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Harada H, Nakamura K, Koyama Y, Kikuchi K, Iwano H, Nabuchi-Kawasaki M, Kubono Y, Sano M, Serizawa Y, Tetsuya H. Mural infective endocarditis with a mass on the fossa ovalis in the right atrium. J Infect Chemother 2024; 30:1179-1181. [PMID: 38570138 DOI: 10.1016/j.jiac.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Infective endocarditis (IE) is a life-threatening disease that affects the endocardial surface of the heart. Although heart valves are commonly involved in IE, in rare cases, vegetation is attached to the cardiac walls without valvular endocardial involvement, which is referred to as mural IE. In this case, a 60-year-old female presented with a seven-day history of fever associated with worsening pain in the right shoulder and left hip. Streptococcus dysgalactiae subsp. Equisimilis was detected in both blood and joint fluid cultures. Although transthoracic echocardiography revealed no mass, transesophageal echocardiography revealed a mobile mass in the fossa ovalis of the right atrium. She was subsequently diagnosed with mural IE and successfully treated with antibiotics without cardiac surgery. To our knowledge, only a few reports have described mural IE with vegetation in or around the fossa ovalis of the right atrium. This case highlights the importance of transesophageal echocardiography in diagnosing mural IE. The treatment strategy for mural IE should be discussed individually and in a multidisciplinary manner because current IE guidelines may not be applicable to mural IE cases due to differences in disease characteristics and clinical course between mural and valvular IE.
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Affiliation(s)
- Hiroki Harada
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
| | - Kaito Nakamura
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yuki Koyama
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Koki Kikuchi
- Department of Infectious Diseases, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyuki Iwano
- Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | | | - Yuta Kubono
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Megumi Sano
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yoshimoto Serizawa
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hoshi Tetsuya
- Department of General Internal Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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Schmidt-Pogoda A, Straeten FA, Beuker C, Werring N, Minnerup J. [Inflammatory causes of stroke-Diagnostics and treatment]. DER NERVENARZT 2024; 95:909-919. [PMID: 39080056 PMCID: PMC11427622 DOI: 10.1007/s00115-024-01711-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 09/27/2024]
Abstract
Inflammatory causes of stroke are frequent and often pose diagnostic and therapeutic challenges due to the scarcity of randomized trials and the absence of clear guideline recommendations for many scenarios. Following the publication of the recommendations of the European Stroke Organization on primary angiitis of the central nervous system (PACNS) last year, the German Neurological Society (DGN) has issued very clear guidelines this year on the diagnostics and treatment of PACNS and updated the recommendations for systemic vasculitides; however, stroke often occurs not only as a result of primary vascular inflammation but also as a complication of another organ infection. Approximately 5% of all patients with sepsis, ca. 20% of patients with bacterial meningitis and up to 40% of patients with bacterial endocarditis suffer from a stroke as a complication. This article summarizes the key characteristics of these inflammatory causes of stroke and particularly focuses on the current recommendations for diagnostic and therapeutic management.
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Affiliation(s)
- Antje Schmidt-Pogoda
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
| | - Frederike A Straeten
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Carolin Beuker
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Nils Werring
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - Jens Minnerup
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
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Rottmann FA, Schorle P, Giesen R, Jäger C. Prosthetic Valve Endocarditis Caused by Pasteurella dagmatis, Germany. Emerg Infect Dis 2024; 30:2202-2204. [PMID: 39320237 PMCID: PMC11431900 DOI: 10.3201/eid3010.240727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
An 81-year-old male patient in Germany had prosthetic valve endocarditis caused by Pasteurella dagmatis after a domestic cat bite. We surgically treated a paravalvular abscess and administered definitive antibiotic therapy consisting of penicillin G and levofloxacin. The patient was discharged from the intensive care unit in good condition 21 days after the surgery.
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Safdar MN, Sohail AA, Iqbal S, Sami S, Sharif H, Shahabuddin S. A surgical odyssey: Conquering a titanic tricuspid vegetation reaching into the superior vena cava - A case report. Int J Surg Case Rep 2024; 123:110180. [PMID: 39182307 PMCID: PMC11388755 DOI: 10.1016/j.ijscr.2024.110180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION Right-sided infective endocarditis, particularly of the tricuspid valve, is rare and challenging to diagnose, often presenting with nonspecific symptoms, and associated with high mortality rates. This case underscores the complexities in managing such conditions and the importance of early diagnosis and multidisciplinary intervention. CASE PRESENTATION This case study details the medical history of a 34-year-old woman who had a background of intravenous drug abuse. She subsequently developed a fungal tricuspid valve endocarditis, leading to the formation of vegetation that extended into the superior vena cava. The mass measured 15 × 3 cm upon surgical removal. DISCUSSION Right-sided infective endocarditis is rare, comprising only 5-10 % of cases, with tricuspid valve endocarditis being even rarer. Damage to the endothelium facilitates bacterial attachment, especially in IV drug users, with Staphylococcus aureus being common. Fungal endocarditis is rare but deadly, with high mortality. Diagnosis relies on the modified Duke criteria, including microbiological and imaging evidence. Major complications affect both valvular and systemic areas. Treatment p1rimarily involves IV antibiotics, but surgery is needed for persistent infections or severe complications. CONCLUSION This case underscores the critical importance of early diagnosis and intervention in managing right-sided infective endocarditis, especially with a fungal pathology and in patients with complex medical histories.
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Affiliation(s)
- Muhammad Nabeel Safdar
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Abdul Ahad Sohail
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Sara Iqbal
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahid Sami
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hasanat Sharif
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Shahabuddin
- Section of Cardiothoracic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Petri F, Mahmoud OK, Zein SE, Alavi SMA, Passerini M, Diehn FE, Verdoorn JT, Tande AJ, Nassr A, Freedman BA, Murad MH, Berbari EF. Wide Variability of the Definitions Used for Native Vertebral Osteomyelitis: Walking the Path for a Unified Diagnostic Framework with a Meta-Epidemiological Approach. Spine J 2024:S1529-9430(24)01047-7. [PMID: 39349257 DOI: 10.1016/j.spinee.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/19/2024] [Accepted: 09/14/2024] [Indexed: 10/02/2024]
Abstract
BACKGROUND CONTEXT Native Vertebral Osteomyelitis (NVO) has seen a rise in incidence, yet clinical outcomes remain poor with high relapse rates and significant long-term sequelae. The 2015 IDSA Clinical Practice Guidelines initiated a surge in scholarly activity on NVO, revealing a patchwork of definitions and numerous synonyms used interchangeably for this syndrome. PURPOSE To systematically summarize these definitions, evaluate their content, distribution over time, and thematic clustering. STUDY DESIGN/SETTING Meta-epidemiological study with a systematic review of definitions. PATIENTS SAMPLE An extensive search of multiple databases was conducted, targeting trials and cohort studies dating from 2005 to present, providing a definition for NVO and its synonyms. OUTCOME MEASURES Analysis of the diagnostic criteria that composed the definitions and the breaking up of the definitions in the possible combinations of diagnostic criteria. METHODS We pursued a thematic synthesis of the published definitions with Boolean logic, yielding single or multiple definitions per included study. Using eight predefined diagnostic criteria, we standardized definitions, focusing on the minimum necessary combinations used. Definition components were visualized using Sankey diagrams. RESULTS The literature search identified 8,460 references, leading to 171 studies reporting on 21,963 patients. Of these, 91.2% were retrospective, 7.6% prospective, and 1.2% RCTs. Most definitions originated from authors, with 29.2% referencing sources. We identified 92 unique combinations of diagnostic criteria across the literature. Thirteen main patterns emerged, with the most common being clinical features with imaging, followed by clinical features combined with imaging and microbiology, and lastly, imaging paired with microbiology. CONCLUSIONS Our findings underscore the need for a collaborative effort to develop standardized diagnostic criteria. We advocate for a future Delphi consensus among experts to establish a unified diagnostic framework for NVO, emphasizing the core components of clinical features and MRI while incorporating microbiological and histopathological insights to improve both patient outcomes and research advancements.
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Affiliation(s)
- Francesco Petri
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Milan, 20157, Italy.
| | - Omar K Mahmoud
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | - Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | | | - Matteo Passerini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco, "L. Sacco" University Hospital, Milan, 20157, Italy; Department of Pathophysiology and Transplantation, University of Milano, Milan, 20122, Italy
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, 55905, MN, USA
| | | | - Aaron J Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA
| | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, 55905, MN, USA
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA; Evidence-based Practice Center, Mayo Clinic, Rochester, 55905, MN, USA
| | - Elie F Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, 55905, MN, USA.
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Alonso-Menchén D, Marín-Arriaza M, Villamarín M, Fernández-Hidalgo N, López-Azor JC, Calderón-Parra J, Águila Fernández-Paniagua E, Hidalgo-Tenorio C, de Alarcón A, Goenaga-Sánchez MÁ, Rodríguez-Esteban MÁ, García Vázquez E, Grillo S, Bouza Santiago E, Muñoz P. Cutibacterium Species Valvular and Cardiac Device-Related Infective Endocarditis: Contemporary Data From the GAMES Prospective Cohort (2008-2023). Clin Infect Dis 2024; 79:663-671. [PMID: 38913722 DOI: 10.1093/cid/ciae334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/06/2024] [Accepted: 06/18/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Information on infective endocarditis (IE) caused by Cutibacterium spp. is limited and new Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) criteria have not yet been properly assessed. We examined clinical characteristics, outcomes, and performance of diagnostic tests for Cutibacterium valvular and cardiac implantable electronic device-related IE (CIED-IE). METHODS Data corresponding to all episodes of Cutibacterium IE recorded from 2008 to 2023 in a prospective national cohort including 46 Spanish hospitals were examined. Possible IE cases were reassessed using the new criteria. The sensitivity of blood cultures, valvular and CIED cultures, and polymerase chain reaction of the 16S rRNA gene and sequencing (16SPCR) was evaluated. RESULTS Of 6692 episodes of IE, 67 (1%) were caused by Cutibacterium spp. with 85% affecting men. Of these, 50 were valve-related (45 prosthetic, 5 native) and 17 CIED-related. The new criteria identified 8 additional cases and reclassified 15 as definite IE. Intracardiac complications (abscess, pseudoaneurysm, perforation, or intracardiac fistula) occurred in 23 of 50 (46%) valvular IE episodes, leading to 18% mortality, and up to 40% mortality if surgery was indicated but could not be performed. All CIED-IE cases underwent device removal and no deaths were recorded. Positive diagnosis rates for blood cultures, valve/device cultures, and 16SPCR were 52%, 70%, and 82%, respectively. CONCLUSIONS Cutibacterium IE is a rare yet potentially life-threatening condition that warrants a high index of suspicion in men with endovascular prosthetic material. The new Duke-ISCVID criteria and molecular techniques are useful for its diagnosis. Considering a significant complication rate, cardiac surgery and removal of CIEDs play a key role in reducing mortality.
