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Meyer HG, Hug BL. Aerococcus urinae endocarditis - A case report. IDCases 2024; 37:e02053. [PMID: 39188366 PMCID: PMC11347057 DOI: 10.1016/j.idcr.2024.e02053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024] Open
Abstract
Aerococcus urinae is a gram-positive coccus bacterium with a previously underestimated prevalence due to morphological similarities to other gram-positive cocci. Development of newer diagnostic technologies (such as matrix-assisted laser desorption ionization time-of-flight mass spectrometry MALDI-TOF) led to increased recognition of Aerococcus urinae as causative organism mainly for urinary tract infections. Its antibiotic susceptibility poses some challenges, with resistance to some drugs of choice for urinary tract infection. We report a case of a 69-year-old male with infective endocarditis of the mitral valve, who initially presented with fever and shoulder pain to the emergency department. The patient reported an episode of obstructive renal infection two weeks earlier, which was treated with trimethoprim-sulfamethoxazole. The unusual presentation with shoulder pain and a new heart murmur led to suspicion of endocarditis. Urine and blood cultures were positive for Aerococcus urinae, echocardiography revealed vegetations on the mitral valve with severe mitral insufficiency. After two weeks of antibiotic treatment, mitral valve replacement was performed, from which the patient recovered. Reports of Aerococcus urinae endocarditis are still limited in number. On the other side, Aerococcus urinae is an emerging bacterial uropathogen with greater relevance than previously believed. We review the case reports of Aerococcus urinae endocarditis and newest literature about its presentation, course, and clinical management.
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Affiliation(s)
- Helene G. Meyer
- Internal Medicine, Lucerne Cantonal Hospital, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
| | - Balthasar L. Hug
- Internal Medicine, Lucerne Cantonal Hospital, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
- Center for Primary and Community Care, University of Lucerne, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern 16, Switzerland
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Martínez-Sellés M, Kortajarena-Urkola X, Muñoz P, Fariñas MC, Armiñanzas C, de Alarcón A, Gutiérrez-Carretero E, Rodríguez-García R, Calderón-Parra J, Ramos-Merino L, Cabello-Ubeda A, Miró JM, Goenaga-Sánchez MÁ. Infective endocarditis in HIV-infected patients. Analysis of a national cohort. Infect Dis (Lond) 2024:1-10. [PMID: 39033499 DOI: 10.1080/23744235.2024.2378328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/06/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence. METHODS Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021. RESULTS From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm3. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6-1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4-1·3). CONCLUSIONS In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.
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Affiliation(s)
- Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV. Universidad Europea. Universidad Complutense, Madrid, Spain
| | | | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid. Instituto de Investigación Sanitaria Gregorio Marañón. CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058). Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - María Carmen Fariñas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla-IDIVAL. CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Madrid, Spain. Universidad de Cantabria, Santander, Spain
| | - Carlos Armiñanzas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Aristides de Alarcón
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Parasitología (UCEIMP). Grupo de Resistencias bacterianas y antimicrobianos CIBERINFEC. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain
| | - Encarnación Gutiérrez-Carretero
- Cardiac Surgery Department. CIBERCV, Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospital Virgen del Rocío, Seville, Spain
| | - Raquel Rodríguez-García
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo. Universidad de Oviedo, Spain
| | - Jorge Calderón-Parra
- Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta de Hierro. IDIPHISA, Madrid, Spain
| | - Lucía Ramos-Merino
- Servicio de Enfermedades Infecciosas, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Alfonso Cabello-Ubeda
- División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación sanitaria Fundación Jimenez Díaz (IIS-FJD, UAM), Spain
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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Anton CI, Buzilă CA, Stanciu SM, Bucurică S, Anghel D, Ștefan AT, Ștefan I, Streinu-Cercel A. Prosthetic Valve Endocarditis: A Retrospective Cohort Study Conducted at "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. Microorganisms 2024; 12:1442. [PMID: 39065210 PMCID: PMC11278736 DOI: 10.3390/microorganisms12071442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To evaluate patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment can be utilized to enhance the quality of care for individuals with infective endocarditis who have undergone prosthetic valve replacement surgery. RESULTS During the period of investigation (January 2017-December 2022), 78 patients diagnosed with infective endocarditis (IE) on a prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 patients (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who received only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of the patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%) and Streptococcus mitis (10.3%). The mortality rate of patients infected with S. aureus was 29.2%, indicating the severity of this infectious agent. CONCLUSIONS Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high.
