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Badran A, Rowe H, Jaffar-Karballai M, Abdelghaffar M, Harky A, Yam TS, Ohri SK. A Single-Centre Experience of the Management of Infective Endocarditis. Heart Lung Circ 2024:S1443-9506(24)00131-8. [PMID: 39117557 DOI: 10.1016/j.hlc.2024.02.013] [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: 04/28/2023] [Revised: 01/03/2024] [Accepted: 02/13/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Treatment for infective endocarditis (IE) is usually medical, with surgery reserved for those failing medical management or developing complications. Currently, 25%-50% of patients undergo surgery for IE with a 70%-80% immediate survival rate. However, there is controversy over the timing of surgery following cerebrovascular events, which occur in 15%-30% of IE patients. This study aimed to investigate whether surgical management is superior to medical management in patients with IE and to determine the optimal timing for surgery following the development of neurological symptoms. METHODS Data were collected retrospectively between 2012 and 2018 from 436 patients diagnosed with IE and treated at our tertiary teaching hospital. The authors analysed the type of treatment, the timing of surgery, and the outcomes of these including mortality, IE recurrence, and length of hospital stay. RESULTS A total of 421 patients were included in the analysis. More than two-thirds (69.1%) of patients underwent surgical intervention. The survival rate of patients having surgery for IE was 77.2%, compared to 50.7% in patients who did not undergo surgical intervention. 6.8% of patients presented with neurological symptoms; 73.3% of these patients had surgery within 14 days with a 90.9% survival. CONCLUSION This study finds surgery to be safe with a seemingly higher survival rate compared to medical management alone, although this may be confounded by patients in the medical group being less likely to have surgery. Surgery in patients presenting with neurological symptoms is safe within 2 weeks from presentation with excellent outcomes.
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Affiliation(s)
- Abdul Badran
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK.
| | - Henry Rowe
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
| | | | - Mariam Abdelghaffar
- School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Bahrain
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Tat Sing Yam
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
| | - Sunil K Ohri
- Department of Cardiothoracic Surgery, University Hospital Southampton, Southampton, UK
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2
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Nappi F. Native Infective Endocarditis: A State-of-the-Art-Review. Microorganisms 2024; 12:1481. [PMID: 39065249 PMCID: PMC11278776 DOI: 10.3390/microorganisms12071481] [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: 06/06/2024] [Revised: 06/18/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Native valve infective endocarditis (NVE) is a global phenomenon, defined by infection of a native heart valve and involving the endocardial surface. The causes and epidemiology of the disease have evolved in recent decades, with a doubling of the average patient age. A higher incidence was observed in patients with implanted cardiac devices that can result in right-sided infection of the tricuspid valve. The microbiology of the disease has also changed. Previously, staphylococci, which are most often associated with health-care contact and invasive procedures, were the most common cause of the disease. This has now been superseded by streptococci. While innovative diagnostic and therapeutic strategies have emerged, mortality rates have not improved and remain at 30%, which is higher than that for many cancer diagnoses. The lack of randomized trials and logistical constraints impede clinical management, and long-standing controversies such as the use of antibiotic prophylaxis persist. This state of the art review addresses clinical practice, controversies, and strategies to combat this potentially devastating disease. A multidisciplinary team will be established to provide care for patients with presumptive NVE. The composition of the team will include specialists in cardiology, cardiovascular surgery, and infectious disease. The prompt administration of combination antimicrobial therapy is essential for effective NVE treatment. Additionally, a meticulous evaluation of each patient is necessary in order to identify any indications for immediate valve surgery. With the intention of promoting a more comprehensive understanding of the procedural management of native infective endocarditis and to furnish clinicians with a reference, the current evidence for the utilization of distinct strategies for the diagnosis and treatment of NVE are presented.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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3
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Patel NN, Ebubechukwu U, Saith SE, Ugoala OS, Kahn AB, McFarlane SI, John S. Crisis in the Chest: Acute Chest Syndrome as a Sequela of Tricuspid Valve Endocarditis. Cureus 2024; 16:e61061. [PMID: 38915989 PMCID: PMC11195809 DOI: 10.7759/cureus.61061] [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: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
The management of acute chest syndrome (ACS) in sickle cell disease occurring concurrently with pulmonary embolism resulting from tricuspid valve endocarditis poses an atypical challenge. We present a case in which this complex interaction occurs and the prompt interventions that were utilized to give the best possible outcome.
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Affiliation(s)
- Nishal N Patel
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Ugochukwu Ebubechukwu
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sunil E Saith
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Onyinye S Ugoala
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Alexa B Kahn
- Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Samy I McFarlane
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
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4
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Gopal K, Radhakrishnan RM, Jose R, Krishna N, Varma PK. Outcomes after surgery for infective endocarditis. Indian J Thorac Cardiovasc Surg 2024; 40:126-137. [PMID: 38827557 PMCID: PMC11139833 DOI: 10.1007/s12055-023-01647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 06/04/2024] Open
Abstract
The role of surgery in infective endocarditis is becoming established the world over. In spite of all recent advances, endocarditis remains a lethal disease following surgery. With the emergence of more difficult-to-treat microorganisms, sicker and older patients with multiple co-morbidities, and an increase in healthcare-associated infections, the need for surgery in the management of infective endocarditis is only bound to increase. Data on the use of surgery in endocarditis till date is largely from observational data due to the relative rarity of the disease and variable practice patterns around the world. Hopefully, with increasing awareness and more inter-institutional and international collaborations, more robust data will emerge to further establish the role of surgery. For the time being, individual patient management will require the active multi-disciplinary approach of an endocarditis team to provide the best possible outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01647-9.
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Affiliation(s)
- Kirun Gopal
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rohik Micka Radhakrishnan
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Rajesh Jose
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Neethu Krishna
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
| | - Praveen Kerala Varma
- Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham (Amrita University), Kochi, India
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5
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Pizzino F, Paradossi U, Trimarchi G, Benedetti G, Marchi F, Chiappino S, Conti M, Di Bella G, Murzi M, Di Sibio S, Concistrè G, Bianchi G, Solinas M. Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience. J Cardiovasc Dev Dis 2024; 11:138. [PMID: 38786960 PMCID: PMC11121817 DOI: 10.3390/jcdd11050138] [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: 03/23/2024] [Revised: 04/19/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). METHODS Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death. RESULTS A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1-3.4, p = 0.03 and HR 2.1, 95% CI 1.2-3.6, p = 0.01, respectively) and Kaplan-Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4-13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4-22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9-1, p < 0.05), abscess (HR 3.5, 95% CI 1.2-10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5-14.1, p < 0.01) were independently associated with the all-cause death endpoint. CONCLUSIONS IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint.
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Affiliation(s)
- Fausto Pizzino
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy; (F.P.); (U.P.); (G.B.); (F.M.); (S.C.)
| | - Umberto Paradossi
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy; (F.P.); (U.P.); (G.B.); (F.M.); (S.C.)
| | - Giancarlo Trimarchi
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.T.); (G.D.B.)
| | - Giovanni Benedetti
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy; (F.P.); (U.P.); (G.B.); (F.M.); (S.C.)
| | - Federica Marchi
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy; (F.P.); (U.P.); (G.B.); (F.M.); (S.C.)
| | - Sara Chiappino
- Cardiology Unit, Heart Centre, Fondazione Gabriele Monasterio—Regione Toscana, 54100 Massa, Italy; (F.P.); (U.P.); (G.B.); (F.M.); (S.C.)
| | - Mattia Conti
- Department of Surgical Molecular Medical and Critical Area Pathology, University of Pisa, 56124 Pisa, Italy;
| | - Gianluca Di Bella
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy; (G.T.); (G.D.B.)
| | - Michele Murzi
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (S.D.S.); (G.C.); (G.B.); (M.S.)
| | - Silvia Di Sibio
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (S.D.S.); (G.C.); (G.B.); (M.S.)
| | - Giovanni Concistrè
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (S.D.S.); (G.C.); (G.B.); (M.S.)
| | - Giacomo Bianchi
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (S.D.S.); (G.C.); (G.B.); (M.S.)
| | - Marco Solinas
- Division of Adult Cardiac Surgery, Fondazione Toscana Gabriele Monasterio, 54100 Massa, Italy; (S.D.S.); (G.C.); (G.B.); (M.S.)
