internal Medicine, Capital Health Regional Medical Center, Trenton, USA
| | - Kristopher Young
- Cardiology, Capital Health Regional Medical Center, Trenton, USA
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19
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He YJ, Ye CS, Xu KY, Yang LL, Wang KL, Wang XM, Li MY, Wu Y, Ying QS, Wang M, Quan SJ, Yang X. Risk factors and survival analysis of haemodialysis complicated with infective endocarditis. Exp Ther Med 2023; 25:203. [PMID: 37090071 PMCID: PMC10119664 DOI: 10.3892/etm.2023.11902] [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: 09/20/2022] [Accepted: 02/22/2023] [Indexed: 04/25/2023] Open
Abstract
The clinical features and risk factors for survival time were analysed in haemodialysis patients complicated with infective endocarditis. A total of 101 infective endocarditis (IE) patients treated at Hangzhou First People's Hospital, from January 1, 2012, to April 1, 2022, were included in the present study. Baseline demographic data and laboratory data were collected for statistical analysis of risk factors and survival time in the IE with haemodialysis group (HD-IE group, n=15) and the IE without haemodialysis group (NHD-IE group, n=86). Haemoglobin, red blood cells, C-reactive protein, procalcitonin, serum albumin, diabetes, invasive procedures, positive blood bacteria culture, heart valve calcification ratio, and left ventricular ejection fraction level were risk factors for infective endocarditis complicated with haemodialysis (P<0.05). Compared with the NHD-IE group, the HD-IE group had an obviously increased risk of mortality (χ2=6.323, P=0.012). The univariate Cox regression analysis showed that age, haemoglobin, red blood cells, serum albumin, left ventricular ejection score, longest vegetation diameter, combined hypotension and diabetes were risk factors for death; furthermore, multivariate Cox regression showed that age (HR=1.187, P=0.015), combined hypotension (HR=0.921, P=0.025) and the longest vegetation diameter (HR=9.191, P=0.004) were independent risk factors affecting the survival of patients. Collectively, the present study revealed that the mortality rate of HD-IE patients was higher than that of NHD-IE patients. Older age, hypotension, and the longest vegetation diameter were independent risk factors affecting the survival of patients. For HD-IE patients, active and effective antibiotic treatment or surgical treatment should be strongly recommended.
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Affiliation(s)
- Ya-Jing He
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Cun-Si Ye
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 529000, P.R. China
| | - Ke-Yang Xu
- Centre for Cancer and Inflammation Research, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong 999077, SAR, P.R. China
| | - Li-Li Yang
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Kai-Le Wang
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Xiao-Mei Wang
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Mei-Yu Li
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Yu Wu
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Qi-Su Ying
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Ming Wang
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
| | - Shi-Jian Quan
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 529000, P.R. China
- Correspondence to: Dr Xiu Yang, Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, P.R. China
| | - Xiu Yang
- Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, P.R. China
- Correspondence to: Dr Xiu Yang, Department of Nephrology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, Zhejiang 310006, P.R. China
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20
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Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [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: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
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Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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21
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Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, Tattevin P, Olaison L, Freiberger T, Hurley J, Hannan MM, Chu V, Hoen B, Moreno A, Cuervo G, Llopis J, Miró JM. Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12:1083-1101. [PMID: 36922460 PMCID: PMC10147876 DOI: 10.1007/s40121-023-00763-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. METHODS The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. RESULTS IE cases from 13 European countries were included. Two periods were considered: 2000-2006 and 2008-2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern-Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49-74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p < 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. CONCLUSIONS Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Freiberger
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - John Hurley
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Margaret M Hannan
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Vivian Chu
- Duke University School of Medicine, Durham, NC, USA
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, University of Lorraine Medical Center at Nancy, EA 4364 APEMAC, University of Lorraine, Nancy, France
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Jaume Llopis
- Biostatistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
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22
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Ostovar R, Schroeter F, Erb M, Kuehnel RU, Hartrumpf M, Albes JM. Endocarditis: Who Is Particularly at Risk and Why? Ten Years Analysis of Risk Factors for In-hospital Mortality in Infective Endocarditis. Thorac Cardiovasc Surg 2023; 71:12-21. [PMID: 35785809 DOI: 10.1055/s-0042-1748950] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Endocarditis is continuously increasing. Evidence exist that the prognosis is adversely affected by the extent of the disease. We looked at risk factors influencing in-hospital mortality (HM). PATIENTS AND METHODS Between 2010 and 2019, 484 patients, 338 males (69.8%) with mean age of 66.1 years were operated on because of proven endocarditis. In a retrospective study, a risk factor analysis was performed. RESULTS Overall HM was 30.17%. Significant influencing factors (odds ratios [ORs] or p-value) for HM were: age (p = 0.004), logistic EuroSCORE (p< 0.001), gender (OR = 1.64), dialysis (OR = 2.64), hepatic insufficiency (OR = 2.17), reoperation (OR = 1.77), previously implanted valve (OR = 1.97), periannular abscess (OR = 9.26), sepsis on admission (OR = 12.88), and number of involved valves (OR = 1.96). Development of a sepsis and HM was significantly lower if Streptococcus mitis was the main pathogen in contrast to other bacteria (p< 0.001). Staphylococcus aureus was significantly more often found in patients with a previously implanted prosthesis (p = 0.03) and in recurrent endocarditis (p = 0.02), while it significantly more often showed peripheral septic emboli than the other pathogens (p< 0.001). CONCLUSION Endocarditis remains life-threatening. Severe comorbidities adversely affected early outcome, particularly, in presence of periannular abscesses. Patients with suspected endocarditis should be admitted to a specialized heart center as early as possible. Streptococcus mitis appears to be less virulent than S. aureus. Further studies are required to verify these findings.