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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;
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
| | - Cosmin Alexandru Buzilă
- Cardiovascular Surgery Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
| | - Silviu Marcel Stanciu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Center for Cardiovascular Diseases, Laboratory of Noninvasive Cardiovascular Functional Explorations, Dr. Carol Davila Central Military Emergency University Hospital, 134 Calea Plevnei Str., 010825 Bucharest, Romania
| | - Săndica Bucurică
- Department of Gastroenterology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Anghel
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
- Department of Internal Medicine, “Dr. Carol Davila” Central Military Emergency University Hospital, 010242 Bucharest, Romania
| | - Alexia Teodora Ștefan
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
| | - Ion Ștefan
- Department of Infectious Diseases, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania;
- Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Adrian Streinu-Cercel
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania
- Department of Infectious Diseases I, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania
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Caldonazo T, Hagel S, Doenst T, Kirov H, Sá MP, Jacquemyn X, Tasoudis P, Franz M, Diab M. Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication-Meta-Analysis of Reconstructed Time-to-Event Data. J Am Heart Assoc 2024; 13:e033404. [PMID: 38533941 PMCID: PMC11179767 DOI: 10.1161/jaha.123.033404] [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: 11/04/2023] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Infective endocarditis represents a life-threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery. METHODS AND RESULTS Three databases were systematically assessed. A pooled analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies with longer follow-up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow-up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24-0.31], P<0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26-0.37], P<0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%). CONCLUSIONS Based on the findings of this study-level meta-analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short- and long-term mortality when compared with conservative treatment.
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Affiliation(s)
- Tulio Caldonazo
- Department of Cardiothoracic SurgeryFriedrich‐Schiller‐University JenaJenaGermany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Friedrich‐Schiller‐University JenaJenaGermany
| | - Torsten Doenst
- Department of Cardiothoracic SurgeryFriedrich‐Schiller‐University JenaJenaGermany
| | - Hristo Kirov
- Department of Cardiothoracic SurgeryFriedrich‐Schiller‐University JenaJenaGermany
| | - Michel Pompeu Sá
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburghPAUSA
- UPMC Heart and Vascular Institute, University of Pittsburgh Medical CenterPittsburghPAUSA
| | | | - Panagiotis Tasoudis
- Division of Cardiothoracic SurgeryUniversity of North CarolinaChapel HillNCUSA
| | - Marcus Franz
- Division of Cardiology, Department of Internal MedicineFriedrich‐Schiller‐University JenaJenaGermany
| | - Mahmoud Diab
- Department of Cardiothoracic SurgeryFriedrich‐Schiller‐University JenaJenaGermany
- Department of Cardiothoracic SurgeryCardiovascular Center RotenburgRotenburg an der FuldaGermany
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5
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Weber C, Hohmann C, Lindner O, Wahlers T, Jung N. Patients with Artificial Heart Valves. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:692-702. [PMID: 37427994 PMCID: PMC10666258 DOI: 10.3238/arztebl.m2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising. METHODS We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature. RESULTS Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses. CONCLUSION Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.