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Cioci AL, Hutton A, Yi S, Khoriaty G, Gottlieb G, Cartledge R, Rubenstein M. Percutaneous aspiration of aortic valve vegetation in a patient with aortic valve endocarditis. Clin Case Rep 2024; 12:e8724. [PMID: 38560283 PMCID: PMC10980779 DOI: 10.1002/ccr3.8724] [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: 08/09/2022] [Revised: 01/23/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message Percutaneous aspiration for debulking of vegetations in right-sided infective endocarditis has been well-described, however, this technique can be employed successfully for left-sided vegetations in select high-risk patients. Abstract We report a case of percutaneous aspiration of an aortic valve vegetation in a patient with prosthetic valve endocarditis. This novel approach was selected after patient declined surgical intervention for an enlarging vegetation despite antibiotic therapy. The procedure was successful, resulting in the complete removal of solid vegetation without complications.
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Affiliation(s)
| | - Anneka Hutton
- Department of Internal MedicineFlorida Atlantic University College of MedicineBoca RatonFloridaUSA
| | - Slee Yi
- Department of General SurgeryFlorida Atlantic University College of MedicineBoca RatonFloridaUSA
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7
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Johansson G, Sunnerhagen T, Gilje P, Ragnarsson S, Rasmussen M. Risk factors for and consequences of positive valve cultures in patients who undergo cardiac surgery while receiving antimicrobial treatment for infective endocarditis. Infect Dis (Lond) 2024; 56:244-254. [PMID: 38100548 DOI: 10.1080/23744235.2023.2293164] [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: 10/02/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Cardiac surgery is required in up to half of the patients with infective endocarditis (IE). Positive valve cultures have been associated with higher in-hospital mortality. The aims were to identify risk factors for positive valve cultures and its relation to outcome. METHODS Patients subjected to heart valve cultures due to surgery for IE in Skåne University Hospital, Lund, between 2012 and 2021 were identified through microbiology records. Risk factors for positive valve cultures and information on mortality and relapse were retrieved through medical records. Univariable and multivariable logistic regressions were performed. RESULTS A total of 345 episodes with IE in 337 patients subjected to cardiac surgery were included and valve cultures were positive in 78 (23%) episodes. In multivariable logistic regression, preoperative fever (adjusted odds ratio (AOR) 2.6, 95% confidence interval (CI) 1.2-5.6, p = 0.02), prosthetic heart valve (AOR 3.3, CI 1.4-7.9, p = 0.01), a single affected valve (AOR 4.8, CI 1.2-20, p = 0.03), blood culture findings of S. aureus, enterococci, or coagulase negative staphylococci compared to viridans streptococci (AOR 20-48, p < 0.001), and a shorter duration of antibiotic treatment (p < 0.001), were associated to positive valve culture. One-year mortality was 13% and a relapse was identified in 2.5% of episodes. No association between positive valve cultures and one-year mortality or relapse was identified. CONCLUSIONS Positive valve cultures were associated to short preoperative antibiotic treatment, IE caused by staphylococci, preoperative fever and prosthetic valve but not to relapse or mortality.
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Affiliation(s)
- Gustav Johansson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Torgny Sunnerhagen
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medial Services, Lund, Sweden
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Patrik Gilje
- Department of Cardiology, Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden
| | - Sigurdur Ragnarsson
- Division of Cardiothoracic Surgery, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Magnus Rasmussen
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
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8
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Wang J, Hou J, Feng K, Wu H, Liu Q, Zhou Z, Li H, Luo L, Fu G, Shang L, Chen G, Huang S, Wu Z. Development and validation of a postoperative bleeding complications prediction model in infective endocarditis. Int J Cardiol 2024; 396:131432. [PMID: 37827281 DOI: 10.1016/j.ijcard.2023.131432] [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: 07/06/2023] [Revised: 09/23/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Bleeding complications are one of the most serious postoperative complications after cardiac surgery and are associated with high mortality, especially in patients with infective endocarditis (IE). Our objectives were to identify the risk factors and develop a prediction model for postoperative bleeding complications in IE patients. METHODS The clinical data of IE patients treated from October 2013 to January 2022 were reviewed. Multivariate logistic regression analysis was used to evaluate independent risk factors for postoperative bleeding complications and develop a prediction model accordingly. The prediction model was verified in a temporal validation cohort. The performance of the model was evaluated in terms of its discrimination power, calibration, precision, and clinical utility. RESULTS A total of 423 consecutive patients with IE who underwent surgery were included in the final analysis, including 315 and 108 patients in the training cohort and validation cohort, respectively. Four variables were selected for developing a prediction model, including platelet counts, systolic blood pressure, heart failure and vegetations on the mitral and aortic valves. In the training cohort, the model exhibited excellent discrimination power (AUC = 0.883), calibration (Hosmer-Lemeshow test, P = 0.803), and precision (Brier score = 0.037). In addition, the model also demonstrated good discrimination power (AUC = 0.805), calibration (Hosmer-Lemeshow test, P = 0.413), and precision (Brier score = 0.067) in the validation cohort. CONCLUSIONS We developed and validated a promising risk model with good discrimination power, calibration, and precision for predicting postoperative bleeding complications in IE patients.
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Affiliation(s)
- Junjie Wang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Hou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kangni Feng
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huawei Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Quan Liu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huayang Li
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Luo
- Department of Cardiac Surgery, First Affiliated Hospital of Xi'an Jiaotong University, China
| | - Guangguo Fu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liqun Shang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangxian Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Cardiothoracic Surgery ICU, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Miao H, Zhang Y, Zhang Y, Zhang J. Update on the epidemiology, diagnosis, and management of infective endocarditis: A review. Trends Cardiovasc Med 2024:S1050-1738(24)00001-X. [PMID: 38199513 DOI: 10.1016/j.tcm.2024.01.001] [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: 11/03/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/12/2024]
Abstract
Despite advancements in the diagnosis and treatment of infective endocarditis (IE), the burden of IE has remained relatively high over the past decade. With an ageing population and an increasing proportion of healthcare-associated IE, the epidemiology of IE has undergone significant changes. Staphylococcus aureus has evolved as the most common causative microorganism, even in most low- and middle-income countries. Several imaging modalities and novel microbiological tests have emerged to facilitate the diagnosis of IE. Outpatient parenteral antibiotic treatment and oral step-down antibiotic treatment have become new trends for the management of IE. Early surgical intervention, particularly within seven days, should be considered in cases of IE with appropriate surgical indications. We comprehensively review the updated epidemiology, microbiology, diagnosis, and management of IE.
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Affiliation(s)
- Huanhuan Miao
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Yuhui Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Yuqing Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China
| | - Jian Zhang
- Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, No. 167 Fuwai Hospital, Beilishi Rd. Xicheng District, Beijing 10037, China.
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10
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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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11
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Caproni S, Ottavi P, Borghetti V, Taddei G, Conti C, Riva A, Di Schino C, Costantini F, Colosimo C. Transient ischemic attack and minor stroke as "surgeons affairs": a narrative review. Neurol Sci 2023; 44:4233-4245. [PMID: 37542547 DOI: 10.1007/s10072-023-06985-5] [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: 05/11/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE The scope of this paper is to review the subtypes of transient ischemic attack (TIA) and minor stroke (mS) in which a surgical treatment is needed, discussing the importance and the timing of a multidisciplinary approach, in order to achieve an optimized management and prevent major strokes or other critical complications. MATERIALS AND METHODS The keywords "transient ischemic attack," "minor stroke," "surgical treatment," "vascular surgery," "heart surgery," "neurosurgery," and "multidisciplinary" were searched using MEDLINE, EMBASE, and Scopus. Relevant search results were discussed by the authors for references inclusion. RESULTS Notwithstanding that best medical therapy is usually the first choice for the most part of cases, there are specific but recurrent etiologies that must be properly recognized because of a potential surgical approach, even in urgency. In fact, symptomatic carotid stenosis, or particular cases of hemodynamic cerebrovascular events, should be promptly referred to vascular surgeon, since increasing evidences highlighted a benefit from an early artery revascularization. In addition, beyond arrhythmic causes, cardioembolic events due to bacterial endocarditis and atrial myxoma should be quickly diagnosed, possibly in emergency department, because they are a presumptive urgency for heart surgery. In addition to the above-mentioned conditions, in patients suffering from vertebrobasilar TIA or mS, clinicians should keep in mind the Bow Hunter disease, because surgical artery decompression can represent the only suitable treatment in selected cases. CONCLUSIONS TIA and mS require a multidisciplinary in order to discuss therapeutic options, comparing risks and benefits and determining the best timing for an optimized management.
