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Gopal K, Radhakrishnan RM, Jose R, Krishna N, Varma PK. Outcomes after surgery for infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:126-137. [PMID: 38827557 PMCID: PMC11139833 DOI: 10.1007/s12055-023-01647-9] [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: 08/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 06/04/2024] Open
Abstract
The role of surgery in infective endocarditis is becoming established the world over. In spite of all recent advances, endocarditis remains a lethal disease following surgery. With the emergence of more difficult-to-treat microorganisms, sicker and older patients with multiple co-morbidities, and an increase in healthcare-associated infections, the need for surgery in the management of infective endocarditis is only bound to increase. Data on the use of surgery in endocarditis till date is largely from observational data due to the relative rarity of the disease and variable practice patterns around the world. Hopefully, with increasing awareness and more inter-institutional and international collaborations, more robust data will emerge to further establish the role of surgery. For the time being, individual patient management will require the active multi-disciplinary approach of an endocarditis team to provide the best possible outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01647-9.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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2
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Durability of Transcatheter Heart Valves: Standardized Definitions and Available Data. J Clin Med 2021; 10:jcm10184180. [PMID: 34575291 PMCID: PMC8472686 DOI: 10.3390/jcm10184180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve replacement is a well-established alternative to surgical aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis. Currently, this technique is shifting towards younger patient groups with intermediate- and low-risk profile, which raises the question about long-term durability. Despite acceptable results up to 5 years, little is currently known about valve performance beyond 5 years. Since valve deterioration, thrombosis and endocarditis seem to be the main factors affecting valve durability, precise and widely accepted definitions of these parameters were stated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in 2017, followed by the Valve in Valve International Data (VIVID) group definitions in 2018 and the Valve Academic Research Consortium 3 (VARC-3) definitions in 2021. Until the introduction of these definitions, interstudy comparisons were difficult due to missing uniformity. Since the release of these recommendations, an increasing number of studies have reported their data on long-term durability using these new criteria. The aim of the present article is to discuss the current definitions on bioprosthetic valve durability, and to summarize the available data on long-term durability of transcatheter aortic valves.
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3
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Salem M, Friedrich C, Saad M, Frank D, Salem M, Puehler T, Schoettler J, Schoeneich F, Cremer J, Haneya A. Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment. J Clin Med 2021; 10:jcm10091868. [PMID: 33925866 PMCID: PMC8123486 DOI: 10.3390/jcm10091868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Active infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE). Method: Analysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020. Results: Patients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; p < 0.001) with higher EuroSCORE II (21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); p < 0.001)) and coronary heart disease (50.6% vs. 38.0%; p < 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%; p < 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%; p = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; p < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%; p < 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min.; p = 0.001) as well as transfusion of blood (4 units (0–27) vs. 2 units (0–14); p < 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438; 1163) vs. 500 mL (250; 1075); p = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: p = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%; p < 0.003). Conclusion: Patients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high.
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Affiliation(s)
- Mohamed Salem
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
- Correspondence: or ; Tel.: +49-431500-67089
| | - Christine Friedrich
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Mohammed Saad
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Derk Frank
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Mostafa Salem
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (M.S.); (D.F.); (M.S.)
| | - Thomas Puehler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jan Schoettler
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Felix Schoeneich
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Jochen Cremer
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
| | - Assad Haneya
- Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany; (C.F.); (T.P.); (J.S.); (F.S.); (J.C.); (A.H.)
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4
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Harky A, Zaim S, Mallya A, George JJ. Optimizing outcomes in infective endocarditis: A comprehensive literature review. J Card Surg 2020; 35:1600-1608. [PMID: 32598562 DOI: 10.1111/jocs.14656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. AIMS In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. MATERIALS & METHODS A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included 'Endocarditis', 'IE', 'Infection', 'Vegetation', 'Duke criteria', 'native valve infection', 'prosthetic valve', 'valve infection', 'endocarditis outcome' and 'endocarditis bacteriology'. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. RESULTS All the relevant findings are summarized in specified tables and within appropriate sections. DISCUSSION It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. CONCLUSION Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Sevim Zaim
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Apeksha Mallya
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
| | - Joel Jacob George
- Department of Medicine, School of Medicine, University of Liverpool, Liverpool, UK
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5
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Bindroo S, Akhter S, Thakur K, Geller C. Austrian Triad Complicated by Septic Arthritis and Aortic Root Abscess. Cureus 2018; 10:e3018. [PMID: 30254807 PMCID: PMC6150766 DOI: 10.7759/cureus.3018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/20/2018] [Indexed: 11/05/2022] Open
Abstract
Austrian syndrome is a very rare manifestation of invasive Streptococcus pneumoniae infection comprising a triad of pneumonia, meningitis, and endocarditis, also known as Osler's triad. We herein report a rare case of Austrian syndrome further complicated by septic arthritis.
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Affiliation(s)
- Sandiya Bindroo
- Internal Medicine, Crozer Chester Medical Center, Upland, USA
| | - Shafinaz Akhter
- Infectious Disease, Penn Medicine Chester County Hospital, Mount Laurel, USA
| | - Kshitij Thakur
- Internal Medicine, University of Kentucky College of Medicine, Kentucky, USA
| | - Charles Geller
- Cardiothoracic Surgery, Crozer Chester Medical Center, Upland, USA
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Aithoussa M, Atmani N, Mounir R, Moutakiallah Y, Bamous M, Abdou A, Nya F, Seghrouchni A, Bellouize S, Drissi M, Elouennass M, Elbekkali Y, Boulahya A. Early results for active infective endocarditis. Pan Afr Med J 2018; 28:245. [PMID: 29881490 PMCID: PMC5989182 DOI: 10.11604/pamj.2017.28.245.13518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/21/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction Cardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death. Methods We retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%). Results in-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years. Conclusion Despite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.