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Affiliation(s)
- David Alonso-Menchén
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín-Arriaza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Miguel Villamarín
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana, Madrid, Spain
| | | | - Carmen Hidalgo-Tenorio
- Servicio de Medicina Interna, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Arístides de Alarcón
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain
| | - Miguel Ángel Goenaga-Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain
| | | | - Elisa García Vázquez
- Servicio de Medicina Interna-Infecciosas, Instituto Murciano de Investigación Biosanitaria, Hospital Clínico Universitario Virgen de la Arrixaca, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - Sara Grillo
- Servei de Medicina Interna, Unitat de Malalties Infeccioses, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilio Bouza Santiago
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Sunnerhagen T, Rasmussen M. Lower Specificity of the European Society of Cardiology 2023 Diagnostic Criteria for Infective Endocarditis When Spondylodiscitis Is Regarded as a Vascular Phenomenon. Clin Infect Dis 2024; 79:612-614. [PMID: 38655757 PMCID: PMC11426265 DOI: 10.1093/cid/ciae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
The ESC diagnostic criteria for infective endocarditis (IE) added spondylodiscitis as a minor criterion. This resulted in that 11 of 1807 patients with Staphylococcus aureus, streptococcal, or Enterococcus faecalis bacteremia, were reclassified from possible to definite IE, of whom only two were treated as IE.
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Affiliation(s)
- Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Clinical Microbiology and Infection Control, Region Skåne Office for Medical Services, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital Lund, Sweden
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Lai CKC, Leung E, He Y, Ching-Chun C, Oliver MOY, Qinze Y, Li TCM, Lee ALH, Li Y, Lui GCY. A Machine Learning-Based Risk Score for Prediction of Infective Endocarditis Among Patients With Staphylococcus aureus Bacteremia-The SABIER Score. J Infect Dis 2024; 230:606-613. [PMID: 38420871 DOI: 10.1093/infdis/jiae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/24/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Early risk assessment is needed to stratify Staphylococcus aureus infective endocarditis (SA-IE) risk among patients with S. aureus bacteremia (SAB) to guide clinical management. The objective of the current study was to develop a novel risk score that is independent of subjective clinical judgment and can be used early, at the time of blood culture positivity. METHODS We conducted a retrospective big data analysis from territory-wide electronic data and included hospitalized patients with SAB between 2009 and 2019. We applied a random forest risk scoring model to select variables from an array of parameters, according to the statistical importance in predicting SA-IE outcome. The data were divided into derivation and validation cohorts. The areas under the curve of the receiver operating characteristic (AUCROCs) were determined. RESULTS We identified 15 741 SAB patients, among them 658 (4.18%) had SA-IE. The AUCROC was 0.74 (95%CI 0.70-0.76), with a negative predictive value of 0.980 (95%CI 0.977-0.983). The four most discriminatory features were age, history of infective endocarditis, valvular heart disease, and community onset. CONCLUSIONS We developed a novel risk score with performance comparable with existing scores, which can be used at the time of SAB and prior to subjective clinical judgment.
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Affiliation(s)
- Christopher Koon-Chi Lai
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- S.H. Ho Research Centre for Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eman Leung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yinan He
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cheung Ching-Chun
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mui Oi Yat Oliver
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu Qinze
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Chun-Man Li
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alfred Lok-Hang Lee
- Department of Microbiology, Prince of Wales Hospital, Hospital Authority, Hong Kong, Hong Kong SAR, China
| | - Yu Li
- Department of Computer Science and Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Grace Chung-Yan Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Tebano G, Zaghi I, Cricca M, Cristini F. Antibiotic Treatment of Infections Caused by AmpC-Producing Enterobacterales. PHARMACY 2024; 12:142. [PMID: 39311133 PMCID: PMC11417830 DOI: 10.3390/pharmacy12050142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 09/14/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024] Open
Abstract
AmpC enzymes are a class of beta-lactamases produced by Gram-negative bacteria, including several Enterobacterales. When produced in sufficient amounts, AmpCs can hydrolyze third-generation cephalosporins (3GCs) and piperacillin/tazobactam, causing resistance. In Enterobacterales, the AmpC gene can be chromosomal- or plasmid-encoded. Some species, particularly Enterobacter cloacae complex, Klebsiella aerogenes, and Citrobacter freundii, harbor an inducible chromosomal AmpC gene. The expression of this gene can be derepressed during treatment with a beta-lactam, leading to AmpC overproduction and the consequent emergence of resistance to 3GCs and piperacillin/tazobactam during treatment. Because of this phenomenon, the use of carbapenems or cefepime is considered a safer option when treating these pathogens. However, many areas of uncertainty persist, including the risk of derepression related to each beta-lactam; the role of piperacillin/tazobactam compared to cefepime; the best option for severe or difficult-to-treat cases, such as high-inoculum infections (e.g., ventilator-associated pneumonia and undrainable abscesses); the role of de-escalation once clinical stability is obtained; and the best treatment for species with a lower risk of derepression during treatment (e.g., Serratia marcescens and Morganella morganii). The aim of this review is to collate the most relevant information about the microbiological properties of and therapeutic approach to AmpC-producing Enterobacterales in order to inform daily clinical practice.
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Affiliation(s)
- Gianpiero Tebano
- Infectious Diseases Unit, Ravenna Hospital, AUSL Romagna, 48100 Ravenna, Italy
| | - Irene Zaghi
- Department of Infectious Diseases, University Hospital of Galway, H91 Galway, Ireland;
| | - Monica Cricca
- Unit of Microbiology, The Greater Romagna Area Hub Laboratory, 47522 Cesena, Italy;
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
| | - Francesco Cristini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy;
- Infectious Diseases Unit, Forlì and Cesena Hospitals, AUSL Romagna, 47121 Forlì and Cesena, Italy
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Cai S, Zhou C, Shan Y, Bao R, Hu L, Pan J, Wang C, Yin J, Hu B. Epidemiology, clinical characteristics, and outcome of infective endocarditis due to Abiotrophia and Granulicatella in a Tertiary Hospital in China, 2015-2023: a retrospective study. BMC Infect Dis 2024; 24:1022. [PMID: 39304837 DOI: 10.1186/s12879-024-09943-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Abiotrophia (ABI) and Granulicatella (GRA) are rare causative pathogens in infective endocarditis (IE). This study aims to describe the epidemiology, clinical characteristics, and outcome of ABI/GRA-IE. The main features of ABI/GRA-IE were compared with Viridans group streptococci (VGS) IE. METHODS From January 2015 to December 2023, a total of 1531 definite IE in Zhongshan Hospital, Fudan University, Shanghai, China were retrospectively enrolled in this study. Clinical and laboratory data were collected. RESULTS Forty-five ABI/GRA-IE cases were identified, representing 2.9% of all IE cases in Zhongshan Hospital between 2015 and 2023, compared to 20.1% of VGS-IE. ABI and GRA IE shared similar clinical characteristics. Congenital valvulopathy was reported in 21 (46.7%) ABI/GRA-IE and 85 (28.8%) VGS-IE (P = 0.025). Pulmonary valve was more frequently affected in ABI/GRA-IE (6 [13.3%]) than VGS-IE (7 [2.4%]) (P = 0.002). Congestive heart failure was observed in 30 (66.7%) ABI/GRA-IE and 103 (34.9%) VGS-IE (P < 0.001). Systemic embolization excluding central nervous system (CNS) occurred in 13 (28.9%) ABI/GRA-IE and 39 (13.2%) VGS-IE (P = 0.012). In-hospital mortality was reported as 4.4% in ABI/GRA-IE and 3.7% in VGS-IE (P = 0.854). CONCLUSION GRA/ABI-IE was approximately one-seventh as prevalent as VGS-IE. Congestive heart failure and systemic embolization (excluding CNS) were more frequent in GRA/ABI-IE compared to VGS-IE. Mortality of ABI/GRA-IE in this study was comparable to that of VGS-IE and lower than previously reported results.
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Affiliation(s)
- Sishi Cai
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunmei Zhou
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuzhang Shan
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong Bao
- Department of Microbiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lijuan Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jue Pan
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Jiasheng Yin
- Department of Cardiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Bijie Hu
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Department of Hospital Infection Management, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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11
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Greve D, Sartori E, Rodriguez Cetina Biefer H, Sima ST, Von Schöning D, Pfäfflin F, Stegemann MS, Falk V, Moter A, Kikhney J, Grubitzsch H. Diagnostic Benefit of Molecular Imaging in Patients Undergoing Heart Valve Surgery for Infective Endocarditis. Microorganisms 2024; 12:1889. [PMID: 39338561 PMCID: PMC11434479 DOI: 10.3390/microorganisms12091889] [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: 08/17/2024] [Revised: 09/06/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
(1) Background: The successful treatment of infective endocarditis (IE) relies on detecting causative pathogens to administer targeted antibiotic therapy. In addition to standard microbiological cultivation of pathogens from tissue obtained during heart valve surgery, the potential of molecular biological methods was evaluated. (2) Methods: A retrospective study was performed on heart valve tissue from 207 patients who underwent heart valve surgery for IE. FISHseq (fluorescence in situ hybridization combined with 16S rRNA gene PCR and sequencing) was performed in addition to conventional culture-based microbiological diagnostics. The diagnostic performance of FISHseq was compared with the conventional methods and evaluated in the clinical context. (3) Results: Overall, FISHseq provided a significantly higher rate of specific pathogen detection than conventional valve culture (68.1% vs. 33.3%, p < 0.001). By complementing the findings from blood culture and valve culture, FISHseq was able to provide a new microbiological diagnosis in 10% of cases, confirm the cultural findings in 24.2% of cases and provide greater diagnostic accuracy in 27.5% of cases. FISHseq could identify a pathogen in blood-culture-negative IE in 46.2% of cases, while valve culture provided only 13.5% positive results (p < 0.001). (4) Conclusions: This study demonstrates that using FISHseq as an additional molecular biological technique for diagnostics in IE adds substantial diagnostic value, with potential implications for the treatment of IE. It provides pathogen detection, especially in cases where conventional microbiological cultivation is negative or inconclusive.
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Affiliation(s)
- Dustin Greve
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Emma Sartori
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
- Department of Cardiac Surgery, City Hospital of Zurich, 8063 Zurich, Switzerland
- Center for Translational and Experimental Cardiology, University of Zurich, 8091 Zurich, Switzerland
| | - Stefania-Teodora Sima
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Dinah Von Schöning
- Department of Microbiology, Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany
| | - Frieder Pfäfflin
- Department for Infectious Diseases and Critical Care Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Miriam Songa Stegemann
- Department for Infectious Diseases and Critical Care Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Partner Site Berlin, DZHK (German Centre for Cardiovascular Research), 13125 Berlin, Germany
- Department of Health Science and Technology, Swiss Federal Institute of Technology, 8093 Zurich, Switzerland
| | - Annette Moter
- Biofilmcenter, Infectious Diseases and Immunology, Institute of Microbiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (J.K.)
- Moter Diagnostics, 12207 Berlin, Germany
- MoKi Analytics GmbH, 12207 Berlin, Germany
| | - Judith Kikhney
- Biofilmcenter, Infectious Diseases and Immunology, Institute of Microbiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203 Berlin, Germany (J.K.)