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Affiliation(s)
- Carolyn Weber
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Christopher Hohmann
- Department III for Internal Medicine – General and Interventional Cardiology, Electrophysiology, Angiology, Pneumology and Intensive Care Medicine, University Hospital Cologne
| | - Oliver Lindner
- Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia, University Hospital Ruhr-University Bochum, Bad Oeynhausen-Universität Bochum
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital Cologne
| | - Norma Jung
- Department I of Internal Medicine – Oncology, Hematology, Division of Infectious Diseases, Clinical Immunology, Hemostaseology and internal Intensive Care Medicine, University Hospital Cologne
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6
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Huang JB, Wen ZK, Lu CC, Yang JR, Li JJ. Risk factors of prolonged intensive care unit stay following cardiac surgery for infective endocarditis. Medicine (Baltimore) 2023; 102:e35128. [PMID: 37746976 PMCID: PMC10519498 DOI: 10.1097/md.0000000000035128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
INTRODUCTION Prolonged intensive care unit (ICU) stay is common in serious patients undergoing cardiac surgery. Prolonged ICU stay is associated with increased mortality and worse prognosis. This study was conducted to determine the risk factors for prolonged ICU stay after cardiac surgery for infective endocarditis (IE) and we try to decrease the operative risk of mortality and morbidity of cardiac surgery for IE. METHODS The retrospective study of patients with IE undergoing cardiac surgery between January 2006 and November 2022 at our hospital was performed. RESULTS 896 patients undergoing cardiac surgery were divided into group of ICU stay ≤ 3d (n = 416) and group p of ICU stay > 3d (n = 480). There were 48 operative deaths (5.4%). Univariable and multivariable analyses showed that factors are associated with prolonged ICU stay following cardiac surgery for IE, including male (P < .001), age (P < .001), weight (P = .009), vegetation length (P < .001), paravalvular leak (P < .001), aortic cross-clamp time (P < .001), cardiopulmonary bypass (CPB) time (P < .001), mechanical ventilation time (P < .001), hospitalized time postoperative (P = .032), creatinine of serum before surgery (P < .001), creatinine of serum 24h after surgery (P = .005), creatinine of serum 48h after surgery (P < .001), fluid balance on operation day (P < .001), postoperative acute kidney injury (P < .001), left ventricular end diastolic dimension (LVEDD) preoperative (P < .001), LVEDD postoperative (P < .001), chest drainage (P = .032), frozen plasma (P = .016), preoperative aortic insufficiency (P < .001), and packed red cells (P < .001). CONCLUSIONS In our study, shortness of ICU stay and optimization of pre-, peri-, and postoperative factors that can shorten ICU stay, therefore, contribute to a better postoperative outcome and leads to lower rates of mortality and morbidity.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Jian-Rong Yang
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
| | - Jun-Jun Li
- Department of Cardiothoracic Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, Nanning, Guangxi, China
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Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, Tattevin P, Olaison L, Freiberger T, Hurley J, Hannan MM, Chu V, Hoen B, Moreno A, Cuervo G, Llopis J, Miró JM. Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012). Infect Dis Ther 2023; 12:1083-1101. [PMID: 36922460 PMCID: PMC10147876 DOI: 10.1007/s40121-023-00763-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/24/2023] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. METHODS The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. RESULTS IE cases from 13 European countries were included. Two periods were considered: 2000-2006 and 2008-2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern-Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49-74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p < 0.01). In-hospital and 6-month mortality rates were comparable between regions and significantly decreased in the second period. CONCLUSIONS Despite an increased complexity of IE cases, prognosis improved in recent years with a significant decrease in 6-month mortality. Outcome did not differ according to the European region (SE versus NCE).
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Affiliation(s)
- Juan Ambrosioni
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - Pierre Tattevin
- Infectious Diseases and ICU, Pontchaillou University Hospital, Rennes, France
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Freiberger
- Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
- Medical Faculty, Masaryk University, Brno, Czech Republic
| | - John Hurley
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Margaret M Hannan
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Vivian Chu
- Duke University School of Medicine, Durham, NC, USA
| | - Bruno Hoen
- Department of Infectious Diseases and Tropical Medicine and Inserm CIC-1424, University of Lorraine Medical Center at Nancy, EA 4364 APEMAC, University of Lorraine, Nancy, France
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain
| | - Jaume Llopis
- Biostatistics Department, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - José M Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, Villarroel 170, 08032, Barcelona, Spain.