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Affiliation(s)
- Mahdi Aithoussa
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Noureddine Atmani
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Reda Mounir
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Younes Moutakiallah
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mehdi Bamous
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdessamad Abdou
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Fouad Nya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Anis Seghrouchni
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Siham Bellouize
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Mohamed Drissi
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Intensive Care of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Mostafa Elouennass
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc.,Department of Bacteriology, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco
| | - Youssef Elbekkali
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
| | - Abdelatif Boulahya
- Department of Cardiovascular Surgery, Mohammed V Teaching Military Hospital, Hay Riad, 10100 Rabat, Morocco.,Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Souissi, Madinat Al Irfane, 10100 Rabat, Moroc
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Pettersson GB, Coselli JS, Pettersson GB, Coselli JS, Hussain ST, Griffin B, Blackstone EH, Gordon SM, LeMaire SA, Woc-Colburn LE. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241-1258.e29. [PMID: 28365016 DOI: 10.1016/j.jtcvs.2016.09.093] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/12/2016] [Accepted: 09/16/2016] [Indexed: 12/23/2022]
Affiliation(s)
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | | | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Steven M Gordon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | - Scott A LeMaire
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex; Texas Heart Institute, Houston, Tex
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8
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Lemaire A, Dombrovskiy V, Saadat S, Batsides G, Ghaly A, Spotnitz A, Lee LY. Patients with Infectious Endocarditis and Drug Dependence Have Worse Clinical Outcomes after Valvular Surgery. Surg Infect (Larchmt) 2017; 18:299-302. [PMID: 28099093 DOI: 10.1089/sur.2016.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Patients with infective endocarditis (IE) are at high risk for post-operative morbidity and death, which might be associated with drug abuse. The purpose of this study is to evaluate the impact of drug dependence on outcomes in patients who have IE and undergo valvular surgery (VS). PATIENTS AND METHODS The Nationwide/National Inpatient Sample 2001-2012 was queried to select patients with IE who had elective VS using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. Among them, patients with drug dependence (PDD) were identified, and their health status and post-operative outcomes were compared with those in patients without drug dependence (control group). Chi-square and Wilcoxon rank sum tests as well as multi-variable regression analysis were used for statistics. RESULTS A total of 809 (12.9%) PDD of the 6,264 patients who underwent VS were evaluated. They were younger compared with those in the control group (39.0 ± 10.8 y vs. 54.4 ± 14.8 y; p < 0.0001), had less age-related co-morbidities such as hypertension, diabetes mellitus, congestive heart failure, renal failure, obesity, but greater rates of alcohol abuse, liver disease, and psychoses. Despite the younger age and fewer co-morbidities, PDD compared with control patients were more likely to have post-operative complications develop overall (odds ratio [OR] = 1.6; 95% confidence interval [CI] 1.34-2.01), including infectious complications (OR = 1.5; 95% CI 1.27-1.78), specifically pneumonia (OR = 1.4; 95% CI 1.14-1.74) and sepsis (OR = 1.4; 95% CI 1.16-1.63), renal complications (OR = 1.5; 95% CI 1.23-1.77), and pulmonary embolism (OR = 1.9; 95% CI 1.44-2.52). Further, PDD had 11% longer hospital length of stay than those in the control groups (p < 0.0001). We did not find significant difference in hospital deaths, however, between these groups. CONCLUSION Drug dependence is associated with worse post-operative outcomes in patients with infective endocarditis who underwent valvular surgery and lengthens their hospital stay.
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Affiliation(s)
- Anthony Lemaire
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Viktor Dombrovskiy
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Siavash Saadat
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - George Batsides
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Aziz Ghaly
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Alan Spotnitz
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
| | - Leonard Y Lee
- Department of Surgery, UMDNJ-Robert Wood Johnson Medical School , New Brunswick, New Jersey
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9
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Endocarditis infecciosa en pacientes diagnosticados de cirrosis hepática. ¿Está indicado el tratamiento quirúrgico? CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Sundaragiri PR, Vallabhajosyula S, Mahfood Haddad T, Esterbrooks DJ. Tricuspid and mitral endocarditis due to methicillin-resistant Staphylococcus aureus exhibiting vancomycin-creep phenomenon. BMJ Case Rep 2015; 2015:bcr2015211974. [PMID: 26531738 PMCID: PMC4654159 DOI: 10.1136/bcr-2015-211974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/04/2022] Open
Abstract
Right-sided infective endocarditis (RIE) is commonly due to Staphylococcus aureus and often involves the tricuspid valve (TV). A 31-year-old man with prior intravenous drug use presented with substernal pain, cough, dyspnoea and fever. Examination revealed a febrile, tachycardic male with peripheral infective endocarditis stigmata and right-heart failure. Laboratory parameters demonstrated leucocytosis, lactic acidosis and methicillin-resistant S. aureus (MRSA) bacteraemia. Echocardiography demonstrated multiple TV echodensities and chest imaging confirmed septic emboli. The MRSA species demonstrated 'vancomycin-creep', necessitating therapy with daptomycin and ceftaroline. Owing to persistent bacteraemia and septic shock, the patient underwent TV surgery, but continued to have a poor postoperative course with subsequent death. Indications for surgical therapy of RIE are limited to the European guidelines and most data are extrapolated from left-heart disease. MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials.
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Affiliation(s)
- Pranathi Rao Sundaragiri
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Saraschandra Vallabhajosyula
- Division of Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Toufik Mahfood Haddad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Dennis J Esterbrooks
- Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
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11
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Noyes AM, Ramu B, Parker MW, Underhill D, Gluck JA. Extracorporeal Membrane Oxygenation as a Bridge to Surgery for Infective Endocarditis Complicated by Aorto-Atrial Fistula and Cardiopulmonary Collapse. Tex Heart Inst J 2015; 42:471-3. [PMID: 26504445 DOI: 10.14503/thij-14-4575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The timing of surgery for active infective endocarditis is challenging when patients exhibit mechanical dysfunction and hemodynamic compromise. Extracorporeal membrane oxygenation has been described in treating sepsis but not, insofar as we know, in treating the acute mechanical sequelae that arise from infective endocarditis. We report perhaps the first case that shows the usefulness of extracorporeal membrane oxygenation as a bridge to definitive treatment in a 35-year-old man who had infective endocarditis followed by aorto-atrial fistula and cardiopulmonary collapse.