- MoKi Analytics GmbH, 12207 Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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12
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Avogadri N, Ivarsson A, Burup Kristensen C, Ragnarsson S, Rasmussen M. Evaluation of the 2023 Duke-ISCVID criteria for infective endocarditis in patients referred to the Lund infective endocarditis team. Infect Dis (Lond) 2024:1-9. [PMID: 39269886 DOI: 10.1080/23744235.2024.2402374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 09/02/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND The Duke criteria for diagnosing infective endocarditis (IE) were recently updated by the International Society for Cardiovascular Infectious Diseases (ISCVID) with the purpose of enhancing diagnostic specificity and sensitivity. This study investigated the performance of the Duke-ISCVID criteria in relation to previous criteria. METHOD This retrospective single centre cohort study included patients referred to the Lund IE Team (LIET) between 2017 and 2022, and compared episodes classified according to the 2000 modified Duke, European Society of Cardiology (ESC) 2015, and 2023 Duke-ISCVID criteria. The LIET's decision to treat episodes as IE served as the reference standard. RESULTS The study cohort comprised 661 episodes of potential IE. The LIET classified 498 (75%) episodes as IE. The Duke-ISCVID criteria classified a slightly higher proportion of episodes as definite IE (56.4%) compared to the ESC 2015 criteria (54.9%), and the modified Duke (51.1%). The Duke-ISCVID criteria had higher sensitivity (72.5%) for definite IE compared to ESC 2015 (70.7%, p = .57) and modified Duke (66.1%, p = .033). The specificities were similar for the Duke-ISCVID criteria (92.6%), compared to ESC 2015 (93.9%, p = .83) and the modified Duke criteria (95.0%, p = .49). When considering both definite and possible IE positive, specificity for all criteria was low: 32.5% for the Duke-ISCVID criteria, 41.7% for ESC 2015 (p = .086), and 42.3% for modified Duke criteria (p = .11), while the sensitivity was not significantly lower. DISCUSSION The Duke-ISCVID criteria demonstrated slightly improved sensitivity for diagnosing IE whereas specificity remained unchanged. Further refinement of the Duke-ISCVID criteria is needed to balance sensitivity and specificity.
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Affiliation(s)
- Nils Avogadri
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alex Ivarsson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Charlotte Burup Kristensen
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
- Cardiology, Department of Clinical Sciences, Lund University, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
- Division of Cardiothoracic Surgery, Department of Clinical Sciences, Lund University, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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13
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Xie O, Davies MR, Tong SYC. Streptococcus dysgalactiae subsp. equisimilis infection and its intersection with Streptococcus pyogenes. Clin Microbiol Rev 2024; 37:e0017523. [PMID: 38856686 PMCID: PMC11392527 DOI: 10.1128/cmr.00175-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
SUMMARYStreptococcus dysgalactiae subsp. equisimilis (SDSE) is an increasingly recognized cause of disease in humans. Disease manifestations range from non-invasive superficial skin and soft tissue infections to life-threatening streptococcal toxic shock syndrome and necrotizing fasciitis. Invasive disease is usually associated with co-morbidities, immunosuppression, and advancing age. The crude incidence of invasive disease approaches that of the closely related pathogen, Streptococcus pyogenes. Genomic epidemiology using whole-genome sequencing has revealed important insights into global SDSE population dynamics including emerging lineages and spread of anti-microbial resistance. It has also complemented observations of overlapping pathobiology between SDSE and S. pyogenes, including shared virulence factors and mobile gene content, potentially underlying shared pathogen phenotypes. This review provides an overview of the clinical and genomic epidemiology, disease manifestations, treatment, and virulence determinants of human infections with SDSE with a particular focus on its overlap with S. pyogenes. In doing so, we highlight the importance of understanding the overlap of SDSE and S. pyogenes to inform surveillance and disease control strategies.
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Affiliation(s)
- Ouli Xie
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Disease Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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14
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Luczak C, Lerman L, Pina Vegas L, Emsen B, Hugues B, Lepeule R, Ternacle J, Huguet R, Lim P, Decousser JW, Fiore A, Itti E, Chevalier X, Abilizi M, Eymard F. Value of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Identifying Osteoarticular Septic Grafts in Suspected Infective Endocarditis: Results from a Large Monocentric Cohort. J Clin Med 2024; 13:5419. [PMID: 39336908 PMCID: PMC11432416 DOI: 10.3390/jcm13185419] [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: 08/20/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
Background: 18F-fluorodeoxyglucose positron emission tomography-CT (FDG-PET/CT) is useful for identifying infective endocarditis (IE) but also the detection of other concomitant septic foci. Previously, we found that FDG-PET/CT identified an osteoarthritic septic graft (OASG) in 19.1% of IE patients, frequently asymptomatic. These preliminary results encouraged us to extend our analyses to a larger population, including all patients initially explored for suspected IE, to assess the prevalence, characteristics, and OASG locations brought out by FDG-PET/CT and to identify predictive factors. Methods: From a single-center cohort of patients referred for a clinical and/or biological suspicion of IE, we included all patients who underwent FDG-PET/CT, mainly performed to confirm a prosthesis heart valve or a foreign cardiac device infection. We excluded those who did not meet the 2015 modified Duke Criteria and those for whom another infectious diagnosis was finally retained or for whom all bacterial samples were negative. Demographic, clinical, bacteriological, imaging, and therapeutic data were collected. FDG-PET/CT images were retrospectively analyzed by three blinded nuclear medicine specialists to identify OASGs. Results: We identified 72 distinct OASG locations by FDG-PET/CT in 48 of 174 patients (27.6%), mainly located in the spine (21 OASGs in 20 patients); 14 patients (8.0%) had several OASG locations. In total, 43.8% of OASG locations were asymptomatic. In multivariate analysis, the presence of OASGs was associated with musculoskeletal pain (p < 0.001) and tricuspid valve involvement (p = 0.002). Conclusions: FDG-PET/CT is useful for identifying OASGs in patients with suspected IE, especially those with tricuspid IE or musculoskeletal pain. The identification of OASGs could impact antibiotic therapy and would allow adapted orthopedic management to be proposed.
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Affiliation(s)
- Cédric Luczak
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Lionel Lerman
- Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Laura Pina Vegas
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Berivan Emsen
- Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Benjamin Hugues
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Raphaël Lepeule
- Department of Microbiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Julien Ternacle
- Department of Cardiology, Haut Leveque Hospital, 33600 Pessac, France
| | - Raphaëlle Huguet
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Pascal Lim
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Jean-Winoc Decousser
- Department of Microbiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Xavier Chevalier
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Mukedaisi Abilizi
- Department of Nuclear Medicine, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
| | - Florent Eymard
- Department of Rheumatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 94000 Créteil, France
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15
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Eichenberger EM, Phadke V, Busch LM, Pouch SM. Infections in Patients with Mechanical Circulatory Support. Infect Dis Clin North Am 2024:S0891-5520(24)00056-4. [PMID: 39261138 DOI: 10.1016/j.idc.2024.07.005] [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: 09/13/2024]
Abstract
Patients on mechanical circulatory support are at heightened risk for infection given the invasive nature of the devices with internal and external components, the surgical implantation of the devices, and the presence of foreign material susceptible to biofilm formation. This review discusses the new International Society for Heart and Lung Transplantation mechanical circulatory support device infection definitions, inclusive of durable and acute mechanical circulatory support infections, and describes their epidemiology, diagnosis, and management. A multidisciplinary approach is essential for optimal management. Timing of transplantation in the context of active infection is addressed, and areas of future research are highlighted.
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Affiliation(s)
- Emily M Eichenberger
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, WMB, Suite 5125, Atlanta, GA 30322, USA.
| | - Varun Phadke
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, WMB, Suite 2101, Atlanta, GA 30322, USA. https://twitter.com/VarunPhadke2
| | - Lindsay M Busch
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, WMB, Suite 5127, Atlanta, GA 30322, USA; Emory Critical Care Center, Emory Healthcare, Atlanta, GA 30322, USA
| | - Stephanie M Pouch
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, WMB, Suite 2305, Atlanta, GA 30322, USA. https://twitter.com/StephaniePouch
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16
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Bielick CG, Arnold CJ, Chu VH. Cardiovascular Implantable Electronic Device Infections: A Contemporary Review. Infect Dis Clin North Am 2024:S0891-5520(24)00055-2. [PMID: 39261140 DOI: 10.1016/j.idc.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Infections associated with cardiac implantable electronic devices (CIEDs) are increasing and are a cause of significant morbidity and mortality. This article summarizes the latest updates with respect to the epidemiology, microbiology, and risk factors for CIED-related infections. It also covers important considerations regarding the diagnosis, management, and prevention of these infections. Newer technologies such as leadless pacemakers and subcutaneous implantable cardioverters and defibrillators are discussed.
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Affiliation(s)
- Catherine G Bielick
- Division of Infectious Diseases, University of Virginia, Charlottesville, VA, USA; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Hospital Medicine, West Span 201, Boston, MA 02215, USA.
| | - Christopher J Arnold
- Division of Infectious Diseases, University of Virginia, Charlottesville, VA, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University Health System, Box 102359, Durham, NC 27710, USA
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17
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Usuda D, Kojima Y, Ono R, Kaneoka Y, Kato M, Sugawara Y, Shimizu R, Inami T, Nakajima E, Tsuge S, Sakurai R, Kawai K, Matsubara S, Tanaka R, Suzuki M, Shimozawa S, Hotchi Y, Osugi I, Katou R, Ito S, Mishima K, Kondo A, Mizuno K, Takami H, Komatsu T, Nomura T, Sugita M. Native valve endocarditis caused by Corynebacterium striatum without underlying structural heart disease or indwelling cardiovascular medical devices: a case report. BMC Infect Dis 2024; 24:939. [PMID: 39251918 PMCID: PMC11384686 DOI: 10.1186/s12879-024-09825-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Corynebacterium striatum (C. striatum) is a gram-positive, anaerobic bacillus found both environmentally and in human skin and nasal mucosa flora. It is reportedly the etiologic agent of community-acquired and nosocomial diseases and is significantly associated with bacteremia and medical endovascular devices. This is the rare case of mitral valve native valve endocarditis (NVE) caused by C. striatum occurring in a young adult without underlying structural heart disease or indwelling cardiovascular medical devices successfully treated with multidisciplinary therapy. CASE PRESENTATION The patient was a 28-year-old female with no medical history. She was transferred our hospital due to sudden onset of vertigo and vomit. A computed tomography on day 2 revealed the hydrocephalus due to the cerebellar infarction, and she underwent posterior fossa decompression for cerebellar infarction. An angiography on day 8 revealed a left vertebral artery dissection, which was suspected be the etiology. Afterwards, a sudden fever of 39 degrees developed on day 38. She was diagnosed with aspiration pneumonia and treated with ampicillin/sulbactam but was still febrile at the time of transfer for rehabilitation. Treatment continued with levofloxacin, the patient had no fever decline, and she was readmitted to our hospital. Readmission blood cultures (3/3 sets) revealed C. striatum, and an echocardiogram revealed an 11 mm long mitral valve vegetation, leading to NVE diagnosis. On the sixth illness day, cardiac failure symptoms manifested. Echocardiography revealed mitral valve rupture. She was transferred again on the 11th day of illness, during which time her mitral valve was replaced. C. striatum was detected in the vegetation. Following surgery, she returned to our hospital, and vancomycin administration continued. The patient was discharged after 31 total days of postoperative antimicrobial therapy. The patient experienced no exacerbations thereafter. CONCLUSIONS We report the rare case of C. striatum mitral valve NVE in a young adult without structural heart disease or indwelling cardiovascular devices. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Daisuke Usuda
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan.
| | - Yuhei Kojima
- Department of Pharmacy, Juntendo University Nerima Hospital, 3-1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Rikuo Ono
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Yuki Kaneoka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Masashi Kato
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Yuto Sugawara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Runa Shimizu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Tomotari Inami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Eri Nakajima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Shiho Tsuge
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Riki Sakurai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Kenji Kawai
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Shun Matsubara
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Risa Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Makoto Suzuki
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Shintaro Shimozawa
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Yuta Hotchi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Ippei Osugi
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Risa Katou
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Sakurako Ito
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Kentaro Mishima
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Akihiko Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Keiko Mizuno
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Hiroki Takami
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Takayuki Komatsu
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-City, 113-8421, Tokyo, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, 3- 1-10, Takanodai, Nerima-City, 177-8521, Tokyo, Japan
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Montarello N, Bioh G, Byrne C, Hassan I, Androshchuk V, Demetrescu C, Mak SM, Rajani R. Cardiac computed tomography in infective endocarditis: "bridging the detection gap". Front Cardiovasc Med 2024; 11:1459833. [PMID: 39309605 PMCID: PMC11415862 DOI: 10.3389/fcvm.2024.1459833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/07/2024] [Indexed: 09/25/2024] Open
Abstract
Infective Endocarditis (IE) remains a significant health challenge. Despite an increasing awareness, mortality is high and has remained largely unchanged over recent decades. Early diagnosis of IE is imperative and to assist clinicians several diagnostic criteria have been proposed. The best known are the Duke criteria. Originally published in 1994, these criteria have undergone significant modifications. This manuscript provides a timeline of the successive changes that have been made over the last 30 years. Changes which to a large degree have reflected both the evolving epidemiology of IE and the proliferation and increasing availability of advanced multi-modality imaging. Importantly, many of these changes now form part of societal guidelines for the diagnosis of IE. To provide validation for the incorporation of cardiac computed tomography (CT) in current guidelines, the manuscript demonstrates a spectrum of pictorial case studies that re-enforce the utility and growing importance of early cardiac CT in the diagnosis and treatment of suspected IE.
