1
|
Giacobbe DR, Salsano A, Santini F, Bassetti M. Antibiotics and Missed Etiological Diagnosis of Infective Endocarditis: A Dangerous Duo. J Clin Med 2022; 11:jcm11154533. [PMID: 35956148 PMCID: PMC9369409 DOI: 10.3390/jcm11154533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 12/10/2022] Open
Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy;
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-010-555-4654; Fax: +39-010-555-6712
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy; (A.S.); (F.S.)
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Francesco Santini
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, 16132 Genoa, Italy; (A.S.); (F.S.)
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy;
- Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| |
Collapse
|
2
|
Kong WKF, Salsano A, Giacobbe DR, Popescu BA, Laroche C, Duval X, Schueler R, Moreo A, Colonna P, Piper C, Calvo-Iglesias F, Badano LP, Srdanovic I, Boutoille D, Huttin O, Stöhr E, Timóteo AT, Vaskelyte JJ, Sadeghpour A, Tornos P, Abid L, Poh KK, Habib G, Lancellotti P. Outcomes of culture-negative vs. culture-positive infective endocarditis: the ESC-EORP EURO-ENDO registry. Eur Heart J 2022; 43:2770-2780. [PMID: 35695691 PMCID: PMC9459867 DOI: 10.1093/eurheartj/ehac307] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/21/2022] [Accepted: 05/25/2022] [Indexed: 12/13/2022] Open
Abstract
AIM Fatality of infective endocarditis (IE) is high worldwide, and its diagnosis remains a challenge. The objective of the present study was to compare the clinical characteristics and outcomes of patients with culture-positive (CPIE) vs. culture-negative IE (CNIE). METHODS AND RESULTS This was an ancillary analysis of the ESC-EORP EURO-ENDO registry. Overall, 3113 patients who were diagnosed with IE during the study period were included in the present study. Of these, 2590 (83.2%) had CPIE, whereas 523 (16.8%) had CNIE. As many as 1488 (48.1%) patients underwent cardiac surgery during the index hospitalization, 1259 (48.8%) with CPIE and 229 (44.5%) with CNIE. The CNIE was a predictor of 1-year mortality [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.04-1.56], whereas surgery was significantly associated with survival (HR 0.49, 95% CI 0.41-0.58). The 1-year mortality was significantly higher in CNIE than CPIE patients in the medical subgroup, but it was not significantly different in CNIE vs. CPIE patients who underwent surgery. CONCLUSION The present analysis of the EURO-ENDO registry confirms a higher long-term mortality in patients with CNIE compared with patients with CPIE. This difference was present in patients receiving medical therapy alone and not in those who underwent surgery, with surgery being associated with reduced mortality. Additional efforts are required both to improve the aetiological diagnosis of IE and identify CNIE cases early before progressive disease potentially contraindicates surgery.
Collapse
Affiliation(s)
- William K F Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Antonio Salsano
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- Division of Cardiac Surgery, Ospedale Policlinico San Martino—IRCCS, Largo Rosanna Benzi, 10, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
- Infectious Diseases Unit, Ospedale Policlinico San Martino—IRCCS, Genoa, Italy
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy ‘Carol Davila’ Euroecolab, Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C. C. Iliescu’, Bucharest, Romania
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | - Xavier Duval
- INSERM Clinical Investigation Center 1425, Université Paris Diderot, Sorbonne Paris-Cité, IAME 1138, Paris, France
- AEPEI Service de Maladies Infectieuses et Tropicales, APHP, Hôpital Bichat, Paris, France
| | | | - Antonella Moreo
- Dipartimento CardioToracoVascolare ‘De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy
| | - Cornelia Piper
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Luigi P Badano
- University of Milano-Bicocca, Milano, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences; Istituto Auxologico Italiano, IRCCS—San Luca Hospital, Milano, Italy
| | - Ilija Srdanovic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
| | - David Boutoille
- Department of Infectious Diseases, CIC UIC 1413 INSERM, University Hospital, Nantes, France
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, Nancy, France
- CIC-Plurithématique 1433, Inserm U1116, CHRU Nancy, Université de Lorraine, CIC-IT, U1433, CHRU de Nancy, France
- INSERM U1254, IADI, Université de Lorraine, Nancy, France
| | | | - Ana Teresa Timóteo
- Secretária-Geral Sociedade Portuguesa Cardiologia, Lisbon, Portugal
- Assistente Hospitalar Graduada Cardiologia, Hospital Santa Marta, Centro Hospitalar Universitário Lisbon Central, Lisbon, Portugal
- NOVA Medical School, Lisbon, Portugal
| | | | - Anita Sadeghpour
- Rajaie Cardiovascular Medical & Research Center, Tehran, Iran
- Duke Cardiovascular MR Center, Durham, NC, USA
| | - Pilar Tornos
- Cardiology Service, Hospital Quiron, Barcelona, Spain
| | | | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gilbert Habib
- Department of Cardiology, APHM, La Timone Hospital, Marseille, France
- University Hospital of Liege (CHU), Liege, Belgium
| | | |
Collapse
|
3
|