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
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8
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Hajduczenia MM, Klefisch FR, Hopf AGM, Grubitzsch H, Stegemann MS, Pfäfflin F, Puhlmann B, Ocken M, Kretzler L, von Schöning D, Falk V, Moter A, Kikhney J. New Perspectives for Prosthetic Valve Endocarditis: Impact of Molecular Imaging by FISHseq Diagnostics. Clin Infect Dis 2023; 76:1050-1058. [PMID: 36318608 PMCID: PMC10029985 DOI: 10.1093/cid/ciac860] [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: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The microbial etiology of prosthetic valve infective endocarditis (PVE) can be difficult to identify. Our aim was to investigate the benefit of molecular imaging technique fluorescence in situ hybridization (FISH) combined with 16S rRNA-gene polymerase chain reaction (PCR) and sequencing (FISHseq) for the analysis of infected prosthetic heart valves. METHODS We retrospectively evaluated the diagnostic outcome of 113 prosthetic valves from 105 patients with suspected PVE, treated in 2003-2013 in the Department of Cardiac Surgery, Charité University Medicine Berlin. Each prosthetic valve underwent cultural diagnostics and was routinely examined by FISH combined with 16S rRNA gene PCR and sequencing. We compared classical microbiological culture outcomes (blood and valve cultures) with FISHseq results and evaluated the diagnostic impact of the molecular imaging technique. RESULTS Conventional microbiological diagnostic alone turned out to be insufficient, as 67% of preoperative blood cultures were noninformative (negative, inconclusive, or not obtained) and 67% of valve cultures remained negative. FISHseq improved the conventional cultural diagnostic methods in PVE in 30% of the cases and increased diagnostic accuracy. Of the valve culture-negative PVE cases, FISHseq succeeded in identifying the causative pathogen in 35%. CONCLUSIONS FISHseq improves PVE diagnostics, complementing conventional cultural methods. In addition to species identification, FISH provides information about the severity of PVE and state of the pathogens (eg, stage of biofilm formation, activity, and localization on and within the prosthetic material). As a molecular imaging technique, FISHseq enables the unambiguous discrimination of skin flora as contaminant or infectious agent.
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Affiliation(s)
- Maria M Hajduczenia
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frank R Klefisch
- Department of Internal Medicine and Intensive Care Medicine, Paulinen Hospital Berlin, Berlin, Germany
| | - Alexander G M Hopf
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam S Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Birgit Puhlmann
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michele Ocken
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Lucie Kretzler
- Clinical Trial Unit, Clinical Study Center, Berlin Institute of Health (BIH), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dinah von Schöning
- Department of Microbiology, Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
- Moter Diagnostics, Berlin, Germany
| | - Judith Kikhney
- Biofilmcenter, Institute for Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- MoKi Analytics GmbH, Berlin, Germany
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9
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García de la Mària C, Cañas MA, Fernández-Pittol M, Dahl A, García-González J, Hernández-Meneses M, Cuervo G, Moreno A, Miró JM, Marco F. Emerging issues on Staphylococcus aureus endocarditis and the role in therapy of daptomycin plus fosfomycin. Expert Rev Anti Infect Ther 2023; 21:281-293. [PMID: 36744387 DOI: 10.1080/14787210.2023.2174969] [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] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Methicillin-resistant and -susceptible Staphylococcus aureus (MRSA/MSSA) infections are a major global health-care problem. Bacteremia with S. aureus exhibits high rates of morbidity and mortality and can cause complicated infections such as infective endocarditis (IE). The emerging resistance profile of S. aureus is worrisome, and several international agencies have appealed for new treatment approaches to be developed. AREAS COVERED Daptomycin presents a rapid bactericidal effect against MRSA and has been considered at least as effective as vancomycin in treating MRSA bacteremia. However, therapy failure is often related to deep-seated infections, e.g. endocarditis, with high bacterial inocula and daptomycin regimens <10 mg/kg/day. Current antibiotic options for treating invasive S. aureus infections have limitations in monotherapy. Daptomycin in combination with other antibiotics, e.g. fosfomycin, may be effective in improving clinical outcomes in patients with MRSA IE. EXPERT OPINION Exploring therapeutic combinations has shown fosfomycin to have a unique mechanism of action and to be the most effective option in preventing the onset of resistance to and optimizing the efficacy of daptomycin, suggesting the synergistic combination of fosfomycin with daptomycin is a useful alternative treatment option for MSSA or MRSA IE.