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Affiliation(s)
- S Caproni
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy.
| | - P Ottavi
- Vascular Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - V Borghetti
- Heart Surgery, Cardio-Thoraco-Vascular Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - G Taddei
- Neurosurgery, Surgery Department, "S. Maria Goretti" Hospital, Via Lucia Scaravelli, 04100, Latina, Italy
| | - C Conti
- Neurosurgery, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - A Riva
- Neurology, Medicine Department, "Università Politecnica delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Chiara Di Schino
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - F Costantini
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
| | - C Colosimo
- Neurology and Stroke Unit, Neuroscience Department, "S. Maria" University Hospital, via Tristano di Joannuccio 1, 05100, Terni, Italy
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12
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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: 186] [Impact Index Per Article: 186.0] [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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13
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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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14
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Miller PC, Schulte LJ, Marghitu T, Huang S, Kaneko T, Damiano RJ, Kachroo P. Outcomes of double-valve surgery for infective endocarditis are improving in the modern era. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00898-X. [PMID: 37802331 DOI: 10.1016/j.jtcvs.2023.09.072] [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: 05/12/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The incidence of infective endocarditis (IE) is rapidly increasing. Contemporary outcomes following high-risk double valve surgery (DVS) for IE are not well described. METHODS Between 2001 and 2021, 211 patients with IE underwent combined aortic and mitral valve surgery at a tertiary care referral center. Data from the Society of Thoracic Surgeons registry, including demographics, operative details, and outcomes, were collected. Risk factors for 30-day and 1-year-mortality were analyzed. Survival was analyzed using Kaplan-Meier and Cox proportional hazards modeling. RESULTS The study cohort had a male preponderance (73%), with a median age of 56 years (interquartile range [IQR], 44 to 63 years). Forty-five patients (21%) had a history of intravenous (IV) drug abuse, 50 (24%) were on preoperative dialysis, and 50 (24%) had prosthetic valve endocarditis. Thirty-day and 1-year mortality were 14% (n = 30) and 30% (n = 61), respectively. On multivariable Cox regression adjusting for age, prosthetic valve endocarditis, postoperative intra-aortic balloon pump (IABP), history of dialysis (adjusted hazard ratio [aHR], 1.9; 95% confidence interval [CI], 1.3 to 2.9; P = .002) and IV drug abuse (aHR, 2.0; 95% CI, 1.1-3.5; P = .02) were predictive of decreased survival. Undergoing surgery after 2010 was predictive of improved survival (aHR, 0.5; 95% CI, 0.3 to 0.8; P = .006). These patients were more likely to undergo urgent/emergent surgery (83% vs 29%; P < .001) and less likely to have an aortic root abscess (40% vs 58%; P = .03) or to require the commando procedure (13% vs 33%; P = .002). CONCLUSIONS In this large series evaluating outcomes of DVS for IE in the modern era, although the mortality risk remained elevated, improving outcomes may be associated with earlier surgical intervention before significant disease progression. Multidisciplinary evaluation for complex IE may be considered to better understand the optimal timing and repair strategy.
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Affiliation(s)
| | - Linda J Schulte
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo
| | | | | | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo
| | - Puja Kachroo
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Mo.
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15
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Zulet P, Olmos C, López J, Vilacosta I, Sáez C, Cabezón G, Gómez D, Jerónimo A, Pérez-Serrano J, San Román JA. Impact of transfer to reference centres and surgical timing on the prognosis of surgically treated patients with infective endocarditis: a prospective multi-centre cohort study. Clin Microbiol Infect 2023; 29:1197.e1-1197.e7. [PMID: 37302571 DOI: 10.1016/j.cmi.2023.06.003] [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: 03/29/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare outcomes in patients with infective endocarditis (IE) first treated in secondary hospitals and then transferred to reference centres for surgery with those in patients diagnosed in reference centres, and to evaluate the impact of surgery timing on prognosis. METHODS Analysis of a prospective cohort of patients with active IE admitted to three reference centres between 1996 and 2022 who underwent cardiac surgery in the first month after diagnosis. Multi-variable analysis was performed to evaluate the impact of transfer to reference centres and time to surgery on 30-day mortality. Adjusted ORs with 95% CIs were calculated. RESULTS Amongst 703 patients operated on for IE, 385 (54.8%) were referred cases. All-cause 30-day mortality did not differ significantly between referred patients and those diagnosed at reference centres (102/385 [26.5%] vs. 78/385 [24.5%], respectively; p 0.552). Variables independently associated with 30-day mortality in the whole cohort were diabetes (OR, 1.76 [95% CI, 1.15-2.69]), chronic kidney disease (OR, 1.83 [95% CI, 1.08-3.10]), Staphylococcus aureus (OR, 1.88 [95% CI, 1.18-2.98]), septic shock (OR, 2.76 [95% CI, 1.67-4.57]), heart failure (OR, 1.41 [95% CI, 0.85-2.11]), acute renal failure before surgery (OR, 1.76 [95% CI, 1.15-2.69]), and the interaction between transfer to reference centres and surgery timing (OR, 1.18 [95% CI, 1.03-1.35]). Amidst referred patients, time from diagnosis to surgery longer than a week was independently associated with 30-day mortality (OR, 2.19 [95% CI, 1.30-3.69]; p 0.003). CONCLUSION Among referred patients, surgery performed >7 days after diagnosis was associated with two-fold higher 30-day mortality.
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Affiliation(s)
- Pablo Zulet
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain.
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Carmen Sáez
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - Gonzalo Cabezón
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Daniel Gómez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Adrián Jerónimo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Madrid, Spain
| | - Javier Pérez-Serrano
- Hospital Universitario La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de La Princesa (IIS-IP), Madrid, Spain
| | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico, Valladolid, Spain; Ciber de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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16
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Yarrarapu SNS, Ottun ARA, Arty F, Ravilla J, Mohan G, Tayyeb M, Anwar D. Infective Endocarditis Complicated by Iatrogenic Intracranial Hemorrhage Secondary to Cefazolin-Induced Coagulopathy. Cureus 2023; 15:e44875. [PMID: 37814735 PMCID: PMC10560317 DOI: 10.7759/cureus.44875] [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: 09/07/2023] [Indexed: 10/11/2023] Open
Abstract
Infective endocarditis can be acute or subacute. It can be caused by viral, bacterial, fungal, and sometimes nonbacterial etiologies. It is an important cause of mortality and morbidity in children as well as adolescents, despite advances in management. A 59-year-old male with a past medical history of aortic valve (AV) replacement on warfarin presented to the Emergency Department with dull right flank pain and poor dentition on examination. Computerized tomography (CT) scans of the abdomen revealed the presence of splenic and renal infarcts. Warfarin was held after the international normalized ratio (INR) was noted to be elevated at 11. Following the activation of the sepsis bundle in the ER, he received intravenous fluids (30 cc/kg) and was started on vancomycin and ceftriaxone. On further evaluation, the transesophageal echocardiogram revealed mobile densities on the aortic surface concerning vegetation. Antibiotics were transitioned to cefazolin, gentamycin, and rifampin for the management of prosthetic valve endocarditis. The patient's INR improved to 3.5 on the third day of hospitalization, and heparin was initiated to maintain anticoagulation for the prosthetic valve. However, on the eighth day of hospitalization, the patient developed left-sided weakness and slurred speech. The CT head showed acute frontoparietal intracranial hemorrhage (ICH), with an INR noted to be 5. Heparin was reversed with protamine sulfate, and vitamin K was administered, following which the INR improved to 2.3. The patient was transferred to intensive care, but on the second day of the ICU stay, the INR again shot up to 6 with normal LFTS. The patient received vitamin K, but the INR only improved to 5. Subsequently, antibiotics were changed from cefazolin to nafcillin. INR thus fell to 1.6 in two days after changing the antibiotics. The patient was soon transferred to a higher center for aortic valve replacement. While few case reports have described severe coagulopathy induced by cefazolin, it is particularly seen with impaired renal function; however, our patient's renal function was completely normal. Coagulopathy is due to the drug's effect on intestinal flora and its structural methyl-thiadiazole side chain, which has similar effects as epoxide reductase inhibitors and results in INR elevation. Patients on cefazolin need to be closely monitored for INR levels every day, as there is a high likelihood of developing complications like ICH, as noted in this patient. While the monitoring of cefazolin levels is not necessarily indicated, it is necessary to place patients on fall precautions and monitor INR levels every day, as mentioned above.
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Affiliation(s)
| | | | - Fnu Arty
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | - Gaurav Mohan
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Muhammad Tayyeb
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - David Anwar
- Cardiology, Monmouth Medical Center, Long Branch, USA
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17
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Fernández-Ruiz M, Aguado JM. Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis. Clin Microbiol Infect 2023; 29:1103-1106. [PMID: 37061092 DOI: 10.1016/j.cmi.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario '12 de Octubre', Instituto de Investigación Sanitaria Hospital '12 de Octubre' (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain.