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Affiliation(s)
- Natalie Montarello
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gabriel Bioh
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Calum Byrne
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Imtiaz Hassan
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vitaliy Androshchuk
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Camelia Demetrescu
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sze Mun Mak
- Department of Radiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
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Ng C, Penney A, Sharaflari R, Pathak A, Howard Iii JH, Jen KY. ANCA-Negative Pauci-Immune Glomerulonephritis Associated with Bartonella Endocarditis. Case Rep Nephrol 2024; 2024:4181660. [PMID: 39279916 PMCID: PMC11398960 DOI: 10.1155/2024/4181660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 08/01/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Kidney complications can occur due to infective endocarditis, one of which is glomerulonephritis. Most often, an immune complex or complement-mediated glomerulonephritis is seen on kidney biopsy. In a minor subset of cases, pauci-immune glomerulonephritis may be present. Most often, such patients will demonstrate the presence of antineutrophil cytoplasmic antibodies (ANCA) on serologic testing. A growing number of cases of ANCA-associated glomerulonephritis due to Bartonella endocarditis have been reported. This type of endocarditis can present diagnostic difficulties given that these patients are often culture negative. Herein, we report a challenging case of ANCA-negative pauci-immune glomerulonephritis showing florid crescents on biopsy that was associated with Bartonella endocarditis.
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Affiliation(s)
- Camille Ng
- College of Medicine California Northstate University, Elk Grove, CA, USA
| | - Angela Penney
- College of Medicine California Northstate University, Elk Grove, CA, USA
| | - Rojin Sharaflari
- College of Medicine California Northstate University, Elk Grove, CA, USA
| | - Akash Pathak
- College of Medicine California Northstate University, Elk Grove, CA, USA
| | | | - Kuang-Yu Jen
- Department of Pathology and Laboratory Medicine University of California Davis Medical Center, Sacramento, CA, USA
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20
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Cusumano JA, Kalogeropoulos AP, Le Provost M, Gallo NR, Levine SM, Inzana T, Papamanoli A. The emerging challenge of Enterococcus faecalis endocarditis after transcatheter aortic valve implantation: time for innovative treatment approaches. Clin Microbiol Rev 2024:e0016823. [PMID: 39235238 DOI: 10.1128/cmr.00168-23] [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: 09/06/2024] Open
Abstract
SUMMARYInfective endocarditis (IE) is a life-threatening infection that has nearly doubled in prevalence over the last two decades due to the increase in implantable cardiac devices. Transcatheter aortic valve implantation (TAVI) is currently one of the most common cardiac procedures. TAVI usage continues to exponentially rise, inevitability increasing TAVI-IE. Patients with TAVI are frequently nonsurgical candidates, and TAVI-IE 1-year mortality rates can be as high as 74% without valve or bacterial biofilm removal. Enterococcus faecalis, a historically less common IE pathogen, is the primary cause of TAVI-IE. Treatment options are limited due to enterococcal intrinsic resistance and biofilm formation. Novel approaches are warranted to tackle current therapeutic gaps. We describe the existing challenges in treating TAVI-IE and how available treatment discovery approaches can be combined with an in silico "Living Heart" model to create solutions for the future.
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Affiliation(s)
- Jaclyn A Cusumano
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York, USA
| | - Andreas P Kalogeropoulos
- Renaissance School of Medicine Division of Cardiology, Stony Brook University, Stony Brook, New York, USA
| | - Mathieu Le Provost
- School of Engineering, Computer Science and Artificial Intelligence, Long Island University, Brooklyn, New York, USA
| | - Nicolas R Gallo
- Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, New York, USA
- School of Engineering, Computer Science and Artificial Intelligence, Long Island University, Brooklyn, New York, USA
| | | | - Thomas Inzana
- College of Veterinary Medicine, Long Island University, Brooklyn, New York, USA
| | - Aikaterini Papamanoli
- Division of Infectious Diseases, Stony Brook University Medical Center, Stony Brook, New York, USA
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21
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López J, Olmos C, Fernández-Hidalgo N. New developments in infective endocarditis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:779-787. [PMID: 38763212 DOI: 10.1016/j.rec.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/18/2024] [Indexed: 05/21/2024]
Abstract
Infective endocarditis is a continually evolving disease. Present-day patients differ significantly from those treated a few decades ago: they tend to be older and have more comorbidities and health care-related episodes, while new groups of patients have emerged with new types of endocarditis, such as those affecting patients with percutaneous valve prostheses. There have also been changes in diagnostic techniques. Although transthoracic and transesophageal echocardiography are still the most commonly used imaging modalities, other techniques, such as 3-dimensional transesophageal ultrasound, cardiac computed tomography, and nuclear medicine tests (PET/CT and SPECT/CT), are increasingly used for diagnosing both the disease and its complications. In recent years, there have also been significant developments in antibiotic therapy. Currently, several treatment strategies are available to shorten the hospital phase of the disease in selected patients, which can reduce the complications associated with hospitalization, improve the quality of life of patients and their families, and reduce the health care costs of the disease. This review discusses the main recent epidemiological, diagnostic and therapeutic developments in infective endocarditis.
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Affiliation(s)
- Javier López
- Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain; Facultad de Medicina, Universidad Europea de Madrid, Madrid, Spain
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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22
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Su LD, Chiu CY, Gaston D, Hogan CA, Miller S, Simon DW, Thakur KT, Yang S, Piantadosi A. Clinical Metagenomic Next-Generation Sequencing for Diagnosis of Central Nervous System Infections: Advances and Challenges. Mol Diagn Ther 2024; 28:513-523. [PMID: 38992308 DOI: 10.1007/s40291-024-00727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/13/2024]
Abstract
Central nervous system (CNS) infections carry a substantial burden of morbidity and mortality worldwide, and accurate and timely diagnosis is required to optimize management. Metagenomic next-generation sequencing (mNGS) has proven to be a valuable tool in detecting pathogens in patients with suspected CNS infection. By sequencing microbial nucleic acids present in a patient's cerebrospinal fluid, brain tissue, or samples collected outside of the CNS, such as plasma, mNGS can detect a wide range of pathogens, including rare, unexpected, and/or fastidious organisms. Furthermore, its target-agnostic approach allows for the identification of both known and novel pathogens. This is particularly useful in cases where conventional diagnostic methods fail to provide an answer. In addition, mNGS can detect multiple microorganisms simultaneously, which is crucial in cases of mixed infections without a clear predominant pathogen. Overall, clinical mNGS testing can help expedite the diagnostic process for CNS infections, guide appropriate management decisions, and ultimately improve clinical outcomes. However, there are key challenges surrounding its use that need to be considered to fully leverage its clinical impact. For example, only a few specialized laboratories offer clinical mNGS due to the complexity of both the laboratory methods and analysis pipelines. Clinicians interpreting mNGS results must be aware of both false negatives-as mNGS is a direct detection modality and requires a sufficient amount of microbial nucleic acid to be present in the sample tested-and false positives-as mNGS detects environmental microbes and their nucleic acids, despite best practices to minimize contamination. Additionally, current costs and turnaround times limit broader implementation of clinical mNGS. Finally, there is uncertainty regarding the best practices for clinical utilization of mNGS, and further work is needed to define the optimal patient population(s), syndrome(s), and time of testing to implement clinical mNGS.
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Affiliation(s)
- LingHui David Su
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
| | - Charles Y Chiu
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Laboratory Medicine and Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
| | - David Gaston
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine A Hogan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Miller
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Delve Bio, Inc., San Francisco, CA, USA
- Department of Laboratory Medicine, University of California, San Francisco, CA, USA
| | - Dennis W Simon
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Pediatric Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kiran T Thakur
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Shangxin Yang
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne Piantadosi
- The Consortium for Clinical Metagenomics in Infectious Diseases, Nashville, TN, USA.
- Department of Pathology and Laboratory Medicine, and Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA, USA.
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Kumar A, Casamassimo P, Kovalchin J, Claman D, Peng J, McDaniel J, Hunt WG, Wong CA. The changing profile of infective endocarditis: A multi-year retrospective study for dentists. Int J Paediatr Dent 2024; 34:673-679. [PMID: 38297423 DOI: 10.1111/ipd.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Infective endocarditis (IE) has high morbidity and mortality and is often attributed to dental procedures. AIM This study characterized variables related to paediatric IE in a paediatric hospital cohort. DESIGN A retrospective review of medical records, from January 1, 2008, to January 1, 2020, to examine demographic, medical and dental history, and risk factors associated with children diagnosed with IE at Nationwide Children's Hospital. RESULTS Of the 242 patients who were admitted with tentative IE diagnoses, 67 met the inclusion criteria: 46 (69%) had underlying cardiac conditions and 21 (31%) had not. One-third had an infection with S. aureus and viridans streptococci. Age was significantly associated with intracardiac devices in children with IE. Mean hospitalization was 25 days, and the mortality was 6 (9%); 41(61%) required surgery for causative defects, and 24 (32%) had dental consultation during admission. CONCLUSION Although cardiac-related conditions were present in most cases, IE occurred in patients without cardiac factors.
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Affiliation(s)
- Ashok Kumar
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Paul Casamassimo
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - John Kovalchin
- Section of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Daniel Claman
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jin Peng
- Research Information Solutions and Innovation Research & Development, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jodee McDaniel
- Division of Pediatric Dentistry and Division of Dental Hygiene, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
| | - W Garrett Hunt
- Section of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Chloe A Wong
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, and Nationwide Children's Hospital, Columbus, Ohio, USA
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Solanki P, Colaco C, Dotel R. Analysis of bacteraemia caused by group C and G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) in Western Sydney over a 6-year period (2015-2020). Eur J Clin Microbiol Infect Dis 2024; 43:1807-1814. [PMID: 39008148 DOI: 10.1007/s10096-024-04903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Streptococcus dysgalactiae subsp. equisimilis (SDSE) has increasingly been recognised as a significant pathogen that causes a myriad of infections, ranging from cellulitis to invasive infections, including bacteraemia and even toxic shock syndrome. The aim of this study was to examine the epidemiology and disease manifestations of bacteraemia caused by SDSE. METHODS We retrospectively reviewed cases of SDSE bacteraemia in adults aged ≥ 18 years admitted to four public hospitals in Western Sydney, Australia, between January 2015 and December 2020. We reviewed demographics, comorbidities, disease manifestations, management, and outcomes. RESULTS There were 108 patients with SDSE bacteraemia over a six-year period. The median age of individuals with SDSE bacteraemia was 70 years (interquartile range, IQR, 58-85 years). Cardiovascular disease (46%), chronic skin conditions (44%) and diabetes (37%) were the most common comorbidities. Ten patients (9%) with SDSE bacteraemia had healthcare-acquired infections. Skin and skin structure infections (SSTIs) were the most common presentations (59%), while bone and joint infections (BJIs) represented 13% of the cases. Twenty patients (19%) had septic shock on presentation. Fifteen patients (14%) were prescribed clindamycin, while one patient received intravenous immunoglobulin (IVIg). Infective endocarditis (IE) was present in 3% of patients; however, only 44% of the total patients had an echocardiogram. The 30-day mortality rate was 13%, but it was greater in those aged > 75 years (21%). The average length of hospital stay for patients who survived was 15 days, and the average duration of intravenous therapy was 12 days. CONCLUSION SDSE bacteraemia is typically a community-onset infection with a fifth of patients in our cohort presenting with septic shock. Though complications such as BJI (13%) and IE (3%) are infrequent, 30-day mortality is high at 21% in those aged > 75 years.
