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Beaumont AL, Mestre F, Decaux S, Bertin C, Duval X, Iung B, Rouzet F, Grall N, Para M, Thy M, Deconinck L. Long-term Oral Suppressive Antimicrobial Therapy in Infective Endocarditis (SATIE Study): An Observational Study. Open Forum Infect Dis 2024; 11:ofae194. [PMID: 38737431 PMCID: PMC11083633 DOI: 10.1093/ofid/ofae194] [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: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 05/14/2024] Open
Abstract
Background The role of suppressive antimicrobial therapy (SAT) in infective endocarditis (IE) management has yet to be defined. The objective of this study was to describe the use of SAT in an IE referral center and the patients' outcomes. Methods We conducted a retrospective observational study in a French IE referral center (Paris). All patients with IE who received SAT between 2016 and 2022 were included. Results Forty-two patients were included (36 male [86%]; median age [interquartile range {IQR}], 73 [61-82] years). The median Charlson Comorbidity Index score (IQR) was 3 (1-4). Forty patients (95%) had an intracardiac device. The most frequent microorganisms were Enterococcus faecalis (15/42, 36%) and Staphylococcus aureus (12/42, 29%). SAT indications were absence of surgery despite clinical indication (28/42, 67%), incomplete removal of prosthetic material (6/42, 14%), uncontrolled infection source (4/42, 10%), persistent abnormal uptake on nuclear imaging (1/42, 2%), or a combination of the previous indications (3/42, 7%). Antimicrobials were mainly doxycycline (19/42, 45%) and amoxicillin (19/42, 45%). The median follow-up time (IQR) was 398 (194-663) days. Five patients (12%) experienced drug adverse events. Five patients (12%) presented with a second IE episode during follow-up, including 2 reinfections (different bacterial species) and 3 possible relapses (same bacterial species). Fourteen patients (33%) in our cohort died during follow-up. Overall, the 1-year survival rate was 84.3% (73.5%-96.7%), and the 1-year survival rate without recurrence was 74.1% (61.4%-89.4%). Conclusions SAT was mainly prescribed to patients with cardiac devices because of the absence of surgery despite clinical indication. Five (12%) breakthrough second IE episodes were reported. Prospective comparative studies are required to guide this empirical practice.
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Affiliation(s)
- Anne-Lise Beaumont
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Femke Mestre
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Sixtine Decaux
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Chloé Bertin
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Xavier Duval
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- Center of Clinical Investigations, Inserm, CIC 1425, Bichat Hospital, AP-HP, Paris, France
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - François Rouzet
- Nuclear Medicine Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, INSERM LVTS U1148, Paris, France
| | - Nathalie Grall
- Bacteriology Department, Bichat Hospital, AP-HP, Paris, France
- Université Paris-Cité, IAME, INSERM, Paris, France
| | - Marylou Para
- Department of Cardiac Surgery, Bichat Hospital, AP-HP, Paris, France
| | - Michael Thy
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
- EA7323, Pharmacology and Drug Evaluation in Children and Pregnant Women, Université Paris Cité, Paris, France
- Medical and Infectious Diseases ICU, Bichat Claude Bernard University Hospital, Université Paris Cité, AP-HP, Paris, France
| | - Laurène Deconinck
- Infectious & Tropical Diseases Department, Bichat Hospital, AP-HP, Paris, France
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Arjomandi Rad A, Zubarevich A, Osswald A, Vardanyan R, Magouliotis DE, Ansaripour A, Kourliouros A, Sá MP, Rassaf T, Ruhparwar A, Sardari Nia P, Athanasiou T, Weymann A. The Surgical Treatment of Infective Endocarditis: A Comprehensive Review. Diagnostics (Basel) 2024; 14:464. [PMID: 38472937 DOI: 10.3390/diagnostics14050464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Infective endocarditis (IE) is a severe cardiac complication with high mortality rates, especially when surgical intervention is delayed or absent. This review addresses the expanding role of surgery in managing IE, focusing on the variation in surgical treatment rates, the impact of patient demographics, and the effectiveness of different surgical approaches. Despite varying global data, a notable increase in surgical interventions for IE is evident, with over 50% of patients undergoing surgery in tertiary centres. This review synthesizes information from focused literature searches up to July 2023, covering preoperative to postoperative considerations and surgical strategies for IE. Key preoperative concerns include accurate diagnosis, appropriate antimicrobial treatment, and the timing of surgery, which is particularly crucial for patients with heart failure or at risk of embolism. Surgical approaches vary based on valve involvement, with mitral valve repair showing promising outcomes compared to replacement. Aortic valve surgery, traditionally favouring replacement, now includes repair as a viable option. Emerging techniques such as sutureless valves and aortic homografts are explored, highlighting their potential advantages in specific IE cases. The review also delves into high-risk groups like intravenous drug users and the elderly, emphasizing the need for tailored surgical strategies. With an increasing number of patients presenting with prosthetic valve endocarditis and device-related IE, the review underscores the importance of comprehensive management strategies encompassing surgical and medical interventions. Overall, this review provides a comprehensive overview of current evidence in the surgical management of IE, highlighting the necessity of a multidisciplinary approach and ongoing research to optimize patient outcomes.