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18
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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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19
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Rahman A, Alqaisi S, Nath J. An Unexpected Outcome of Streptococcus sanguinis Endocarditis Associated With Orthodontic Bracing in a Young Healthy Patient. Cureus 2023; 15:e39864. [PMID: 37404441 PMCID: PMC10315059 DOI: 10.7759/cureus.39864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
We present a case of Streptococcus sanguinis endocarditis in a 26-year-old female following orthodontic bracing. The rarity and debilitating consequences of endocarditis caused by Streptococcus sanguinis are elaborated. The patient exhibited severe regurgitation with the eccentric posteriorly directed flow, leading to significant cardiac strain, further accentuated by systolic flow reversal in the right superior pulmonary vein. Surgical intervention, including mitral valve replacement, was crucial in addressing the underlying infection, restoring valve function, and preventing further complications. However, a second mitral valve replacement was performed due to recurrent bioprosthesis endocarditis. This case underscores the unique challenges of Streptococcus sanguinis endocarditis, emphasizing the need for a multidisciplinary approach and individualized decision-making to optimize patient care.
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Affiliation(s)
- Ali Rahman
- Internal Medicine, Mather Hospital, Northwell Health, Port Jefferson, USA
| | - Sura Alqaisi
- Internal Medicine, Memorial Healthcare, Pembroke Pines, USA
| | - Jayant Nath
- Cardiology/Imaging, Memorial Healthcare, Pembroke Pines, USA
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20
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Fernández-Cisneros A, Andreu A, Hernández-Meneses M, Llopis J, Sandoval E, Pereda D, Alcocer J, Castellá M, Miró JM, Quintana E. Does Quality of Life in Survivors of Surgery for Acute Left-Sided Infective Endocarditis Differ from Non-Endocarditis Patients? Microorganisms 2023; 11:microorganisms11041058. [PMID: 37110481 PMCID: PMC10142739 DOI: 10.3390/microorganisms11041058] [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: 03/19/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Surgery for left-sided infective endocarditis (IE) has been demonstrated to improve patients' survival rates but information about quality of life (QoL) after surgery is scarce. The aim of this study was to assess the postoperative outcomes and QoL after surgery for IE patients compared to patients undergoing cardiac surgery for non-IE indications. Adult patients with definite acute left-sided IE were matched 1:1 to patients who underwent cardiac surgery for non-endocarditic purposes from 2014 to 2019. QoL was assessed using the SF-36 survey at the last follow-up. A total of 105 patients were matched. The IE group had higher rates of preoperative stroke (21% vs. 7.6%, p = 0.005) and higher stages of NYHA class (p < 0.001), EuroSCORE II (12.3 vs. 3.0, p < 0.001) and blood cell count abnormalities (p < 0.001). The IE group had higher incidence of low cardiac output syndrome (13.3% vs. 4.8%, p = 0.029), dialysis (10.5% vs 1.0%, p = 0.007) and prolonged mechanical ventilation (16.2% vs. 2.9%, p = 0.002) after surgery. At the last follow-up, subcomponents of the SF-36 QoL survey were not different between the groups. Patients who underwent cardiac surgery for IE demonstrated a higher risk profile with a higher rate of postoperative complications. Once recovered from the acute phase of the disease, the reported QoL at follow-up was comparable to that of matched cardiac patients operated for non-IE purposes.
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Affiliation(s)
| | - Aida Andreu
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Marta Hernández-Meneses
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jaume Llopis
- Department of Genetics, Microbiology and Statistics, Faculty of Biology, University of Barcelona, 08036 Barcelona, Spain
| | - Elena Sandoval
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Daniel Pereda
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jorge Alcocer
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Manuel Castellá
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Jose M Miró
- Infectious Diseases Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Eduard Quintana
- Cardiovascular Surgery Department, Hospital Clinic-IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
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21
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Charlesworth M, Williams B, Ray S. Infective endocarditis. BJA Educ 2023; 23:144-152. [PMID: 36960439 PMCID: PMC10028394 DOI: 10.1016/j.bjae.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023] Open
Affiliation(s)
- M. Charlesworth
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - B.G. Williams
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S. Ray
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Manchester, UK
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22
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Surgical Atrial Septal Patch Endocarditis in a Patient with a Complete Corrected Atrioventricular Canal Defect: A Case Report and Review of the Literature. Diagnostics (Basel) 2023; 13:diagnostics13050856. [PMID: 36900000 PMCID: PMC10000392 DOI: 10.3390/diagnostics13050856] [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: 02/09/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Infective endocarditis (IE) is common in patients with corrected congenital heart disease (CHD) with a residual lesion, but is rarely found on surgical patches used to close atrial septal defects (ASDs). This is also reflected in the current guidelines that do not recommend antibiotic therapy for patients with a repaired ASD with no residual shunt six months after closure (percutaneous or surgical). However, the situation could be different in the case of mitral valve endocarditis, which causes leaflet disruption with severe mitral insufficiency and could seed the surgical patch. We present herein a 40-year-old male patient with a past medical history of a complete surgically corrected atrioventricular canal defect performed in childhood who presented with fever, dyspnea and severe abdominal pain. Transthoracic and transesophageal echocardiography (TTE and TEE) revealed vegetation at the level of the mitral valve and the interatrial septum. The CT scan confirmed ASD patch endocarditis and multiple septic emboli, guiding the therapeutic management. An accurate evaluation of cardiac structures should be mandatory when a systemic infection is detected in CHD patients, even if the defects were surgically corrected, because the detection and eradication of such infectious foci as well as a surgical reintervention are particularly difficult to achieve in this subpopulation.
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23
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Agrawal A, Arockiam AD, Jamil Y, El Dahdah J, Honnekeri B, Chedid El Helou M, Kassab J, Wang TKM. Contemporary risk models for infective endocarditis surgery: a narrative review. Ther Adv Cardiovasc Dis 2023; 17:17539447231193291. [PMID: 37646184 PMCID: PMC10469256 DOI: 10.1177/17539447231193291] [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: 02/28/2023] [Accepted: 07/21/2023] [Indexed: 09/01/2023] Open
Abstract
Infective endocarditis is a complex heterogeneous condition involving the infection of the endocardium and heart valves, leading to severe complications, including death. Surgery is often indicated in patients with infective endocarditis but is associated with elevated risk compared with other forms of cardiac surgery. Risk models play an important role in many cardiac surgeries as they can help inform clinicians and patients regarding procedural risk, decision-making to proceed or not, and influence perioperative management; however, they remain under-utilized in the infective endocarditis settings. Another crucial role of such risk models is to assess predicted versus found mortality, thereby allowing an assessment of institutional performance in infective endocarditis surgery. Traditionally, general cardiac surgery risk models such as European System for Cardiac Operative Risk Evaluation (EuroSCORE), EuroSCORE II, and Society of Thoracic Surgeon's score have been applied to endocarditis surgery. However, there has been the development of many endocarditis surgery-specific scores over the last decade. This review aims to discuss clinical characteristics and applications of all contemporary risk scores in the setting of surgical treatment of infective endocarditis.
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Affiliation(s)
- Ankit Agrawal
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aro Daniela Arockiam
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yasser Jamil
- Yale-Waterbury, Department of Internal Medicine, Yale School of Medicine, Waterbury, CT, USA
| | - Joseph El Dahdah
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bianca Honnekeri
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Michel Chedid El Helou
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Main Campus, J1-5, Cleveland, OH 44195, USA
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24
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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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Li J, Ruegamer T, Brochhausen C, Menhart K, Hiergeist A, Kraemer L, Hellwig D, Maier LS, Schmid C, Jantsch J, Schach C. Infective Endocarditis: Predictive Factors for Diagnosis and Mortality in Surgically Treated Patients. J Cardiovasc Dev Dis 2022; 9:jcdd9120467. [PMID: 36547464 PMCID: PMC9788195 DOI: 10.3390/jcdd9120467] [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: 10/18/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Diagnosis of infective endocarditis (IE) often is challenging, and mortality is high in such patients. Our goal was to characterize common diagnostic tools to enable a rapid and accurate diagnosis and to correlate these tools with mortality outcomes. Methods: Because of the possibility of including perioperative diagnostics, only surgically treated patients with suspected left-sided IE were included in this retrospective, monocentric study. A clinical committee confirmed the diagnosis of IE. Results: 201 consecutive patients (age 64 ± 13 years, 74% male) were finally diagnosed with IE, and 14 patients turned out IE-negative. Preoperative tests with the highest sensitivity for IE were positive blood cultures (89.0%) and transesophageal echocardiography (87.5%). In receiver operating characteristics, vegetation size revealed high predictive power for IE (AUC 0.800, p < 0.001) with an optimal cut-off value of 11.5 mm. Systemic embolism was associated with mortality, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) had predictive power for mortality. Conclusion: If diagnostic standard tools remain inconclusive, we suggest employing novel cut-off values to increase diagnostic accuracy and accelerate diagnosis. Patients with embolism or elevated NT-proBNP deserve a closer follow-up.
