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Ardeshna A, Gupta S, Rossouw PE, Valiathan M. Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2. Dent Clin North Am 2024; 68:707-724. [PMID: 39244252 DOI: 10.1016/j.cden.2024.05.005] [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: 09/09/2024]
Abstract
This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.
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Affiliation(s)
- Anil Ardeshna
- Department of Orthodontics, Rutgers School of Dental Medicine, Newark, NJ, USA.
| | - Sumit Gupta
- Private Practice, Rak Dental Care & Implant Centre, Ras Al Khaimah, United Arab Emirates
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, University of Rochester, Eastman Institute for Oral Health
| | - Manish Valiathan
- Department of Orthodontics, Case Western Reserve University, 9601 Chester Avenue, Cleveland, OH 44106, USA
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Dingen H, Jordal S, Bratt S, Aukrust P, Busund R, Jakobsen Ø, Dalén M, Ueland T, Svenarud P, Haaverstad R, Saeed S, Risnes I. Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicenter case-control study. BMC Infect Dis 2024; 24:913. [PMID: 39227795 PMCID: PMC11370320 DOI: 10.1186/s12879-024-09782-3] [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: 05/06/2024] [Accepted: 08/21/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease. METHODS Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models. RESULTS The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78). CONCLUSIONS In this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.
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Affiliation(s)
- Håvard Dingen
- Department of Internal Medicine, Stord Hospital, Stord, Norway
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, Norway
| | - Stina Jordal
- Department of Medicine, Section of Infectious diseases, Haukeland University Hospital, Bergen, Norway
| | - Sorosh Bratt
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Pål Aukrust
- Research Institute of Internal Medicine & Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rolf Busund
- Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway
| | - Øyvind Jakobsen
- Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, Tromsø, Norway
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Thor Ueland
- Research Institute of Internal Medicine & Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Thrombosis Research Center (TREC), Division of internal medicine, University Hospital of North Norway, Tromsø, Norway
| | - Peter Svenarud
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Rune Haaverstad
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
- Institute of Clinical Science, Medical Faculty, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway.
| | - Ivar Risnes
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
- Department of Thoracic and Cardiovascular Surgery, Oslo University Hospital Ullevål, Oslo, Norway
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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 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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Ackermann P, Marin-Cuartas M, Weber C, De La Cuesta M, Lichtenberg A, Petrov A, Hagl C, Aubin H, Matschke K, Diab M, Luehr M, Akhyari P, Tugtekin SM, Saha S, Doenst T, Wahlers T, Borger MA, Misfeld M. Sex-related differences in patients with infective endocarditis requiring cardiac surgery: insights from the CAMPAIGN Study Group. Eur J Cardiothorac Surg 2024; 66:ezae292. [PMID: 39073913 DOI: 10.1093/ejcts/ezae292] [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: 02/09/2024] [Revised: 05/22/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024] Open
Abstract
OBJECTIVES Sex-related differences play a role in cardiovascular disease-related outcomes. There is, however, a knowledge gap regarding sex-specific differences in patients with infective endocarditis (IE)-requiring surgical treatment. This study aims to analyse sex-related differences in the clinical presentation, treatment and clinical outcomes of patients with IE-requiring surgical treatment from the multicentric Germany-wide CAMPAIGN registry. METHODS Patients with IE who underwent cardiac surgery between 1994 and 2018 at six German centres were retrospectively analysed. Outcomes were compared based on patients' sex. Primary outcomes were 30-day mortality and mid-term survival. RESULTS A total of 4917 patients were included in the analysis (1364 female [27.7%] and 3553 male [72.3%]). Female patients presented with more comorbidities and higher surgical risk (EuroScore II 12.0% vs 10.0%, P < 0.001). The early postoperative course of female patients was characterized by longer ventilation times (20.0 h vs 16.0 h; P = 0.004), longer intensive care unit stay (4.0 days vs 3.0 days; P < 0.001), and more frequent new-onset dialysis (265 [20.3%] vs 549 [16.3%]; P = 0.001). The 30-day mortality was 13.8% and 15.5% in female and male patients, respectively (P = 0.06). The estimated mid-term survival was significantly higher amongst male patients (56.1% vs 45.4%; Log-rank P < 0.001). Female sex was an independent predictor of mid-term mortality (HR 1.2 [95% CI 1.0-1.4], P = 0.01). CONCLUSIONS Male patients more frequently undergo cardiac surgery for IE. However, female patients have a higher surgical risk profile and subsequently an increased early postoperative morbidity, but with similar 30-day mortality compared with male patients. The estimated mid-term survival is lower amongst female patients.
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Affiliation(s)
- Paula Ackermann
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Manuela De La Cuesta
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Asen Petrov
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich Heine University, Düsseldorf, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Mahmoud Diab
- Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg, Rontenburg an der Fulda, Germany
| | - Maximilian Luehr
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Payam Akhyari
- Department of Cardiothoracic Surgery, RWTH Aachen, Aachen, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, University Hospital, University of Dresden, Dresden, Germany
| | - Shekhar Saha
- Department of Cardiac Surgery, University Hospital LMU Munich, Munich, Germany
| | - Torsten Doenst
- Department of Cardiac Surgery, University Hospital of Jena, Jena, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, RPAH, Sydney, Australia
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
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Destrem AL, Maillard A, Simonet M, Simeon S, Contejean A, Vignau C, Pires L, Isnard M, Vitrat V, Delory T, Maillet M. Effectiveness and safety of cefazolin versus cloxacillin in endocarditis due to methicillin-susceptible Staphylococcus spp.: a multicenter propensity weighted cohort study. Eur J Clin Microbiol Infect Dis 2024; 43:1569-1577. [PMID: 38806841 DOI: 10.1007/s10096-024-04851-6] [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: 03/21/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE To compare the effectiveness and safety of cefazolin versus cloxacillin for the treatment of infective endocarditis (IE) due to methicillin-sensitive Staphylococci (MSS). METHODS Data were retrospectively collected on patients treated for a definite MSS endocarditis who received cefazolin or cloxacillin for at least 10 consecutive days in six French hospitals between January-1 2014 and December-31 2020. The primary endpoint was treatment failure defined as a composite of death within 90 days of starting antibiotherapy, or embolic event during antibiotherapy, or relapse of IE within 90 days of stopping antibiotherapy. We used Cox regression adjusted for the inverse probability of treatment weighting of receiving cefazolin. RESULTS 192 patients were included (median age 67.8 years). IE was caused by S.aureus in 175 (91.1%) and by coagulase-negative staphylococci in 17 (8.9%). Ninety-four patients (48.9%) received cefazolin, and 98 (51%) received cloxacillin. 34 patients (34.7%) with cefazolin and 26 (27.7%) with cloxacillin met the composite primary endpoint, with no significant differences between groups (adjusted HR = 1.13, 95% CI 0.63 to 2.03). There were no significant differences in secondary efficacy endpoints or biological safety events. CONCLUSION The effectiveness of cefazolin did not significantly differ from cloxacillin for the treatment of MSS endocarditis.
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Affiliation(s)
- Anne-Laure Destrem
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Alexis Maillard
- Infectious Diseases Department, Pitié-Salpêtrière University Hospital, Paris, France
| | - Mathieu Simonet
- Infectious Diseases Department, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Soline Simeon
- Infectious Diseases Department, Henri Mondor University Hospital, Paris, France
| | - Adrien Contejean
- Infectious Diseases Department, Cochin University Hospital, Paris, France
- Hematology Department, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Clémentin Vignau
- Infectious Diseases Department, Grenoble University Hospital, Grenoble, France
| | - Lucas Pires
- Clinical Research Unit, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Margaux Isnard
- Infectious Diseases Department, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Virginie Vitrat
- Infectious Diseases Department, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Tristan Delory
- Clinical Research Unit, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Mylène Maillet
- Infectious Diseases Department, Centre Hospitalier Annecy Genevois, Annecy, France.
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Rajeev M, Singh SP, Raheja D, Yadav M, Agstam S. An Unusual Complication of Early Prosthetic Valve Endocarditis. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00465-8. [PMID: 39198125 DOI: 10.1053/j.jvca.2024.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/10/2024] [Accepted: 07/15/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Meera Rajeev
- Intensive Care for Cardiothoracic and Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarvesh Pal Singh
- Intensive Care for Cardiothoracic and Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Dhruv Raheja
- Intensive Care for Cardiothoracic and Vascular Surgery, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Yadav
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Agstam
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Lane J, Read JM, Rahmany Z, Reely K, Hicks CM, Martin DE. Development of Palpable Purpura in a Patient With Infective Endocarditis: A Case Report. Cureus 2024; 16:e63601. [PMID: 39087182 PMCID: PMC11290593 DOI: 10.7759/cureus.63601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Infective endocarditis (IE) can present with a variety of signs and symptoms, including skin lesions. The few papers describing a relationship between IE and vasculitis are split between IE being able to mimic vasculitis and between IE indeed being associated with a vasculitis involving the skin, kidney, gastrointestinal tract, or peripheral nerves. It is important for clinicians to distinguish between an isolated vasculitis, infective endocarditis, and IE-associated vasculitis because the treatments and outcomes are different. We report a case of a patient with a history of intravenous (IV) drug use who initially presented with chest pain, was started on vancomycin following diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) IE, left against medical advice (AMA), and then returned to the hospital due to development of a purpuric rash. We contend that while he did not have a skin biopsy due to time delay, his symmetrically distributed purpura was consistent with cutaneous vasculitis. His symptoms, including his rash and an acute kidney injury (AKI), improved with antibiotics to treat the endocarditis.
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Affiliation(s)
- Jordan Lane
- Internal Medicine, Unity Health, Searcy, USA
| | - John M Read
- Internal Medicine, Unity Health, Searcy, USA
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Azelmat S, Baadi T, Benaissa E, Jaafari A, Chadli M. Infective Endocarditis Caused by Carbapenemase-Producing Klebsiella pneumoniae on a Prosthetic Valve: A Case Report and Review of the Literature. Cureus 2024; 16:e64639. [PMID: 39149690 PMCID: PMC11325291 DOI: 10.7759/cureus.64639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/17/2024] Open
Abstract
Infective endocarditis (IE) is a rare but severe disease due to frequent and serious complications. Healthcare-associated cases often involve Staphylococcus aureus, while Gram-negative bacteria such as Klebsiella pneumoniae, though rare, pose severe challenges due to their resistance profiles. We report a case of a 68-year-old woman with a history of hypertension and mitral valve replacement 12 years ago, who was admitted to the intensive care unit (ICU) for management of non-traumatic, afebrile altered mental status due to intracerebral hemorrhage from anticoagulant overdose. His stay in the ICU revealed septic shock with multi-organ failure caused by carbapenemase (New Delhi metallo-β-lactamase (NDM))-producing K. pneumoniae complicated by IE on the prosthetic mitral valve. Despite treatment with meropenem, colistin, and tigecycline, the patient succumbed to septic shock after 15 days of therapy. This case highlights the importance of close surveillance of nosocomial infections and the need for prompt management strategies integrating medical and surgical approaches to reduce the high mortality associated with such infections.