Resende P, Fortes CQ, do Nascimento EM, Sousa C, Querido Fortes NR, Thomaz DC, de Bragança Pereira B, Pinto FJ, de Oliveira GMM. In-hospital Outcomes of Infective Endocarditis from 1978 to 2015: Analysis Through Machine-Learning Techniques. CJC Open 2022; 4:164-172. [PMID: 35198933 PMCID: PMC8843990 DOI: 10.1016/j.cjco.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Early identification of patients with infective endocarditis (IE) at higher risk for in-hospital mortality is essential to guide management and improve prognosis. METHODS A retrospective analysis was conducted of a cohort of patients followed up from 1978 to 2015, classified according to the modified Duke criteria. Clinical parameters, echocardiographic data, and blood cultures were assessed. Techniques of machine learning, such as the classification tree, were used to explain the association between clinical characteristics and in-hospital mortality. Additionally, the log-linear model and graphical random forests (GRaFo) representation were used to assess the degree of dependence among in-hospital outcomes of IE. RESULTS This study analyzed 653 patients: 449 (69.0%) with definite IE; 204 (31.0%) with possible IE; mean age, 41.3 ± 19.2 years; 420 (64%) men. Mode of IE acquisition: community-acquired (67.6%), nosocomial (17.0%), undetermined (15.4%). Complications occurred in 547 patients (83.7%), the most frequent being heart failure (47.0%), neurologic complications (30.7%), and dialysis-dependent renal failure (6.5%). In-hospital mortality was 36.0%. The classification tree analysis identified subgroups with higher in-hospital mortality: patients with community-acquired IE and peripheral stigmata on admission; and patients with nosocomial IE. The log-linear model showed that surgical treatment was related to higher in-hospital mortality in patients with neurologic complications. CONCLUSIONS The use of a machine-learning model allowed identification of subgroups of patients at higher risk for in-hospital mortality. Peripheral stigmata, nosocomial IE, absence of vegetation, and surgery in the presence of neurologic complications are predictors of fatal outcomes in machine learning-based analysis.
Collapse
Affiliation(s)
- Plinio Resende
- Department of Cardiology/ICES, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudio Querido Fortes
- Department of Infectious Diseases, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Catarina Sousa
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | | | | | | | | | | |
Collapse
|
4
|
Comparing Treatment Outcomes of Ampicillin-Sulbactam, Other β-Lactams, and Vancomycin in Blood Culture-Negative Infective Endocarditis. Antibiotics (Basel) 2021; 10:antibiotics10121476. [PMID: 34943689 PMCID: PMC8698808 DOI: 10.3390/antibiotics10121476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
Selection of proper antibiotics for blood culture-negative infective endocarditis (BCNIE) is difficult due to limited data on antibiotic regimens for BCNIE in existing literature. The aim of this study was to compare ampicillin-sulbactam, other β-lactams antibiotics, and vancomycin among patients with BCNIE to determine the proper antibiotic regimens. This retrospective study included adult patients with BCNIE admitted to Severance Hospital from November 2005 to August 2017. Patients were classified into three groups as, treated with ampicillin-sulbactam, other β-lactams, and vancomycin. The primary outcome was 1-year all-cause mortality. A total of 74 cases with BCNIE were enrolled in this study. There were no statistically significant differences in clinical characteristics between the three groups. One-year mortality did not significantly differ between the study groups either. Further, in-hospital mortality, 28-day mortality and overall mortality showed no difference. However, Cox-regression analysis showed nosocomial infective endocarditis as an independent risk factor and a protective effect of surgery on 1-year mortality. This study showed no clear difference in the outcomes of BCNIE as per the antibiotic therapy but suggested the beneficial effect of surgical treatment. With increasing global concern of antimicrobial resistance, it might be reasonable to select ampicillin-sulbactam-based antibiotic therapy while actively considering surgical treatment in BCNIE.
Collapse
|
5
|
Suardi LR, de Alarcón A, García MV, Ciezar AP, Hidalgo Tenorio C, Martinez-Marcos FJ, Concejo-Martínez E, De la Torre Lima J, Vinuesa García D, Luque Márquez R, Ojeda G, Reguera Iglesias JM, Lomas JM, Lopez-Cortes LE. Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study. Infect Dis (Lond) 2021; 53:755-763. [PMID: 34038316 DOI: 10.1080/23744235.2021.1925342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To assess the impact of blood cultures negative infective endocarditis (BCNIE) on in-hospital mortality. METHODS Prospective multicentre study with retrospective analysis of a Spanish cohort including adult patients with definite IE. Cardiac implantable devices infection were excluded. Comparisons between blood cultures positive and BCNIE groups were performed to analyse in-hospital mortality. RESULTS 1001 cases were included of which 83 (8.3%) had BCNIE. Alternative microbiological diagnosis was achieved for 39 (47%) out 83 cases. The most frequent identifications were: Coxiella burnetii (11; 28.2%), Tropheryma whipplei (4; 10.3%), Streptococcus gallolyticus (4;10.3%) and Staphylococcus epidermidis (3; 7.7%). Surgery was performed more frequently in BCNIE group (57.8 vs. 36.9%, p < .001). All-cause in-hospital mortality rate was 26.7% without statistical difference between compared groups. BCNIE was not associated to worse mortality rate in Cox regression model (aHR = 1.37, 95% CI 0.90-2.07, p = .14). Absence of microbiological diagnosis was also not associated to worse in-hospital prognosis (aHR = 1.62, 95% CI 0.99-2.64, p = .06). CONCLUSIONS In our cohort, BCNIE was not associated to greater in-hospital mortality based in multivariate Cox regression models. The variables most frequently associated with mortality were indicated but not performed surgery (aHR = 2.48, 95% CI 1.73-3.56, p < .001), septic shock (aHR = 2.24, 95% CI 1.68-2.99, p < .001), age over 65 years (aHR = 1.88, 95% CI 1.40-2.52, p < .001) and complicated endocarditis (aHR = 1.79, 95% CI 1.36-2.37, p < .001).