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12
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Shokoohi H, Haywood Y, Najam F, Taheri MR. Emergent double valve replacement in Austrian syndrome. Am J Emerg Med 2014; 33:314.e3-6. [PMID: 25218621 DOI: 10.1016/j.ajem.2014.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/09/2014] [Indexed: 10/24/2022] Open
Abstract
Bi-valvular pneumococcal endocarditis in Austrian syndrome, which includes a triad of pneumococcal endocarditis, pneumonia, and meningitis, is a rare but life-threatening disease. We present a case of a woman found to have Austrian syndrome who presented to the emergency department (ED) with dehydration and radiographical signs of lobar pneumonia and quickly deteriorated to fulminant cardiogenic shock in less than four hours. An early echocardiogram in the ED confirmed a diagnosis of bi-valvular endocarditis with severe aortic and mitral valve insufficiency and large vegetations on the valve leaflets requiring emergent surgical intervention with double valve replacement. Assumed meningitis as a part of the triad of Austrian syndrome was confirmed by imaging the day after hospital admission. Early diagnosis of endocarditis by obtaining the echocardiogram in the ED along with emergent surgical intervention allowed for a favorable outcome for the patient.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency Medicine, The George Washington University, Washington, DC.
| | - Yolanda Haywood
- Department of Emergency Medicine, The George Washington University, Washington, DC
| | - Farzad Najam
- Department of Cardiovascular Thoracic Surgery, The George Washington University, Washington, DC
| | - M Reza Taheri
- Department of Radiology, The George Washington University, Washington, DC
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Savage EB, Saha-Chaudhuri P, Asher CR, Brennan JM, Gammie JS. Outcomes and prosthesis choice for active aortic valve infective endocarditis: analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2014; 98:806-14. [PMID: 25085561 DOI: 10.1016/j.athoracsur.2014.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 04/29/2014] [Accepted: 05/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND National prosthesis use in active aortic valve infective endocarditis (IE) is unreported. Prosthesis usage and outcomes in patients undergoing an aortic valve operation with active IE was evaluated. METHODS The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to identify patients with active IE who underwent an aortic valve operation from January 1, 2005, to June 30, 2011. All patients with active IE were included. Demographics, procedures, outcomes, and trends were analyzed. RESULTS Of 11,560 patients who were identified as having active IE, 8,421 (73%) had no prior operations (primary) and 3,139 (27%) had a history of any prior cardiac operation (reoperative). Operations for primary vs reoperative patients included isolated replacement in 88.5% vs 58.7% and root replacement in 7.2% vs 29.9%. Major morbidity was 60.8% vs 68%, and the unadjusted mortality rate was 9.8% vs 21.1%. Over time, for primary operations, biologic valve use increased (57% to 67%), and mechanical and homograft valve use decreased (30% to 24% and 9% to 6%; p < 0.001). For reoperations, biologic valve use increased (38% to 52%), and mechanical and homograft use decreased (20% to 17% and 38% to 28%; p < 0.001). Homografts were used more often in reoperations (32% vs 7%). CONCLUSIONS Morbidity and mortality rates death are high for operations for active IE. Biologic valves were increasingly used vs mechanical and homograft valves. Homograft valves were used more often in reoperative patients after any prior cardiac operation. The mortality rate varied among prosthesis groups but may be related to the severity of infection and type of procedure performed.
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Affiliation(s)
- Edward B Savage
- Department of Cardiothoracic Surgery, Cleveland Clinic Florida, Weston, Florida.
| | | | - Craig R Asher
- Department of Cardiology, Cleveland Clinic Florida, Weston, Florida
| | - J Matthew Brennan
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
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Pang PYK, Sin YK, Lim CH, Tan TE, Lim SL, Chao VTT, Chua YL. Surgical management of infective endocarditis: an analysis of early and late outcomes. Eur J Cardiothorac Surg 2014; 47:826-32. [PMID: 25027271 DOI: 10.1093/ejcts/ezu281] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 06/10/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To review our experience of surgical management of infective endocarditis (IE) over a 13-year period and analyse the outcomes and associated prognostic factors. METHODS A retrospective review was conducted for 191 consecutive patients who underwent surgery for native and prosthetic valve endocarditis (PVE) between January 2000 and December 2012. Surgical outcomes were reviewed to include survival and postoperative complications. Follow-up was complete for 172 of 179 patients (96.1%) surviving to hospital discharge, with a mean follow-up of 6.6 ± 3.7 years. RESULTS Mean age was 47.4 ± 14.9 years with 113 (63.9%) males. Native valve endocarditis was present in 177 patients (92.7%). Sixty-three patients (33.0%) presented with embolic complications. The brain was the most common site of embolism, involving 25 patients (13.1%). Streptococcus viridans was the most common infective organism, isolated in 68 patients (35.7%), followed by Staphylococcus aureus in 30 patients (15.7%). Eighty-seven patients (45.5%) had active endocarditis at the time of surgery. The mitral valve was infected in 136 patients (71.2%), the aortic valve in 66 (34.6%), the tricuspid valve in 29 (15.2%) and multiple valves in 38 (19.9%). Nineteen patients (9.9%) were intravenous drug users (IVDU). Twelve IVDUs (63.2%) suffered from tricuspid valve IE, compared with 7 of 162 patients (4.3%) in the non-IVDU population (P < 0.001). The most common indication for early surgery was intractable cardiac failure. Twelve patients (6.3%) died during the hospital stay for surgical treatment of IE. Logistic multivariate analysis identified preoperative creatinine clearance and stroke as independent predictors of in-hospital mortality. Overall 10-year survival and freedom from valve-related reoperation were 74.8 and 90.3%, respectively. Age, PVE, S. aureus endocarditis and postoperative left ventricular ejection fraction (LVEF) ≤45% were factors influencing long-term survival. CONCLUSIONS Surgical management of endocarditis continues to be challenging and is associated with significant morbidity and mortality. This report of 191 patients who underwent valve surgery for IE shows that in-hospital mortality is influenced by preoperative renal function and stroke at the time of presentation. The optimal timing for surgery in patients with stroke remains controversial. Long-term survival was negatively influenced by increasing age, moderate to severely impaired LVEF, prosthetic valve IE and S. aureus infection.