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Affiliation(s)
- Cristina García de la Mària
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Maria-Alexandra Cañas
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | | | - Anders Dahl
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Javier García-González
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain
| | - Jose M Miró
- Infectious Diseases Service, Hospital Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). University of Barcelona, Barcelona, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Marco
- Microbiology Department, Centre Diagnòstic Biomèdic (CDB) Hospital Clínic, Barcelona, Spain.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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10
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Holcman K, Rubiś P, Ząbek A, Boczar K, Podolec P, Kostkiewicz M. Advances in Molecular Imaging in Infective Endocarditis. Vaccines (Basel) 2023; 11:420. [PMID: 36851297 PMCID: PMC9967666 DOI: 10.3390/vaccines11020420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/04/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Infective endocarditis (IE) is a growing epidemiological challenge. Appropriate diagnosis remains difficult due to heterogenous etiopathogenesis and clinical presentation. The disease may be followed by increased mortality and numerous diverse complications. Developing molecular imaging modalities may provide additional insights into ongoing infection and support an accurate diagnosis. We present the current evidence for the diagnostic performance and indications for utilization in current guidelines of the hybrid modalities: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime-labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) along with positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). The role of molecular imaging in IE diagnostic work-up has been constantly growing due to technical improvements and the increasing evidence supporting its added diagnostic and prognostic value. The various underlying molecular processes of 99mTc-HMPAO-SPECT/CT as well as 18F-FDG PET/CT translate to different imaging properties, which should be considered in clinical practice. Both techniques provide additional diagnostic value in the assessment of patients at risk of IE. Nuclear imaging should be considered in the IE diagnostic algorithm, not only for the insights gained into ongoing infection at a molecular level, but also for the determination of the optimal clinical therapeutic strategies.
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Affiliation(s)
- Katarzyna Holcman
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Andrzej Ząbek
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Krzysztof Boczar
- Department of Electrocardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Magdalena Kostkiewicz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland
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11
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Seminari E, Cambieri P, Pieri TC, Roda S, Colaneri M, Gallazzi I, Asperges E, Bono E, Lissandrin R, Marvulli LN, Bruno R. Culture negative endocarditis and the role of proper blood culture collection: results from a tertiary care Centre of Northern Italy. Infect Dis (Lond) 2023; 55:67-70. [PMID: 36082839 DOI: 10.1080/23744235.2022.2121854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Elena Seminari
- Clinica di Malattie Infettive, Fondazione IRCSS Policlinico San Matteo, Pavia, Italy
| | - Patrizia Cambieri
- UOC Microbiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Teresa Chiara Pieri
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Silvia Roda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marta Colaneri
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Ilaria Gallazzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Erika Asperges
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Enrica Bono
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Raffaella Lissandrin
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Lea Nadia Marvulli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- UOC Microbiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
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12
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Fernández-Cisneros A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Barriuso C, Castellá M, Ambrosioni J, Pericàs JM, Vidal B, Falces C, Ibáñez C, Perdomo J, Rovira I, García-de-la-María C, Moreno A, Almela M, Perisinotti A, Dahl A, Castro P, Miró JM, Quintana E. Risk scores' performance and their impact on operative decision-making in left-sided endocarditis: a cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:33-42. [PMID: 36346471 PMCID: PMC9816251 DOI: 10.1007/s10096-022-04516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022]
Abstract
The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.
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Affiliation(s)
- A. Fernández-Cisneros
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Hernández-Meneses
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Llopis
- grid.5841.80000 0004 1937 0247Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
| | - E. Sandoval
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - D. Pereda
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Alcocer
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - C. Barriuso
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain
| | - M. Castellá
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - J. Ambrosioni
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Pericàs
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain ,grid.411083.f0000 0001 0675 8654Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute of Research, CIBERehd, Barcelona, Spain
| | - B. Vidal
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Falces
- grid.5841.80000 0004 1937 0247Cardiology Department, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. Ibáñez
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. Perdomo
- grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - I. Rovira
- grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Anesthesiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C. García-de-la-María
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Moreno
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M. Almela
- grid.5841.80000 0004 1937 0247Microbiology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - A. Perisinotti
- grid.410458.c0000 0000 9635 9413Nuclear Medicine Department, Biomaterials and Nanomedicine (CIBER-BBN), Hospital Clinic-IDIBAPS, University of Barcelona & Biomedical Research Networking Center of Bioengineering, Barcelona, Spain
| | - A. Dahl
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - P. Castro
- grid.5841.80000 0004 1937 0247Internal Medicine Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J. M. Miró
- grid.5841.80000 0004 1937 0247Infectious Diseases Service, Hospital Clínic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E. Quintana
- grid.5841.80000 0004 1937 0247Cardiovascular Surgery Department, Hospital Clínic - IDIBAPS, University of Barcelona, C/Villarroel 170, 08036 Barcelona, CP Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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13
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Dahl A, Fowler VG, Miro JM, Bruun NE. Sign of the Times: Updating Infective Endocarditis Diagnostic Criteria to Recognize Enterococcus faecalis as a Typical Endocarditis Bacterium. Clin Infect Dis 2022; 75:1097-1102. [PMID: 35262664 DOI: 10.1093/cid/ciac181] [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: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
The modified Duke criteria requires that Enterococcus faecalis bacteremia must be both community-acquired and without known focus in order to be considered a microbiological "Major" diagnostic criterion in the diagnosis of infective endocarditis. We believe that the microbiological diagnostic criteria should be updated to regard E. faecalis as a "typical" endocarditis bacterium as is currently the case, for example, viridans group streptococci and Staphylococcus aureus. Using data from a prospective study of 344 patients with E. faecalis bacteremia evaluated with echocardiography, we demonstrate that designating E. faecalis as a "typical" endocarditis pathogen, regardless the place of acquisition or the portal of entry, improved the sensitivity to correctly identify definite endocarditis from 70% (modified Duke criteria) to 96% (enterococcal adjusted Duke criteria).