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Affiliation(s)
- Jing Li
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Tamara Ruegamer
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Department for Pathology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Karin Menhart
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Andreas Hiergeist
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lukas Kraemer
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Dirk Hellwig
- Department for Nuclear Medicine, University Heart Center, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Lars S. Maier
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christof Schmid
- Department for Cardiac, Thoracic and Cardiovascular Surgery, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstraße 19-21, 50935 Köln, Germany
| | - Christian Schach
- Department for Internal Medicine II, University Heart Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
- Correspondence: ; Tel.: +49-941-944-7210; Fax: +49-941-944-7235
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26
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Primus CP, Woldman S. Infective Endocarditis Remains a Deadly Disease-It's Bad News, Especially When Staphylococci and Enterococci Are Involved: A Call to Action. J Am Heart Assoc 2022; 11:e026788. [PMID: 35946465 PMCID: PMC9496283 DOI: 10.1161/jaha.122.026788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christopher P Primus
- Barts Heart Centre St Bartholomew's Hospital, Barts Health NHS Trust London United Kingdom
| | - Simon Woldman
- Barts Heart Centre St Bartholomew's Hospital, Barts Health NHS Trust London United Kingdom.,University College London London United Kingdom
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27
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Amirkhosravi F, Al Abri Q, Lu AJ, El Nihum LI, Eng RK, von Ballmoos MCW, Ramchandani MK. Acute mitral valve regurgitation secondary to papillary muscle rupture due to infective endocarditis. J Cardiothorac Surg 2022; 17:173. [PMID: 35804449 PMCID: PMC9270734 DOI: 10.1186/s13019-022-01854-2] [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: 11/30/2021] [Accepted: 04/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines. CASE PRESENTATION This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge. CONCLUSION In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.
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Affiliation(s)
| | - Qasim Al Abri
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Smith Tower Suite 1401, Houston, TX, 77030, USA
| | | | | | - Renee K Eng
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Moritz C Wyler von Ballmoos
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Smith Tower Suite 1401, Houston, TX, 77030, USA
| | - Mahesh K Ramchandani
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin St, Smith Tower Suite 1401, Houston, TX, 77030, USA.
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28
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Bea C, Vela S, García-Blas S, Perez-Rivera JA, Díez-Villanueva P, de Gracia AI, Fuertes E, Oltra MR, Ferrer A, Belmonte A, Santas E, Pellicer M, Colomina J, Doménech A, Bodi V, Forner MJ, Chorro FJ, Bonanad C. Infective Endocarditis in the Elderly: Challenges and Strategies. J Cardiovasc Dev Dis 2022; 9:jcdd9060192. [PMID: 35735821 PMCID: PMC9224959 DOI: 10.3390/jcdd9060192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.
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Affiliation(s)
- Carlos Bea
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sara Vela
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Sergio García-Blas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
| | | | | | - Ana Isabel de Gracia
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Eladio Fuertes
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Maria Rosa Oltra
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Ana Ferrer
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Andreu Belmonte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
| | - Enrique Santas
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Mauricio Pellicer
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
| | - Javier Colomina
- Servicio de Microbiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Alberto Doménech
- Servicio de Cirugía Cardiovascular, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain;
| | - Vicente Bodi
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Maria José Forner
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (C.B.); (S.V.); (A.I.d.G.); (E.F.); (M.R.O.); (A.F.); (A.B.); (M.J.F.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
| | - Francisco Javier Chorro
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red-Cardiovascular, 28029 Madrid, Spain
| | - Clara Bonanad
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain; (S.G.-B.); (E.S.); (M.P.); (V.B.); (F.J.C.)
- Instituto de Investigación Sanitaria INCLIVA, 46010 Valencia, Spain
- Departamento de Medicina, Universidad de Valencia, 46010 Valencia, Spain
- Correspondence:
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29
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Aldred B, Drekonja DM. Timing of Patient Management Decisions Relative to Echocardiography in Staphylococcus aureus Bacteremia; A Single-Center Retrospective Analysis. Open Forum Infect Dis 2022; 9:ofac290. [PMID: 35873286 PMCID: PMC9297306 DOI: 10.1093/ofid/ofac290] [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: 05/07/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with Staphylococcus aureus bacteremia (SAB), endocarditis evaluation includes transthoracic echocardiography (TTE) and, in patients at increased risk of endocarditis, subsequent transesophageal echocardiography (TEE). In patients deemed to warrant TEE, it has not been well-studied whether performing TTE prior to TEE influences clinicians’ decision-making.
Methods
This retrospective case series studied clinician behavior at a large Veterans Affairs medical center regarding the care of adult patients diagnosed with SAB who completed both TTE and TEE (n = 206 episodes of SAB). The timing of key patient management decisions were compared to the timing of the patient’s TTE and TEE. It was inferred whether each management decision could have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included: documentation of antibiotic treatment duration, initiation of synergistic antibiotics, consultation of relevant specialists, ordering of relevant imaging studies, and performance of valve surgery or cardiac device explanation.
Results
The primary outcome (any of the above five management decisions taking place) occurred after completion of TTE but prior to TEE in 13 SAB episodes (6.3%). The primary outcome occurred after completion of both TTE and TEE in 178 SAB episodes (86.4%). Documentation of antibiotic treatment duration accounted for the large majority of observed management decisions.
Conclusion
Among patients with SAB who are deemed to warrant TEE for endocarditis evaluation, TTE results alone rarely prompt clinical management decisions.
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Affiliation(s)
- Bruce Aldred
- Infectious Diseases Fellow Department of Infectious Diseases and International Medicine University of Minnesota Minneapolis , MN , USA
| | - Dimitri Maximilian Drekonja
- Chief, Infectious Disease Section , Minneapolis VA Health Care System Minneapolis VA Health Care System Minneapolis, MN , USA
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30
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Vervoort D, An KR, Elbatarny M, Tam DY, Quastel A, Verma S, Connelly KA, Yanagawa B, Fremes SE. Dealing with the epidemic of endocarditis in people who inject drugs. Can J Cardiol 2022; 38:1406-1417. [PMID: 35691567 DOI: 10.1016/j.cjca.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-sided IE compared to those with non-IDU-IE and a majority are a result of S. aureus. While most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part related to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons but also infectious disease specialists, drug addiction experts, social workers, neurologists and/or neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns such as overdoses. In this review, we describe the pathophysiological, clinical, surgical, social, and ethical characteristics of IDU-IE and the management thereof. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Quastel
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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31
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Zeng X, Wu J, Li X, Xiong W, Tang L, Li X, Zhuang J, Yu R, Chen J, Jian X, Lei L. Application of Metagenomic Next-Generation Sequencing in the Etiological Diagnosis of Infective Endocarditis During the Perioperative Period of Cardiac Surgery: A Prospective Cohort Study. Front Cardiovasc Med 2022; 9:811492. [PMID: 35369282 PMCID: PMC8965566 DOI: 10.3389/fcvm.2022.811492] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 12/13/2022] Open
Abstract
Objective The present study aimed to prospectively evaluate the role of metagenomic next-generation sequencing (mNGS) in the etiological diagnosis of patients with perioperative infective endocarditis (IE). Methods From May 1st, 2019 to December 31st, 2020, a total of 99 patients with IE were enrolled in the present study according to the modified Duke criteria, etiological, and pathological results. 11 non-IE patients undergoing heart valve surgery in the same period were selected as the control group. A blood culture test was performed immediately after admission, and the valves harvested operatively were examined by blood culture and mNGS. Results In the IE group, there were 29 cases (29.3%) with positive blood culture, 16 cases (16.2%) with positive valve culture, and 85 cases (85.9%) with positive valve mNGS. Compared to culture-based detection, mNGS achieved better performance with a sensitivity, specificity, area under the curve (AUC) of 0.859, 0.727, and 0.793, respectively. The combined approach using culture and mNGS further improved the diagnostic accuracy (sensitivity 89.9%, specificity 72.7%, AUC 0.813). Preoperative white blood cell (P = 0.029) and neutrophils (P = 0.046) were identified as independent factors affecting the detection rate of mNGS. In the mNGS-positive group, 95 strains of pathogens were found and 10 cases were identified with mixed infection. There were 72 gram-positive bacteria and 14 gram-negative bacteria. mNGS positive group displayed higher species richness than mNGS negative group with enrichment of Streptococcus sanguis, Streptococcus buccalis, and Streptococcus griseus. Proteobacteria and Actinomycetes were enriched in mNGS negative group. Notably, six patients showed disconcordant results between culture and mNGS. Rothia aeria was identified in the blood culture, valve culture, and valve mNGS in one patient. Bartonella Quintana and Coxiella burnetii, which were fastidious intracellular bacteria, were found in two blood and valve culture-negative cases. Conclusions mNGS outperformed the conventional culture method and displayed high accuracy in detecting pathogens in IE patients. This study provided support for the use of mNGS in the etiological diagnosis of IE.