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Affiliation(s)
- Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Chong Hee Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Teing Ee Tan
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - See Lim Lim
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Victor T T Chao
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Yeow Leng Chua
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
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Grossi P, Dalla Gasperina D. Treatment ofPseudomonas aeruginosainfection in critically ill patients. Expert Rev Anti Infect Ther 2014; 4:639-62. [PMID: 17009943 DOI: 10.1586/14787210.4.4.639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Critically ill patients are on the increase in the present clinical setting. Aging of our population and increasingly aggressive medical and therapeutic interventions, including implanted foreign bodies, organ transplantation and advances in the chemotherapy of malignant diseases, have created a cohort of particularly vulnerable patients. Pseudomonas aeruginosa is one of the leading gram-negative organisms associated with nosocomial infections. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant, complicating the choice of therapy. The epidemiology, microbiology, mechanisms of resistance and currently available and future treatment options for the most relevant infections caused by P. aeruginosa are reviewed.
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Affiliation(s)
- Paolo Grossi
- University of Insubria, Infectious Diseases Department, viale Borri 57, 21100 Varese, Italy.
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16
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Jain SR, Prajapati JS, Phasalkar MA, Roy BH, Jayram AA, Shah SR, Singh T, Thakkar AS. Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.55031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Manne MB, Shrestha NK, Lytle BW, Nowicki ER, Blackstone E, Gordon SM, Pettersson G, Fraser TG. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012; 93:489-93. [PMID: 22206953 DOI: 10.1016/j.athoracsur.2011.10.063] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 10/19/2011] [Accepted: 10/25/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND The risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes. METHODS A retrospective review of consecutive patients who underwent surgery for native and prosthetic valve endocarditis between January 1, 2003, and December 31, 2007, was conducted. Surgical outcomes were reviewed to include survival and postoperative complications. Survival was evaluated at end of hospital stay, 30 days, 1 year, and at last follow-up. RESULTS Four hundred twenty-eight patients underwent surgery for IE during the study period: 248 (58%) had native valve endocarditis and 180 (42%) had prosthetic valve endocarditis. Overall 90% of patients survived to hospital discharge. When compared with patients with native valve infection, patients with prosthetic infection had significantly higher 30-day mortality (13% versus 5.6%; p<0.01), but long-term survival was not significantly different (35% versus 29%; p=0.19). Patients with IE caused by Staphylococcus aureus had significantly higher hospital mortality (15% versus 8.4%; p<0.05), 6-month mortality (23% versus 15%; p=0.05), and 1-year mortality (28% versus 18%; p=0.02) compared with non-S aureus IE. CONCLUSIONS Surgical treatment of IE was associated with 90% hospital survival. Outcomes within the 30 days were better for native valve than for prosthetic valve endocarditis. Long-term outcomes were similar. Finally, S aureus was associated with significantly higher mortality compared with other pathogens.
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Affiliation(s)
- Mahesh B Manne
- Department of Internal Medicine, Medicine Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Complicaciones neurológicas de la endocarditis infecciosa: controversias. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Anesthetic management of aortocaval fistula repair associated with aortic valve replacement, severe aortic regurgitation, and bacterial endocarditis. J Anesth 2011; 25:263-6. [PMID: 21409354 DOI: 10.1007/s00540-011-1104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
Abstract
We report a case of an adult male who had received a gunshot to the abdomen 12 years earlier. He presented with manifestations of high-output congestive heart failure (CHF), aortic regurgitation (AR), and pulmonary septic embolism. Further investigation revealed an aortocaval fistula (ACF). Following endovascular repair of the ACF, we observed an immediate rise in systemic vascular resistance (SVR), decrease in central venous pressure (CVP), increase in regurgitant flow across the aortic valve, and decrease in central mixed venous oxygenation. A combination of vasodilators and vasopressors was used to maintain hemodynamics. Milrinone infusion was necessary after cardiopulmonary bypass to maintain cardiac output. Even though local anesthesia and light sedation were used for ACF closure, the hemodynamics changed dramatically throughout the procedure. ACF closure under local anesthesia and sedation is preferred because the hemodynamics alterations under local anesthesia are less severe. The rise in SVR and regurgitant flow across aortic valve is less dramatic. As a result, hemodynamic management and separation from cardiopulmonary bypass are easier.
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20
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Pallás Beneyto LA, Rodríguez Luis O, Bayarri VM. [Infective endocarditis: the role of surgery]. Med Clin (Barc) 2011; 136:67-72. [PMID: 20045529 DOI: 10.1016/j.medcli.2009.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 10/15/2009] [Accepted: 10/22/2009] [Indexed: 11/16/2022]
Abstract
Infective endocarditis (IE) is a serious disease which can carry a bad prognosis if it is not appropriately treated. Sometimes the clinical evolution is unfavourable despite an optimal medical therapy with antibiotics. Surgery in these cases has an important role to eliminate the source of infection or to perform a valve replacement. The surprising evolution of patients operated in critic circumstances take us to analyze the role of early surgery. As physicians, we need to know these patients' risks and to establish the adequate surgical indications.
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Abstract
INTRODUCTION AND OBJECTIVES Prosthetic valve endocarditis is associated with high morbidity and mortality, particularly when urgent surgery is needed. The identification of factors that predict a poor prognosis is the first step in improving outcomes. The study objectives were to characterize patients with prosthetic valve endocarditis who need urgent surgery and to identify factors that predict in-hospital mortality in this high-risk group. METHODS From a database of 648 consecutive patients with infective endocarditis diagnosed between 1996 and 2006 at four tertiary-care centers with cardiac surgery facilities, 46 patients with left-sided prosthetic valve endocarditis who needed urgent surgery were identified. A retrospective study was carried out to determine these patients' main characteristics and to identify predictors of in-hospital mortality. RESULTS The main indications for urgent surgery were heart failure (57%) and persistent infection (33%). In-hospital mortality was 41%. Factors significantly associated with a poor prognosis were fever at admission, persistent infection, positive blood cultures, persistently positive cultures, and echocardiographic evidence of vegetations (P< .05). No specific microorganism was associated with a poor prognosis. CONCLUSIONS Prosthetic valve endocarditis was associated with high mortality when urgent surgery was needed. Although heart failure was the principle reason for urgent surgery, it did not lead to a worse in-hospital prognosis. The presence of vegetations and uncontrolled infection were the main factors associated with higher in-hospital mortality in patients with left-sided infective endocarditis who needed urgent surgery.