Collapse
Affiliation(s)
- Lorenzo Roberto Suardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy/Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - María Victoria García
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - Antonio Plata Ciezar
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - Carmen Hidalgo Tenorio
- Staff of Infectious Diseases Unit, University Hospital Virgen de las Nieves/Biomedical Research Institute (IBS), Granada, Spain
| | | | | | | | | | - Rafael Luque Márquez
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Guillermo Ojeda
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - José M Reguera Iglesias
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - José M Lomas
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Luis E Lopez-Cortes
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain
| | | |
Collapse
|
6
|
Meidrops K, Zuravlova A, Osipovs JD, Kalejs M, Groma V, Petrosina E, Reinis A, Strike E, Dumpis U, Erglis A, Stradins P. Comparison of outcome between blood culture positive and negative infective endocarditis patients undergoing cardiac surgery. J Cardiothorac Surg 2021; 16:147. [PMID: 34044847 PMCID: PMC8161995 DOI: 10.1186/s13019-021-01532-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Up to 30% or even more of all infective endocarditis (IE) cases are recognized as blood culture negative, meaning that the causative agent is left unidentified. The prompt diagnosis together with the identification of causative microorganism and targeted antibiotic treatment can significantly impact the prognosis of the disease and further patient’s health status. In some studies, blood culture negative endocarditis has been shown to be associated with delayed diagnosis, worse outcome and course of the disease, and a greater number of intra and postoperative complications. Methods We retrospectively analysed the medical records of all patients who underwent cardiac surgery for endocarditis between years 2016 and 2019. The aim of this study was to analyse short and long-term mortality and differences of laboratory, clinical and echocardiography parameters in patients with blood culture positive endocarditis (BCPE) and blood culture negative endocarditis (BCNE) and its possible impact on the clinical outcome. Results In our study population were 114 (55.1%) blood culture positive and 93 (44.9%) blood culture negative cases of infectious endocarditis. The most common pathogens in the blood culture positive IE group were S.aureus in 36 cases (31.6%), Streptococcus spp. in 27 (23.7%), E.faecalis in 24 (21.1%), and other microorganisms in 27 (23.7%). Embolic events were seen in 60 patients (28.9%). In univariate analyses, detection of microorganism, elevated levels of procalcitonin were found to be significantly associated with intrahospital death, however it did not reach statistical significance in multivariate analyses. Among microorganisms, S.aureus was significantly associated with intrahospital death in both univariate and multivariate analyses. Conclusions There are no statistically significant differences between groups of BCPE and BCNE in terms of intrahospital mortality, hospital and ICU stay or 3-year mortality. There were higher levels of procalcitonin in BCPE group, however procalcitonin failed to show independent association with mortality in multivariate analysis. The most common microorganism in the BCPE group was S.aureus. It was associated with independently higher intrahospital mortality when compared to other causative microorganisms.
Collapse
Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia. .,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia.
| | - Arina Zuravlova
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | | | - Martins Kalejs
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| | - Valerija Groma
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | - Eva Petrosina
- Statistics Unit, Riga Stradins University, 14 Balozu Street, Riga, LV-1007, Latvia.,Faculty of Physics, Mathematics and Optometry, UL House of Science, University of Latvia, 3 Jelgavas Street, Riga, LV-1004, Latvia
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | - Eva Strike
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Department of Cardiovascular Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, LV-1002, Latvia
| | - Uga Dumpis
- Department of Infection Control, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| | - Andrejs Erglis
- Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia.,Faculty of Medicine, UL House of Science, University of Latvia, 3 Jelgavas Street, Riga, LV-1004, Latvia
| | - Peteris Stradins
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| |
Collapse
|
7
|
Godfrey R, Curtis S, Schilling WH, James PR. Blood culture negative endocarditis in the modern era of 16S rRNA sequencing. Clin Med (Lond) 2021; 20:412-416. [PMID: 32675149 DOI: 10.7861/clinmed.2019-0342] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as Coxiella and Bartonella spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. However, these organisms can be difficult to diagnose. We outline a systematic approach to BCNE. Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
Collapse
Affiliation(s)
| | - Sally Curtis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | | |
Collapse
|
8
|
Evaluation of Laboratory Predictors for In-Hospital Mortality in Infective Endocarditis and Negative Blood Culture Pattern Characteristics. Pathogens 2021; 10:pathogens10050551. [PMID: 34063295 PMCID: PMC8147437 DOI: 10.3390/pathogens10050551] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 04/25/2021] [Accepted: 04/29/2021] [Indexed: 12/27/2022] Open
Abstract
Objective: This study aimed to identify possible differences between blood culture-negative and blood culture-positive groups of infective endocarditis (IE), and explore the associations between biological parameters and in-hospital mortality. Methods: This was a retrospective study of patients hospitalized for IE between 2007 and 2017. Epidemiological, clinical and paraclinical characteristics, by blood culture-negative and positive groups, were collected. The best predictors of in-hospital mortality based on the receiver-operating characteristic (ROC) analysis and AUC (area under the curve) results were identified. Results: A total of 126 IE patients were included, 54% with negative blood cultures at admission. Overall, the in-hospital mortality was 28.6%, higher in the blood culture-negative than positive group (17.5% vs. 11.1%, p = 0.207). A significant increase in the Model for End-Stage Liver Disease Excluding International Normalized Ratio (MELD-XI) score was observed in the blood culture-negative group (p = 0.004), but no baseline characteristics differed between the groups. The best laboratory predictors of in-hospital death in the total study group were the neutrophil count (AUC = 0.824), white blood cell count (AUC = 0.724) and MELD-XI score (AUC = 0.700). Conclusion: Classic laboratory parameters, such as the white blood cell count and neutrophil count, were associated with in-hospital mortality in infective endocarditis. In addition, MELD-XI was a good predictor of in-hospital death.