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Affiliation(s)
- Anders Dahl
- Department of Cardiology, Herlev-Gentofte University Hospital Copenhagen, Denmark
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Spain
| | - Vance G Fowler
- Department of Infectious Diseases, Duke University Hospital, Durham, North Carolina, USA
| | - José M Miro
- Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
- Clinical institutes, Copenhagen and Aalborg Universities, Denmark
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14
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Poorzand H, Hamidi F, Sheybani F, Ghaderi F, Fazlinezhad A, Alimi H, Bigdelu L, Khosravi Bizhaem S. Infective Endocarditis: Clinical Characteristics and Echocardiographic Findings. Front Cardiovasc Med 2022; 9:789624. [PMID: 35445085 PMCID: PMC9014855 DOI: 10.3389/fcvm.2022.789624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Infective endocarditis (IE) remains a disease with high morbidity and mortality. The aim of this study was to determine the clinical characteristics and echocardiographic features of patients with IE. Methods We analyzed patients with either definitive or probable diagnosis of IE who were hospitalized in a teaching hospital in Mashhad, Iran between June 2011 and January 2020. Patients who survived were followed up by echocardiography for at least 6-month after hospital discharge. Results A total of 82 cases with IE were included of which 62 (75.6%) received definitive diagnosis. The mean age was 39.7 ± 18.7 years and 52 (63.4%) were male. The most common preexisting structural cardiac abnormality that predispose patients to IE were congenital heart diseases (28 %) of which bicuspid aortic valve was more common (n = 12, 14.6%), followed by ventricular septal defect (n = 9, 11%) and Tetralogy of Fallot (TOF) (n = 2, 2.4%). Three (3.6 %) cases had rheumatic heart disease and 12 (14.6 %) were injecting drug users. The most common causative pathogen was Staphylococcus aureus, detected in 7 (19.4%) cases. Follow-up echocardiography revealed right or left ventricular failure in 10 (12.1%) cases. Cardiac complications occurred in 41 (50%) cases and systemic complications in 63 (76.8%). All-cause mortality was 41.5% (n = 34) and 6 (18.1%) patients died due to cardiovascular complications. Conclusions The short- and long-term prognosis in IE was poor and the predictors for in-hospital and 1-year mortality were defined as heart failure and septic shock. Congenital heart disease and intravenous illicit drug using (IVDU) were the most common predisposing condition which may necessitate a revision in the IE prophylaxis recommendations.