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Affiliation(s)
- Parthsinh Solanki
- Department of Infectious Diseases, Blacktown Hospital, Sydney, NSW, Australia.
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Clinton Colaco
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
- The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, NSW, Australia
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25
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Pan S, Zhao Y, Zhou K, Chen S, Maimaitiming M, Wu J, Tuerxun M, Chong Y, Zhu J. Incidence and Outcomes of Brucella Endocarditis in a High-Prevalence Area: A Single-Center Study. J Epidemiol Glob Health 2024; 14:905-913. [PMID: 38829489 PMCID: PMC11444021 DOI: 10.1007/s44197-024-00232-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of Brucella endocarditis (BE) and observe the factors related to death to provide guidance for clinical treatment. METHODS This study examined all patients with BE admitted to The First People's Hospital of Kashi Prefecture between January 2017 and November 2023. Clinical characteristics and follow-up outcomes were collected for analysis. RESULTS This study revealed 774 cases of brucellosis and 14 cases of BE, with an overall incidence rate of 1.88%. Most of the patients were male (71.43%) and lived in areas where brucellosis is common. Patients ranged in age from 26 to 68 years. Common symptoms reported among patients included chest tightness and fatigue, and a significant portion also presented with congestive heart failure. Most patients exhibited normal white blood cell counts (WBC) but had elevated levels of C-reactive protein (CRP). Transthoracic ultrasound (TTE) revealed cardiac valve vegetation in all patients, along with positive blood cultures. Six patients (42.86%) completed heart surgery, and ten (71.43%) completed anti-infection treatment. Six patients died, five of whom did not undergo surgery. The other patient with Marfan syndrome died after surgery. Sex, WBC count, neutrophil (NEUT) and total bilirubin (TBIL) were significant factors associated with regression in BE patients (P < 0.05) according to univariate analysis. CONCLUSIONS Patients with BE in Kashi have a severe clinical presentation at diagnosis, but early detection with improved cardiac ultrasound and aggressive treatment can improve the prognosis.
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Affiliation(s)
- Shufang Pan
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- Department of Infectious Diseases, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Yunyue Zhao
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
- Department of Cardiology, The Third Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Kaixiang Zhou
- Department of Rheumatology, The Third Affiliated Hospital of Sun Yat-sen University, Zhao Qing Hospital, Zhaoqing, 526000, China
| | - Shuru Chen
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Miriban Maimaitiming
- Department of Infectious Diseases, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Jing Wu
- Department of Infectious Diseases, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Maimaitiaili Tuerxun
- Department of Infectious Diseases, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China
| | - Yutian Chong
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Jianyun Zhu
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
- Department of Infectious Diseases, The First People's Hospital of Kashi Prefecture, Kashi, 844000, China.
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Qiu Y, Lau L, Khan Z, Messika-Zeitoun D, Ruel M, Chan V. Longitudinal Outcomes Following Mitral Valve Repair for Infective Endocarditis. Microorganisms 2024; 12:1809. [PMID: 39338483 PMCID: PMC11434133 DOI: 10.3390/microorganisms12091809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024] Open
Abstract
Mitral valve repair is the ideal approach in managing mitral valve infective endocarditis for patients requiring surgery. However, viable repair is influenced by the extent of valve destruction and there can be technical challenges in reconstruction following debridement. Overall, data describing long-term outcomes following mitral repair of infective endocarditis are scarce. We, therefore, assessed the late outcomes of 101 consecutive patients who underwent mitral valve repair for IE at the University of Ottawa Heart Institute from 2001 to 2021. The 5- and 10-year survival rate was 80.8 ± 4.7% and 61.2 ± 9.2%, respectively. Among these 101 patients, 7 ultimately required mitral valve reoperation at a median of 5 years after their initial operation. These patients were of a mean age of 35.9 ± 7.3 years (range 22-44 years) at the time of their initial operation. The 5- and 10-year freedom from mitral valve reoperation was 93.6 ± 3.4% and 87.7 ± 5.2%, respectively. Overall, mitral valve repair can be an effective method for treating infective endocarditis with a favourable freedom from reoperation and mortality over the long term.
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Affiliation(s)
- Yuan Qiu
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Lawrence Lau
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Zaim Khan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
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Carvajal V, Reyes FB, Gonzalez D, Schwartz M, Whiltlow A, Alegria JR. Endocarditis in Adult Congenital Heart Disease Patients: Prevention, Recognition, and Management. Curr Cardiol Rep 2024; 26:1031-1045. [PMID: 39212775 PMCID: PMC11379749 DOI: 10.1007/s11886-024-02103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE OF REVIEW Present an updated overview of the prevention, diagnosis, and management of infective endocarditis in adult patients with congenital heart disease. RECENT FINDINGS Care for patients with infective endocarditis is changing in the areas of specialized teams, diagnostics, and prevention. Endocarditis teams should be involved in the care of ACHD patients. The 2023 Duke Criteria for Infective Endocarditis and the 2023 European Society of Cardiology Guidelines have updated the criteria for diagnosis including new major criteria such as CT and positron emission computed tomography with 18F-fluorodeoxyglucose (FDG) scans. Immunological, PCR, and nucleic acid-based tests are now acceptable means to isolate infective organisms. Clindamycin is no longer recommended for antibiotic prophylaxis due to resistance and side effect profile. Special considerations for antibiotic prophylaxis and management must be made for specific congenital heart diseases in adulthood and pregnant ACHD patients. Infective endocarditis (IE), a potentially devastating clinical entity, is a feared threat to the health of adults with congenital heart disease (ACHD). IE needs a systematic approach for its prevention, early diagnosis and management with a multidisciplinary IE team's involvement. There have been changes in the diagnostics and management of IE, which is reflected in updated diagnostic criteria. Timely blood cultures and imaging continue to be the mainstay of diagnosis, however the timing of blood cultures, microbiological testing, and types of diagnostic imaging such as the positron emission computed tomography with 18F-fluorodeoxyglucose (FDG) scan are new. Bicuspid aortic valves, ventricular septal defects, transcatheter pulmonary valve replacements, and tetralogy of Fallot are diagnoses at higher risk for IE in the ACHD population. The following article will focus on the preventive strategies, in addition to novel diagnostic and therapeutic approaches of IE in ACHD patients.
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Affiliation(s)
- Victoria Carvajal
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Fernando Baraona Reyes
- Department of Cardiology, Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David Gonzalez
- Department of Medicine, Cleveland Clinic Akron General, 1 Akron General Avenue, Akron, OH, 44307, USA
| | - Matthew Schwartz
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Angela Whiltlow
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA
| | - Jorge R Alegria
- Levine Congenital Heart Center and Sanger Heart and Vascular Institute, Wake Forest University, Atrium Health, 1001 Blythe Blvd, Suite 500, Charlotte, NC, 28203, USA.
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de Alarcón A. Infective endocarditis in 21st century Spain: a persistent therapeutic challenge in a changing scenario. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:747-749. [PMID: 38701883 DOI: 10.1016/j.rec.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 03/07/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Arístides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología, Hospital Universitario Virgen del Rocío, Seville, Spain.
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Takahashi Y, Nakade J, Zaimoku Y, Watanabe N, Watari T, Otsuka Y, Iwata Y, Kanamori H. Culture-negative infective endocarditis due to Neisseria bacilliformis identified via 16S rRNA gene analysis from resected valve tissue: Case report and review of the literature. J Infect Chemother 2024:S1341-321X(24)00235-6. [PMID: 39214385 DOI: 10.1016/j.jiac.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024]
Abstract
Blood culture-negative infective endocarditis (BCNE) has a poorer prognosis than culture-positive cases. Thus, it is crucial to determine the pathogenic microorganism using molecular diagnostic techniques, in addition to conventional techniques, including cultures of blood and/or resected valve tissue. Herein, we report a case of culture-negative infective endocarditis (IE) caused by Neisseria bacilliformis, as identified by 16S rRNA analysis of valve tissue. N. bacilliformis a non-gonococcal and non-meningococcal Neisseria species that partially comprises the oropharyngeal microbiome, and reports of invasive infections have increased recently. We conducted a literature review of IE caused by N. bacilliformis and found that beta-lactam antibiotics were effective with a relatively favorable prognosis. To the best of our knowledge, this is the first case of culture-negative IE in which N. bacilliformis was identified via 16S rRNA analysis.
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Affiliation(s)
- Yoshinori Takahashi
- Department of General Medicine and Infectious Diseases, JA Toyama Koseiren Takaoka Hospital, Takaoka, Toyama, Japan.
| | - Junya Nakade
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan; Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitaka Zaimoku
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Naoki Watanabe
- Department of Clinical Laboratory, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Tomohisa Watari
- Department of Clinical Laboratory, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yoshihito Otsuka
- Department of Clinical Laboratory, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yasunori Iwata
- Department of Nephrology and Rheumatology, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hajime Kanamori
- Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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Lawson E, Jacques A, Italiano C, Robinson JO. Infective endocarditis outcomes at a tertiary hospital in Western Australia: a retrospective cohort study from 2016 to 2021. Intern Med J 2024. [PMID: 39194359 DOI: 10.1111/imj.16508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Infective endocarditis (IE) is a severe infection with considerable mortality. It is associated with geographical variation, complicating diagnosis and treatment of patients in a standardised manner. AIM To evaluate the characteristics and management outcomes of patients with IE in Royal Perth Hospital (RPH). METHODS A single-centre, retrospective cohort study. Data were collected from medical records of 131 patients with a diagnosis of IE admitted to RPH between 2016 and 2021. RESULTS Eighty-four patients with definite IE were included for analysis. The median age of patients was 51.5 years and 77.4% were male. Compared to the general Australian population, there was disproportionately greater representation of Indigenous Australians (21.4%), those with a history of injecting drug use (IDU) (27.4%), rheumatic heart disease (14.3%) and previous IE (13.1%). The most commonly affected valve was the mitral valve in 46.4% of patients, and the most common pathogen was Staphylococcus aureus in 47.6% of patients. Twelve-month mortality was 16.7%, with significantly increased mortality in those treated non-surgically (25.6% vs 7.3%, P = 0.025). Factors associated with undergoing surgery included the presence of aortic valve disease, perivalvular extension of infection and infection with Enterococcus faecalis, whereas IDU, tricuspid valve disease and S. aureus infection were associated with non-surgical management. Adherence to multidisciplinary team review was 75.0%, and surgical management was performed in 70.7% of patients meeting an indication for surgery. CONCLUSION IE mortality rates remain high, particularly in patients who do not undergo surgical management. Streamlined MDT assessment and referral for surgical management where appropriate is necessary to improve outcomes.