Collapse
|
9
|
Salsano A, Giacobbe DR, Del Puente F, Natali R, Miette A, Moscatelli S, Perocchio G, Scarano F, Porto I, Mariscalco G, Bassetti M, Santini F. Culture-negative infective endocarditis (CNIE): impact on postoperative mortality. Open Med (Wars) 2020; 15:571-579. [PMID: 33336013 PMCID: PMC7712125 DOI: 10.1515/med-2020-0193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/30/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Poor postoperative outcomes have been reported after surgery for infective endocarditis (IE). Whether the absence of positive cultures impacts the prognosis remains a matter of discussion. The aim of this study was to evaluate the impact of negative cultures on the prognosis of surgically treated IE. Methods This was a single-center, retrospective study. From January 2000 to June 2019, all patients who underwent valvular surgery for IE were included in the study. The primary endpoint was early postoperative mortality. A covariate balancing propensity score was developed to minimize the differences between the culture-positive IE (CPIE) and culture-negative IE (CNIE) cohorts. Using the estimated propensity scores as weights, an inverse probability treatment weighting (IPTW) model was built to generate a weighted cohort. Then, to adjust for confounding related to CPIE and CNIE, a doubly robust method that combines regression model with IPTW by propensity score was adopted to estimate the causal effect of the exposure on the outcome. Results During the study period, 327 consecutive patients underwent valvular repair/replacement with the use of cardiopulmonary bypass and cardioplegic cardiac arrest for IE. Their mean age was 61.4 ± 15.4 years, and 246 were males (75.2%). Native valve IE and prosthetic valve IE accounted for 87.5% and 12.5% of cases, respectively. Aortic (182/327, 55.7%) and mitral valves (166/327, 50.8%) were mostly involved; 20.5% of isolated mitral valve diseases were repaired (22/107 patients). The tricuspid valve was involved in 10 patients (3.3%), and the pulmonary valve in 1 patient (<1%). Fifty-nine patients had multiple-valve disease (18.0%). Blood cultures were negative in 136/327 (41.6 %). A higher postoperative mortality was registered in CNIE than in CPIE patients (19% vs 9%, respectively, p = 0.01). The doubly robust analysis after IPTW by propensity score showed CNIE to be associated with early postoperative mortality (odds ratio 2.10; 95% CI, 1.04–4.26, p = 0.04). Conclusions In our cohort, CNIE was associated with a higher early postoperative mortality in surgically treated IE patients after dedicated adjustment for confounding. In this perspective, any effort to improve preoperative microbiological diagnosis, thus allowing targeted therapeutic initiatives, might lead to overall better postoperative outcomes in surgically treated IE.
Collapse
Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Filippo Del Puente
- Clinica Malattie Infettive, Ospedale Policlinico San Martino – IRCCS, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Roberto Natali
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Ambra Miette
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Sara Moscatelli
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Giacomo Perocchio
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| | - Flavio Scarano
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Italo Porto
- Division of Cardiology, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Internal Medicine (DIMI), University of Genoa, Genova, Italy
| | - Giovanni Mariscalco
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
| | - Matteo Bassetti
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, University of Genoa, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genoa, Genova, Italy
| |
Collapse
|
10
|
Firiana L, Siswanto BB, Yonas E, Prakoso R, Pranata R. Factors Affecting Mortality in Patients with Blood-Culture Negative Infective Endocarditis. Int J Angiol 2020; 29:12-18. [PMID: 32132811 DOI: 10.1055/s-0039-3402744] [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: 10/25/2022] Open
Abstract
Infective endocarditis retains high morbidity and mortality rates despite recent advances in diagnostics, pharmacotherapy, and surgical intervention. Risk stratification in endocarditis patients, including blood-culture negative endocarditis, is crucial in deciding the optimal management strategy; however, the studies investigating risk stratification in these patients were lacking despite the difference with blood-culture positive endocarditis. The aim of this study is to identify risk factors associated with in-hospital mortality in blood-culture negative infective endocarditis patients. A retrospective cohort study was conducted at National Cardiovascular Center Harapan Kita, Jakarta in blood-culture negative infective endocarditis patients from 2013 to 2015. Patient characteristics, clinical parameters, echocardiographic parameters, and clinical complications were collected from medical records and hospital information systems. There were 146 patients that satisfy the inclusion and exclusion criteria out of 162 patients with blood-culture infective endocarditis. The in-hospital mortality rate was 13.5%. On bivariate analyses, factors that were related to in-hospital mortality include New York Heart Association (NYHA) class III and IV heart failure ( p = 0.007), history of hypertension ( p = 0.021), stroke during hospitalization ( p < 0.001), the decline in renal function ( p < 0.001), and surgery ( p = 0.028). Variables that were independently associated with mortality upon multivariate analysis were heart failure NYHA functional class III and IV (OR 7.56, p = 0.011), worsening kidney function (OR 10.23, p < 0.001), and stroke during hospitalization (OR 8.92, p = 0.001). Presence of heart failure with NYHA functional class III and IV, worsening kidney function, and stroke during hospitalization were independently associated with in-hospital mortality in blood-culture infective endocarditis patients.