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Affiliation(s)
- Sanae Azelmat
- Microbiology, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - Tarik Baadi
- Anesthesia and Intensive Care, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | | | - Abdelhamid Jaafari
- Anesthesia and Intensive Care, Mohammed V Military Training Hospital, Mohammed V University, Rabat, MAR
| | - Mariama Chadli
- Bacteriology, Mohammed V Military Training Hospital, Rabat, MAR
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Crepin DM, Chavignon M, Verhoeven PO, Laurent F, Josse J, Butin M. Staphylococcus capitis: insights into epidemiology, virulence, and antimicrobial resistance of a clinically relevant bacterial species. Clin Microbiol Rev 2024:e0011823. [PMID: 38899876 DOI: 10.1128/cmr.00118-23] [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: 06/21/2024] Open
Abstract
SUMMARYStaphylococcus capitis is divided into two subspecies, S. capitis subsp. ureolyticus (renamed urealyticus in 1992; ATCC 49326) and S. capitis subsp. capitis (ATCC 27840), and fits with the archetype of clinically relevant coagulase-negative staphylococci (CoNS). S. capitis is a commensal bacterium of the skin in humans, which must be considered an opportunistic pathogen of interest particularly as soon as it is identified in a clinically relevant specimen from an immunocompromised patient. Several studies have highlighted the potential determinants underlying S. capitis pathogenicity, resistance profiles, and virulence factors. In addition, mobile genetic element acquisitions and mutations contribute to S. capitis genome adaptation to its environment. Over the past decades, antibiotic resistance has been identified for S. capitis in almost all the families of the currently available antibiotics and is related to the emergence of multidrug-resistant clones of high clinical significance. The present review summarizes the current knowledge concerning the taxonomic position of S. capitis among staphylococci, the involvement of this species in human colonization and diseases, the virulence factors supporting its pathogenicity, and the phenotypic and genomic antimicrobial resistance profiles of this species.
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Affiliation(s)
- Deborah M Crepin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marie Chavignon
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Paul O Verhoeven
- CIRI, Centre International de Recherche en Infectiologie, GIMAP Team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Faculté de Médecine, Université Jean Monnet, St-Etienne, France
- Service des agents infectieux et d'hygiène, Centre Hospitalier Universitaire de St-Etienne, St-Etienne, France
| | - Frédéric Laurent
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Centre National de Référence des Staphylocoques, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Josse
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marine Butin
- CIRI, Centre International de Recherche en Infectiologie, Staphylococcal pathogenesis team, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Service de Néonatologie et Réanimation Néonatale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
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Yaghoobi MH, Heidari E, Shafiee A, Seighali N, Maghsoodi MR, Bakhtiyari M. Statin therapy improves outcomes in infective endocarditis: evidence from a meta-analysis. Egypt Heart J 2024; 76:70. [PMID: 38847975 PMCID: PMC11161449 DOI: 10.1186/s43044-024-00495-1] [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: 05/12/2023] [Accepted: 05/14/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Beyond its ability to decrease cholesterol, statin medication has been proved to have a variety of pleiotropic effects, such as anti-inflammatory and immunomodulatory effects. Statins are an appealing therapeutic option for individuals with infective endocarditis because of these effects, as the condition is linked to a strong inflammatory response. METHODS A comprehensive search was done in Medline/PubMed, Cochrane database (CENTRAL), and Google Scholar to identify relevant studies reporting outcomes of interest (rate of mortality, intensive care unit admission, and embolic events) comparing those who are on statin therapy to nonusers were included. We performed a random effect meta-analysis to pool each study's individual results. RESULTS Three articles were included in the study. The pooled results regarding our primary endpoint showed there was a significant reduction in mortality among statin users in all time points (1-year mortality: OR 0.69, 95% CI 0.61-0.79, I2: 0%; Chi2 = 0.01; p < 0.0001). Meta-analysis for the secondary outcome showed statin users are less frequently admitted to the intensive care unit (OR 0.73, 95% CI 0.59-0.90, I2: 0%; Chi2 = 0.00; p = 0.0004). The rate of mortality was significantly lower for those with a previous history of cerebrovascular disease who were on statin therapy compared to those without cerebrovascular diseases (CVD). CONCLUSIONS The results of the present study support a significant association with statin therapy as a potential treatment proposed for individuals at risk of infective endocarditis.
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Affiliation(s)
| | - Ehsan Heidari
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Shafiee
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
| | - Niloofar Seighali
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
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11
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations From ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. JACC Cardiovasc Imaging 2024; 17:669-701. [PMID: 38466252 DOI: 10.1016/j.jcmg.2024.01.004] [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] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multisocietal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multifocal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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12
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Lecomte R, Deschanvres C, Bourreau A, Ruffier d'Epenoux L, Le Turnier P, Gaborit B, Chauveau M, Michel M, Le Tourneau T, Bémer P, Corvec S, Boutoille D. Comparative effectiveness of empirical antibiotic treatments in methicillin-susceptible Staphylococcus aureus infective endocarditis: A post hoc analysis of a prospective French cohort study. Int J Infect Dis 2024; 142:106989. [PMID: 38428479 DOI: 10.1016/j.ijid.2024.106989] [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: 12/05/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES The empirical treatment of infective endocarditis is still debated. The aim of this study was to compare the impact of empirical treatment with antistaphylococcal penicillin (ASP) or cefazolin vs. other treatments in methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis. METHODS A post hoc analysis of a prospective cohort study of patients hospitalized in a French reference centre with MSSA endocarditis was conducted between 2013 and 2022. The primary outcome was the duration of bacteraemia under treatment. RESULTS Of the 208 patients included, 101 patients (48.6%) were classified in the reference group (ASP or cefazolin) and 107 (52.4%) in the non-reference group. Empirical treatment with ASP/cefazolin was associated with a shorter duration of bacteraemia compared to other treatments (3.6 d vs. 4.6 d, P = 0.01). This difference was not corrected by the addition of an aminoglycoside (3.6 d vs. 4.7 d, P < 0.01). In multivariate analysis, empirical treatment with ASP/cefazolin was associated with a duration of bacteraemia ≤72 h (P = 0.02), whereas endocarditis on native valves (P = 0.01), and intracardiac abscess were associated with longer duration of bacteraemia (P = 0.01). CONCLUSIONS Empirical treatment of endocarditis with ASP or Cefazolin is more effective than other treatments in MSSA endocarditis, even when the other treatments are combined with aminoglycosides.
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Affiliation(s)
- Raphaël Lecomte
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France.
| | - Colin Deschanvres
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Alexis Bourreau
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | | | - Paul Le Turnier
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Benjamin Gaborit
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Marie Chauveau
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
| | - Magali Michel
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - Thierry Le Tourneau
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | | | - Stéphane Corvec
- Department of Bacteriology, Nantes, France; Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - David Boutoille
- Department of Infectious Diseases, CHU Hôtel-Dieu, Nantes, France; Centre d'Investigation Clinique, Unité d'Investigation Clinique, Nantes, France
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13
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Heart Rhythm 2024; 21:e1-e29. [PMID: 38466251 DOI: 10.1016/j.hrthm.2024.01.043] [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] [Indexed: 03/12/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Wang W, Itagaki S, Egorova N. Minimally invasive procedures for right side infective endocarditis: A targeted literature review. Catheter Cardiovasc Interv 2024; 103:1050-1061. [PMID: 38363035 DOI: 10.1002/ccd.30967] [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: 11/09/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Right-side infective endocarditis (RSIE) is caused by microorganisms and develops into intracardiac and extracardiac complications with high in-hospital and 1-year mortality. Treatments involve antibiotic and surgical intervention. However, those presenting with extremes e.g. heart failure, or septic shock who are not ideal candidates for conventional medical therapy might benefit from minimally invasive procedures. OBJECTIVE This review summarizes existing observational studies that reported minimally invasive procedures to debulk vegetation due to infective endocarditis either on valve or cardiac implantable electronic devices. METHODS A targeted literature review was conducted to identify studies published in PubMed/MEDLINE, EMBASE, and Cochrane Central Database from January 1, 2015 to June 5, 2023. The efficacy and/or effectiveness of minimally invasive procedural interventions to debulk vegetation due to RSIE were summarized following PRISMA guidelines. RESULTS A total of 11 studies with 208 RSIE patients were included. There were 9 studies that assessed the effectiveness of the AngioVac system and 2 assessed the Penumbra system. Overall procedure success rate was 87.9%. Among 8 studies that reported index hospitalization, 4 studies reported no death, while the other 4 studies reported 10 deaths. CONCLUSIONS This study demonstrates that multiple systems can provide minimally invasive procedure options for patients with RSIE with high procedural success. However, there are mixed results regarding complications and mortality rates. Further large cohort studies or randomized clinical trials are warranted to assess and/or compare the efficacy and safety of these systems.
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Affiliation(s)
- Weijia Wang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Shinobu Itagaki
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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15
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Anton CI, Ștefan I, Dumitrache SM, Ștefan AT, Răduț D, Nistor CE, Ranetti AE, Adella-Sîrbu C, Ioniță-Radu F. Analysis of Aetiological Agents in Infectious Endocarditis in the Central Military Emergency University Hospital "Dr. Carol Davila" Bucharest. Microorganisms 2024; 12:910. [PMID: 38792742 PMCID: PMC11123831 DOI: 10.3390/microorganisms12050910] [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: 12/28/2023] [Revised: 02/26/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a pathological condition caused by various microbial agents that can lead to severe complications affecting the heart. Accurate diagnosis is crucial for the effective management of patients with IE. Blood culture is the gold standard for identifying the primary infectious agents, which is a key factor in diagnosing IE using the modified Duke criteria. OBJECTIVE The main objective of this study was to investigate the distribution of the etiological agents of IE and the most common secondary diagnoses associated with it. METHOD A total of 152 patients aged 23-95 years with a diagnosis of IE and proven etiology (through blood cultures or serological tests) were included in this study. RESULTS The most common etiological agent identified through blood tests was Enterococcus faecalis, which was detected in 39 patients (23.5%). Staphylococcus aureus was the second most common agent and was identified in 33 patients (19.9%), followed by Staphylococcus epidermidis, which was identified in 12 patients (13.1%). Nine patients (5.8%) had high levels of anti-Coxiella burnetti IgG phase I and II antibodies. CONCLUSIONS IE is a leading cause of death in the Department of Infectious Diseases. Early and accurate diagnosis, along with interdisciplinary treatment, can significantly increase the chances of patient survival. Currently, Enterococcus faecalis and Staphylococcus aureus are the dominant etiological agents of IE, highlighting the need to revise protocols for prophylaxis, diagnosis, and initial treatment of this condition.
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Affiliation(s)
- Corina-Ioana Anton
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania; (C.-I.A.); (D.R.)
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
| | - Ion Ștefan
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania; (C.-I.A.); (D.R.)
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Simona Mihaela Dumitrache
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania; (C.-I.A.); (D.R.)
| | - Alexia-Teodora Ștefan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
| | - Diana Răduț
- Department of Infectious Diseases, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania; (C.-I.A.); (D.R.)
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
| | - Claudiu-Eduard Nistor
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
- Thoracic Surgery Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Aurelian-Emil Ranetti
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
- Endocrinologic Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Carmen Adella-Sîrbu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
- Clinical Neurosciences Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Academy of Romanian Scientists, 50041 Bucharest, Romania
| | - Florentina Ioniță-Radu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.-T.Ș.); (C.-E.N.); (A.-E.R.)