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Affiliation(s)
- Xiaodong Zeng
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinlin Wu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xin Li
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weiping Xiong
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lili Tang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xueming Li
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | | | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Xuhua Jian
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liming Lei
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
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Mills MT, Al-Mohammad A, Warriner DR. Changes and advances in the field of infective endocarditis. Br J Hosp Med (Lond) 2022; 83:1-11. [DOI: 10.12968/hmed.2021.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. Thus, patients with infective endocarditis may first present to the acute or general physician, who may have a variable knowledge of the condition. The diagnosis of infective endocarditis can be challenging, relying on clinical, imaging and microbiological features. Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
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Affiliation(s)
- Mark T Mills
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdallah Al-Mohammad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David R Warriner
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Department of Cardiology, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Zhang M, Ge Q, Qiao T, Wang Y, Xia X, Zhang X, Zhou J. Prognostic Value of Lymphocyte-to-White Blood Cell Ratio for In-Hospital Mortality in Infective Endocarditis Patients. Int J Clin Pract 2022; 2022:8667054. [PMID: 35685545 PMCID: PMC9159181 DOI: 10.1155/2022/8667054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/31/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background The prognosis of Infective endocarditis (IE) is poor, and we conducted this investigation to evaluate the worth of admission lymphocyte-to-white blood cell ratio (LWR) for prediction of short-term outcome in IE patients. Methods We retrospectively assessed the medical records of 147 IE patients from January 2017 to December 2019. Patients were divided into the survivor group and nonsurvivor group. Univariate and multivariate analyses were applied to estimate the independent factors contribution to in-hospital death, and receiver-operator characteristic (ROC) curve was utilized to check the performance. Results The levels of LWR (0.17 ± 0.08 vs. 0.10 ± 0.06) were significantly increased among the survivor group compared with the nonsurvivor group (P = 0.001). Multivariate analysis displayed that LWR (hazard ratio (HR): 1.755, 1.304-2.362, P < 0.001) was not interfered by other confounding factors for early death. Moreover, ROC analysis suggested that LWR (cutoff value = 0.10) performed the best among assessed indexes for the forecast of primary outcome (area under curve (AUC) = 0.750, 95% confidence interval (CI) = 0.634-0.867, P < 0.001, sensitivity = 70.0%, specificity = 76.4%), and the proportion of in-hospital mortality was remarkably inferior in patients with LWR > 0.10 than in those with LWR ≤ 0.10. (5.83% vs. 31.8%, P < 0.001). Conclusions LMR is an independent, simple, universal, inexpensive, and reliable prognostic parameter to identify high-risk IE patients for in-hospital mortality.
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Affiliation(s)
- Mengying Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Qiuxia Ge
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Tengfei Qiao
- Department of Laboratory Medicine, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yaman Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Xiaohong Xia
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Xiang Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
| | - Jun Zhou
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, China
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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Pavasini R, Tan TC, Sinning C. Timing for diagnosis and treatment in initially uncomplicated endocarditis: still a thorny issue. Eur Heart J Case Rep 2022; 6:ytab348. [PMID: 35187391 PMCID: PMC8852256 DOI: 10.1093/ehjcr/ytab348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Rita Pavasini
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Cona, Ferrara 44124, Italy
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, Western Sydney University, 18 Blacktown Rd, Blacktown New South Wales 2148, Australia
| | - Christoph Sinning
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20251 Hamburg, Germany
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Huang S, Zhou Z, Luo L, Yue Y, Liu Q, Feng K, Hou J, Wang K, Chen J, Li H, Huang L, Fu G, Chen G, Liang M, Wu Z. Preoperative serum albumin: a promising indicator of early mortality after surgery for infective endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1445. [PMID: 34733997 PMCID: PMC8506743 DOI: 10.21037/atm-21-3913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022]
Abstract
Background Despite novel improvements in the diagnosis and treatment of infective endocarditis (IE), there has been no significant improvement in the survival rate of IE, which indicates that many details still need to be optimized in the preoperative assessment. We sought to evaluate preoperative serum albumin as a biomarker for predicting early mortality after IE surgery. Methods Between October 2013 and June 2019, patients with a definite diagnosis of IE were enrolled in this study. Patients’ albumin levels at admission were used as the preoperative albumin levels. Restricted cubic spline and multivariate logistic regression analyses were performed to evaluate the relationship between albumin and early mortality. Receiver operating characteristic curve analyses were performed to assess the role of albumin in predicting early mortality and compare the predictive capacity of traditional models with models that included albumin. Results Of the 276 IE patients, 20 (7.2%) died in hospital or within 30 days of surgery. Hypoalbuminemia (an albumin level <3.5 g/dL) was present in 109 (39.5%) patients. The multivariate logistic regression analysis showed that preoperative albumin was inversely associated with early mortality [adjusted odds ratio (OR) =0.22 per 1 g/dL, 95% confidence interval (CI): 0.07–0.65, P=0.006] after full adjustment. Preoperative albumin had value in predicting early mortality [area under the curve (AUC) =0.72, 95% CI: 0.61–0.84; P<0.01]. After adding albumin to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Charlson score, the predictive ability of the model was further improved (EuroSCORE II: AUC =0.55; 95% CI: 0.42–0.67 to AUC =0.72; 95% CI: 0.61–0.84; Charlson score: AUC =0.73; 95% CI: 0.64–0.83 to AUC =0.78; 95% CI: 0.68–0.88). Conclusions Preoperative serum albumin is inversely associated with early mortality after IE surgery, and is a promising prognostic indicator in preoperative risk stratification assessments of IE patients.
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Affiliation(s)
- Suiqing Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhuoming Zhou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Li Luo
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yuan Yue
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Quan Liu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Kangni Feng
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Hou
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Keke Wang
- Department of Emergency, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiantao Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Huayang Li
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Lin Huang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Guangguo Fu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Guangxian Chen
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengya Liang
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhongkai Wu
- Department of Cardiac Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Suardi LR, de Alarcón A, García MV, Ciezar AP, Hidalgo Tenorio C, Martinez-Marcos FJ, Concejo-Martínez E, De la Torre Lima J, Vinuesa García D, Luque Márquez R, Ojeda G, Reguera Iglesias JM, Lomas JM, Lopez-Cortes LE. Blood culture-negative infective endocarditis: a worse outcome? Results from a large multicentre retrospective Spanish cohort study. Infect Dis (Lond) 2021; 53:755-763. [PMID: 34038316 DOI: 10.1080/23744235.2021.1925342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND To assess the impact of blood cultures negative infective endocarditis (BCNIE) on in-hospital mortality. METHODS Prospective multicentre study with retrospective analysis of a Spanish cohort including adult patients with definite IE. Cardiac implantable devices infection were excluded. Comparisons between blood cultures positive and BCNIE groups were performed to analyse in-hospital mortality. RESULTS 1001 cases were included of which 83 (8.3%) had BCNIE. Alternative microbiological diagnosis was achieved for 39 (47%) out 83 cases. The most frequent identifications were: Coxiella burnetii (11; 28.2%), Tropheryma whipplei (4; 10.3%), Streptococcus gallolyticus (4;10.3%) and Staphylococcus epidermidis (3; 7.7%). Surgery was performed more frequently in BCNIE group (57.8 vs. 36.9%, p < .001). All-cause in-hospital mortality rate was 26.7% without statistical difference between compared groups. BCNIE was not associated to worse mortality rate in Cox regression model (aHR = 1.37, 95% CI 0.90-2.07, p = .14). Absence of microbiological diagnosis was also not associated to worse in-hospital prognosis (aHR = 1.62, 95% CI 0.99-2.64, p = .06). CONCLUSIONS In our cohort, BCNIE was not associated to greater in-hospital mortality based in multivariate Cox regression models. The variables most frequently associated with mortality were indicated but not performed surgery (aHR = 2.48, 95% CI 1.73-3.56, p < .001), septic shock (aHR = 2.24, 95% CI 1.68-2.99, p < .001), age over 65 years (aHR = 1.88, 95% CI 1.40-2.52, p < .001) and complicated endocarditis (aHR = 1.79, 95% CI 1.36-2.37, p < .001).