Collapse
Affiliation(s)
- Lira Firiana
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta
| | - Emir Yonas
- Faculty of Medicine, Universitas Yarsi, Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| |
Collapse
|
11
|
Ren Z, Mo X, Chen H, Peng J. A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018. BMC Infect Dis 2019; 19:945. [PMID: 31703633 PMCID: PMC6842136 DOI: 10.1186/s12879-019-4609-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years. Methods Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018. Results A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality. Conclusions Our study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.
Collapse
Affiliation(s)
- Zuning Ren
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xichao Mo
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
12
|
Blood Culture-Negative but Clinically Diagnosed Infective Endocarditis Complicated by Intracranial Mycotic Aneurysm, Brain Abscess, and Posterior Tibial Artery Pseudoaneurysm. Case Rep Neurol Med 2018; 2018:1236502. [PMID: 30533235 PMCID: PMC6250033 DOI: 10.1155/2018/1236502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 10/30/2018] [Indexed: 11/17/2022] Open
Abstract
Blood culture-negative endocarditis is often severe and difficult to diagnose. It is necessary to emphasize the importance for the early diagnosis and accurate treatment of blood culture-negative endocarditis. Here, we described the relevant clinical information of a blood culture-negative but clinically diagnosed infective endocarditis complicated by intracranial mycotic aneurysm, brain abscess, and posterior tibial artery pseudoaneurysm. This patient was a 65-year-old man with a 9-month history of intermittent fever and died in the end for the progressive neurological deterioration. Although the blood culture is negative, this patient was clinically diagnosed as infective endocarditis according to Duke criteria. This patient course was complicated not only by cerebral embolism, intracranial mycotic aneurysm, and brain abscess but also by posterior tibial artery aneurysm of the lower extremity. The clinical findings of this patient suggest that the confirmatory microbiology is essential for the treatment of blood culture-negative infective endocarditis. Clinicians should be aware of the detriment of blood culture-negative infective endocarditis for its multiple complications may occur in one patient. The delayed etiological diagnosis and insufficient treatment may aggregate the clinical outcome of blood culture-negative infective endocarditis.
Collapse
|
13
|
Abegaz TM, Bhagavathula AS, Gebreyohannes EA, Mekonnen AB, Abebe TB. Short- and long-term outcomes in infective endocarditis patients: a systematic review and meta-analysis. BMC Cardiovasc Disord 2017; 17:291. [PMID: 29233094 PMCID: PMC5728061 DOI: 10.1186/s12872-017-0729-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022] Open
Abstract
Background Despite advances in medical knowledge, technology and antimicrobial therapy, infective endocarditis (IE) is still associated with devastating outcomes. No reviews have yet assessed the outcomes of IE patients undergoing short- and long-term outcome evaluation, such as all-cause mortality and IE-related complications. We conducted a systematic review and meta-analysis to examine the short- and long-term mortality, as well as IE-related complications in patients with definite IE. Methods A computerized systematic literature search was carried out in PubMed, Scopus and Google Scholar from 2000 to August, 2016. Included studies were published studies in English that assessed short-and long-term mortality for adult IE patients. Pooled estimations with 95% confidence interval (CI) were calculated with DerSimonian-Laird (DL) random-effects model. Sensitivity and subgroup analyses were also performed. Publication bias was evaluated using inspection of funnel plots and statistical tests. Results Twenty five observational studies (retrospective, 14; prospective, 11) including 22,382 patients were identified. The overall pooled mortality estimates for IE patients who underwent short- and long-term follow-up were 20% (95% CI: 18.0–23.0, P < 0.01) and 37% (95% CI: 27.0–48.0, P < 0.01), respectively. The pooled prevalence of cardiac complications in patients with IE was found to be 39% (95%CI: 32.0–46.0) while septic embolism and renal complications accounted for 25% (95% CI: 20.0–31) and 19% (95% CI: 14.0–25.0) (all P < 0.01), respectively. Conclusion Irrespective of the follow-up period, a significantly higher mortality rate was reported in IE patients, and the burden of IE-related complications were immense. Further research is needed to assess the determinants of overall mortality in IE patients, as well as well-designed observational studies to conform our results. Electronic supplementary material The online version of this article (10.1186/s12872-017-0729-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tadesse Melaku Abegaz
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Akshaya Srikanth Bhagavathula
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemayehu B Mekonnen
- Medication Safety Chair, College of Pharmacy, King Saud University, Riadh, Saudi Arabia
| | - Tamrat Befekadu Abebe
- Department of Clinical pharmacy, School of Phamacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Master's Program in Health Economics, Policy and Managment; Student; Department of Learning, Informatics, Managent and Ethics, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
14
|
Cochrane A. Aortic Valve Prosthetic Endocarditis Remains a Challenging Problem. Heart Lung Circ 2017; 27:274-275. [PMID: 29102435 DOI: 10.1016/j.hlc.2017.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew Cochrane
- Dept of Cardiothoracic Surgery, Monash Medical Centre & Dept of Surgery, Monash University, Melbourne, Vic, Australia.