- Department of Gastroenterology, ‘Dr. Carol Davila’ Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
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Goehringer F, Lalloué B, Selton-Suty C, Alla F, Botelho-Nevers E, Chirouze C, Curlier E, El Hatimi S, Gagneux-Brunon A, le Moing V, Lim P, Piroth L, Strady C, Tribouilloy C, Virion JM, Agrinier N, Duval X, Hoen B. Compared Performance of the 2023 Duke-International Society for Cardiovascular Infectious Diseases, 2000 Modified Duke, and 2015 European Society of Cardiology Criteria for the Diagnosis of Infective Endocarditis in a French Multicenter Prospective Cohort. Clin Infect Dis 2024; 78:937-948. [PMID: 38330171 DOI: 10.1093/cid/ciae035] [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: 06/02/2023] [Revised: 09/03/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The 2023 Duke-International Society for Cardiovascular Diseases (ISCVID) criteria for infective endocarditis (IE) were proposed as an updated diagnostic classification of IE. Using an open prospective multicenter cohort of patients treated for IE, we compared the performance of these new criteria to that of the 2000 Modified Duke and 2015 European Society of Cardiology (ESC) criteria. METHODS Cases of patients treated for IE between January 2017 and October 2022 were adjudicated as certain IE or not. Each case was also categorized as either definite or possible/rejected within each classification. Sensitivity, specificity, and accuracy were estimated with 95% confidence intervals. RESULTS Of the 1194 patients analyzed (mean age, 66.1 years; 71.2% males), 414 (34.7%) had a prosthetic valve and 284 (23.8%) had a cardiac implanted electronic device (CIED); 946 (79.2%) were adjudicated as certain IE; 978 (81.9%), 997 (83.5%), and 1057 (88.5%) were classified as definite IE in the 2000 modified Duke, 2015 ESC, and 2023 Duke-ISCVID criteria, respectively. The sensitivity of each set of criteria was 93.2% (95% confidence interval [CI], 91.6-94.8), 95.0% (95% CI, 93.7-96.4), and 97.6% (95% CI, 96.6-98.6), respectively (P < .001 for all 2-by-2 comparisons). Corresponding specificity rates were 61.3% (95% CI, 55.2-67.4), 60.5% (95% CI, 54.4-66.6), and 46.0% (95% CI, 39.8-52.2), respectively. In patients without CIED, sensitivity rates were 94.8% (95% CI, 93.2-96.4), 96.5% (95% CI, 95.1-97.8), and 97.7% (95% CI, 96.6-98.8); specificity rates were 59.0% (95% CI, 51.6-66.3), 56.6% (95% CI, 49.3-64.0), and 53.8% (95% CI, 46.3-61.2), respectively. CONCLUSIONS Overall, the 2023 Duke-ISCVID criteria had a significantly higher sensitivity but a significantly lower specificity compared with older criteria. This decreased specificity was mainly attributable to patients with CIED.
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Affiliation(s)
- Francois Goehringer
- Service de maladies infectieuses et tropicales, CHRU de Nancy, Nancy, France
| | - Benoit Lalloué
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | | | - François Alla
- INSERM, BPH, U1219, I-prev/PHARES, CIC 1401, Universite Bordeaux, Bordeaux, France
- Service de prévention, CHU de Bordeaux, Bordeaux, France
| | - Elisabeth Botelho-Nevers
- Service de maladies infectieuses, CHU de Saint-Etienne, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université de Lyon, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France
| | - Catherine Chirouze
- Chrono-environnement UMR6249, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
- Service de maladies infectieuses et tropicales, CHU Jean Minjoz, Besançon, France
| | - Elodie Curlier
- Service de maladies infectieuses, CHU de la Guadeloupe, Pointe-à-Pitre, France
| | | | - Amandine Gagneux-Brunon
- Service de maladies infectieuses, CHU de Saint-Etienne, Saint-Etienne, France
- CIRI-Centre International de Recherche en Infectiologie, Team GIMAP, Université Jean Monnet, Université de Lyon, Inserm, U1111, CNRS, UMR530, Saint-Etienne, France
| | - Vincent le Moing
- Service de Maladies Infectieuses et Tropicales, CHU de Montpellier, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Pascal Lim
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
| | - Lionel Piroth
- Service de maladies infectieuses, CHU de Dijon, Dijon, France
- CHU Dijon-Bourgogne, INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne, Dijon, France
| | | | | | - Jean-Marc Virion
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Nelly Agrinier
- CHRU de Nancy, INSERM, CIC, Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Xavier Duval
- Inserm CIC 1425, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat Claude-Bernard, Paris, France
- Inserm UMR-1137 IAME, Paris, France
- UFR de Médecine-Bichat, Université Paris Cité, Paris, France
| | - Bruno Hoen
- Ecole de santé publique-UR 4360 Apemac, Université de Lorraine, Nancy, France
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I 2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. J Nucl Cardiol 2024; 34:101786. [PMID: 38472038 DOI: 10.1016/j.nuclcard.2023.101786] [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: 03/14/2024]
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA.
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Leterrier J, Iung B, de Tymoski C, Deconinck L, Para M, Duval X, Provenchere S, Mesnier J, Delhomme C, Haviari S, Urena M, Suc G. Sex differences and outcomes in surgical infective endocarditis. Eur J Cardiothorac Surg 2024; 65:ezae114. [PMID: 38521543 DOI: 10.1093/ejcts/ezae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Cardiac surgery for infective endocarditis (IE) is associated with significant hospital mortality, and female sex may be associated with worse outcomes. However, the impact of sex on the presenting characteristics, management, and outcomes of patients operated on for acute infective endocarditis (IE) has not been adequately studied. OBJECTIVES The goal of our study was to analyse differences in management and outcome of IE between women and men who undergo surgery. METHODS Clinical data of 717 patients undergoing cardiac surgery for IE between December 2005 and December 2019 were prospectively collected. Sex-related postoperative outcomes including in-hospital mortality were recorded. Univariable and multivariable analyses were performed to identify potential sex-related determinant of in-hospital mortality. RESULTS In all, 532 male patients (74.2%) and 185 female patients (25.8%) underwent surgery for IE. At baseline, women had more frequent mitral regurgitation with 63 patients (34.1%) than men with 135 patients (25.4%) (P = 0.002). Female sex was associated with higher in-hospital mortality (23.2% versus 17.3%, P = 0.049). However, multivariable analysis revealed age (P < 0.01), antibiotics < 7 days before surgery (P = 0.01) and staphylococcal IE (P < 0.01) but not female sex (P = 0.99) as independent determinants of hospital mortality. CONCLUSIONS In this study of patients operated-on for IE, female sex was associated with more severe manifestations of IE and significantly higher in-hospital mortality. However, after multivariable analysis, initial presentation, but not sex, seemed to determine clinical outcomes.
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Affiliation(s)
| | - Bernard Iung
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Christian de Tymoski
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
| | - Laurene Deconinck
- Université Paris Cité, Paris, France
- Infectious Diseases Department, Bichat Hospital, APHP, Paris, France
| | - Marylou Para
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
- Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Université Paris Cité, Paris, France
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Inserm, UMR-1137, IAME, Paris, France
| | - Sophie Provenchere
- Inserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HP, Paris, France
- Anesthesia and Critical Care Department, DMU Parabol, Bichat Claude Bernard University Hospital, APHP, Paris, France
| | - Jules Mesnier
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | | | - Skerdi Haviari
- Université Paris Cité, Paris, France
- Epidemiology Biostatistics & Clinical Research Department, Bichat, APHP, Paris, France
- UPC-Inserm UMR1137 IAME, Paris, France
| | - Marina Urena
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
| | - Gaspard Suc
- Cardiology Bichat, AP-HP, Paris, France
- UMRS1148, INSERM, 75018, Paris, France
- Université Paris Cité, Paris, France
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19
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Bourque JM, Birgersdotter-Green U, Bravo PE, Budde RPJ, Chen W, Chu VH, Dilsizian V, Erba PA, Gallegos Kattan C, Habib G, Hyafil F, Khor YM, Manlucu J, Mason PK, Miller EJ, Moon MR, Parker MW, Pettersson G, Schaller RD, Slart RHJA, Strom JB, Wilkoff BL, Williams A, Woolley AE, Zwischenberger BA, Dorbala S. 18F-FDG PET/CT and radiolabeled leukocyte SPECT/CT imaging for the evaluation of cardiovascular infection in the multimodality context: ASNC Imaging Indications (ASNC I2) Series Expert Consensus Recommendations from ASNC, AATS, ACC, AHA, ASE, EANM, HRS, IDSA, SCCT, SNMMI, and STS. Clin Infect Dis 2024:ciae046. [PMID: 38466039 DOI: 10.1093/cid/ciae046] [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: 03/12/2024] Open
Abstract
This document on cardiovascular infection, including infective endocarditis, is the first in the American Society of Nuclear Cardiology Imaging Indications (ASNC I2) series to assess the role of radionuclide imaging in the multimodality context for the evaluation of complex systemic diseases with multi-societal involvement including pertinent disciplines. A rigorous modified Delphi approach was used to determine consensus clinical indications, diagnostic criteria, and an algorithmic approach to diagnosis of cardiovascular infection including infective endocarditis. Cardiovascular infection incidence is increasing and is associated with high morbidity and mortality. Current strategies based on clinical criteria and an initial echocardiographic imaging approach are effective but often insufficient in complicated cardiovascular infection. Radionuclide imaging with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/CT leukocyte scintigraphy can enhance the evaluation of suspected cardiovascular infection by increasing diagnostic accuracy, identifying extracardiac involvement, and assessing cardiac implanted device pockets, leads, and all portions of ventricular assist devices. This advanced imaging can aid in key medical and surgical considerations. Consensus diagnostic features include focal/multi-focal or diffuse heterogenous intense 18F-FDG uptake on valvular and prosthetic material, perivalvular areas, device pockets and leads, and ventricular assist device hardware persisting on non-attenuation corrected images. There are numerous clinical indications with a larger role in prosthetic valves, and cardiac devices particularly with possible infective endocarditis or in the setting of prior equivocal or non-diagnostic imaging. Illustrative cases incorporating these consensus recommendations provide additional clarification. Future research is necessary to refine application of these advanced imaging tools for surgical planning, to identify treatment response, and more.
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Affiliation(s)
- Jamieson M Bourque
- Cardiovascular Division and the Cardiovascular Imaging Center, Departments of Medicine and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Paco E Bravo
- Divisions of Nuclear Medicine, Cardiothoracic Imaging and Cardiovascular Medicine, Director, Nuclear Cardiology and Cardiovascular Molecular Imaging, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wengen Chen
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Vivian H Chu
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Vasken Dilsizian
- University of Maryland School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Baltimore, MD, USA
| | - Paola Anna Erba
- Department of Medicine and Surgery University of Milano Bicocca and Nuclear Medicine, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gilbert Habib
- Cardiology Department, Hôpital La Timone, Marseille, France
| | - Fabien Hyafil
- Nuclear Cardiology and Nuclear Medicine Department, DMU IMAGINA, Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore
| | - Jaimie Manlucu
- London Heart Rhythm Program, Western University, London Health Sciences Centre (University Hospital), London, Ontario, Canada
| | - Pamela Kay Mason
- Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, USA
| | - Edward J Miller
- Nuclear Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Matthew W Parker
- Echocardiography Laboratory, Division of Cardiovascular Medicine, University of Massachusetts T.H. Chan School of Medicine, Worcester, MA, USA
| | - Gosta Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Schaller
- Department of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Riemer H J A Slart
- Medical Imaging Centre, Department of Nucleare, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, the Netherlands
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Harvard Medical School, Boston, MA, USA
| | - Bruce L Wilkoff
- Cardiac Pacing & Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | | | - Ann E Woolley
- Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Jatteppanavar B, Choudhury A, Panda PK, Bairwa M. Community-acquired multidrug-resistant pneumonia, bacteraemia, and infective endocarditis: A case report. World J Crit Care Med 2024; 13:87459. [PMID: 38633471 PMCID: PMC11019630 DOI: 10.5492/wjccm.v13.i1.87459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The prevalence of multidrug-resistant (MDR) bacteria has increased globally, with extensive drug-resistant (XDR) bacteria posing a threat to patients. CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health. Despite negative results for tropical fever infections, he had neutrophilic leucocytosis, acute kidney injury, and chest imaging findings suggestive of bilateral consolidations. On day two, he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia, and community-acquired pneumonia. Despite treatment with broad-spectrum antibiotics, he did not respond and succumbed to death on day five. CONCLUSION This case highlights that clinicians/public should be aware of MDR community-acquired pneumonia, bacteraemia, and endocarditis which ultimately culminate in high rates of morbidity and mortality. Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities. Simultaneously, route cause analysis of community-acquired MDR/XDR pathogens is a global need.