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Affiliation(s)
- Lorenzo Roberto Suardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy/Infectious Diseases Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - María Victoria García
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - Antonio Plata Ciezar
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - Carmen Hidalgo Tenorio
- Staff of Infectious Diseases Unit, University Hospital Virgen de las Nieves/Biomedical Research Institute (IBS), Granada, Spain
| | | | | | | | | | - Rafael Luque Márquez
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Guillermo Ojeda
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen de la Victoria, Malaga, Spain
| | - José M Reguera Iglesias
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Regional University Hospital, Malaga, Spain
| | - José M Lomas
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Luis E Lopez-Cortes
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen Macarena, Department of Medicine, University of Seville, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain
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Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample. PLoS One 2021; 16:e0256757. [PMID: 34478475 PMCID: PMC8415585 DOI: 10.1371/journal.pone.0256757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/13/2021] [Indexed: 11/19/2022] Open
Abstract
Background The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use. Methods Hospitalizations of adult (≥18 years old) patients diagnosed with IE were identified in the 2016 National Inpatient Sample using ICD-10 codes. Multivariable logistic and linear regression were used to compare IE patient outcomes between those with and without pulmonary complications and to identify predictors of pulmonary complications. Interaction terms were used to assess the impact of drug-use IE (DU-IE) and pulmonary complications on inpatient outcomes. Results In 2016, there were an estimated 88,995 hospitalizations of patients diagnosed with IE. Of these hospitalizations,15,490 (17%) were drug-use related. Drug-use IE (DU-IE) had the highest odds of pulmonary complications (OR 2.97, 95% CI 2.50, 3.45). At least one pulmonary complication was identified in 6,580 (7%) of IE patients. DU-IE hospitalizations were more likely to have a diagnosis of pyothorax (3% vs. 1%, p<0.001), lung abscess (3% vs. <1%, p<0.001), and septic pulmonary embolism (27% vs. 2%, p<0.001). Pulmonary complications were associated with longer average lengths of stay (CIE 7.22 days 95% CI 6.11, 8.32), higher hospital charges (CIE 78.51 thousand dollars 95% CI 57.44, 99.57), more frequent post-discharge transfers (acute care: OR 1.37, 95% CI 1.09, 1.71; long-term care: OR 2.19, 95% CI 1.83, 2.61), and increased odds of inpatient mortality (OR 1.81 95% CI 1.39, 2.35). Conclusion and relevance IE with pulmonary complications is associated with worse outcomes. Patients with DU-IE have a particularly high prevalence of pulmonary complications that may require timely thoracic surgical intervention, likely owing to right-sided valve involvement. More research is needed to determine optimal management strategies for complications to improve patient outcomes.
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Varela Barca L, Fernández-Felix BM, Navas Elorza E, Mestres CA, Muñoz P, Cuerpo-Caballero G, Rodríguez-Abella H, Montejo-Baranda M, Rodríguez-Álvarez R, Gutiérrez Díez F, Goenaga MA, Quintana E, Ojeda-Burgos G, de Alarcón A, Vidal-Bonet L, Centella Hernández T, López-Menéndez J. Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis. Eur J Cardiothorac Surg 2021; 57:724-731. [PMID: 31782783 DOI: 10.1093/ejcts/ezz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.
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Affiliation(s)
- Laura Varela Barca
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Borja M Fernández-Felix
- University of Alcalá de Henares, Madrid, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | | | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón-Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hugo Rodríguez-Abella
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Regino Rodríguez-Álvarez
- Department of Cardiovascular Surgery, University Hospital Marques de Valdecilla, Santander, Spain
| | | | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC, University Hospital Virgen del Rocío, Seville, Spain
| | - Laura Vidal-Bonet
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Tomasa Centella Hernández
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jose López-Menéndez
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
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Lin YW, Jiang M, Wei XB, Huang JL, Su Z, Wang Y, Chen JY, Yu DQ. Prognostic value of D-dimer for adverse outcomes in patients with infective endocarditis: an observational study. BMC Cardiovasc Disord 2021; 21:279. [PMID: 34090346 PMCID: PMC8180106 DOI: 10.1186/s12872-021-02078-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/24/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Increased D-dimer levels have been shown to correlate with adverse outcomes in various clinical conditions. However, few studies with a large sample size have been performed thus far to evaluate the prognostic value of D-dimer in patients with infective endocarditis (IE). METHODS 613 patients with IE were included in the study and categorized into two groups according to the cut-off of D-dimer determined by receiver operating characteristic (ROC) curve analysis for in-hospital death: > 3.5 mg/L (n = 89) and ≤ 3.5 mg/L (n = 524). Multivariable regression analysis was used to determine the association of D-dimer with in-hospital adverse events and six-month death. RESULTS In-hospital death (22.5% vs. 7.3%), embolism (33.7% vs 18.2%), and stroke (29.2% vs 15.8%) were significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L. Multivariable analysis showed that D-dimer was an independent risk factor for in-hospital adverse events (odds ratio = 1.11, 95% CI 1.03-1.19, P = 0.005). In addition, the Kaplan-Meier curve showed that the cumulative 6-month mortality was significantly higher in patients with D-dimer > 3.5 mg/L than in those with D-dimer ≤ 3.5 mg/L (log-rank test = 39.19, P < 0.0001). Multivariable Cox regression analysis showed that D-dimer remained a significant predictor for six-month death (HR 1.11, 95% CI 1.05-1.18, P < 0.001). CONCLUSIONS D-dimer is a reliable prognostic biomarker that independently associated with in-hospital adverse events and six-month mortality in patients with IE.
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Affiliation(s)
- Ying-Wen Lin
- 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, Guangzhou, 510080, China
- Shantou University Medical College, Shantou, 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, Guangzhou, 510080, China
| | - Xue-Biao Wei
- 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, Guangzhou, 510080, China
- Department of Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 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, Guangzhou, 510080, China
| | - Zedazhong Su
- 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, Guangzhou, 510080, China
| | - Yu 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, Guangzhou, 510080, China
| | - Ji-Yan Chen
- 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, 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, Guangzhou, 510080, China.
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Godfrey R, Curtis S, Schilling WH, James PR. Blood culture negative endocarditis in the modern era of 16S rRNA sequencing. Clin Med (Lond) 2021; 20:412-416. [PMID: 32675149 DOI: 10.7861/clinmed.2019-0342] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Blood culture negative endocarditis (BCNE) accounts for up to 20% of infective endocarditis. While the most common cause of BCNE remains the initiation of antibiotics prior to culture, intracellular organisms such as Coxiella and Bartonella spp account for a significant proportion of cases. Identifying the infecting organism remains important to ensure optimal antimicrobial treatment. However, these organisms can be difficult to diagnose. We outline a systematic approach to BCNE. Over half of patients with infective endocarditis now undergo early surgery and 16S ribosomal ribonucleic acid (rRNA) polymerase chain reaction (PCR) of excised tissue can be vitally important to secure a diagnosis. Molecular testing is likely to become a key tool in improving outcomes from BCNE and contribute to an improved understanding of the aetiology. We advocate modifying the Duke criteria to incorporate organisms identified on molecular testing, including 16S rRNA PCR, in particular from explanted tissue.
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Affiliation(s)
| | - Sally Curtis
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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42
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Serota DP, Chueng TA, Schechter MC. Applying the Infectious Diseases Literature to People who Inject Drugs. Infect Dis Clin North Am 2021; 34:539-558. [PMID: 32782101 DOI: 10.1016/j.idc.2020.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
People who inject drugs (PWID) presenting with injection drug use-associated infections are an understudied population excluded from most prospective infectious disease (ID) clinical trials. Careful application of the existing ID literature to PWID must consider their unique medical, psychological, and social challenges. Identification and treatment of the underlying substance use disorder are key underpinnings to any successful ID intervention.
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Affiliation(s)
- David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA.