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Affiliation(s)
- Roya Ostovar
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Filip Schroeter
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Michael Erb
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Ralf-Uwe Kuehnel
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Martin Hartrumpf
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Johannes M Albes
- Department of Cardiovascular Surgery, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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23
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Kunz M, Götzinger F, Emrich I, Schwenger V, Böhm M, Mahfoud F. Cardio-renal interaction - Clinical trials update 2022. Nutr Metab Cardiovasc Dis 2022; 32:2451-2458. [PMID: 36064690 DOI: 10.1016/j.numecd.2022.07.002] [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: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 10/31/2022]
Abstract
AIMS Chronic kidney disease is a common cardiovascular risk indicator and strongly associated with increased morbidity and mortality. The heart and kidneys are pathophysiologically closely connected, which becomes particularly obvious in patients with cardiorenal syndrome. This review summarizes clinically relevant studies on the cardio-renal interaction published in 2021 and 2022. DATA SYNTHESIS Selected trials published in high-impact journals were chosen from the database Pubmed and included in this review. New evidence about the selective mineralocorticoid receptor antagonist finerenone and the renoprotective sodium-glucose co-transporter-2-inhibitors (SGLT2-Inhibitors) are discussed and we update on novel insights about the treatment of arterial hypertension in patients with severe chronic kidney disease with the thiazide-like diuretic chlorthalidone. Finally, data on infective endocarditis in patients on chronic hemodialysis and the treatment of secondary hyperparathyroidism with the calcimimetic drug etelcalcetide in patients with end stage kidney disease are critically reviewed. CONCLUSION Several important studies investigating cardio-renal interactions were recently published may affect clinical practice. The graphical abstract (Fig. 1) depicts the most relevant clinical studies investigating cardio-renal interactions.
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Affiliation(s)
- Michael Kunz
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, 66424 Homburg, Germany.
| | - Felix Götzinger
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, 66424 Homburg, Germany
| | - Insa Emrich
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, 66424 Homburg, Germany
| | - Vedat Schwenger
- Department of Nephrology, Klinikum der Landeshauptstadt Stuttgart gKAöR - Katharinenhospital, 70174 Stuttgart, Germany
| | - Michael Böhm
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, 66424 Homburg, Germany
| | - Felix Mahfoud
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland, Saarland University, 66424 Homburg, Germany
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24
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Musci T, Grubitzsch H. Healthcare-Associated Infective Endocarditis—Surgical Perspectives. J Clin Med 2022; 11:jcm11174957. [PMID: 36078887 PMCID: PMC9457102 DOI: 10.3390/jcm11174957] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022] Open
Abstract
Health-care-associated infective endocarditis (HCA-IE), a disease with a poor prognosis, has become increasingly important. As surgical treatment is frequently required, this review aims to outline surgical perspectives on HCA-IE. We searched PubMed to identify publications from January 1980 to March 2022. Reports were evaluated by the authors against a priori inclusion/exclusion criteria. Studies reporting on surgical treatment of HCA-IE including outcome were selected. Currently, HCA-IE accounts for up to 47% of IE cases. Advanced age, cardiac implants, and comorbidity are important predispositions, and intravascular catheters or frequent vascular access are significant sources of infection. Staphylococci and enterococci are the leading causative microorganisms. Surgery, although frequently indicated, is rejected in 24–69% because of prohibitive risk. In-hospital mortality is significant after surgery (29–50%) but highest in patients rejected for operation (52–83%). Furthermore, the length of hospital stay is prolonged. With aging populations, age-dependent morbidity, increasing use of cardiac implants, and growing healthcare utilization, HCA-IE is anticipated to gain further importance. A better understanding of pathogenesis, clinical profile, and outcomes is paramount. Further research on surgical treatment is needed to provide more comprehensive information for defining the most suitable treatment option, finding the optimal time for surgery, and reducing morbidity and mortality.