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Affiliation(s)
| | - Arnab Choudhury
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Prasan Kumar Panda
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Mukesh Bairwa
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
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21
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Broncano J, Rajiah PS, Vargas D, Sánchez-Alegre ML, Ocazionez-Trujillo D, Bhalla S, Williamson E, Fernández-Camacho JC, Luna A. Multimodality Imaging of Infective Endocarditis. Radiographics 2024; 44:e230031. [PMID: 38329903 DOI: 10.1148/rg.230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Infective endocarditis (IE) is a complex multisystemic disease resulting from infection of the endocardium, the prosthetic valves, or an implantable cardiac electronic device. The clinical presentation of patients with IE varies, ranging from acute and rapidly progressive symptoms to a more chronic disease onset. Because of its severe morbidity and mortality rates, it is necessary for radiologists to maintain a high degree of suspicion in evaluation of patients for IE. Modified Duke criteria are used to classify cases as "definite IE," "possible IE," or "rejected IE." However, these criteria are limited in characterizing definite IE in clinical practice. The use of advanced imaging techniques such as cardiac CT and nuclear imaging has increased the accuracy of these criteria and has allowed possible IE to be reclassified as definite IE in up to 90% of cases. Cardiac CT may be the best choice when there is high clinical suspicion for IE that has not been confirmed with other imaging techniques, in cases of IE and perivalvular involvement, and for preoperative treatment planning or excluding concomitant coronary artery disease. Nuclear imaging may have a complementary role in prosthetic IE. The main imaging findings in IE are classified according to the site of involvement as valvular (eg, abnormal growths [ie, "vegetations"], leaflet perforations, or pseudoaneurysms), perivalvular (eg, pseudoaneurysms, abscesses, fistulas, or prosthetic dehiscence), or extracardiac embolic phenomena. The differential diagnosis of IE includes evaluation for thrombus, pannus, nonbacterial thrombotic endocarditis, Lambl excrescences, papillary fibroelastoma, and caseous necrosis of the mitral valve. The location of the lesion relative to the surface of the valve, the presence of a stalk, and calcification or enhancement at contrast-enhanced imaging may offer useful clues for their differentiation. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jordi Broncano
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Prabhakar Shanta Rajiah
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Vargas
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Maria Luisa Sánchez-Alegre
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Daniel Ocazionez-Trujillo
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Eric Williamson
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - José Carlos Fernández-Camacho
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
| | - Antonio Luna
- From the Department of Radiology, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Avenida el Brillante n° 36, 14012, Córdoba, Spain (J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (P.S.R., E.W.); Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.V.); Department of Radiology, Hospital Universitario Gregorio Marañón, Madrid, Spain (M.L.S.A.); Department of Radiology, McGovern Medical School, UT Health Houston, Houston, Tex (D.O.T.); Section of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (S.B.); Department of Cardiology, Hospital de la Cruz Roja-Grupo Corpal, Córdoba, Spain (J.C.F.C.); Department of Radiology, Section of MRI, Clínica las Nieves, Jaén, Spain (A.L.)
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22
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Graversen PL, Hadji-Turdeghal K, Møller JE, Bruun NE, Laghmoch H, Jensen AD, Petersen JK, Bundgaard H, Iversen K, Povlsen JA, Moser C, Smerup M, Jensen HS, Søgaard P, Helweg-Larsen J, Faurholt-Jepsen D, Østergaard L, Køber L, Fosbøl EL. NatIonal Danish endocarditis stUdieS - Design and objectives of the NIDUS registry. Am Heart J 2024; 268:80-93. [PMID: 38056547 DOI: 10.1016/j.ahj.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
AIMS The NatIonal Danish endocarditis stUdieS (NIDUS) registry aims to investigate the mechanisms contributing to the increasing incidence of infective endocarditis (IE) and to discover risk factors associated to the course, treatment and clinical outcomes of the disease. METHODS The NIDUS registry was created to investigate a nationwide unselected group of patients hospitalized for IE. The National Danish healthcare registries have been queried for validated IE diagnosis codes (International Classification of Disease, 10th edition [ICD-10]: DI33, DI38, and DI398). Subsequently, a team of 28 healthcare professionals, including experts in endocarditis, will systematically review and evaluate all identified patient records using the modified Duke Criteria and the 2015 European Society of Cardiology modified diagnostic criteria. The registry will contain all cases with definite or possible IE found in primary data sources in Denmark between January 1, 2016, and December 31, 2021. We will gather individual patient data, such as clinical, microbiological, and echocardiographic characteristics, treatment regimens, and clinical outcomes. A digital data collection form will be used to the gathering of data. A sample of approximately 4,300 individual patients will be evaluated using primary data sources. CONCLUSIONS AND PERSPECTIVES The NIDUS registry will be the first comprehensive nationwide IE registry, contributing critical knowledge about the course, treatment, and clinical outcomes of the disease. Additionally, it will significantly aid in identifying areas in which future research is needed.
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Affiliation(s)
- Peter L Graversen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Katra Hadji-Turdeghal
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Research Unit of Cardiology, Department of Cardiology, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Hicham Laghmoch
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Jeppe K Petersen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Jonas A Povlsen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Morten Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mikus E, Fiorentino M, Sangiorgi D, Fiaschini C, Tenti E, Tremoli E, Calvi S, Costantino A, Tripodi A, Zucchetta F, Savini C. Surgical Treatment of Active Endocarditis Pre- and Post-COVID-19 Pandemic Onset. Biomedicines 2024; 12:233. [PMID: 38275404 PMCID: PMC10813261 DOI: 10.3390/biomedicines12010233] [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: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite advanced diagnosis and treatment, infective endocarditis (IE) is a potentially life-threatening condition. The impact of COVID-19 on the diagnosis and outcome of the surgical treatment of IE is uncertain. The aim of this study was to analyze the incidence, characteristics, and outcomes of surgically treated IE before and after the COVID-19 pandemic. METHODS This study retrospectively analyzed the data of 535 patients who underwent valve surgical procedures for IE between January 2010 and December 2022 in a single cardiac surgery center. Patients were divided into two groups depending on the date of their operation: before (n = 393) and after (n = 142) COVID-19 onset. In order to balance the groups, inverse probability of treatment weighting (IPTW) calculated from the propensity score (PS) was applied. Weighted univariate logistic regressions were reported for outcomes; weights were derived from IPTW. Interrupted time series analysis (ITSA) according to Linden's method was used to evaluate the changes in the manifestation of IE after 11 March 2020. RESULTS Patients from the post-COVID-19 cohort (after 11 March 2020) had a greater number of comorbidities such as diabetes (29.6% vs. 16.3% p = 0.001), hypertension (71.1% vs. 59.5% p = 0.015), and preoperative kidney injury requiring dialysis (9.2% vs. 2.5% p = 0.002), but the median additive and logistic EuroSCORE were not statistically different. In the post-COVID-19 group, we observed a greater prevalence of Staphylococcus aureus-related endocarditis (24.5% vs. 15.4% p = 0.026), a consequent reduction in Staphylococcus non aureus-related endocarditis (12.2% vs. 20.1% p = 0.048), and a decrease in aortic valve replacements (43.0% vs. 53.9%), while the number of mitral valve replacements and repair was greater (21.1% vs. 15.0% and 6.3% vs. 4.3%, respectively). No differences were found in the two groups concerning early death, death, or relapse at 1 year after surgery. Data obtained by multivariable analysis identified preoperative renal dysfunction requiring dialysis as the only common risk factor for early mortality via stratifying by time periods in analysis. CONCLUSIONS The incidence of surgically treated IE significantly increases after the COVID-19 pandemic with a higher incidence of mitral valve involvement with respect to the aortic valve. Although a delay in surgical timing occurred during the COVID-19 pandemic, data in terms of mortality and outcomes were largely unaffected.
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Affiliation(s)
- Elisa Mikus
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Mariafrancesca Fiorentino
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Diego Sangiorgi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Costanza Fiaschini
- Cardiac Surgery Department, IRCCS Azienda Ospedaliera Universitaria di Bologna, 40138 Bologna, Italy;
| | - Elena Tenti
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Elena Tremoli
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Antonino Costantino
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Alberto Tripodi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Fabio Zucchetta
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
| | - Carlo Savini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48031 Cotignola, Italy; (M.F.); (D.S.); (E.T.); (E.T.); (S.C.); (A.C.); (A.T.); (F.Z.); (C.S.)
- Department of Experimental Diagnostic and Surgical Medicine (DIMEC), University of Bologna, 40126 Bologna, Italy
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24
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Glaser N, Sartipy U, Dismorr M. Prosthetic Valve Endocarditis After Aortic Valve Replacement With Bovine Versus Porcine Bioprostheses. J Am Heart Assoc 2024; 13:e031387. [PMID: 38156596 PMCID: PMC10863842 DOI: 10.1161/jaha.123.031387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/05/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Whether a bovine or porcine aortic valve bioprosthesis carries a higher risk of endocarditis after aortic valve replacement is unknown. The aim of this study was to compare the risk of prosthetic endocarditis in patients undergoing aortic valve replacement with a bovine versus porcine bioprosthesis. METHODS AND RESULTS This nationwide, population-based cohort study included all patients who underwent surgical aortic valve replacement with a bovine or porcine bioprosthesis in Sweden from 1997 to 2018. Regression standardization was used to account for intergroup differences. The primary outcome was prosthetic valve endocarditis, and the secondary outcomes were all-cause mortality and early prosthetic valve endocarditis. During a maximum follow-up time of 22 years, we included 21 022 patients, 16 603 with a bovine valve prosthesis and 4419 with a porcine valve prosthesis. The mean age was 73 years, and 61% of the patients were men. In total, 910 patients were hospitalized for infective endocarditis: 690 (4.2%) in the bovine group and 220 (5.0%) in the porcine group. The adjusted cumulative incidence of prosthetic valve endocarditis at 15 years was 9.5% (95% CI, 6.2%-14.4%) in the bovine group and 2.8% (95% CI, 1.4%-5.6%) in the porcine group. The absolute risk difference between the groups at 15 years was 6.7% (95% CI, 0.8%-12.5%). CONCLUSIONS The risk of endocarditis was higher in patients who received a bovine compared with a porcine valve prosthesis after surgical aortic valve replacement. This association should be considered in patients undergoing both surgical and transcatheter aortic valve replacement.