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Sila CA. Neurological complications of bacterial endocarditis. HANDBOOK OF CLINICAL NEUROLOGY 2010; 96:221-229. [PMID: 20109683 DOI: 10.1016/s0072-9752(09)96013-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Cathy A Sila
- Stroke & Cerebrovascular Center, Neurological Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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Sy RW, Bannon PG, Bayfield MS, Brown C, Kritharides L. Survivor Treatment Selection Bias and Outcomes Research. Circ Cardiovasc Qual Outcomes 2009; 2:469-74. [DOI: 10.1161/circoutcomes.109.857938] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Raymond W. Sy
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Paul G. Bannon
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Matthew S. Bayfield
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Chris Brown
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
| | - Leonard Kritharides
- From the Department of Cardiology, Concord Repatriation General Hospital (R.W.S., L.K.), and the Departments of Cardiology and Cardiothoracic Surgery, Royal Prince Alfred Hospital (R.W.S., P.G.B., M.S.B.), Sydney South Western Area Health Service, University of Sydney, Sydney, Australia; The Baird Surgical Research Institute (P.G.B., M.S.B.), Newton, Australia; and the National Health and Medical Research Council Clinical Trials Centre (C.B.), University of Sydney, Sydney, Australia
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27
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Influence of preoperative antibiotherapy on valve culture results and outcome of endocarditis requiring surgery. J Infect 2009; 59:42-8. [DOI: 10.1016/j.jinf.2009.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/25/2009] [Accepted: 04/27/2009] [Indexed: 12/20/2022]
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[Evaluation of the status of patients with severe infection, criteria for intensive care unit admittance. Spanish Society for Infectious Diseases and Clinical Microbiology. Spanish Society of Intensive and Critical Medicine and Coronary Units]. Enferm Infecc Microbiol Clin 2009; 27:342-52. [PMID: 19409668 DOI: 10.1016/j.eimc.2008.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 05/26/2008] [Indexed: 12/11/2022]
Abstract
Recent studies have shown that early attention in patients with serious infections is associated with a better outcome. Assistance in intensive care units (ICU) can effectively provide this attention; hence patients should be admitted to the ICU as soon as possible, before clinical deterioration becomes irreversible. The objective of this article is to compile the recommendations for evaluating disease severity in patients with infections and describe the criteria for ICU admission, updating the criteria published 10 years ago. A literature review was carried out, compiling the opinions of experts from the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC, Spanish Society for Infectious Diseases and Clinical Microbiology) and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC, Spanish Society for Intensive Medicine, Critical Care and Coronary Units) as well as the working groups for infections in critically ill patients (GEIPC-SEIMC and GTEI-SEMICYUC). We describe the specific recommendations for ICU admission related to the most common infections affecting patients, who will potentially benefit from critical care. Assessment of the severity of the patient's condition to enable early intensive care is stressed.
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Snygg‐Martin U, Gustafsson L, Rosengren L, Alsiö Å, Ackerholm P, Andersson R, Olaison L. Cerebrovascular Complications in Patients with Left‐Sided Infective Endocarditis Are Common: A Prospective Study Using Magnetic Resonance Imaging and Neurochemical Brain Damage Markers. Clin Infect Dis 2008; 47:23-30. [DOI: 10.1086/588663] [Citation(s) in RCA: 221] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Dzudie A, Mercusot A, de Gevigney G, Delahaye F. [Timing and indications for surgical intervention in infective endocarditis]. Ann Cardiol Angeiol (Paris) 2008; 57:93-7. [PMID: 18402927 DOI: 10.1016/j.ancard.2008.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 02/21/2008] [Indexed: 11/17/2022]
Abstract
This paper reviews current knowledge on the indications for and timing of cardiac surgery in patients with infective endocarditis. The main indications for surgery are haemodynamic compromise, persisting infection, peripheral embolisation, large size of vegetations, large valvular and paravalvular damage and infections caused by certain microorganisms.
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Affiliation(s)
- A Dzudie
- Service cardiologique, hôpital Louis-Pradel, 28, avenue du Doyen-Lépine, 69677 Bron cedex, France
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Lagier JC, Letranchant L, Selton-Suty C, Nloga J, Aissa N, Alauzet C, Carteaux JP, May T, Doco-Lecompte T. [Staphylococcus aureus bacteremia and endocarditis]. Ann Cardiol Angeiol (Paris) 2008; 57:71-77. [PMID: 18395179 DOI: 10.1016/j.ancard.2008.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 02/21/2008] [Indexed: 05/26/2023]
Abstract
The prevalence of Stapylococcus bacteriaemia is increasing worldwide, because of the increasing use of invasive procedures leading to nosocomial infections, but also of a changing way of life (increasing fashion for tattoos or piercing, use of intravenous drugs). Infective endocarditis develops in 10-30% of the cases of staphylococcus bacteriaemia. Staphylococcus aureus endocarditis must be suspected when it develops in the year following heart surgery or implantation of permanent devices. In drug users, it usually involves the tricuspid valve. According to the resistance of the germ to meticillin, antibiotic therapy uses a combination of intravenous penicillin or glycopeptide and an aminoside. Other antibiotics such as fosfomycin, rifampicin, fusidic acid, or clindamycin can be used when aminosides are contra-indicated. The role of newer antibiotic agents, such as daptomycin or linezolide, remains to be established.