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25
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Ting SW, Chen JJ, Lee TH, Kuo G. Surgical versus medical treatment for infective endocarditis in patients on dialysis: a systematic review and meta-analysis. Ren Fail 2022; 44:706-713. [PMID: 35450507 PMCID: PMC9037223 DOI: 10.1080/0886022x.2022.2064756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infective endocarditis (IE) is a serious infection and causes significant morbidity and mortality. However, the benefit of surgery for endocarditis besides antibiotic treatment in dialysis patients remains controversial. We performed a systematic review of studies published between 1960 and February 2022. Meta-analysis was conducted with a random-effects model to explore the in-hospital, 30, 60, 90, 180-d, and 1-year mortality rates in adult dialysis patients with IE. Sensitivity analysis, subgroup analysis, and meta-regression were performed to explore potential sources of heterogeneity. Confidence of evidence was evaluated by the GRADE system. Thirteen studies were included. The pooled odds ratio of in-hospital mortality was 0.62 (95% confidence interval [CI]: 0.30–1.28, p = .17), with moderate heterogeneity (I2 = 62%, p < .01). Three studies reported 30-d mortality, and the pooled odds ratio for surgery compared with medical treatment was even lower (0.36; 95% CI: 0.22–0.61, p < .01), with low heterogeneity (I2 = 0%, p = .86). With studies on fewer than 30 patients excluded, the sensitivity analysis revealed a low odds ratio of in-hospital mortality for surgery versus medical treatment (0.52; 95% CI: 0.27–0.99, p = .047), with moderate heterogeneity (I2 = 63%, p < .01). Subgroup analysis revealed no significant differences between any two comparator subgroups. Based on a very low strength of evidence, compared with medical treatment, surgical treatment for IE in patients on dialysis is not associated with lower in-hospital mortality. When studies on fewer than 30 patients were excluded, surgical treatment was associated with better survival.
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Affiliation(s)
- Sze-Wen Ting
- Department of Dermatology, New Taipei City Municipal Tucheng Hospital, New Taipei City, ROC
| | - Jia-Jin Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC
| | - Tao-Han Lee
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC.,Department of Nephrology, New Taipei City Municipal Tucheng Hospital, New Taipei City, ROC
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC
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26
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Yang X, Chen H, Zhang D, Shen L, An G, Zhao S. Global magnitude and temporal trend of infective endocarditis, 1990-2019: results from the Global Burden of Disease Study. Eur J Prev Cardiol 2021; 29:1277-1286. [PMID: 34739047 DOI: 10.1093/eurjpc/zwab184] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/01/2021] [Indexed: 12/17/2022]
Abstract
AIMS To estimate the spatiotemporal patterns in infective endocarditis (IE) burden along with its attributable risk factors at the national, regional, and global levels, which is essential to optimize the targeted prevention, clinical practice, and research. METHODS AND RESULTS Based on all available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of IE in 204 countries and regions from 1990 to 2019 were reconstructed by Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We depicted the epidemiological characteristics of IE in detail by gender, region, and age. Globally, 1 090 527 incident cases, 66 322 deaths, and 1 723 594 DALYs of IE were estimated in 2019. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) increased from 9.91 and 0.73 to 13.80 and 0.87 per 100 000 person-years over the past 30 years, respectively. ASIR were consistently more pronounced in higher socio-demographic index (SDI) regions. The leading ASMR in 2019 appeared in the High SDI region, with the largest increase in the past three decades. The age-specific burden rate of IE among people over 25 years old usually increased with age, and the annual increasing trend was more obvious for people over 60 years of age, especially in higher SDI regions. CONCLUSION The incidence and mortality of IE have continued to rise in the past 30 years, especially in higher SDI regions. The patient population was gradually shifting from the young to the elderly.
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Affiliation(s)
- Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Hui Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Clinical Research Center of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Dandan Zhang
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Lin Shen
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Guipeng An
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Department of Cardiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
| | - Shaohua Zhao
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China.,Key Laboratory of Cardiovascular Proteomics of Shandong Province, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, Shandong 250012, China
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27
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Dialysis and Endocarditis: Proving What We Know, Learning What We Didn't. J Am Coll Cardiol 2021; 77:1641-1643. [PMID: 33795038 DOI: 10.1016/j.jacc.2021.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 02/12/2021] [Indexed: 11/20/2022]
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