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Affiliation(s)
- Natalie Glaser
- Department of CardiologyStockholm South General HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
| | - Michael Dismorr
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
- Department of Cardiothoracic SurgeryKarolinska University HospitalStockholmSweden
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25
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Llah ST, Sharif S, Ullah S, Sheikh SA, Shah MA, Shafi OM, Dar T. Infective endocarditis surgery timing. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 58:16-22. [PMID: 37487789 DOI: 10.1016/j.carrev.2023.07.007] [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: 12/21/2022] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The optimum timing of surgical intervention in complicated left-sided infective endocarditis is not well established. Guidelines from various professional societies are not consistent regarding this. Data concerning this remains limited with conflicting results. METHODS The national inpatient database (NIS) was used to identify patients hospitalized from the year 2016 to 2020 for infective endocarditis and who underwent surgical intervention for complicated left-sided endocarditis. Primary and secondary outcomes were analyzed in patients who had surgical intervention within 7 days (early surgery group) and after 7 days (late surgery group) of the index hospitalization. RESULTS Primary outcome [composite of all-cause death, acute cerebrovascular accident (CVA), peripheral septic emboli, intracranial or intraspinal abscess, and cardiac arrest] was better in the early surgery group compared to the late surgery group 32.6 % vs 45.1 % [adjusted Odds ratio (aOR) = 0.59, 95 % Confidence interval (CI) = 0.52-0.67, P value ≪ 0.001]. This was mainly due to better incidence of acute CVA (15.7 %vs 24 %, aOR = 0.59, CI = 0.50-0.69, P value ≪ 0.001), peripheral septic emboli (18.5 % vs 27.3 %, aOR = 0.60, CI = 0.52-0.70, P value ≪ 0.001) and intracranial/intraspinal abscess (1.2 % vs 4.74 %, aOR = 0.24, CI = 0.14-0.38, P value ≪ 0.001). There is no difference in the incidence of all-cause in-hospital death (7.57 % vs 7.75 % aOR = 0.97, CI = 0.77-1.23, P value = 0.82) or cardiac arrest (3.4 % vs 3.54 %, aOR = 0.96, CI = 0.68-1.35, P value = 0.80). CONCLUSION Surgical intervention within 7 days of index hospitalization is associated with a better incidence of acute CVA, peripheral septic emboli, and intracranial or intraspinal abscess but not with a better incidence of all-cause in-hospital death.
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Affiliation(s)
- Sibghat Tul Llah
- CHI Saint Vincent Infirmary, 2 St Vincent Cir, Little Rock, AR 72205, USA.
| | - Sumaiya Sharif
- CHI Saint Vincent Hospital, 300 Werner St, Hot Springs, AR 71913, USA
| | - Sami Ullah
- International Medical College, Medical College Rd, Tongi 1711, Bangladesh
| | - Shoaib Altaf Sheikh
- ECU Health North Hospital, 250 Smith Church Rd, Roanoke Rapids, NC 27870, USA
| | - Mohamed Adil Shah
- Government Medical College, Karan Nagar, Srinagar, Jammu and Kashmir, India
| | - Obeid M Shafi
- University of Arkansas, 2801 S University Ave, Little Rock, AR 72204, USA
| | - Tawseef Dar
- University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
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26
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Koike M, Doi T, Morishita K, Uruno K, Kawasaki-Nabuchi M, Komuro K, Iwano H, Naraoka S, Nagahara D, Yuda S. Impact of Hemoglobin Level, White Blood Cell Count, Renal Dysfunction, and Staphylococcus as the Causative Organism on Prediction of In-Hospital Mortality from Infective Endocarditis. Int Heart J 2024; 65:199-210. [PMID: 38556331 DOI: 10.1536/ihj.23-360] [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] [Indexed: 04/02/2024]
Abstract
Infective endocarditis (IE) is a highly fatal disease in cases of delayed diagnosis and treatment, although its incidence is low. However, there have been few single-center studies in which the risk of in-hospital death from IE was stratified according to laboratory findings on admission and the organism responsible for IE. In this study, a total of 162 patients who were admitted to our hospital during the period from 2009 to 2021, who were suspected of having IE according to the modified Duke classification, and for whom IE was confirmed by transesophageal echocardiography were retrospectively analyzed. Patients were observed for a mean-period of 43.7 days with the primary endpoint being in-hospital death. The in-hospital death group had a lower level of hemoglobin (Hb), higher white blood cell (WBC) count, lower level of estimated glomerular filtration rate (eGFR), and higher frequency of Staphylococcus being the causative agent than those in the non-in-hospital death group. In overall multivariate analysis, Hb, WBC count, eGFR, and Staphylococcus as the causative agent were identified to be significant prognostic determinants. IE patients with Hb < 10.6 g/dL, WBC count > 1.4 × 104/μL, eGFR < 28.1 mL/minute/1.7 m2, and Staphylococcus as the causative agent had significantly and synergistically increased in-hospital death rates compared to those in other IE patients. Low level of Hb, high WBC count, low eGFR, and Staphylococcus as the causative agent of IE were independent predictors of in-hospital mortality, suggesting that these 4 parameters may be combined to additively stratify the risk of in-hospital mortality.
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Affiliation(s)
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kosuke Uruno
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kaoru Komuro
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital
| | | | - Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital
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27
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Gressens SB, Souhail B, Pilmis B, Lourtet-Hascoët J, Podglajen I, Fiore A, Fihman V, Mainardi JL, Lepeule R, Lebeaux D, Dubert M. Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration. Eur J Clin Microbiol Infect Dis 2024; 43:95-104. [PMID: 37964043 DOI: 10.1007/s10096-023-04705-7] [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: 08/28/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. OBJECTIVES To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. METHODS This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. RESULTS The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). CONCLUSIONS Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis.
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Affiliation(s)
- S B Gressens
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France.
| | - B Souhail
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
| | - B Pilmis
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - J Lourtet-Hascoët
- Service de Microbiologie, Unité Mobile d'Infectiologie, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - I Podglajen
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - A Fiore
- Service de Chirurgie Cardiaque, Hôpitaux Universitaires Henri Mondor, Assistance Publique - Hôpitaux de Paris, 94000, Créteil, France
| | - V Fihman
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité de Bactériologie - Hygiène, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - J L Mainardi
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - R Lepeule
- Département de Prévention, Diagnostic, et Traitement des Infections, Unité Transversale de traitement des Infections, Assistance Publique - Hôpitaux de Paris, Hôpital Henri-Mondor, Créteil, France
- EA 7380 Dynamyc, EnvA, Université-Paris-Est-Créteil, Créteil, France
| | - D Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
| | - M Dubert
- Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges-Pompidou, AP-HP Centre-Université Paris cité, 20 rue Leblanc, 75015, Paris, France
- Université Paris Cité, Paris, France
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Oliva A, Cogliati Dezza F, Cancelli F, Curtolo A, Falletta A, Volpicelli L, Venditti M. New Antimicrobials and New Therapy Strategies for Endocarditis: Weapons That Should Be Defended. J Clin Med 2023; 12:7693. [PMID: 38137762 PMCID: PMC10743892 DOI: 10.3390/jcm12247693] [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: 10/05/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
The overall low-quality evidence concerning the clinical benefits of different antibiotic regimens for the treatment of infective endocarditis (IE), which has made it difficult to strongly support or reject any regimen of antibiotic therapy, has led to a discrepancy between the available guidelines and clinical practice. In this complex scenario, very recently published guidelines have attempted to fill this gap. Indeed, in recent years several antimicrobials have entered the market, including ceftobiprole, ceftaroline, and the long-acting lipoglycopeptides dalbavancin and oritavancin. Despite being approved for different indications, real-world data on their use for the treatment of IE, alone or in combination, has accumulated over time. Furthermore, an old antibiotic, fosfomycin, has gained renewed interest for the treatment of complicated infections such as IE. In this narrative review, we focused on new antimicrobials and therapeutic strategies that we believe may provide important contributions to the advancement of Gram-positive IE treatment, providing a summary of the current in vitro, in vivo, and clinical evidence supporting their use in clinical practice.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (F.C.D.); (F.C.); (A.C.); (A.F.); (L.V.); (M.V.)
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29
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Figulla HR. Editorial: Infective endocarditis: A forgotten disease without progress? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:16-17. [PMID: 37652846 DOI: 10.1016/j.carrev.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Hans R Figulla
- Friedrich-Schiller University, Jena, 07743 Jena, Germany.
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30
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Hémar V, Camou F, Roubaud-Baudron C, Ternacle J, Pernot M, Greib C, Dijos M, Wirth G, Chaussade H, Peuchant O, Bonnet F, Issa N. The Mortality of Infective endocarditis with and without Surgery in Elderly (MoISE) Study. Clin Infect Dis 2023; 77:1440-1448. [PMID: 37369092 DOI: 10.1093/cid/ciad384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear. METHODS We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. RESULTS We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality. CONCLUSIONS Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.
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Affiliation(s)
- Victor Hémar
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Fabrice Camou
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Claire Roubaud-Baudron
- Pôle de Gérontologie Clinique, Bordeaux University Hospital Bordeaux, France
- INSERM BRIC UMR 1312, University of Bordeaux, Bordeaux, France
| | - Julien Ternacle
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Mathieu Pernot
- Cardiac Surgery Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Carine Greib
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Marina Dijos
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Gaetane Wirth
- Infectious Diseases Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Hélène Chaussade
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Olivia Peuchant
- Bacteriology Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Fabrice Bonnet
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Nahéma Issa
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
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Dini G, Verrotti A, Girella E, De Angelis F, Sardone M, Gorello P, Arcioni F. Infective endocarditis caused by Gemella haemolysans in a patient with bicuspid aortic valve: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231211707. [PMID: 37954543 PMCID: PMC10638876 DOI: 10.1177/2050313x231211707] [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: 06/24/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
Gemella haemolysans is a gram-positive coccus, and commensal of the upper respiratory tract and oral mucosa. In rare cases, it has been identified as an opportunistic pathogen in the development of endocarditis. Here, we describe a case of Gemella haemolysans endocarditis in a patient with bicuspid aortic valve. A 14-year-old male presented to our hospital with a 1-month history of intermittent fever. Gemella haemolysans was isolated from the patient's blood cultures. Transesophageal echocardiography revealed severe aortic stenosis and a pseudoaneurysm of the mitral-aortic intervalvular fibrosa. The patient underwent aortic valve replacement with pseudoaneurysm of the mitral-aortic intervalvular fibrosa repair and remained symptom-free during follow-up. This case highlights the importance of considering atypical pathogens as causative agents of infective endocarditis.
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Affiliation(s)
- Gianluca Dini
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | | | - Elisabetta Girella
- Department of Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy
| | - Francesca De Angelis
- Department of Cardiology, “Santa Maria della Misericordia” Hospital, Perugia, Italy
| | - Mariagrazia Sardone
- Department of Cardiology, “Santa Maria della Misericordia” Hospital, Perugia, Italy
| | - Paolo Gorello
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Francesco Arcioni
- Pediatric Hematology-Oncology Unit, “Santa Maria della Misericordia” Hospital, Perugia, Italy
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Whitehead T, Moore A, Agarwal A, Appleby J. Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use. BMJ Case Rep 2023; 16:e250098. [PMID: 37914175 PMCID: PMC10626919 DOI: 10.1136/bcr-2022-250098] [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: 11/03/2023] Open
Abstract
We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, and Enterococcus faecalis on blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.
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Affiliation(s)
| | - Amber Moore
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Hetta HF, Rashed ZI, Ramadan YN, Al-Kadmy IMS, Kassem SM, Ata HS, Nageeb WM. Phage Therapy, a Salvage Treatment for Multidrug-Resistant Bacteria Causing Infective Endocarditis. Biomedicines 2023; 11:2860. [PMID: 37893232 PMCID: PMC10604041 DOI: 10.3390/biomedicines11102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Infective endocarditis (IE) is defined as an infection of the endocardium, or inner surface of the heart, most frequently affecting the heart valves or implanted cardiac devices. Despite its rarity, it has a high rate of morbidity and mortality. IE generally occurs when bacteria, fungi, or other germs from another part of the body, such as the mouth, spread through the bloodstream and attach to damaged areas in the heart. The epidemiology of IE has changed as a consequence of aging and the usage of implantable cardiac devices and heart valves. The right therapeutic routes must be assessed to lower complication and fatality rates, so this requires early clinical suspicion and a fast diagnosis. It is urgently necessary to create new and efficient medicines to combat multidrug-resistant bacterial (MDR) infections because of the increasing threat of antibiotic resistance on a worldwide scale. MDR bacteria that cause IE can be treated using phages rather than antibiotics to combat MDR bacterial strains. This review will illustrate how phage therapy began and how it is considered a powerful potential candidate for the treatment of MDR bacteria that cause IE. Furthermore, it gives a brief about all reported clinical trials that demonstrated the promising effect of phage therapy in combating resistant bacterial strains that cause IE and how it will become a hope in future medicine.