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Affiliation(s)
- J-C Lagier
- Service de maladies infectieuses et tropicales, CHU de Nancy, 54511 Vandoeuvre-les-Nancy cedex, France
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Seo SW, Kim TH, Hyon MS, Choo EJ, Jeon MH, Moon C, Song D, Kim JH, Lee YG, Choi JH, Jeon W, Jo YS, Choi MH. Characteristics of Infective Endocarditis in 4 University Hospitals where Staphylococcus aureus is the Most Common Causative Organism. Infect Chemother 2008. [DOI: 10.3947/ic.2008.40.6.316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sung Woo Seo
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Tae Hyong Kim
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Min Su Hyon
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Eun Ju Choo
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Min Hyok Jeon
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Chul Moon
- Department of Surgery, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Dan Song
- Department of Surgery, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Jong Hwa Kim
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Yong Gwan Lee
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Jong Hyo Choi
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Woong Jeon
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Young Sin Jo
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
| | - Moon Han Choi
- Department of Internal Medicine, Soon Chun Hyang University, College of Medicine, Seoul, Korea
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Abstract
Infective endocarditis (IE) is estimated to have an incidence of five to seven cases per 100,000 person-years. Although not a common clinical entity, IE is associated with substantial morbidity and risk of mortality. IE, especially infections due to Staphylococcus aureus, are increasingly healthcare-associated infections. Despite significant advances in diagnosis and management, mortality from IE has changed little since the availability of penicillin; however, this lack of improvement in mortality is likely due to an increasing number of infections from more virulent and drug-resistant pathogens coupled with infections that occur in patients with other comorbidities and those associated with prosthetic valves. Surgery is an important part of therapy for many patients, but surprisingly, little evidence is available to help clinicians determine which patients will benefit most from surgical therapy for the management of IE.
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Affiliation(s)
- Patricia D Brown
- Wayne State University School of Medicine, Detroit Receiving Hospital, 5S, 4201 St. Antoine, Detroit, MI 48201, USA.
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Cohen E, Bishara J, Medalion B, Sagie A, Garty M. Infective endocarditis due to Actinomyces neuii. ACTA ACUST UNITED AC 2007; 39:180-3. [PMID: 17366042 DOI: 10.1080/00365540600802007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Actinomyces endocarditis is very rare. At present the only Actinomyces species identified causing endocarditis are A. israelii, A. bovis, A. viscosus, A. pyogenes, A. meyeri and A. funkei. We here report the first case of endocarditis caused by Actinomyces neuii.
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Affiliation(s)
- Eytan Cohen
- Recanati Centre for Internal Medicine and Research, Clinical Pharmacology Unit, Petah Tikva, Israel
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Tleyjeh IM, Ghomrawi HMK, Steckelberg JM, Hoskin TL, Mirzoyev Z, Anavekar NS, Enders F, Moustafa S, Mookadam F, Huskins WC, Wilson WR, Baddour LM. The Impact of Valve Surgery on 6-Month Mortality in Left-Sided Infective Endocarditis. Circulation 2007; 115:1721-8. [PMID: 17372170 DOI: 10.1161/circulationaha.106.658831] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background—
The role of valve surgery in left-sided infective endocarditis has not been evaluated in randomized controlled trials. We examined the association between valve surgery and all-cause 6-month mortality among patients with left-sided infective endocarditis.
Methods and Results—
A total of 546 consecutive patients with left-sided infective endocarditis were included. To minimize selection bias, propensity score to undergo valve surgery was used to match patients in the surgical and nonsurgical groups. To adjust for survivor bias, we matched the follow-up time so that each patient in the nonsurgical group survived at least as long as the time to surgery in the respective surgically-treated patient. We also used valve surgery as a time-dependent covariate in different Cox models. A total of 129 (23.6%) patients underwent surgery within 30 days of diagnosis. Death occurred in 99 of the 417 patients (23.7%) in the nonsurgical group versus 35 deaths among the 129 patients (27.1%) in the surgical group. Eighteen of 35 (51%) patients in the surgical group died within 7 days of valve surgery. In the subset of 186 cases (93 pairs of surgical versus nonsurgical cases) matched on the logit of their propensity score, diagnosis decade, and follow-up time, no significant association existed between surgery and mortality (adjusted hazard ratio, 1.3; 95% confidence interval, 0.5 to 3.1). With a Cox model that incorporated surgery as a time-dependent covariate, valve surgery was associated with an increase in the 6-month mortality with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.1 to 3.2). Because the proportionality hazard assumption was violated in the time-dependent analysis, we performed a partitioning analysis. After adjustment for early (operative) mortality, surgery was not associated with a survival benefit (adjusted hazard ratio, 0.92; 95% confidence interval, 0.48 to 1.76).
Conclusions—
The results of our study suggest that valve surgery in left-sided infective endocarditis is not associated with a survival benefit and could be associated with increased 6-month mortality, even after adjustment for selection and survivor biases as well as confounders. Given the disparity between the results of our study and those of other observational studies, well-designed prospective studies are needed to further evaluate the role of valve surgery in endocarditis management.
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Affiliation(s)
- Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn, USA.
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Mocchegiani R, Pergolini M, Nataloni M. Infective endocarditis: outcome in surviving patients with intracardiac complications. J Cardiovasc Med (Hagerstown) 2007; 8:163-8. [PMID: 17312432 DOI: 10.2459/01.jcm.0000260818.66071.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the outcome of 15 patients who survived infective endocarditis with abscesses and other intracardiac complications. METHODS Abscesses were associated with native valve endocarditis in seven patients and prosthetic valve endocarditis in eight patients; fistulas were observed in three patients, and subaortic perforation in three patients. Sensitivity for the detection of abscesses was 42.8% and 92.8% using transthoracic and transoesophageal echocardiography, respectively. Eleven patients underwent surgical treatment with no operative mortality, whereas four patients were only medically treated. RESULTS During follow-up (mean 8.26 years), two patients died (13%) and six recurrences (five early and one late prosthetic valve endocarditis) required re-intervention for prosthesis dysfunction (40%); an improvement in New York Heart Association class in survivors and no changes in echocardiographic lesions were observed. CONCLUSIONS Infective intracardiac complications do not seem to significantly reduce the overall survival (87%) of patients at long-term follow-up.