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Affiliation(s)
- Eli Lawson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame Australia, Perth, Western Australia, Australia
| | - Claire Italiano
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
| | - James O Robinson
- Department of Infectious Diseases, Royal Perth Hospital, Perth, Western Australia, Australia
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La Canna G, Torracca L, Barbone A, Scarfò I. Unexpected Infective Endocarditis: Towards a New Alert for Clinicians. J Clin Med 2024; 13:5058. [PMID: 39274271 PMCID: PMC11396651 DOI: 10.3390/jcm13175058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 08/17/2024] [Accepted: 08/21/2024] [Indexed: 09/16/2024] Open
Abstract
Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.
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Affiliation(s)
- Giovanni La Canna
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Lucia Torracca
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Alessandro Barbone
- Cardiac Surgery Department, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
| | - Iside Scarfò
- Applied Diagnostic Echocardiography, IRCCS Humanitas Clinical and Research Hospital, 20089 Rozzano, Milan, Italy
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32
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Pizzi MN. Does digital positron emission tomography/computed tomography represent a step forward in the diagnostic accuracy of infective endocarditis? J Nucl Cardiol 2024:102024. [PMID: 39182823 DOI: 10.1016/j.nuclcard.2024.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Maria Nazarena Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Nuclear Cardiology Unit, Department of Nuclear Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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d'Almeida S, Reischmann K, Andreß S, Felbel D, Stephan T, Hay B, Rohlmann F, Buckert D, Rottbauer W, Markovic S. Evaluating the Duke Criteria for infectious endocarditis in a single-center retrospective study. Sci Rep 2024; 14:19524. [PMID: 39174590 PMCID: PMC11341858 DOI: 10.1038/s41598-024-70196-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
The Duke Criteria have shaped the way infectious endocarditis (IE) is diagnosed in the last 30 years. This study aims to evaluate their current validity and importance in the diagnostic of IE. A retrospective cohort study was conducted on 163 consecutive patients who presented at the University Hospital in Ulm (Germany) with clinical suspicion of IE between 2009 and 2019. With patients' medical records we differentiated between definitive endocarditis (DIE), possible endocarditis (PIE) and rejected endocarditis (RIE) and assessed the validity of the Duke Criteria in comparison to the final discharge diagnosis. We then tried to identify new potential parameters as an addition to the current valid Duke Criteria. The validity of the Duke Criteria improves with the length of hospitalization (especially cardiac imaging criterion, RIE 33.3%, PIE 31.6% and DIE 41.9%, p = 0.622 at admission and RIE 53.3%, PIE 68.4%, DIE 92.2%, p < 0.001 at discharge). At admission, overall sensitivity and specificity were respectively 29.5 and 91.2% in the DIE group. At discharge, sensitivity in the DIE group rose to 77.5% and specificity decreased to 79.4%. Of all screened metrics, microhematuria (p = 0.124), leukocyturia, (p = 0.075), younger age (p = 0.042) and the lack of rheumatoid disease (p = 0.011) showed a difference in incidence (p < 0.2) when comparing DIE and RIE group. In multivariate regression only microhematuria qualified as a potential sixth minor criterion at admission. Even with the latest technological breakthroughs our findings suggest that the Duke Criteria continue to hold value in the accurate assessment of IE. Future efforts must shorten the time until diagnosis.
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Affiliation(s)
- Sascha d'Almeida
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany.
| | - Kathrin Reischmann
- Department of Anesthesiology and Intensive Care, Ulm University Medical Center, Ulm, Germany
| | - Stefanie Andreß
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Dominik Felbel
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Tilman Stephan
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | - Birgit Hay
- Department of Medical Biometry and Statistics, Ulm University Medical Center, Ulm, Germany
| | - Friederike Rohlmann
- Department of Medical Biometry and Statistics, Ulm University Medical Center, Ulm, Germany
| | - Dominik Buckert
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
| | | | - Sinisa Markovic
- Department of Medicine II, Ulm University Medical Center, Ulm, Germany
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Gopal K, Bhaskaran PN, Moni M, Shashindran N. Aspergillus endocarditis. Indian Heart J 2024:S0019-4832(24)00166-4. [PMID: 39179154 DOI: 10.1016/j.ihj.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/07/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024] Open
Abstract
Aspergillus endocarditis is a rare cause of fungal endocarditis caused by the hyaline mold Aspergillus. The disease most commonly occurs in persons who are immunosuppressed and has a high mortality. Clinical presentation is often with long standing fever, embolic manifestations, and often heart murmurs. Diagnosis of aspergillus endocarditis is often delayed due to the low propensity for Aspergillus to grow in blood culture. Aspergillus endocarditis is characterized by large vegetations and also by frequently being found on the walls of the heart and not on the valves and hence can be missed if not carefully looked for. Definitive diagnosis is often by a combination of microbiological culture and histopathological examination of obtained tissue. Ancillary serological tests like galactomannan assay and polymerase chain reaction also help in the diagnosis. Treatment of aspergillus endocarditis virtually always requires a combination of prolonged antifungal therapy and surgery to enable a cure for these patients.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular & Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India.
| | - Praveena Nediyara Bhaskaran
- Division of Infectious Diseases, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Merlin Moni
- Division of Infectious Diseases, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Nandita Shashindran
- Department of Microbiology, Amrita Institute of Medical Sciences and Research Center, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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Heller A, Zerdzitzki M, Hegner P, Song Z, Schach C, Hitzenbichler F, Kozakov K, Thiedemann C, Provaznik Z, Schmid C, Li J. Clinical Characterization of Pathogens, Risk Factors and Quality of Life in an Observational Study of Native vs. Prosthetic Aortic Valve Endocarditis Surgery. Life (Basel) 2024; 14:1029. [PMID: 39202771 PMCID: PMC11355113 DOI: 10.3390/life14081029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Background: Native (NVE) and prosthetic (PVE) aortic valve endocarditis (AVE) remain a surgical challenge with an ongoing trend towards more complex surgical procedures. Methods: First-time NVE was compared with PVE, focusing on pathogens, risk factors, perioperative course, postoperative follow-up, including recurrent infection, as well as health-related quality of life (HRQOL). Results: From 2007 to 2022, surgical intervention for AVE was necessary in 231 patients with 233 episodes of infective aortic valve endocarditis, i.e., there were only two cases of reinfection (NVE group). The study group consisted of 130 cases with NVE and 103 with PVE. Overall, a median of 40.3% of survivors were in NYHA class I or II. In-hospital mortality was higher in the PVE group with 13.3%. The most common pathogen was Staphylococcus aureus, with 24.9% across both groups. EuroSCORE II was higher in the PVE group (19.0 ± 14.3% total, NVE 11.1 ± 8.1%, PVE 27.8 ± 14.6%; p < 0.05), reflecting an older, more co-morbid patient cohort. Abscess formation was also more common in the PVE group, while vegetations were more common in the NVE group. The 5-year and 10-year survival rates did not differ significantly between NVE and PVE and were 74.4% and 52.2% for the NVE group, respectively, and 67.4% and 52.9% for the PVE group, respectively. The HRQOL as assessed by the Minnesota Living with HF Questionnaire (MLHFQ) demonstrated no significant difference between both groups. Conclusions: Long-term survival and QoL after surgical treatment of infective aortic valve endocarditis are excellent and do not depend on the type of replacement.
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Affiliation(s)
- Anton Heller
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Matthäus Zerdzitzki
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
- Department of Vascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany
| | - Philipp Hegner
- Department of Internal Medicine II—Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (P.H.); (C.S.)
| | - Zhiyang Song
- Institute of Mathematics, Ludwig-Maximilian University Munich, 80539 Munich, Germany
| | - Christian Schach
- Department of Internal Medicine II—Cardiology, University Medical Center Regensburg, 93053 Regensburg, Germany; (P.H.); (C.S.)
| | - Florian Hitzenbichler
- Department of Infectiology, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Kostiantyn Kozakov
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Claudius Thiedemann
- Department of Orthopedics and Trauma Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany;
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
| | - Jing Li
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany (K.K.); (Z.P.); (C.S.); (J.L.)
- Department of Occupational Medicine, University Medical Center Regensburg, 93053 Regensburg, Germany
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Issa R, Chaaban N, Salahie A, Honnekeri B, Parizher G, Xu B. Infective Endocarditis in Patients with End-Stage Renal Disease on Dialysis: Epidemiology, Risk Factors, Diagnostic Challenges, and Management Approaches. Healthcare (Basel) 2024; 12:1631. [PMID: 39201188 PMCID: PMC11353797 DOI: 10.3390/healthcare12161631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
Infective endocarditis (IE) poses a significant clinical challenge, especially among patients with end-stage renal disease (ESRD) undergoing dialysis, and is associated with high morbidity and mortality rates. This review provides a contemporary discussion of the epidemiology, risk factors, diagnostic challenges, and management strategies for IE among ESRD patients, including a literature review of recent studies focused on this vulnerable population. The review highlights the multifactorial nature of IE risk in ESRD patients, emphasizing the roles of vascular access type, dialysis modality, and comorbid conditions. It also explores the diagnostic utility of different imaging modalities and the importance of a multidisciplinary approach in managing IE, including both medical and surgical interventions. The insights from this review aim to contribute to the improvement of patient outcomes through early recognition, appropriate antimicrobial therapy, and timely surgical intervention when necessary.
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Affiliation(s)
- Rochell Issa
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nourhan Chaaban
- Department of Cardiology, University of Toledo, Toledo, OH 43606, USA
| | - Abdullah Salahie
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bianca Honnekeri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Gary Parizher
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Oldberg K, Rasmussen M. Make Modern Microbiology Matter More in the 2023 European Society of Cardiology Guidelines for the Management of Infective Endocarditis. Clin Infect Dis 2024; 79:336-338. [PMID: 38655671 PMCID: PMC11327790 DOI: 10.1093/cid/ciae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
The European Society of Cardiology (ESC) 2023 guidelines for the management of infective endocarditis (IE) stress that a multidisciplinary approach is needed to manage patients with IE. In our view, the guidelines do not include the relevant perspectives from modern microbiology. The diagnostic criteria for IE were changed in the ESC 2023 guidelines, and many IE-causing pathogens are either not clearly defined. Moreover, an improved understanding of the relationship between bacterial species and the risk for IE has not been implemented. The guidelines give detailed and, in our view, incorrect instructions about diagnostic testing in blood culture-negative IE without presenting proper evidence. Other important diagnostic aspects, such as the value of repeated blood cultures and incubation time for blood cultures, are not discussed. We believe that a multidisciplinary collaboration that include microbiologists would have improved these guidelines, and we hope for a future harmonization of diagnostic criteria for IE.
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Affiliation(s)
- Karl Oldberg
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medial Services, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Division for Infectious Diseases, Skåne University Hospital, Lund, Sweden
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Díez-Vidal A, Martínez-Martín P, González-Muñoz B, Tung-Chen Y. Point-of-care Ultrasound in Infectious Diseases: Current Insights and Future Perspectives. Clin Infect Dis 2024; 79:420-429. [PMID: 38769593 DOI: 10.1093/cid/ciae285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 05/22/2024] Open
Abstract
Point-of-care ultrasound (POCUS) is a safe, noninvasive technique performed at the patient's bedside, providing immediate results to the operator. It complements physical examination and facilitates clinical decision-making. In infectious diseases, POCUS is particularly valuable, offering an initial assessment in cases of suspected infection. It often leads to an early tentative diagnosis enabling the prompt initiation of antimicrobial treatment without the delay associated with traditional radiology. POCUS provides direct visualization of affected organs, assists in evaluating fluid balance, and facilitates various interventions, all while reducing patient discomfort. For infectious disease specialists, becoming proficient in POCUS is a critical future challenge, requiring dedicated training for effective utilization.