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Affiliation(s)
- Helal F. Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt;
| | - Zainab I. Rashed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt; (Z.I.R.); (Y.N.R.)
| | - Yasmin N. Ramadan
- Department of Microbiology and Immunology, Faculty of Pharmacy, Assiut University, Assiut 71515, Egypt; (Z.I.R.); (Y.N.R.)
| | - Israa M. S. Al-Kadmy
- Branch of Biotechnology, Department of Biology, College of Science, Mustansiriyah University, Baghdad P.O. Box 10244, Iraq
| | - Soheir M. Kassem
- Department of Internal Medicine and Critical Care, Faculty of Medicine, Assuit University, Assiut 71515, Egypt;
| | - Hesham S. Ata
- Department of Pathology, College of Medicine, Qassim University, Buraydah 51452, Qassim, Saudi Arabia;
| | - Wedad M. Nageeb
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt;
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 226] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Ruythooren F, Ghijselings S, Cools J, Depypere M, De Munter P, Metsemakers WJ, Vles G. Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? J Bone Jt Infect 2023; 8:209-218. [PMID: 38039332 PMCID: PMC10655073 DOI: 10.5194/jbji-8-209-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/21/2023] [Indexed: 12/03/2023] Open
Abstract
Background: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joint resection or replacement. Prognostic factors have been proposed to guide decision-making. We hypothesized that most of these factors can be simplified to three subgroups based on the route of infection: contiguous spreading, direct inoculation or hematogenous seeding. Methods: A total of 41 patients have been treated surgically for SA of the native hip at our tertiary hospital during the last 16 years. Medical records were studied, and various patient and disease characteristics were collated. Results: Significant differences between (1) level of fitness, (2) condition of the hip joint, (3) micro-organisms and (4) chance of femoral head preservation were found for patients with SA of the native hip resulting from the three aforementioned subgroups. Femoral head resection was necessary at one point in 85 % of patients. Patients with hematogenous infections of undamaged hips had a reasonable chance (53 %) of avoiding joint resection or replacement. Hip arthroplasty was performed on 46.3 % of patients, with an infection rate of 10.5 %. Conclusion: Patients with SA of the native hip resulting from contiguous spreading, hematogenous seeding or direct inoculation differ significantly and should be considered distinct clinical entities. Route of infection is directly related to the chance of femoral head preservation and should, therefore, guide decision-making. Only patients with hematogenous infection to a previously healthy hip had the possibility of femoral head preservation.
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Affiliation(s)
- Fred Ruythooren
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Jordi Cools
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Traumatology, University Hospitals Leuven - Gasthuisberg, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - George Vles
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
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Nedel W, Boniatti MM, Lisboa T. Endocarditis in critically ill patients: a review. Curr Opin Crit Care 2023; 29:430-437. [PMID: 37646776 DOI: 10.1097/mcc.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW To summarize the advances in literature that support the best current practices regarding infective endocarditis (IE) in critically ill patients. RECENT FINDINGS IE due to rheumatic diseases has decreased significantly, and in fact, the majority of cases are associated with degenerative valvopathies, prosthetic valves, and cardiovascular implantable electronic devices. The Duke criteria were recently updated, addressing the increasing incidence of new risk factors for IE, such as IE associated with the use of endovascular cardiac implantable electronic devices and transcatheter implant valves. The presence of organ dysfunction, renal replacement therapies, or extracorporeal membrane oxygenation should be considered in the choice of drug and dosage in critically ill patients with suspected or confirmed IE. As highlighted for other severe infections, monitoring of therapeutic antibiotic levels is a promising technique to improve outcomes in critically ill patients with organ dysfunction. SUMMARY The diagnostic investigation of IE must consider the current epidemiological criteria and the diagnostic particularities that these circumstances require. A careful evaluation of these issues is necessary for the prompt clinical or surgical management of this infection.
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Affiliation(s)
- Wagner Nedel
- Hospital de Clinicas de Porto Alegre
- Hospital Nossa Senhora Conceição
| | - Marcio Manozzo Boniatti
- Hospital de Clinicas de Porto Alegre
- Programa de Pos-Graduação Cardiologia, UFRGS
- Universidade LaSalle, Canoas
| | - Thiago Lisboa
- Hospital de Clinicas de Porto Alegre
- Universidade LaSalle, Canoas
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
- Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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37
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Wang Q, Qiu J, Huang JL, Jiang M, Lu JQ, Wu D, Wei XB, Yu DQ. Prognostic Value of Blood Urea Nitrogen for Short-Term Mortality in Patients with Infective Endocarditis. Infect Dis Ther 2023; 12:2353-2366. [PMID: 37751020 PMCID: PMC10600074 DOI: 10.1007/s40121-023-00867-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Blood urea nitrogen (BUN) is a metabolic product validated to be an independent risk factor in the prognosis of several diseases. However, the prognostic value of BUN in patients with infective endocarditis (IE) remains unevaluated. METHODS A total of 1371 patients with a diagnosis of IE were included and divided into four groups according to BUN (mmol/L) at admission: < 3.5 (n = 343), 3.5-4.8 (n = 343), 4.8-6.8 (n = 341), and ≥ 6.8 (n = 344). Restricted cubic spline was used to assess the association of BUN with in-hospital mortality. Multivariate analysis was performed to identify the independent risk factors for adverse outcomes. RESULTS The in-hospital mortality reached 7.4%, while the 6-month mortality was 9.8%. The restricted cubic spline plot exhibited an approximately linear relationship between BUN and in-hospital mortality. Receiver operating characteristics curve analysis showed that the optimal cut-off of BUN for predicting in-hospital death was 6.8 mmol/L. Kaplan-Meier analysis showed that patients with BUN > 6.8 mmol/L had a higher 6-month mortality than other groups (log rank = 97.9, P < 0.001). Multivariate analysis indicated that BUN > 6.8 mmol/L was an independent predictor indicator for both in-hospital [adjusted odds ratio (aOR) = 2.365, 95% confidence interval (CI) 1.292-4.328, P = 0.005] and 6-month mortality [adjusted hazard ratio (aHR) = 2.171, 95% CI 1.355-3.479, P = 0.001]. CONCLUSIONS BUN is suitable for independently predicting short-term mortality in patients with IE.
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Affiliation(s)
- Qi Wang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jia Qiu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jie-Leng Huang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Mei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Jun-Quan Lu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Di Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Xue-Biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
| | - Dan-Qing Yu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China.
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Opriș DR, Vacariu V, Ion AP, Szigyarto T, Arbănași EM, Russu E, Opriș MM. Rare Case of Raoultella planticola Infective Endocarditis after Mitral Valve Replacement Surgery. Diseases 2023; 11:133. [PMID: 37873777 PMCID: PMC10594412 DOI: 10.3390/diseases11040133] [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: 08/13/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023] Open
Abstract
Infective endocarditis remains a condition associated with high morbidity and mortality, regardless of advances in diagnosis and therapeutics. The etiology, microbiology, and epidemiology of infective endocarditis have changed in the last years, with healthcare-associated infective endocarditis being responsible for a myriad of cases. Raoultella planticola is rarely the cause of infective endocarditis. We present a 72-year-old Caucasian female with a history of mitral valve replacement for rheumatic valve disease two months before the current presentation, without any immunosuppressive pathologies, diagnosed with Raoultella planticola infective endocarditis. Long-drawn antibiotic treatment led to a full recovery with no evidence of recurrence or relapse. This report highlights the importance of a multimodal approach for the diagnosis of bacterial etiology, the importance of selection and duration of an appropriate antibiotic regimen, and the presence of a rare opportunistic bacteria that has proven pathogenicity in a wide range of organ systems, usually in patients with several risk factors.
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Affiliation(s)
- Diana Roxana Opriș
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540136 Targu Mures, Romania
| | - Victor Vacariu
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540136 Targu Mures, Romania
| | - Alexandru Petru Ion
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Timea Szigyarto
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540136 Targu Mures, Romania
| | - Emil Marian Arbănași
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (E.M.A.)
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania; (E.M.A.)
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Maria Mihaela Opriș
- Emergency Institute of Cardiovascular Diseases and Transplantation (IUBCVT), 540136 Targu Mures, Romania
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Comeaux S, Jamison K, Voeltz M. Contemporary Features and Management of Endocarditis. Diagnostics (Basel) 2023; 13:3086. [PMID: 37835829 PMCID: PMC10572623 DOI: 10.3390/diagnostics13193086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
Infective endocarditis is a rare but devastating disease. Morbidity and mortality rates have failed to improve despite new technological advances. The disease has evolved over time with new significant populations at risk-most notably those with prosthetic valves or implantable cardiovascular devices. These devices pose new challenges for achieving a timely and accurate diagnosis of infection. While the modified Duke criteria is accepted as the gold standard for diagnosing native valve endocarditis, it has been shown to have significantly inferior sensitivity when it comes to identifying infections related to right-heart endocarditis, prosthetic valves, and indwelling cardiac devices. Additionally, prosthetic valves and cardiovascular implantable electronic devices can exhibit shadowing and artifact, rendering transthoracic echocardiography and transesophageal echocardiography results inconclusive or even normal. Having a keen awareness of the varying clinical presentations, as well as emerging valvular imaging modalities such as F-fluorodeoxyglucose cardiac positron-emission tomography plus computed tomography, promises to improve the evaluation and diagnosis of infective endocarditis. However, indications for appropriate use of these studies and guidance on modern clinical management are still needed.
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Affiliation(s)
- Shelby Comeaux
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Kiara Jamison
- Department of Graduate Medical Education Internal Medicine, Northside Hospital, Lawrenceville, GA 30046, USA;
| | - Michele Voeltz
- Department of Cardiology, Northside Cardiovascular Institute, Lawrenceville, GA 30046, USA
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40
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Graversen PL, Østergaard L, Voldstedlund M, Wandall-Holm MF, Smerup MH, Køber L, Fosbøl EL. Microbiological Etiology in Patients with IE Undergoing Surgery and for Patients with Medical Treatment Only: A Nationwide Study from 2010 to 2020. Microorganisms 2023; 11:2403. [PMID: 37894060 PMCID: PMC10608926 DOI: 10.3390/microorganisms11102403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/29/2023] Open
Abstract
Microbiological etiology has been associated with surgery for infective endocarditis (IE) during admission, especially Staphylococcus aureus. We aimed to compare patient characteristics, microbiological characteristics, and outcomes by treatment choice (surgery or not). We identified patients with first-time IE between 2010 and 2020 and examined the microbiological etiology of IE according to treatment choice. To identify factors associated with surgery during initial admission, we used the Aalen-Johansen estimator and an adjusted cause-specific Cox model. One-year mortality stratified by microbiological etiology and treatment choice was assessed using unadjusted Kaplan-Meier estimates and an adjusted Cox proportional hazard model. A total of 6255 patients were included, of which 1276 (20.4%) underwent surgery during admission. Patients who underwent surgery were younger (65 vs. 74 years) and less frequently had cerebrovascular disease, cardiovascular disease, diabetes, and chronic kidney disease. Patients with Staphylococcus aureus IE were less likely to undergo surgery during admission (13.6%) compared to all other microbiological etiologies. One-year mortality according to microbiological etiology in patients who underwent surgery was 7.0%, 5.3%, 5.5%, 9.6%, 13.2, and 11.2% compared with 24.2%, 19.1%, 27,6%, 25.2%, 21%, and 16.9% in patients who received medical therapy for Staphylococcus aureus, Streptococcus spp., Enterococcus spp., coagulase-negative Staphylococci, "other microbiological etiologies", and blood culture-negative infective endocarditis, respectively. Patients with IE who underwent surgery differed in terms of microbiology, more often having Streptococci than those who received medical therapy. Contrary to expectations, Staphylococcus aureus was more common among patients who received medical therapy only.