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Aksoy O, Sexton DJ, Wang A, Pappas PA, Kourany W, Chu V, Fowler VG, Woods CW, Engemann JJ, Corey GR, Harding T, Cabell CH. Early Surgery in Patients with Infective Endocarditis: A Propensity Score Analysis. Clin Infect Dis 2007; 44:364-72. [PMID: 17205442 DOI: 10.1086/510583] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 10/02/2006] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND An accurate assessment of the predictors of long-term mortality in patients with infective endocarditis is not possible using retrospective data because of inherent treatment biases and predictable imbalances in the distribution of prognostic factors. Largely because of these limitations, the role of surgery in long-term survival has not been adequately studied. METHODS Data were collected prospectively from 426 patients with infective endocarditis. Variables associated with surgery in patients who did not have intracardiac devices who had left-side-associated valvular infections were determined using multivariable analysis. Propensity scores were then assigned to each patient based on the likelihood of undergoing surgery. Using individual propensity scores, 51 patients who received medical and surgical treatment were matched with 51 patients who received medical treatment only. RESULTS The following factors were statistically associated with surgical therapy: age, transfer from an outside hospital, evidence of infective endocarditis on physical examination, the presence of infection with staphylococci, congestive heart failure, intracardiac abscess, and undergoing hemodialysis without a chronic catheter. After adjusting for surgical selection bias by propensity score matching, regression analysis of the matched cohorts revealed that surgery was associated with decreased mortality (hazard ratio, 0.27; 95% confidence interval, 0.13-0.55). A history of diabetes mellitus (hazard ratio, 4.81; 95% confidence interval, 2.41-9.62), the presence of chronic intravenous catheters at the beginning of the episode (hazard ratio, 2.65; 95% confidence interval, 1.31-5.33), and paravalvular complications (hazard ratio, 2.16; 95% confidence interval, 1.06-4.44) were independently associated with increased mortality. CONCLUSIONS Differences between clinical characteristics of patients with infective endocarditis who receive medical therapy versus patients who receive surgical and medical therapy are paramount. After controlling for inherent treatment selection bias and imbalances in prognostic factors using propensity score methodology, risk factors associated with increased long-term mortality included diabetes mellitus, the presence of a chronic catheter at the onset of infection, and paravalvular complications. In contrast, surgical therapy was associated with a significant long-term survival benefit.
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Affiliation(s)
- Olcay Aksoy
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Al-Jasser AM, Enani MA, Al-Fagih MR. Endocarditis caused by Abiotrophia defectiva. Libyan J Med 2007. [DOI: 10.3402/ljm.v2i1.4691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Mushira A Enani
- Department of Medicine, Section of Adult Infectious Diseases, Armed Forces Hospital
| | - Mohammed R Al-Fagih
- Department of Cardiac Surgery, Prince Sultan Cardiac Centre. Riyadh, Saudi Arabia
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40
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Borghetti V, Bovelli D, D'Addario G, Fiaschini P, Fioriello F, Nardi S, Cappanera S, Pardini A. Importance of surgical timing on postoperative outcome in patients with native valve acute endocarditis. J Cardiovasc Med (Hagerstown) 2006; 7:793-9. [PMID: 17060804 DOI: 10.2459/01.jcm.0000250866.33036.b5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The present study was undertaken to establish whether surgical outcome could be influenced by surgical timing in patients affected by native valve endocarditis (NVE). METHODS From March 2002 to December 2004, 19 patients underwent surgical operation for NVE. Aortic valve replacement (AVR) was performed in ten patients (53%), mitral valve repair (MVRep) was performed in five patients (26%) and multivalvular procedures were performed in the remaining four patients (21%). In three patients (15.5%), emergency surgery was required for refractory congestive heart failure, urgent surgery was necessary in ten patients [in six patients (31%) for paravalvular abscess, in three patients (15.5%) for macrovegetations and in one patient (6%) for systemic embolism, respectively], five patients (26.3%) with isolated valve incompetence underwent elective surgery, whereas delayed surgery was reserved for one patient (6%) because of pre-operative embolic stroke. RESULTS There were no surgical procedure, cardiac or infectious related deaths at 30 days in the entire group. One patient died from an intravenous overdose. Follow-up was 100% complete in the 18 hospital survivors and ranged from 4 to 37 months (mean 14.2 +/- 10 months). There were no late death, recurrence of endocarditis, or re-operation at follow-up. CONCLUSIONS The surgical results for NVE are excellent if surgical timing criteria are correctly applied during the acute phase of the infectious process. Immediate surgical correction is required when rapid hemodynamic deterioration occurs whereas a more aggressive surgical approach appears to be advisable in the case of paravalvular abscess, macrovegetations or systemic embolism. Delayed surgery is recommended when pre-operative stroke develops.
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Gianfagna P. Echocardiography in infective endocarditis: what is the best time and what is the best approach? J Cardiovasc Med (Hagerstown) 2006; 7:667-8. [PMID: 16932079 DOI: 10.2459/01.jcm.0000242999.82546.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Affiliation(s)
- Rhys P Beynon
- Department of Cardiology, Wythenshawe Hospital, Manchester M23 9LT
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Anguera I, del Río A, Moreno A, Paré C, Mestres CA, Miró JM. Complications of native and prosthetic valve infective endocarditis: Update in 2006. Curr Infect Dis Rep 2006; 8:280-8. [PMID: 16822371 DOI: 10.1007/s11908-006-0072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infective endocarditis is a rare disease associated with significant morbidity and mortality. In the past decades, there have been significant improvements in the management of infective endocarditis. Complications are frequent and include heart failure, embolic episodes, periannular complications, and central nervous system events. Surgical therapy has been fundamental in the reduction of mortality in complicated cases. This paper is an overview of the main complications of native and prosthetic infective endocarditis and its treatment.