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Affiliation(s)
- Alejandro Díez-Vidal
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
| | - Patricia Martínez-Martín
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- CIBERINFEC, Carlos III Health Institute, Madrid, Spain
| | - Borja González-Muñoz
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
| | - Yale Tung-Chen
- IdiPAZ Hospital La Paz Institute for Health Research, La Paz University Hospital, Madrid, Spain
- Internal Medicine Department, La Paz University Hospital, Madrid, Spain
- Department of Medicine, Alfonso X El Sabio University, Madrid, Spain
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39
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Fourré N, Zimmermann V, Senn L, Monney P, Tzimas G, Caruana G, Tozzi P, Kirsch M, Guery B, Papadimitriou-Olivgeris M. Evaluation of the HANDOC Score and the 2023 International Society of Cardiovascular Infectious Diseases and European Society of Cardiology Duke Clinical Criteria for the Diagnosis of Infective Endocarditis Among Patients With Streptococcal Bacteremia. Clin Infect Dis 2024; 79:434-442. [PMID: 38842414 PMCID: PMC11327781 DOI: 10.1093/cid/ciae315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Streptococci are a common cause of infective endocarditis (IE). We aimed to evaluate the performance of the HANDOC score to identify patients at high risk for IE and the Duke clinical criteria of the European Society of Cardiology (ESC; 2015 and 2023 versions) and the 2023 version from the International Society of Cardiovascular Infectious Diseases (ISCVID) in diagnosing IE among patients with streptococcal bacteremia. METHODS This retrospective study included adult patients with streptococcal bacteremia hospitalized at Lausanne University Hospital. Episodes were classified as IE by the Endocarditis Team. A HANDOC score >2 classified patients as high risk for IE. RESULTS Among 851 episodes with streptococcal bacteremia, IE was diagnosed in 171 episodes (20%). Among 607 episodes with non-β-hemolytic streptococci, 213 (35%) had HANDOC scores >2 points; 132 (22%) had IE. The sensitivity of the HANDOC score to identify episodes at high risk for IE was 95% (95% confidence interval [CI], 90%-98%), the specificity 82% (95% CI, 78%-85%), and the negative predictive value (NPV) 98% (95% CI, 96%-99%). 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria classified 114 (13%), 145 (17%), and 126 (15%) episodes as definite IE, respectively. Sensitivity (95% CI) for the 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria was calculated at 65% (57%-72%), 81% (74%-86%), and 73% (65%-79%), respectively, with specificity (95% CI) at 100% (98%-100%), 99% (98%-100%), and 99% (98%-100%), respectively. CONCLUSIONS The HANDOC score showed an excellent NPV to identify episodes at high risk for IE. Among the different versions of the Duke criteria, the 2023 Duke-ISCVID version fared better for the diagnosis of IE among streptococcal bacteremia.
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Affiliation(s)
- Nicolas Fourré
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Virgile Zimmermann
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Georgios Tzimas
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgia Caruana
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Benoit Guery
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Matthaios Papadimitriou-Olivgeris
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infection Prevention and Control Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Infectious Diseases Service, Cantonal Hospital of Sion and Institut Central des Hôpitaux, Sion, Switzerland
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Hillstedt E, Dencker M, Nilson B, Oldberg K, Rasmussen M. The first report of Staphylococcus argenteus endocarditis with visualized valve vegetations. IDCases 2024; 37:e02058. [PMID: 39253401 PMCID: PMC11381430 DOI: 10.1016/j.idcr.2024.e02058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 09/11/2024] Open
Abstract
Staphylococcus argenteus was recently defined as a species and has previously often been mistaken for Staphylococcus aureus due to the difficulties of conventional laboratory methods to distinguish the two species. The clinical presentation of infections caused by S. argenteus is largely unknown, and its virulence has since the definition of the species been debated. Here we present, to our knowledge, the first case of infective endocarditis due to S. argenteus with valve vegetations visualized on echocardiography. The 74-year-old male patient with biological aortic valve prothesis presented with a rapid onset of diffuse symptoms and his condition hastily deteriorated to septic shock followed by several complications such as intracranial septic emboli, severe heart failure, and intracardiac thrombus. After conservative treatment and management of the multiple complications, the patient recovered and was eventually discharged to his original housing situation.
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Affiliation(s)
- Ebba Hillstedt
- Department of Perioperative Medicine and Intensive Care Medicine, Skåne University Hospital, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
- Department of Medicine, Nyköping Hospital, Sörmland Region, Nyköping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Sweden
| | - Magnus Dencker
- Department of Medical Imaging and Physiology, Skåne University Hospital, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Bo Nilson
- Department of Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Sweden
- Division of Medical Microbiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Karl Oldberg
- Department of Clinical Microbiology, Infection Prevention and Control, Office for Medical Services, Region Skåne, Sweden
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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Schmidt-Hellerau K, Camp J, Marmulla PA, Rieg S, Jung N. In Which Patients Does the 2023 Duke-ISCVID Criteria for Infective Endocarditis Increase the Diagnosis of "Definite Endocarditis"?-A Preliminary Analysis in the Prospectively Evaluated DERIVE Cohort. J Clin Med 2024; 13:4721. [PMID: 39200863 PMCID: PMC11355459 DOI: 10.3390/jcm13164721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 07/30/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: Recently, an update of the Duke criteria for the diagnosis of infectious endocarditis has been published: the 2023 Duke-ISCVID criteria. To gain an insight into which proportion of patients are affected by the new criteria, and which criteria might be the most relevant for the expected increase in sensitivity, we analysed data from a registry of cardiovascular infections. Methods: The 2023 Duke-ISCVID criteria were applied to patients who were diagnosed with and treated for endocarditis after having been classified as "possible" endocarditis according to the 2015 ESC Modified Duke criteria. In patients thus newly classified as "definite endocarditis", diagnostic factors leading to this reclassification were described. Results: Of 397 patients, 48 (12%) did not fulfil the definition "definite infectious endocarditis" according to the 2015 ESC Modified Duke criteria. Of these, six (13%) fulfilled the definition when the 2023 Duke-ISCVID criteria were applied. A main factor triggering this reclassification was the consideration of microorganisms identified using valve PCR. Conclusions: As expected, the sensitivity of the new 2023 Duke-ISCVID criteria is increased in this cohort, mainly through the incorporation of new diagnostic methods in the criteria. Further studies are required to assess the effect on specificity in detail.
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Affiliation(s)
- Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Köln, Germany (N.J.)
| | - Johannes Camp
- Division of Infectious Diseases, Department of Medicine II, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, 70196 Freiburg, Germany
| | - Philipp Alexander Marmulla
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Köln, Germany (N.J.)
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre—University of Freiburg, Faculty of Medicine, University of Freiburg, 70196 Freiburg, Germany
| | - Norma Jung
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Köln, Germany (N.J.)
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Meyer HG, Hug BL. Aerococcus urinae endocarditis - A case report. IDCases 2024; 37:e02053. [PMID: 39188366 PMCID: PMC11347057 DOI: 10.1016/j.idcr.2024.e02053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024] Open
Abstract
Aerococcus urinae is a gram-positive coccus bacterium with a previously underestimated prevalence due to morphological similarities to other gram-positive cocci. Development of newer diagnostic technologies (such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry MALDI-TOF) led to increased recognition of Aerococcus urinae as causative organism mainly for urinary tract infections. Its antibiotic susceptibility poses some challenges, with resistance to some drugs of choice for urinary tract infection. We report a case of a 69-year-old male with infective endocarditis of the mitral valve, who initially presented with fever and shoulder pain to the emergency department. The patient reported an episode of obstructive renal infection two weeks earlier, which was treated with trimethoprim-sulfamethoxazole. The unusual presentation with shoulder pain and a new heart murmur led to suspicion of endocarditis. Urine and blood cultures were positive for Aerococcus urinae, echocardiography revealed vegetations on the mitral valve with severe mitral insufficiency. After two weeks of antibiotic treatment, mitral valve replacement was performed, from which the patient recovered. Reports of Aerococcus urinae endocarditis are still limited in number. On the other side, Aerococcus urinae is an emerging bacterial uropathogen with greater relevance than previously believed. We review the case reports of Aerococcus urinae endocarditis and newest literature about its presentation, course, and clinical management.
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Affiliation(s)
- Helene G. Meyer
- Internal Medicine, Lucerne Cantonal Hospital, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Balthasar L. Hug
- Internal Medicine, Lucerne Cantonal Hospital, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
- Center for Primary and Community Care, University of Lucerne, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
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43
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Villanueva DM, Lonks JR, Geffert S, Panaccione S, Larkin J, Charla S, Li J, Hong T. Escherichia coli ST1193 O75 H5: A rare cause of native valve endocarditis with multifocal emboli to brain and spleen. IDCases 2024; 37:e02052. [PMID: 39220422 PMCID: PMC11362767 DOI: 10.1016/j.idcr.2024.e02052] [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: 06/24/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Escherichia coli (E. coli) is a facultative anaerobic gram-negative rod bacterium, which can acquire pathogenicity through the acquisition of additional genetic material. We present a case of E. coli ST1193, an emerging global multidrug-resistant (MDR) high-risk clone, causing native valve endocarditis and septic brain and splenic emboli in a 67-year-old woman.
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Affiliation(s)
- Diana M. Villanueva
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - John R. Lonks
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Sara Geffert
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
- Microbiology Laboratory, Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI 02903, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Sophia Panaccione
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Jerome Larkin
- Division of Infectious Diseases, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Swapna Charla
- Microbiology Laboratory, Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI 02903, USA
| | - Jennifer Li
- Microbiology Laboratory, Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI 02903, USA
| | - Tao Hong
- Microbiology Laboratory, Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI 02903, USA
- Department of Pathology and Laboratory Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
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Boodman C, Gupta N, van Griensven J, Van Bortel W. Bartonella quintana detection among arthropods and their hosts: a systematic review and meta-analysis. Parasit Vectors 2024; 17:328. [PMID: 39095833 PMCID: PMC11295871 DOI: 10.1186/s13071-024-06413-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Bartonella quintana is a body louse-borne bacterium causing bacteremia and infective endocarditis. We aimed to describe B. quintana detection among arthropods and their hosts. METHODS We searched databases in PubMed Central/MEDLINE, Scopus, Embase, and Web of Science from January 1, 1915 (the year of B. quintana discovery) to January 1, 2024, to identify publications containing specific search terms relating to B. quintana detection among arthropods. Descriptive statistics and meta-analysis of pooled prevalence using random-effects models were performed for all arthropods and body and head lice. RESULTS Of 1265 records, 62 articles were included, describing 8839 body lice, 4962 head lice, and 1692 other arthropods, such as different species of fleas, bedbugs, mites, and ticks. Arthropods were collected from 37 countries, of which 28 had arthropods with B. quintana DNA. Among articles that reported B. quintana detection among individual arthropods, 1445 of 14,088 (0.1026, 95% CI [0.0976; 0.1077]) arthropods tested positive for B. quintana DNA, generating a random-effects model global prevalence of 0.0666 (95% CI [0.0426; 0.1026]). Fifty-six studies tested 8839 body lice, of which 1679 had B. quintana DNA (0.1899, 95% CI [0.1818; 0.1983]), generating a random-effects model pooled prevalence of 0.2312 (95% CI [0.1784; 0.2843]). Forty-two studies tested 4962 head lice, of which 390 head lice from 20 studies originating from 11 different countries had B. quintana DNA (0.0786, 95% CI [0.0713; 0.0864]). Eight studies detected B. quintana DNA exclusively on head lice. Five studies reported greater B. quintana detection on head lice than body lice; all originated from low-resource environments. CONCLUSIONS Bartonella quintana is a vector-borne bacterium with a global distribution, disproportionately affecting marginalized populations. Bartonella quintana DNA has been detected in many different arthropod species, though not all of these arthropods meet criteria to be considered vectors for B. quintana transmission. Body lice have long been known to transmit B. quintana. A limited number of studies suggest that head lice may also act as possible vectors for B. quintana in specific low-resource contexts.