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Affiliation(s)
- Arian Arjomandi Rad
- Medical Sciences Division, University of Oxford, Oxford OX3 9DU, UK
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Alina Zubarevich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Anja Osswald
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Robert Vardanyan
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | | | - Ali Ansaripour
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Antonios Kourliouros
- Department of Cardiothoracic Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery, UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA 15224, USA
| | - Tienush Rassaf
- Department of Cardiology, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, 45138 Essen, Germany
| | - Arjang Ruhparwar
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London SW7 5NH, UK
| | - Alexander Weymann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany
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Gill GS, Chakrala T, Kanmanthareddy A, Alla VM. Transcatheter vacuum aspiration of valvular and lead related infective endocarditis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:8-15. [PMID: 37331887 DOI: 10.1016/j.carrev.2023.06.006] [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: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes. METHODS PubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed. RESULTS Data from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50-85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each. CONCLUSIONS Transcatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.
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Affiliation(s)
- Gauravpal S Gill
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Teja Chakrala
- Department on Medicine, University of Florida, Gainesville, FL, USA
| | - Arun Kanmanthareddy
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA
| | - Venkata Mahesh Alla
- Division of Cardiovascular Disease, Creighton University School of Medicine, Omaha, NE, USA.
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Hémar V, Camou F, Roubaud-Baudron C, Ternacle J, Pernot M, Greib C, Dijos M, Wirth G, Chaussade H, Peuchant O, Bonnet F, Issa N. The Mortality of Infective endocarditis with and without Surgery in Elderly (MoISE) Study. Clin Infect Dis 2023; 77:1440-1448. [PMID: 37369092 DOI: 10.1093/cid/ciad384] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is increasingly affecting older patients. However, data on their management are sparse, and the benefits of surgery in this population are unclear. METHODS We included patients with left-sided IE (LSIE) aged ≥ 80 years enrolled in a prospective endocarditis cohort managed in Aquitaine, France, from 2013 to 2020. Geriatric data were collected retrospectively to identify factors associated with the 1-year risk of death using Cox regression. RESULTS We included 163 patients with LSIE (median age, 84 years; men, 59%; rate of prosthetic LSIE, 45%). Of the 105 (64%) patients with potential surgical indications, 38 (36%) underwent valve surgery: they were younger, more likely to be men with aortic involvement, and had a lower Charlson comorbidity index. Moreover, they had better functional status at admission (ie, the ability to walk unassisted and a higher median activities of daily living [ADL] score; n = 5/6 vs 3/6, P = .01). The 1-year mortality rate in LSIE patients without surgical indications was 28%; it was lower in those who were operated on compared with those who were not despite a surgical indication (16% vs 66%, P < .001). Impaired functional status at admission was strongly associated with mortality regardless of surgical status. In patients unable to walk unassisted or with an ADL score <4, there was no significant surgical benefit for 1-year mortality. CONCLUSIONS Surgery improves the prognosis of older patients with LSIE and good functional status. Surgical futility should be discussed in patients with altered autonomy. The endocarditis team should include a geriatric specialist.
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Affiliation(s)
- Victor Hémar
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Fabrice Camou
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Claire Roubaud-Baudron
- Pôle de Gérontologie Clinique, Bordeaux University Hospital Bordeaux, France
- INSERM BRIC UMR 1312, University of Bordeaux, Bordeaux, France
| | - Julien Ternacle
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Mathieu Pernot
- Cardiac Surgery Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Carine Greib
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Marina Dijos
- Cardiology Department, Bordeaux University Hospital-Haut-Lévêque, Pessac, France
| | - Gaetane Wirth
- Infectious Diseases Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Hélène Chaussade
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Olivia Peuchant
- Bacteriology Department, Bordeaux University Hospital-Pellegrin, Bordeaux, France
| | - Fabrice Bonnet
- Internal Medicine and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
| | - Nahéma Issa
- Intensive Care and Infectious Diseases Department, Bordeaux University Hospital-Saint-André Bordeaux, France
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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: 157] [Impact Index Per Article: 157.0] [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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6
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Ramos-Martínez A, Domínguez F, Muñoz P, Marín M, Pedraz Á, Fariñas MC, Tascón V, de Alarcón A, Rodríguez-García R, Miró JM, Goikoetxea J, Ojeda-Burgos G, Escrihuela-Vidal F, Calderón-Parra J. Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry. PLoS One 2023; 18:e0290998. [PMID: 37682961 PMCID: PMC10490835 DOI: 10.1371/journal.pone.0290998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment. METHODS Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed. RESULTS The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke. CONCLUSIONS Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