| |
Collapse
|
15
|
Fournier PE, Gouriet F, Casalta JP, Lepidi H, Chaudet H, Thuny F, Collart F, Habib G, Raoult D. Blood culture-negative endocarditis: Improving the diagnostic yield using new diagnostic tools. Medicine (Baltimore) 2017; 96:e8392. [PMID: 29381916 PMCID: PMC5708915 DOI: 10.1097/md.0000000000008392] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Blood culture-negative endocarditis (BCNE) may represent up to 70% of all endocarditis cases, depending on series. From 2001 to 2009, we implemented in our laboratory a multimodal diagnostic strategy for BCNE that included systematized testing of blood, and when available, valvular biopsy specimens using serological, broad range molecular, and histopathological assays. A causative microorganism was identified in 62.7% of patients.In this study from January 2010 to December 2015, in an effort to increase the number of identified causative microorganisms, we prospectively added to our diagnostic protocol specific real-time (RT) polymerase chain reaction (PCR) assays targeting various endocarditis agents, and applied them to all patients with BCNE admitted to the 4 public hospitals in Marseille, France.A total of 283 patients with BCNE were included in the study. Of these, 177 were classified as having definite endocarditis. Using our new multimodal diagnostic strategy, we identified an etiology in 138 patients (78.0% of cases). Of these, 3 were not infective (2.2%) and 1 was diagnosed as having Mycobacterium bovis BCG endocarditis. By adding specific PCR assays from blood and valvular biopsies, which exhibited a significantly greater sensitivity (P < 10) than other methods, causative agents, mostly enterococci, streptococci, and zoonotic microorganisms, were identified in an additional 27 patients (14 from valves only, 11 from blood only, and 2 from both). Finally, in another 107 patients, a pathogen was detected using serology in 37, valve culture in 8, broad spectrum PCR from valvular biopsies and blood in 19 and 2, respectively, immunohistochemistry from valves in 3, and a combination of several assays in 38.By adding specific RT-PCR assays to our systematic PCR testing of patients with BCNE, we increased the diagnostic efficiency by 24.3%, mostly by detecting enterococci and streptococci that had not been detected by other diagnostic methods, but also agents requiring specific management such as Mycoplasma hominis and Tropheryma whipplei.
Collapse
Affiliation(s)
- Pierre-Edouard Fournier
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Frédérique Gouriet
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Jean-Paul Casalta
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| | - Hubert Lepidi
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
| | - Hervé Chaudet
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
| | | | | | - Gilbert Habib
- Service de Cardiologie, Hôpital de la Timone, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, UM63, CNRS7278, IRD198, Inserm1095, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, IHU Méditerranée-Infection
- Fédération de Microbiologie Clinique, Hôpital de la Timone, Rue Saint-Pierre
| |
Collapse
|
16
|
Infective endocarditis: Absence of microbiological diagnosis is an independent predictor of inhospital mortality. Int J Cardiol 2016; 220:162-5. [DOI: 10.1016/j.ijcard.2016.06.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/20/2016] [Accepted: 06/22/2016] [Indexed: 01/13/2023]
|
17
|
Menu E, Gouriet F, Casalta JP, Tissot-Dupont H, Vecten M, Saby L, Hubert S, Salaun E, Theron A, Grisoli D, Lavoute C, Collart F, Habib G, Raoult D. Evaluation of empirical treatment for blood culture-negative endocarditis. J Antimicrob Chemother 2016; 72:290-298. [PMID: 27678286 DOI: 10.1093/jac/dkw362] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Much progress has been made in understanding the main causes of blood culture-negative endocarditis (BCNE). Few studies concerning BCNE treatment (due to previous antibiotics used or fastidious pathogens) are available. We performed this study to evaluate the effectiveness of our therapeutic protocol in BCNE, based on compliance with the protocol, outcome and 1 year mortality. PATIENTS AND METHODS We collected prospectively and analysed retrospectively cases of BCNE between 2002 and 2014, using a simplified and standardized protocol developed by our multidisciplinary team. We apply two kinds of protocols to treat BCNE, which include only four intravenous antimicrobial agents: amoxicillin, vancomycin, gentamicin and amphotericin B. RESULTS We had 177 patients with definite BCNE. There were 154 (87.0%) patients treated with both appropriate antimicrobial agents and appropriate duration of treatment. We analysed the causes of inappropriate treatment in 13 (7.3%) cases and inappropriate duration in 10 (5.6%) cases. The treatment changes were justified in all cases except one of discharge against medical advice. The fatality rate was 5.1% (nine cases) and all deaths occurred in the group of patients who were treated with appropriate treatment; however, four deaths were not attributable to empirical treatment failure. Concerning the other deaths, the lack of surgical management, in association with empirical treatment, could explain our protocol's failure, such as poorly tolerated surgery. CONCLUSIONS Our protocol is efficient and our mortality rate was low, compared with the literature review. This may result from a strategy that uses a sampling procedure and a standardized protocol at the same time.