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Affiliation(s)
- Peter Laursen Graversen
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
| | - Marianne Voldstedlund
- Department of Data Integration and Analysis, Statens Serum Institut, 2300 Copenhagen, Denmark;
| | - Malthe Faurschou Wandall-Holm
- Danish Multiple Sclerosis Registry, Department of Neurology, University of Copenhagen—Rigshospitalet, 2600 Glostrup, Denmark;
| | - Morten Holdgaard Smerup
- Department of Cardiothoracic Surgery, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark; (L.Ø.); (L.K.); (E.L.F.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Ramos-Martínez A, González-Merino P, Suanzes-Martín E, la Fuente MMD, Escudero-López G, Andrés-Eisenhofer A, Expósito-Palomo E, Gutierrez-Villanueva A, Diego-Yagüe I, Múñez E, Fernandez-Cruz A, Calderón-Parra J. Risk of endocarditis among patients with coagulase-negative Staphylococcus bacteremia. Sci Rep 2023; 13:15613. [PMID: 37730691 PMCID: PMC10511700 DOI: 10.1038/s41598-023-41888-7] [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: 03/01/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023] Open
Abstract
Coagulase-negative staphylococci (CoNS) are currently considered typical microorganisms causing infective endocarditis (IE) in patients with prosthetic valves. The objective was to determine variables associated with IE in patients with CoNS bacteremia. We performed an analysis of the clinical characteristics of patients with CoNS bacteremia admitted to a university hospital in Madrid (Spain) from 2021 to December 2022 according to the occurrence of IE. This study is an evaluation of a bacteremia registry. During the study period, 106 patients with CoNS bacteremia were detected. In 85 patients an echocardiogram was performed during hospital admission to rule out IE. Among them, 12 episodes were detected that met IE criteria (14.2%). Of the 6 patients with heart valve prostheses, 5 patients (83.3%) had IE (p < 0.001). Patients with IE more frequently had positive blood cultures more than 12 h after the first draw (58.3% versus 13.4%; p < 0.001). There was a tendency to associate community-acquired bacteremia and to that all blood culture bottles obtained were positive with an increased risk of IE (p = 0.091 and p = 0,057, respectively). Attributable mortality to infection was higher in patients with IE relative to all other patients (16.7% vs. 0%; p = 0.033). The multivariable analysis included having valve prosthesis and persistent bacteremia for more than 12 h. Both were independently associated with IE: valve prosthesis OR 38.6 (95% CI 5.8-258; p < 0.001) and persistent bacteremia OR 2.6 (95% CI 1.1-6.8; p = 0.046). In conclusion, a high percentage of cases of CoNS bacteremia may be due to IE. Some of the variables related to a higher risk of IE, such as having a valvular prosthesis or presenting positive blood cultures for more than 12 h, should lead to rule out or confirm the presence of IE by performing echocardiography.
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Affiliation(s)
- Antonio Ramos-Martínez
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain.
| | | | - Elena Suanzes-Martín
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Gabriela Escudero-López
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ane Andrés-Eisenhofer
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Esther Expósito-Palomo
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Itziar Diego-Yagüe
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Elena Múñez
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Ana Fernandez-Cruz
- Internal Medicine Department, Infectious Diseases Unit, Autonomous University of Madrid, Instituto Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHSA), Hospital Universitario Puerta de Hierro, C/ Maestro Rodrigo 2, 28222, Majadahonda, Spain
| | - Jorge Calderón-Parra
- Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Halavaara M, Huotari K, Anttila VJ, Järvinen A. Healthcare-associated infective endocarditis: source of infection and burden of previous healthcare exposure. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e152. [PMID: 37771746 PMCID: PMC10523553 DOI: 10.1017/ash.2023.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 09/30/2023]
Abstract
Objective Prevention of healthcare-associated infective endocarditis (HAIE) is based on characterization of underlying factors. Our object was to describe the source of infection, microbiological etiology, and healthcare-related risk factors for HAIE. Design Retrospective population-based study. Patients Adult patients diagnosed with HAIE during 2013-2017 who resided in the study area in Southern Finland with adult population of 0.9 million. Results Ninety-five HAIE episodes were included. Ten episodes were related to cardiac surgery. Of the remaining 85 episodes, 11 were classified as nosocomial (ie, acquired and diagnosed during ongoing hospitalization) and 74 as non-nosocomial HAIE. Staphylococcus aureus caused 45% of nosocomial episodes, but only 16% of non-nosocomial episodes (P = 0.039). Most common sources of infection in non-nosocomial HAIE were previous hospitalization (24%), dialysis (18%), and urologic procedures (15%). Enterococcus spp. caused 23% of non-nosocomial HAIE, and more than half of them were associated with urologic or gastrointestinal procedures. Two-thirds of the non-nosocomial HAIE patients had recent hospitalization or invasive procedure. We counted previous healthcare-related risk factors for IE and those who had two or more of them had higher in-hospital and one-year mortality. Conclusion Our study indicates the importance of non-nosocomial acquisition of HAIE and S. aureus as the major pathogen in nosocomial episodes. Enterococcal infections dominate in non-nosocomial cases and further studies are needed to identify patients at risk for enterococcal IE after urological or gastrointestinal procedure.
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Affiliation(s)
- Mika Halavaara
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Huotari
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Veli-Jukka Anttila
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Asko Järvinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Hermanns H, Alberts T, Preckel B, Strypet M, Eberl S. Perioperative Complications in Infective Endocarditis. J Clin Med 2023; 12:5762. [PMID: 37685829 PMCID: PMC10488631 DOI: 10.3390/jcm12175762] [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: 08/04/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
Infective endocarditis is a challenging condition to manage, requiring collaboration among various medical professionals. Interdisciplinary teamwork within endocarditis teams is essential. About half of the patients diagnosed with the disease will ultimately have to undergo cardiac surgery. As a result, it is vital for all healthcare providers involved in the perioperative period to have a comprehensive understanding of the unique features of infective endocarditis, including clinical presentation, echocardiographic signs, coagulopathy, bleeding control, and treatment of possible organ dysfunction. This narrative review provides a summary of the current knowledge on the incidence of complications and their management in the perioperative period in patients with infective endocarditis.
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Affiliation(s)
| | - Tim Alberts
- Department of Anesthesiology, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (H.H.); (B.P.); (M.S.); (S.E.)
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44
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Lockhart PB, Chu V, Zhao J, Gohs F, Thornhill MH, Pihlstrom B, Mougeot FB, Rose GA, Sun YP, Napenas J, Munz S, Farrehi PM, Sollecito T, Sankar V, O'Gara PT. Oral hygiene and infective endocarditis: a case control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:333-342. [PMID: 37085335 DOI: 10.1016/j.oooo.2023.02.020] [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] [Received: 12/22/2022] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine if oral hygiene is associated with infective endocarditis (IE) among those at moderate risk for IE. STUDY DESIGN This is a case control study of oral hygiene among hospitalized patients with IE (cases) and outpatients with heart valve disease but without IE (controls). The primary outcome was the mean dental calculus index. Secondary outcomes included other measures of oral hygiene and periodontal disease (e.g., dental plaque, gingivitis) and categorization of blood culture bacterial species in case participants. RESULTS The 62 case participants had 53% greater mean dental calculus index than the 119 control participants (0.84, 0.55, respectively; difference = 0.29, 95% CI: 0.11, 0.48; P = .002) and 26% greater mean dental plaque index (0.88, 0.70, respectively; difference = 0.18, 95% CI: 0.01.0.36; P = .043). Overall, cases reported fewer dentist and dental hygiene visits (P = .013) and fewer dental visits in the 12 weeks before enrollment than controls (P = .007). Common oral bacteria were identified from blood cultures in 27 of 62 cases (44%). CONCLUSIONS These data provide evidence to support and strengthen current American Heart Association guidance that those at risk for IE can reduce potential sources of IE-related bacteremia by maintaining optimal oral health through regular professional dental care and oral hygiene procedures.
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Affiliation(s)
- Peter B Lockhart
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA.
| | - Vivian Chu
- Department of Medicine, Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Jing Zhao
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Frank Gohs
- Atrium Health Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Martin H Thornhill
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA; Department of Oral and Maxillofacial Medicine, Oral Surgery and Oral Pathology, University of Sheffield, School of Clinical Dentistry, Sheffield, UK
| | - Bruce Pihlstrom
- Department of Developmental and Surgical Sciences, University of Minnesota, School of Dentistry, Minneapolis, MN, USA
| | - Farah Bahrani Mougeot
- Department of Oral Medicine, Atrium Health's Carolinas Medical Center, Microbiome Research Laboratory, Charlotte, NC, USA
| | | | - Yee-Ping Sun
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel Napenas
- Department of Oral Medicine/Oral & Maxillofacial Surgery, Atrium Health's Carolinas Medical Center, Charlotte, NC, USA
| | - Stephanie Munz
- Department of Oral & Maxillofacial Surgery/Hospital Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Peter M Farrehi
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vidya Sankar
- Division of Oral Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic Sciences, Tufts University School of Dentistry, Boston, MA, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Boston, MA, USA
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45
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Calzado S, Hernández-Meneses M, Llopis J, Boix-Palop L, Dietl B, Calbo E, Andrés M, García X, Agustí C, Dorca E, Tricas JM, Díez de Los Ríos J, Cuquet J, Cárdenas A, Roca JM, Ortiz M, Caresia AP, Guillamon L, Quintana E, Ambrosioni J, Gasch O, Miró JM. The hidden side of infective endocarditis: Diagnostic and management of 500 consecutive cases in noncardiac surgery centers (2009-2018). Surgery 2023; 174:602-610. [PMID: 37321885 DOI: 10.1016/j.surg.2023.04.061] [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: 09/14/2022] [Revised: 03/06/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND We aimed to describe infective endocarditis cases from noncardiac surgery centers, as current knowledge on infective endocarditis is derived mostly from cardiac surgery hospitals. METHODS An observational retrospective study (2009-2018) was conducted in 9 noncardiac surgery hospitals in Central Catalonia. All adult patients diagnosed with definitive infective endocarditis were included. Transferred and nontransferred cohorts were compared, and a logistic regression model was used to ascertain the prognostic factors. RESULTS Overall, 502 infective endocarditis episodes were included: 183 (36.5%) were transferred to the cardiac surgery center, whereas 319 were not, with (18.7%) and without (45%) surgical indications. Cardiac surgery was performed in 83% of transferred patients. In-hospital (14% vs 23%) and 1-year (20% vs 35%) mortality rates were significantly lower in transferred patients (P < .001). Among the patients not undergoing cardiac surgery despite an indication, 55 (54%) died within 1 year. The multivariate analysis identified the following independent predictive factors for in-hospital mortality: Staphylococcus aureus infective endocarditis (odds ratio: 1.93 [1.08, 3.47]), heart failure (odds ratio: 3.87 [2.28, 6.57]), central nervous system embolism (odds ratio: 2.95 [1.41, 5.14]), and Charlson score (odds ratio: 1.19 [1.09, 1.30]), whereas community acquisition (odds ratio: 0.52 [0.29, 0.93]), cardiac surgery (odds ratio: 0.42 [0.20, 0.87]), but not transfer (odds ratio: 1.23 [0.84, 3.95]) were identified as protective factors. One-year mortality was associated with S. aureus infective endocarditis (odds ratio: 1.82 [1.04, 3.18]), heart failure (odds ratio: 3.74 [2.27, 6.16]), and Charlson score (odds ratio: 1.23 [1.13, 1.33]), whereas cardiac surgery (odds ratio: 0.41 [0.21, 0.79]) was identified as a protective factor. CONCLUSION Patients not transferred to a referral cardiac surgery center have a worse prognosis compared to those ultimately transferred, as cardiac surgery is associated with lower mortality rates.