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Affiliation(s)
- Ignasi Anguera
- University of Barcelona, Hospital Clinic Universitari, Helios-Villarroel Building--Desk no. 26, Villarroel, 170, 08036, Barcelona, Spain
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The surgical treatment of infective endocarditis: An overview. Indian J Thorac Cardiovasc Surg 2006. [DOI: 10.1007/s12055-006-0504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Stevens MP, Edmond MB. Endocarditis Due to Vancomycin-Resistant Enterococci: Case Report and Review of the Literature. Clin Infect Dis 2005; 41:1134-42. [PMID: 16163631 DOI: 10.1086/444459] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 06/02/2005] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Endocarditis due to vancomycin-resistant enterococci (VRE) is rare, and the literature consists almost exclusively of reports of single cases. METHODS We report a case of VRE prosthetic valve endocarditis and review 18 cases of native and prosthetic valve VRE endocarditis reported in the literature. RESULTS The majority of cases were due to Enterococcus faecium. Nearly all of these infections were hospital acquired, and the vast majority of patients had significant underlying disease processes, including dialysis and transplantation. More than three-quarters of cases were left-sided, and the aortic valve was most commonly involved. Peripheral stigmata of endocarditis were not reported in any of the cases. Approximately 40% of patients developed cardiac complications. Nearly three-quarters of patients survived, despite the difficulties associated with providing bactericidal antimicrobial therapy, and only 4 patients underwent valve replacement. CONCLUSIONS VRE endocarditis is an uncommon nosocomial infection that affects patients with significant comorbid conditions. Most cases are due to E. faecium, and the aortic valve is involved in at least one-half of cases. One-third of patients require surgical treatment. Optimal antimicrobial therapy remains undefined, but an attempt to identify bactericidal combination therapy should be sought.
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Affiliation(s)
- Michael P Stevens
- Virginia Commonwealth University Medical Center, Richmond, VA 23298-0019, USA
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Abstract
Infective endocarditis (IE) is an evolving disease with a persistently high mortality and morbidity, even in the modern era of advanced diagnostic imaging, improved antimicrobial chemotherapy, and potentially curative surgery. Despite these improvements in health care, the incidence of the disease has remained unchanged over the past two decades and may even be increasing. Chronic rheumatic heart disease is now an uncommon antecedent, whereas degenerative valve disease of the elderly, mitral valve prolapse, intravenous drug misuse, preceding valve replacement, and vascular instrumentation have become increasingly common, coinciding with an increase in staphylococcal infections and those caused by fastidious organisms. The current understanding of this difficult condition is reviewed and recent developments in medical and surgical management are updated.
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Affiliation(s)
- B D Prendergast
- Department of Cardiology, Wythenshawe Hospital, Manchester, UK.
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Affiliation(s)
- Daniel M Couri
- Mayo Graduate School of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Cazorla C, Grenier de Cardenal D, Schuhmacher H, Thomas L, Wack A, May T, Rabaud C. Complications infectieuses et mésusage de la buprénorphine à haut dosage. Presse Med 2005; 34:719-24. [PMID: 16026125 DOI: 10.1016/s0755-4982(05)84025-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND High-dose buprenorphine (HDB) treatment began in France in 1996 according to relatively unrestricted prescription rules. Continued heroin injection by patients on HDB maintenance treatment and even HDB injection remain underestimated and may lead to a variety of infectious diseases. OBJECTIVES Description of infectious complications occurring in patients receiving HDB maintenance treatment. METHODS Retrospective study of drug addicts receiving HDB maintenance treatment, injecting (or highly suspected of injecting) it, and hospitalized for infections (other than HIV or viral hepatitis) in the department of infectious and tropical diseases in Nancy University Hospital. Data collection covered 1998 through 2003. RESULTS We identified 21 case reports, 9 concerning infectious endocarditis, 8 cutaneous abscesses, 2 osteoarticular infections, 1 meningitis and 1 Candida retinitis. The sex-ratio was of 1 woman for 2 men, and the patients' mean age was 29.8 years. Globally 13 patients had systemic infections. Nine patients admitted having injected HDB (and no other drugs) (including the case of Candida retinitis), while in the other 12 cases, the patients continued injecting heroin as well. The role of misused HDB was strongly suspected in those 12 infections, but was not clearly confirmed. All patients recovered from the infections. The long-term psychosocial outcome remains unknown. CONCLUSION The cases analyzed illustrate the dual reality that HDB is often ineffective as a maintenance treatment, since some patients continue to inject heroin, and that its misuse can have infectious consequences. The results of HDB maintenance treatment substitution are mixed. The individual benefit/risk ratio must be improved. Networking is crucial, notably between physician and pharmacist, and the monitoring system must be reinforced.
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Affiliation(s)
- C Cazorla
- Service des maladies infectieuses et tropicales, CHU de Nancy (54)
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Nevado J, De Alarcón A, Hernández A. Caspofungin: a new therapeutic option for fungal endocarditis. Clin Microbiol Infect 2005; 11:248. [PMID: 15715728 DOI: 10.1111/j.1469-0691.2005.01078.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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50
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Steinbach WJ, Perfect JR, Cabell CH, Fowler VG, Corey GR, Li JS, Zaas AK, Benjamin DK. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect 2004; 51:230-47. [PMID: 16230221 DOI: 10.1016/j.jinf.2004.10.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 10/25/2004] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The optimal management of Candida infective endocarditis (IE) is unknown. METHODS We reviewed all 879 cases of Candida IE reported from 1966-2002 in the peer-reviewed literature to better understand the role of medical and surgical therapies. This review included 163 patients from 105 reports that met our inclusion criteria: 31 cases treated with antifungal monotherapy, 25 cases treated with medical antifungal combination therapy, and 107 cases treated with adjunctive surgical plus medical antifungal therapy. We also used meta-analytic techniques to evaluate 22 observational case-series (72 patients) of the 105 reports with two or more patients with definite Candida IE. RESULTS We found that in patients who underwent adjunctive surgery there was a lower reported proportion of deaths [prevalence odds ratio (POR)=0.56; 95% confidence interval (CI)=0.16, 1.99)]. Higher mortality was noted in patients treated prior to 1980 (POR=2.03; 95% CI=0.55, 7.61), treated with antifungal monotherapy (POR=1.49; 95% CI=0.39, 5.81), infected with Candida parapsilosis (POR=1.51; 95% CI=0.41, 5.52), or with left-sided endocarditis (POR=2.36; 95% CI=0.55, 10.07). CONCLUSIONS Medical antifungal therapy of Candida IE is poorly characterized, and recent antifungal developments lend promise for those patients who cannot undergo surgery.
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Affiliation(s)
- William J Steinbach
- Division of Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC 27710, USA.
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