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Affiliation(s)
- Carl Boodman
- University of Manitoba, Winnipeg, MB, Canada.
- Institute of Tropical Medicine, Antwerp, Belgium.
- University of Antwerp, Antwerp, Belgium.
| | - Nitin Gupta
- Institute of Tropical Medicine, Antwerp, Belgium
- University of Antwerp, Antwerp, Belgium
- Department of Infectious Disease, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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45
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Brandariz-Núñez D, Luances-Rodríguez A, Feijoo-Vilanova P, Gutiérrez-Urbón JM, Ramudo-Cela L, Martín-Herranz MI, Margusino-Framiñán L. Dalbavancin as consolidation therapy for infective endocarditis in patients with comorbidity. A real world experience. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:334-340. [PMID: 38881525 PMCID: PMC11231482 DOI: 10.37201/req/012.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/10/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Infective endocarditis (IE) is a potentially life-threatening infection, the incidence of which has in creased in recent decades, particularly among elderly patients with comorbidity. The primary objective of this study was to evaluate the effectiveness of dalbavancin in the consolidation therapy of IE in patients with comorbidity six months after the end of treatment (EOT). METHODS An observational and retrospective study was conducted on patients with a Charlson Comorbidity Index (CCI) ≥ 3 who were diagnosed with IE and received consolidation therapy with dalbavancin. RESULTS Forty-eight patients were included, 58.3% were male, mean age of 76.2 years (IQR: 66-88), and a mean age adjusted CCI of 6.5 (IQR: 5-7.5). Definite IE was diagnosed in 77% of cases. The most frequently isolated microorganisms were Staphylococcus aureus (45.8%) followed by Enterococcus spp. (31.3%). Complications of IE were observed in 67.7% of cases, and cardiac surgery was performed in 27% of patients. The primary reason for using dalbavancin was outpatient parenteral antibiotic therapy in 85.4% of cases. The effectiveness at EOT was 93.8%. At six months, six IE-related deaths, four unrelated deaths, and two IE relapses were observed. The effectiveness was 77%. Adverse effects related to DBV were reported in 4.2% of cases, of which 2% were considered serious. CONCLUSIONS Dalbavancin has proven to be an effective alternative as consolidation antibiotherapy for IE in elderly patients with comorbidity. Moreover, a very favorable safety profile with few associated adverse effects has been observed in this population.
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Affiliation(s)
- D Brandariz-Núñez
- David Brandariz-Núñez, Pharmacy Department, Universitary Complex Hospital A Coruña (CHUAC). A Coruña, Spain.
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46
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Boodman C, Garcia OF, Kabbani D, Villalobos APC, Beeson A, Marx GE, van Griensven J, Doucette K. Donor-Derived Bartonella quintana Infection in Solid Organ Transplantation: An Emerging Public Health Issue With Diagnostic Challenges. Open Forum Infect Dis 2024; 11:ofae381. [PMID: 39192995 PMCID: PMC11348938 DOI: 10.1093/ofid/ofae381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/04/2024] [Indexed: 08/29/2024] Open
Abstract
Bartonella quintana is a louse-borne intracellular bacterium that remains a neglected cause of bacteremia, bacillary angiomatosis, and infective endocarditis among individuals experiencing poverty. In October 2023, Health Canada notified Canadian organ transplantation programs of an outbreak of donor-derived B quintana infection. From March to August 2023, 5 cases of donor-derived B quintana disease were acquired in Alberta, Canada, from 3 deceased donors who had experienced homelessness. Similar cases recently occurred in the United States. In this article, we discuss strategies to screen organ donors and monitor transplant recipients for B quintana infection using epidemiologic risk factors, physical examination signs, and laboratory diagnostic tests. We review the limitations of existing diagnostic tests for B quintana and describe how these problems may be magnified in the organ transplantation context.
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Affiliation(s)
- Carl Boodman
- Division of Infectious Diseases, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Unit of Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Oscar Fernandez Garcia
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy Beeson
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Grace E Marx
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Johan van Griensven
- Unit of Neglected Tropical Diseases, Institute of Tropical Medicine, Antwerp, Belgium
| | - Karen Doucette
- Department of Infectious Disease, Faculty of Medicine and Dentistry Medicine, University of Alberta, Edmonton, Alberta, Canada
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47
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Sheehy J, Scott AP, Henden AS, Kennedy G, Redmond AM, Stewart AG. Low rates of complications and β-lactam resistance in viridans group streptococci bloodstream infection among cancer patients receiving chemotherapy. J Antimicrob Chemother 2024; 79:2040-2047. [PMID: 38973602 DOI: 10.1093/jac/dkae209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/04/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Viridans group streptococci (VGS) bloodstream infection (BSI) frequently occurs in cancer patients receiving chemotherapy, and is associated with infective endocarditis (IE) in up to 20% of cases in the general population. OBJECTIVES In cancer patients receiving chemotherapy with VGS BSI, we aimed to: (i) determine the incidence of infective complications including IE, (ii) assess the utility of echocardiography in this patient population, (iii) determine the duration and type of antimicrobial therapy received for monomicrobial infections, and (iv) determine the evolution of antimicrobial resistance. METHODS VGS BSIs (excluding Streptococcus pneumoniae and Streptococcus pseudopneumoniae) in cancer patients receiving chemotherapy were identified from a statewide public pathology database between 2013 and 2022 at our tertiary centre. Medical records were accessed for clinical, microbiological and radiological data. RESULTS Of 581 patient episodes screened, 183 episodes involving 171 patients met inclusion criteria. Of these, 51% were bone marrow transplantation (BMT) patients, 40% were non-BMT haematology patients, and 8% were solid organ malignancy patients. The median age was 55 years, and 96% were neutropenic at the time of blood culture collection. A transthoracic echocardiogram was performed for 71% of episodes, and one patient met modified Duke's criteria for definite IE, although this diagnosis was not suspected on clinical grounds. Other complications were uncommon. Benzylpenicillin resistance was rare (2.9%) and did not change over time. Most episodes (75%) were treated with piperacillin/tazobactam. For monomicrobial BSIs, the median antibiotic duration was 5 days (IQR 2-7) post-neutropenia resolution. CONCLUSIONS Infective complications and antimicrobial resistance are rare in cancer patients with VGS BSI. This may provide a safe opportunity to limit both investigations (e.g. echocardiogram) and prolonged exposure to broad-spectrum antimicrobials.
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Affiliation(s)
- Joshua Sheehy
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Ashleigh P Scott
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Andrea S Henden
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Translational Cancer Immunotherapy, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Glen Kennedy
- Department of Haematology and Bone Marrow Transplant, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew M Redmond
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Adam G Stewart
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Herston, QLD, Australia
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48
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Chesdachai S, Baddour LM, Sohail MR, Palraj BR, Madhavan M, Tabaja H, McGinnis MT, Fida M, Challener DW, DeSimone DC. Outcome of Corynebacterial Bloodstream Infection in Patients With Cardiac Implantable Electronic Devices: A Brief Report and Systematic Review. Open Forum Infect Dis 2024; 11:ofae441. [PMID: 39161858 PMCID: PMC11331626 DOI: 10.1093/ofid/ofae441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 07/27/2024] [Indexed: 08/21/2024] Open
Abstract
Cardiac implantable electronic device infection in the context of corynebacterial bloodstream infection (BSI) remains poorly understood. From 2012 to 2023 at Mayo Clinic, 4 of 12 patients with corynebacterial BSI had cardiac implantable electronic device infection: 1 patient was diagnosed during a relapsing BSI episode. Undefined source, persistent BSI, and the presence of a prosthetic cardiac valve were common characteristics.
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Affiliation(s)
- Supavit Chesdachai
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Bharath Raj Palraj
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Malini Madhavan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hussam Tabaja
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Madiha Fida
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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49
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Yoshitake S, Kusama Y, Shiomi F, Nakahashi T, Toyota N, Yoshizawa K, Ito Y, Kamimura K. First Pediatric Case of Endocarditis Caused by Moraxella nonliquefaciens : Importance of Molecular Diagnosis. Pediatr Infect Dis J 2024; 43:e289. [PMID: 38534791 DOI: 10.1097/inf.0000000000004339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Affiliation(s)
- Saeka Yoshitake
- Department of Pediatrics, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Yoshiki Kusama
- Department of Infection Control and Prevention, Graduate School of Medicine/Faculty of Medicine, Osaka University, Suita, Japan
| | - Fuko Shiomi
- Department of Clinical Laboratory, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Toru Nakahashi
- Department of Pediatrics, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Naoki Toyota
- Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Yusuke Ito
- Department of Pediatric Infectious Diseases, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
| | - Katsunori Kamimura
- Department of Pediatrics, Hyogo Prefectural Amagasaki Medical Center, Amagasaki, Japan
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50
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Cewers A, Sunnerhagen T, Gilje P, Wannheden F, Bläckberg J, Wierup P, Larsson M, Rasmussen M. Even a single positive blood culture may matter - A case of prosthetic valve infective endocarditis caused by Corynebacterium kroppenstedtii. IDCases 2024; 37:e02049. [PMID: 39184333 PMCID: PMC11342749 DOI: 10.1016/j.idcr.2024.e02049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/30/2024] [Indexed: 08/27/2024] Open
Abstract
Corynebacterium is a skin commensal bacterium that can contaminate blood cultures. It is however also a rare cause of infective endocarditis (IE). Here we report a case of Corynebacterium kroppenstedtii aortic prosthesis IE in a 76-year-old man where only a single blood culture bottle was positive initially. C. kroppenstedtii is a very rare cause of IE, only reported two times previously. The diagnosis in our case was confirmed by repeated blood culture positivity and eventually by detection of DNA from C. kroppenstedtii on heart valves after valve exchange surgery. At surgery an aortic root abscess was detected and the valve was replaced by a homograft. Recovery was complicated by antibiotic-induced nephrotoxicity and treatment was concluded with moxifloxacin in combination with rifampicin. Recovery was uneventful. This case demonstrates that growth in even a single blood culture bottle may be important in patients with prosthetic heart valves.
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Affiliation(s)
- Adam Cewers
- Division of Infection Medicine, Helsingborg Hospital, Helsingborg, Sweden
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrik Gilje
- Department of Cardiology, Clinical Sciences, Lund University and Skane University Hospital, SE-221 85 Lund, Sweden
| | - Fredrik Wannheden
- Department of Clinical Physiology, Clinical Sciences, Lund University, SE-221 85 Lund, Sweden
| | - Jonas Bläckberg
- Division of Infection Medicine, Helsingborg Hospital, Helsingborg, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Per Wierup
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Mårten Larsson
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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