Collapse
Affiliation(s)
- Estelle Menu
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Frédérique Gouriet
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.,Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
| | - Jean-Paul Casalta
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.,Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
| | - Hervé Tissot-Dupont
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France.,Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
| | - Maude Vecten
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Ludivine Saby
- Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Sandrine Hubert
- Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Erwan Salaun
- Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Dominique Grisoli
- Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Cécile Lavoute
- Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Department of Cardiology, Centre Hospitalier Universitaire, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Didier Raoult
- Department of Infectious Diseases, Hôpital de la Timone, AP-HM, Aix-Marseille University, Marseille, France .,Aix-Marseille Université, URMITE, UM63, CNRS7278, IRD198, Inserm 1095, Faculté de médecine, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France
| |
Collapse
|
18
|
García J, Fortuny C, Riaza L, Soler M, Bassa P, Riera E. Diagnosis by 18 F-FDG PET/CT of infective endocarditis, staging and monitoring of antibiotic treatment after transposition of surgically corrected great arteries. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
García JR, Fortuny C, Riaza L, Soler M, Bassa P, Riera E. Diagnosis by (18)F-FDG PET/CT of infective endocarditis, staging and monitoring of antibiotic treatment after transposition of surgically corrected great arteries. Rev Esp Med Nucl Imagen Mol 2015; 35:115-7. [PMID: 26654886 DOI: 10.1016/j.remn.2015.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
Abstract
Infective endocarditis is one of the leading causes of fever of unknown origin in those patients with intravascular catheters, prosthetic valves or cardiovascular implantable electronic devices. The diagnosis of infective endocarditis is made according to modified Duke criteria, which are based on blood culture and echocardiographic findings. Demonstration of vegetation with the transoesophageal echocardiography may be difficult in these cases with previous anatomical changes, especially in early phases. Positron emission tomography with (18)F-fluorodeoxyglucose ((18)F-FDG PET/CT) is well known to show an increased glucidic metabolism in malignant, inflammatory, and infectious processes. Thus, it provides useful functional imaging that enables the disease causing the fever of unknown origin to be detected well before structural changes are evident. Moreover, (18)F-FDG PET/CT helps to detect infectious extra-cardiac involvement, since the whole body is imaged with this technique. (18)F-FDG PET/CT may have an additional promising role for the monitoring of response to antimicrobial therapy in patients with established infective endocarditis, thus evaluating standard treatment outcome, as well as evaluating the need for alternative/intensified treatment options.
Collapse
Affiliation(s)
| | - C Fortuny
- Servicio Pediatría, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España
| | - L Riaza
- Servicio Radiología, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, España
| | | | | | | |
Collapse
|
20
|
Lamas CC, Fournier PE, Zappa M, Brandão TJD, Januário-da-Silva CA, Correia MG, Barbosa GIF, Golebiovski WF, Weksler C, Lepidi H, Raoult D. Diagnosis of blood culture-negative endocarditis and clinical comparison between blood culture-negative and blood culture-positive cases. Infection 2015; 44:459-66. [PMID: 26670038 DOI: 10.1007/s15010-015-0863-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/28/2015] [Indexed: 12/27/2022]
Abstract
PURPOSE To analyze the clinical characteristics of blood culture-negative endocarditis (BCNE) and how it compares to those of blood culture-positive endocarditis (BCPE) cases and show how molecular tools helped establish the etiology in BCNE. METHODS Adult patients with definite infective endocarditis (IE) and having valve surgery were included. Valves were studied by polymerase chain reaction (PCR). Statistical analysis compared BCNE and BCPE. RESULTS One hundred and thirty-one patients were included; 53 (40 %) had BCNE. The mean age was 45 ± 16 years; 33 (62 %) were male. BCNE was community-acquired in 41 (79 %). Most patients were referred from other hospitals (38, 73 %). Presentation was subacute in 34 (65 %), with fever in 47/53 (90 %) and a new regurgitant murmur in 34/42 (81 %). Native valves were affected in 74 %, mostly left-sided. All echocardiograms showed major criteria for IE. Antibiotics were used prior to BC collection in 31/42 (74 %). Definite histological diagnosis was established for 35/50 (70 %) valves. PCR showed oralis group streptococci in 21 (54 %), S. aureus in 3 (7.7 %), gallolyticus group streptococci in 2 (5.1 %), Coxiella burnetii in 1 (2.5 %) and Rhizobium sp. in 1 (2.5 %). In-hospital mortality was 9/53 (17 %). Fever (p = 0.06, OR 4.7, CI 0.91-24.38) and embolic complications (p = 0.003, OR 3.3, CI 1.55-6.82) were more frequent in BCPE cases, while new acute regurgitation (p = 0.05, OR 0.3, CI 0.098-0.996) and heart failure (p = 0.02, OR 0.3, CI 0.13-0.79) were less so. CONCLUSIONS BCNE resulted mostly from prior antibiotics and was associated with severe hemodynamic compromise. Valve histopathology and PCR were useful in confirming the diagnosis and pointing to the etiology of BCNE.