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Affiliation(s)
- Hoorak Poorzand
- Division of Cardiovascular Medicine, Cardiovascular Department, Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Hamidi
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
- *Correspondence: Fatemeh Hamidi
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Ghaderi
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsoon Fazlinezhad
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Division of Cardiovascular Medicine, Cardiovascular Department, Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Bigdelu
- Cardiovascular Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeede Khosravi Bizhaem
- Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
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15
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Peláez Ballesta AI, García Vázquez E, Gómez Gómez J. Infective endocarditis treated in a secondary hospital: epidemiological, clinical, microbiological characteristics and prognosis, with special reference to patients transferred to a third level hospital. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:35-42. [PMID: 34845895 PMCID: PMC8790653 DOI: 10.37201/req/092.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To analyse the clinical and epidemiological characteristics and mortality-related factors of patients admitted to a secondary hospital with Infective Endocarditis (IE). METHODS Observational study of a cohort of patients who have been diagnosed with IE in a secondary hospital and evaluated in accordance with a pre-established protocol. RESULTS A total of 101 cases were evaluated (years 2000-2017), with an average age of 64 years and a male-to-female ratio of 2:1. 76% of the cases had an age-adjusted Charlson comorbidity index of >6, with 21% having had a dental procedure and 36% with a history of heart valve disease. The most common microorganism was methicillin-susceptible S. aureus (36%), with bacterial focus of unknown origin in 54%. The diagnostic delay time was 12 days in patients who were transferred, compared to 8 days in patients who were not transferred (p=0.07); the median surgery indication delay time was 5 days (IQR 13.5). The in-hospital mortality rate was 34.6% and the prognostic factors independently associated with mortality were: cerebrovascular events (OR 98.7%, 95% CI, 70.9-164.4); heart failure (OR 27.3, 95% CI, 10.2-149.1); and unsuitable antibiotic treatment (OR 7.2, 95% CI, 1.5-10.5). The mortality rate of the patients who were transferred and who therefore underwent surgery was 20% (5/25). CONCLUSIONS The onset of cerebrovascular events, heart failure and unsuitable antibiotic treatment are independently and significantly associated with in-hospital mortality. The mortality rate was higher than the published average (35%); the diagnostic delay was greater in patients for whom surgery was indicated.
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Affiliation(s)
- A I Peláez Ballesta
- Ana Isabel Peláez Ballesta, Internal Medicine Department of the Hospital General Universitario Rafael Méndez (Lorca). Spain.
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16
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Holcman K, Rubiś P, Stępień A, Graczyk K, Podolec P, Kostkiewicz M. The Diagnostic Value of 99mTc-HMPAO-Labelled White Blood Cell Scintigraphy and 18F-FDG PET/CT in Cardiac Device-Related Infective Endocarditis-A Systematic Review. J Pers Med 2021; 11:jpm11101016. [PMID: 34683157 PMCID: PMC8540535 DOI: 10.3390/jpm11101016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 12/19/2022] Open
Abstract
(1) Background: Treatment of cardiac arrhythmias and conduction disorders with the implantation of a cardiac implantable electronic device (CIED) may lead to complications. Cardiac device-related infective endocarditis (CDRIE) stands out as being one of the most challenging in terms of its diagnosis and management. Developing molecular imaging modalities may provide additional insights into CDRIE diagnosis. (2) Methods: We performed a systematic literature review to critically appraise the evidence for the diagnostic performance of the following hybrid techniques: single photon emission tomography with technetium99m-hexamethylpropyleneamine oxime–labeled autologous leukocytes (99mTc-HMPAO-SPECT/CT) and positron emission tomography with fluorodeoxyglucose (18F-FDG PET/CT). An analysis was performed in accordance with PRISMA and GRADE criteria and included articles from PubMed, Embase and Cochrane databases. (3) Results: Initially, there were 2131 records identified which had been published between 1971–2021. Finally, 18 studies were included presenting original data on the diagnostic value of 99mTc-HMPAO-SPECT/CT or 18F-FDG PET/CT in CDRIE. Analysis showed that these molecular imaging modalities provide high diagnostic accuracy and their inclusion in diagnostic criteria improves CDRIE work-up. (4) Conclusions: 99mTc-HMPAO-SPECT/CT and 18F-FDG PET/CT provide high diagnostic value in the identification of patients at risk of CDRIE and should be considered for inclusion in the CDRIE diagnostic process.
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Affiliation(s)
- Katarzyna Holcman
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
- Correspondence:
| | - Paweł Rubiś
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Agnieszka Stępień
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Katarzyna Graczyk
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
| | - Magdalena Kostkiewicz
- Department of Nuclear Medicine, John Paul II Hospital, 31-202 Krakow, Poland;
- Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, 31-202 Krakow, Poland; (P.R.); (A.S.); (K.G.); (P.P.)
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17
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Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, Zurich, Switzerland
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