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, 1120 Northwest 14 Street, Suite 851, Miami, FL 33136, USA; Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA. https://twitter.com/teresachueng
| | - Marcos C Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303, USA. https://twitter.com/limbsandlungs
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43
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Arregle F, Martel H, Philip M, Gouriet F, Casalta JP, Riberi A, Torras O, Casalta AC, Camoin-Jau L, Lavagna F, Renard S, Ambrosi P, Lepidi H, Collart F, Hubert S, Drancourt M, Raoult D, Habib G. Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome. Arch Cardiovasc Dis 2021; 114:527-536. [PMID: 33935000 DOI: 10.1016/j.acvd.2021.01.004] [Citation(s) in RCA: 3] [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: 11/15/2020] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infective endocarditis (IE) is associated with a high mortality rate, related in part to neurological complications. Studies suggest that valvular surgery should be performed early when indicated, but is often delayed by the presence of neurological complications. AIM To assess the effect of delaying surgery in patients with IE and neurological complications and to identify factors predictive of death. METHODS In a prospective, single-centre study in a referral centre for IE, all patients with IE underwent systematic screening for neurological complications. The primary outcome was 6-month death. In patients presenting with neurological complications, the prognosis according to surgical status was analysed and a Cox regression model used to identify variables predictive of death. RESULTS Between April 2014 and January 2018, 351 patients with a definite diagnosis of left-sided IE were included. Ninety-four patients (26.8%) presented with at least one neurological complication. Fifty-nine patients (17.7%) died during 6-month follow-up. Six-month mortality rates did not differ significantly between patients with and without neurological complications (P=0.60). Forty patients had a temporary surgical contraindication because of neurological complications. During the period of surgical contraindication, seven of these patients (17.5%) died, six (15.0%) presented a new embolic event, and 12 (30.0%) presented cardiac or septic deterioration. In multivariable analysis, predictive factors of death in patients presenting with neurological complications were temporary surgical contraindication (hazard ratio 7.36, 95% confidence interval 1.61-33.67; P=0.010) and presence of a mechanical prosthetic valve (hazard ratio 16.40, 95% confidence interval 2.22-121.17; P=0.006). CONCLUSIONS Patients with a temporary surgical contraindication due to neurological complications had a higher risk of death and frequent major complications while waiting for surgery. When indicated, the decision to postpone surgery in the early phase should be weighed against the risk of infectious or cardiac deterioration.
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Affiliation(s)
- Florent Arregle
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Helene Martel
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Mary Philip
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Frederique Gouriet
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Jean Paul Casalta
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Olivier Torras
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | | | - Laurence Camoin-Jau
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France; Department of Hematology, La Timone Hospital, 13005 Marseille, France
| | - Flora Lavagna
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Sebastien Renard
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Pierre Ambrosi
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Hubert Lepidi
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Sandrine Hubert
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France
| | - Michel Drancourt
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Didier Raoult
- Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France
| | - Gilbert Habib
- AP-HM, La Timone Hospital, Cardiology Department, 13005 Marseille, France; Aix Marseille Univ, IRD, AP-HM, MEPHI, IHU-Méditerranée Infection, 13005 Marseille, France.
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Weininger G, Mori M, Geirsson A. Variables That Account for the Heterogeneity in Left-Sided Infective Endocarditis. Ann Thorac Surg 2021; 112:1034-1035. [PMID: 33484677 DOI: 10.1016/j.athoracsur.2020.11.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Gabe Weininger
- Section of Cardiac Surgery, Yale University School of Medicine, 330 Cedar St, New Haven, CT 06511
| | - Makoto Mori
- Section of Cardiac Surgery, Yale University School of Medicine, 330 Cedar St, New Haven, CT 06511
| | - Arnar Geirsson
- Section of Cardiac Surgery, Yale University School of Medicine, 330 Cedar St, New Haven, CT 06511.
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45
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De Palo M, Scicchitano P, Malvindi PG, Paparella D. Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis. Antibiotics (Basel) 2021; 10:antibiotics10010050. [PMID: 33419074 PMCID: PMC7825452 DOI: 10.3390/antibiotics10010050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/25/2020] [Accepted: 01/03/2021] [Indexed: 12/25/2022] Open
Abstract
The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).
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Affiliation(s)
- Micaela De Palo
- Section of Cardiac Surgery, A.O.U. Consorziale Policlinico di Bari, 70124 Bari, Italy
- Correspondence: (M.D.P.); (D.P.); Tel.: +39-080-559-4404 (M.D.P.); +39-080-919-9162 (D.P.)
| | - Pietro Scicchitano
- Section of Cardiology, F. Perinei Hospital, Altamura, 70022 Bari, Italy;
| | | | - Domenico Paparella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy
- Department of Medical and Surgical Science, University of Foggia, 71122 Foggia, Italy
- Correspondence: (M.D.P.); (D.P.); Tel.: +39-080-559-4404 (M.D.P.); +39-080-919-9162 (D.P.)
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46
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Infective endocarditis in intravenous drug users. Trends Cardiovasc Med 2020; 30:491-497. [DOI: 10.1016/j.tcm.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 12/16/2022]
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47
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Gatzoflias S, Beier MA, Ning Y, Kossar A, Gailes M, Guaman K, Segall M, Vasireddi A, Wang C, Takeda K, Takayama H, Bapat V, Naka Y, Argenziano M, Smith CR, Gordon R, Gutierrez J, Kurlansky P, George I. Efficacy of Primary Surgical Versus Medical Intervention for Treatment of Left-Sided Infective Endocarditis. Ann Thorac Surg 2020; 110:1615-1621. [DOI: 10.1016/j.athoracsur.2020.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/06/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
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48
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Escudero-Sánchez R, Mendoza Lizardo SS, Batlle López E, Campelo Gutierrez C, Losa García JE, Velasco Arribas M. [Impact of surgery on the mortality of infective endocarditis in a hospital without cardiac surgery]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:436-443. [PMID: 33045817 PMCID: PMC7712346 DOI: 10.37201/req/005.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery. METHODS Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke's criteria. RESULTS Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%). CONCLUSIONS Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened.
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Affiliation(s)
- R Escudero-Sánchez
- Rosa Escudero Sánchez, Servicio Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Ctra Colmenar Viejo, Km 9,1 (28034) Madrid (Spain).
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49
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Diab M, Musleh R, Lehmann T, Sponholz C, Pletz MW, Franz M, Schulze PC, Witte OW, Kirchhof K, Doenst T, Günther A. Risk of postoperative neurological exacerbation in patients with infective endocarditis and intracranial haemorrhage. Eur J Cardiothorac Surg 2020; 59:ezaa347. [PMID: 33036027 DOI: 10.1093/ejcts/ezaa347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cardiac surgery in patients with infective endocarditis (IE) and preoperative intracranial haemorrhage (pre-ICH) is a highly debatable issue, and guidelines are still not well defined. The goal of this study was to investigate the effect of cardiac surgery and its timing on the clinical outcomes of patients with IE and pre-ICH. METHODS We did a single-centre retrospective analysis of data from patients with preoperative brain imaging who had surgery for left-sided IE between January 2007 and May 2018. RESULTS Among the 363 patients included in the study, 34 had pre-ICH. Hospital mortality was similar between the patients with and without pre-ICH (29% vs 27%, respectively; P = 0.84). Unadjusted, postoperative neurological deterioration appeared higher in patients with pre-ICH (24% vs 17%; P = 0.35). In multivariable analysis, pre-ICH did not qualify as an independent predictor for either postoperative neurological deterioration [odds ratio 1.10, 95% confidence interval (CI) 0.44-2.73; P = 0.84] or hospital mortality (odds ratio 1.02, 95% CI 0.43-2.40; P = 0.96). Postoperative partial thromboplastin time was significantly elevated in 4 patients with relevant post-ICH compared with those patients without relevant post-ICH (65.5 vs 37.6, respectively; P = 0.004). CONCLUSIONS Pre-ICH was not an independent predictor for postoperative neurological deterioration or hospital mortality in patients with IE. Postoperative coagulation management seems to be crucial in patients with IE with ICH. Although this is to date the largest monocentric study addressing surgical decision and timing, the number of patients with pre-ICH was low. Therefore, these conclusions should be regarded with caution; randomized clinical trials are needed.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Rita Musleh
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Marcus Franz
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Klaus Kirchhof
- Division of Neuroradiology, Department of Radiology, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
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50
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Dixit N, Escobedo ES, Ebrahimi R. Use of the 1,3-β-D-Glucan Assay for the Early Detection of Fungal Endocarditis in a 45-Year-Old Man. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926206. [PMID: 33077701 PMCID: PMC7556349 DOI: 10.12659/ajcr.926206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Male, 45-year-old Final Diagnosis: Fungal endocarditis Symptoms: Cough • fever • hemiplegia • malaise • shortness of breath Medication: — Clinical Procedure: Endarterectomy • valve replacement surgery Specialty: Cardiology
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Affiliation(s)
- Neal Dixit
- Department of Internal Medicine, University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, USA
| | - Evelyn S Escobedo
- School of Medicine, University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, USA
| | - Ramin Ebrahimi
- Department of Internal Medicine, Cardiology Division, University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, USA
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