Collapse
Affiliation(s)
- Cristiane C Lamas
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil. .,Unigranrio, Rio de Janeiro, Brazil.
| | | | - Monica Zappa
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | | | - Didier Raoult
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| |
Collapse
|
21
|
Romeu Prieto JM, Lizcano Lizcano AM, López de Toro Martín Consuegra I, Largo Pau J, López Almodóvar LF, García Camacho E. Endocarditis con hemocultivos negativos: infección por Mycoplasma hominis. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
22
|
Romeu Prieto JM, Lizcano Lizcano AM, López de Toro Martín Consuegra I, Largo Pau J, López Almodóvar LF, García Camacho E. Culture-negative Endocarditis: Mycoplasma hominis Infection. ACTA ACUST UNITED AC 2015; 68:1037-8. [PMID: 26481285 DOI: 10.1016/j.rec.2015.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 07/24/2015] [Indexed: 12/13/2022]
Affiliation(s)
| | | | | | - José Largo Pau
- Servicio de Medicina Interna, Hospital Virgen de la Salud de Toledo, Toledo, Spain
| | | | - Eva García Camacho
- Servicio de Cardiología, Hospital Virgen de la Salud de Toledo, Toledo, Spain
| |
Collapse
|
23
|
San Román JA, Vilacosta I, López J, Sarriá C. Critical Questions About Left-Sided Infective Endocarditis. J Am Coll Cardiol 2015; 66:1068-76. [DOI: 10.1016/j.jacc.2015.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 12/18/2022]
|
24
|
Moragas M, Sánchez R, Soler M, Puig Cozar M, Riera E, García JR. Detection of ICD electrode infection using ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:863-864. [PMID: 25151026 DOI: 10.1016/j.rec.2014.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Mercè Moragas
- PET-CETIR Unit, Esplugues de Llobregat, Barcelona, Spain.
| | - Raúl Sánchez
- Nuclear Medicine Service ERESA, Valencia University General Hospital, Valencia, Spain
| | - Marina Soler
- PET-CETIR Unit, Esplugues de Llobregat, Barcelona, Spain
| | - María Puig Cozar
- Nuclear Medicine Service ERESA, Valencia University General Hospital, Valencia, Spain
| | - Eduard Riera
- PET-CETIR Unit, Esplugues de Llobregat, Barcelona, Spain
| | | |
Collapse
|
25
|
Detección de infección del electrodo del DAI mediante tomografía por emisión de positrones-tomografía computarizada con 18F-fluorodesoxiglucosa. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2014.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
26
|
Siciliano RF, Mansur AJ, Castelli JB, Arias V, Grinberg M, Levison ME, Strabelli TMV. Community-acquired culture-negative endocarditis: clinical characteristics and risk factors for mortality. Int J Infect Dis 2014; 25:191-5. [DOI: 10.1016/j.ijid.2014.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 01/01/2023] Open
|
27
|
Sun XL, Zhang J, Wang GG, Zhuang XF, Yang YM, Zhu J, Tan HQ, Yu LT. Comparison of characteristics and short-term outcome from fungal infective endocarditis in prosthetic valve endocarditis versus native valve endocarditis. Am J Cardiol 2013; 112:111-6. [PMID: 23562383 DOI: 10.1016/j.amjcard.2013.02.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 12/19/2022]
Abstract
Fungal infective endocarditis (IE) is a rare, serious, and potentially lethal disease, yet its clinical characteristics and short-term outcomes remain poorly understood. A detailed comparative analysis of fungal prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE) has not been performed. This study was designed to explore the general characteristics, treatment patterns, and outcomes of patients with fungal IE in a Chinese hospital and compare these data between PVE and NVE. Four hundred ninety-three patients were admitted to Fuwai hospital from January 2002 to December 2010. Fungal IE accounted for 7% (32 cases) of cases. Of these patients, 19 (59%) patients had NVE, 12 (37%) PVE, and 1 (3%) cardiac device-related infective endocarditis (CDRIE). Candida albicans remained the predominant causative pathogen (47% of all IE). Patients with NVE, compared with PVE patients, were older (50 years vs 37 years, p = 0.034), had less frequent history of previous endocarditis (0 vs 25%, p = 0.049), and were more likely to have a history of diabetes (37% vs 0, p = 0.026) and be in an immunocompromised state (37% vs 0, p = 0.026). Nearly half of the patients died of refractory heart failure, followed by severe sepsis and stroke. In-hospital mortality rate was 38%, and the 3-month cumulative mortality rate was 47%. Recurrence of IE was more common in fungal PVE patients (42% vs 5%, p = 0.022) during the 90-day follow-up. In conclusion, fungal IE is associated with high mortality and recurrence rates. Surgery performed in selected cases may improve the outcomes, but the recurrence rate remains high.
Collapse
|