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Affiliation(s)
- Sonia Calzado
- Department of Infectious Diseases, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Jaume Llopis
- Department of Genetics, Microbiology, and Statistics, Faculty of Biology, University of Barcelona, Spain
| | - Lucía Boix-Palop
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Beatriz Dietl
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Esther Calbo
- Department of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Andrés
- Department of Internal Medicine, Hospital Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Xelo García
- Department of Internal Medicine, Hospital Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Carme Agustí
- Department of Internal Medicine, Hospital de Sant Celoni, Barcelona, Spain
| | - Esther Dorca
- Department of Internal Medicine, Hospital de Sant Celoni, Barcelona, Spain
| | - José M Tricas
- Department of Internal Medicine, Fundació Sanitària Mollet, Barcelona, Spain
| | | | - Jordi Cuquet
- Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - Antonio Cárdenas
- Department of Internal Medicine, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Juan Manuel Roca
- Department of Internal Medicine, Hospital Plató, Barcelona, Spain
| | - María Ortiz
- Department of Internal Medicine, Hospital Plató, Barcelona, Spain
| | - Ana Paula Caresia
- Department of Infectious Diseases, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Laura Guillamon
- Department of Infectious Diseases, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Eduard Quintana
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, University of Barcelona, Spain
| | - Juan Ambrosioni
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, University of Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Oriol Gasch
- Department of Infectious Diseases, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain.
| | - José M Miró
- Department of Infectious Diseases, Hospital Clínic-IDIBAPS, University of Barcelona, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Benjanuwattra J, Bell AL, Yang MV, Mora BL, Jenkins LA, Sethi P. An enigmatic presentation of Escherichia coli endocarditis: Emphasizing the role of brain magnetic resonance imaging. Clin Case Rep 2023; 11:e7878. [PMID: 37705583 PMCID: PMC10495614 DOI: 10.1002/ccr3.7878] [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: 04/25/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
Key Clinical Message Infective endocarditis should be considered in any febrile individual with acute onset neurological symptoms. If suspicion is high, a negative brain computed tomography does not virtually exclude embolism, and magnetic resonance imaging is warranted. Abstract A diagnosis of infective endocarditis (IE) is often delayed, particularly in those infected with unusual organisms. Hereby, we report a case of a female patient presented with dysarthria, confusion, and altered mental status after being treated for Escherichia coli bacteremia. Computed tomography of the brain was unrevealing; however, scattered embolic phenomena were visualized on magnetic resonance imaging (MRI). The case underscores the importance of clinical awareness, particularly in the setting of unusual microorganisms, and the role of brain MRI in the diagnosis of IE.
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Affiliation(s)
- Juthipong Benjanuwattra
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Amanda L Bell
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Mingxiao V Yang
- School of Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Barbara L Mora
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Leigh Ann Jenkins
- Division of Cardiology Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Pooja Sethi
- Division of Cardiology Texas Tech University Health Sciences Center Lubbock Texas USA
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Kuo YS, Tsai YM. Exploring the Risk Factors and Possible Role of Calcium in Infective Endocarditis. Diagnostics (Basel) 2023; 13:2386. [PMID: 37510130 PMCID: PMC10378623 DOI: 10.3390/diagnostics13142386] [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: 05/25/2023] [Revised: 06/25/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Infective endocarditis (IE) is a severe and potentially life-threatening infection that affects the endocardium, the inner lining of the heart chambers and valves. Although rare, it is a potentially fatal condition, with an incidence of 3-10 cases per 100,000 people per year in developed countries and a mortality rate of up to 30% within 30 days. Early identification and diagnosis are critical for improving outcomes. The diagnosis of IE typically involves a combination of biomarkers, blood cultures, and echocardiography. However, currently, there are no specific biomarkers for the early detection of IE. Given the lack of specific biomarkers for IE, serum calcium levels have been suggested to play a unique role in IE. There have been few articles on the correlation between serum calcium and IE, suggesting that patients with endocarditis and lower levels of serum calcium may have a poorer prognosis. Therefore, in this article, we focus on biomarkers of endocarditis and discuss the evidence showing serum calcium as a potential indicator of IE.
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Affiliation(s)
- Yen-Shou Kuo
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
| | - Yuan-Ming Tsai
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Saadia S, Sultan FAT, Iqbal S, Fatimi SH, Nasir A. Case report: Aorto-left atrial fistula-A rare complication of native aortic valve endocarditis. Egypt Heart J 2023; 75:58. [PMID: 37432517 DOI: 10.1186/s43044-023-00384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Aorto-cavitary fistula is a rare complication of infective endocarditis. Multimodal imaging is commonly required to assess the severity and extent of infection because of the complex pathology of the valvular and paravalvular apparatus in endocarditis. CASE PRESENTATION We present an unusual case of a middle-aged man with recent history of meningoencephalitis who developed infective endocarditis complicated by ruptured abscess in inter-valvular fibrosa between aortic and mitral valve resulting in free communication or fistula formation between aorta and left atrium. Patient underwent double valve replacement (aortic and mitral) along with repair of the aorta. CONCLUSIONS Our case highlights recognition of this rare clinical presentation of aorto-left atrial fistula in infective endocarditis and the diagnostic role of transesophageal echocardiography in good clinical outcome with aggressive and timely management.
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Affiliation(s)
- Sheema Saadia
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Fateh Ali Tipoo Sultan
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Sara Iqbal
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Saulat Hasnain Fatimi
- Section of Cardiothoracic Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aiysha Nasir
- Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Nappi F, Avtaar Singh SS. Host-Bacterium Interaction Mechanisms in Staphylococcus aureus Endocarditis: A Systematic Review. Int J Mol Sci 2023; 24:11068. [PMID: 37446247 DOI: 10.3390/ijms241311068] [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: 04/20/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Staphylococci sp. are the most commonly associated pathogens in infective endocarditis, especially within high-income nations. This along with the increasing burden of healthcare, aging populations, and the protracted infection courses, contribute to a significant challenge for healthcare systems. A systematic review was conducted using relevant search criteria from PubMed, Ovid's version of MEDLINE, and EMBASE, and data were tabulated from randomized controlled trials (RCT), observational cohort studies, meta-analysis, and basic research articles. The review was registered with the OSF register of systematic reviews and followed the PRISMA reporting guidelines. Thirty-five studies met the inclusion criteria and were included in the final systematic review. The role of Staphylococcus aureus and its interaction with the protective shield and host protection functions was identified and highlighted in several studies. The interaction between infective endocarditis pathogens, vascular endothelium, and blood constituents was also explored, giving rise to the potential use of antiplatelets as preventative and/or curative agents. Several factors allow Staphylococcus aureus infections to proliferate within the host with numerous promoting and perpetuating agents. The complex interaction with the hosts' innate immunity also potentiates its virulence. The goal of this study is to attain a better understanding on the molecular pathways involved in infective endocarditis supported by S. aureus and whether therapeutic avenues for the prevention and treatment of IE can be obtained. The use of antibiotic-treated allogeneic tissues have marked antibacterial action, thereby becoming the ideal substitute in native and prosthetic valvular infections. However, the development of effective vaccines against S. aureus still requires in-depth studies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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50
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Donal E, Tribouilloy C, Sadeghpour A, Laroche C, Tude Rodrigues AC, Pereira Nunes MDC, Kang DH, Hernadez-Meneses M, Kobalava Z, De Bonis M, Dworakowski R, Ivanovic B, Holicka M, Kitai T, Cruz I, Huttin O, Colonna P, Lancellotti P, Habib G. Cardiac device-related infective endocarditis need for lead extraction whatever the device according to the ESC EORP EURO-ENDO registry. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead064. [PMID: 37465258 PMCID: PMC10351571 DOI: 10.1093/ehjopen/oead064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/26/2023] [Accepted: 03/20/2023] [Indexed: 07/20/2023]
Abstract
Aims Cardiac device-related infective endocarditis (CDRIE) is a severe complication of cardiac device (CD) implantation and is usually treated by antibiotic therapy and percutaneous device extraction. Few studies report the management and prognosis of CDRIE in real life. In particular, the rate of device extraction in clinical practice and the management of patients with left heart infective endocarditis (LHIE) and an apparently non-infected CD (LHIE+CDRIE-) are not well described. Methods and results We sought to study in EURO-ENDO, the characteristics, prognosis, and management of 483 patients with a CD included in the European Society of Cardiology EurObservational Research Programme EURO-ENDO registry. Three populations were compared: 280 isolated CDRIE (66.7 ± 14.3 years), 157 patients with LHIE and an apparently non-infected CD (LHIE+CDRIE-) (71.1 ± 13.6), and 46 patients with both LHIE and CDRIE (LHIE+CDRIE+) (70.2 ± 10.1). Echocardiography was not always transoesophageal echography (TOE); it was transthoracic echography (TTE) for isolated CDRIE in 88.4% (TOE = 67.6%), for LHIE+CDRIE- TTE = 93.0% (TOE = 58.6%), and for CDRIE+LHIE+ TTE = 87.0% (TOE = 63.0%). Nuclear imaging was performed in 135 patients (positive for 75.6%). In-hospital mortality was lower in isolated CDRIE 13.2% vs. 22.3% and 30.4% for LHIE+CDRIE- and LHIE+CDRIE+ (P = 0004). Device extraction was performed in 62.1% patients with isolated CDRIE, 10.2% of LHIE+CDRIE- patients, and 45.7% of CDRIE+LHIE+ patients. Device extraction was associated with a better prognosis [hazard ratio 0.59 (0.40-0.87), P = 0.0068] even in the LHIE+CDRIE- group (P = 0.047). Conclusion Prognosis of endocarditis in patients with a CD remains poor, particularly in the presence of an associated LHIE. Although recommended by guidelines, device extraction is not always performed. Device removal was associated with better prognosis, even in the LHIE+CDRIE- group.
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Affiliation(s)
- Erwan Donal
- Corresponding author. Tel: +33299282525, Fax: +33299282510,
| | | | - Anita Sadeghpour
- Echocardiography Research Centre, Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | - Cécile Laroche
- European Society of Cardiology, EORP, Sophia-Antipolis, France
| | - Ana Clara Tude Rodrigues
- servico de Echocardiografia—InRad-HC—Faculdade de Medicina, Universidade de Sao Paulo, SP, Brazil
| | - Maria do Carmo Pereira Nunes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Duk-Hyun Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, Korea
| | - Marta Hernadez-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Michele De Bonis
- Cardiac Surgery, Innovation and Research, ‘Vita-Salute’ San Raffaele University Hospital, Milan 20132, Italy
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital and King's College London, Denmark Hill, London SE5 9RS, UK
| | | | - Maria Holicka
- Department of Cardiology, University Hospital Brno, Jihlavska 20, Brno 62500, Czech Republic
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ines Cruz
- Departamento de Cardiologia, Hospital Garcia de Orta, Almada, Portugal
| | - Olivier Huttin
- F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists Network, INSERM 1116, CHRU de Nancy, Nancy, France
| | - Paolo Colonna
- Department of Cardiology, Polyclinic of Bari—Hospital, Bari 70124, Italy
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, GIGA Cardiovascular Sciences, CHU Sart Tilman, University of Liege Hospital, Liege, Belgium
- Department of Cardiology, Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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