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Affiliation(s)
- Antonio Ramos-Martínez
- Unit of Infectious Diseases, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain
- Instituto Investigación Sanitaria Puerta de Hierro—Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Autonomous University of Madrid, Majadahonda, Spain
| | - Fernando Domínguez
- Department of Cardiology, University Hospital Puerta de Hierro, Majadahonda, Spain
| | - Patricia Muñoz
- Department of Cardiology, University Hospital Puerta de Hierro, Majadahonda, Spain
- Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
- Complutense University of Madrid, Madrid, Spain
| | - Mercedes Marín
- Department of Clinical Microbiology and Infectious Diseases, University General Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Álvaro Pedraz
- Department of Cardiac Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
| | - Mª Carmen Fariñas
- Department of Infectious Diseases, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
- CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Institute of Health Carlos III, Madrid, Spain
- University of Cantabria, Santander, Spain
| | - Valentín Tascón
- Department of Cardiovascular Surgery, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS), Seville, Spain
- University of Seville/CSIC/University, Seville, Spain
- Hospital Virgen del Rocío, Seville, Spain
| | - Raquel Rodríguez-García
- Department of Intensive Medicine, University Hospital Central of Asturias, Oviedo, Spain
- University of Oviedo, Oviedo, Spain
| | - José María Miró
- Infectious Diseases Service, Hospital Clinic-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Josune Goikoetxea
- Department of Infectious Diseases, University Hospital de Cruces, Bilbao, Spain
| | - Guillermo Ojeda-Burgos
- Department of Internal Medicine, University Hospital Virgen de la Victoria, Málaga, Spain
| | - Francesc Escrihuela-Vidal
- University of Barcelona, Barcelona, Spain
- Department of Infectious Diseases, University Hospital of Bellvitge, Barcelona, Spain
- Research Institut of Biomedicine of Bellvitge, Barcelona, Spain
| | - Jorge Calderón-Parra
- Unit of Infectious Diseases, Department of Internal Medicine, University Hospital Puerta de Hierro, Majadahonda, Spain
- Instituto Investigación Sanitaria Puerta de Hierro—Segovia de Arana (IDIPHSA), Majadahonda, Spain
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7
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N'cho-Mottoh MPB, Erpelding ML, Roubaud C, Delahaye F, Fraisse T, Dijos M, Ennezat PV, Fluttaz A, Richard B, Beaufort C, Nazeyrollas P, Brasselet C, Pineau O, Tattevin P, Curlier E, Iung B, Forestier E, Selton-Suty C. The impact of transoesophageal echocardiography in elderly patients with infective endocarditis. Arch Cardiovasc Dis 2023; 116:258-264. [PMID: 37147149 DOI: 10.1016/j.acvd.2023.04.001] [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: 10/19/2022] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.
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Affiliation(s)
| | - Marie-Line Erpelding
- CHRU of Nancy, Inserm, université de Lorraine, CIC, épidémiologie clinique, 54000 Nancy, France
| | | | | | | | - Marina Dijos
- University Hospital of Bordeaux, 33000 Bordeaux, France
| | | | | | | | | | | | | | | | | | - Elodie Curlier
- University Hospital of Guadeloupe, Les Abymes 97142, France
| | - Bernard Iung
- Bichat-Claude Bernard Hospital, 75018 Paris, France
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8
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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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9
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Mid- and Long-Term Surgical Outcomes Due to Infective Endocarditis in Elderly Patients: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11226693. [PMID: 36431170 PMCID: PMC9693182 DOI: 10.3390/jcm11226693] [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: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) is one of the true remaining dreaded situations in cardiovascular medicine. Current international guidelines do not include specific recommendations for treatment options of infective endocarditis (conventional vs. surgical) based on the patient's age, functional status or comorbidities. Elderly patients have less invasive and often delayed surgeries compared to younger patients due to their shorter long-term survival probabilities. In the setting of IE, this might not be the right treatment, as surgery is the only curative option in up to 50% of all endocarditis patients. The aim of our study was to evaluate the mid- and long-term surgical outcomes due to infective endocarditis of patients aged ≥70 years. METHODS Between 2002 and 2020, a retrospective study with 137 patients aged 70 years and older and 276 patients aged below 70 years was conducted. Altogether, 413 consecutive patients who received surgery due to infective native or prosthetic valve endocarditis were assigned to either the elderly (E)-Group or the control (C)-Group. Primary endpoints were short- and long-term MACCEs (Major Adverse Cardiac and Cerebrovascular Events) as a composite of death or major adverse events, and secondary endpoints were intraoperative variables and postoperative course. RESULTS Preoperative risk factors differed significantly. Elderly patients had more arterial hypertension, atrial fibrillation, diabetes, chronic renal insufficiency and coronary heart disease. Fewer of them were in a state of emergency. Time from diagnosis to OR, antibiotic pretreatment, length of surgery and cardiopulmonary bypass time were significantly longer in the E-Group. Furthermore, 44.5% of patients in the E-Group had prosthesis endocarditis as opposed to 29.7% in the C-group. During postoperative follow-up, new onset of hemodialysis, duration of ventilation, delirium, reintubation and tracheotomy rates were significantly higher in the E-Group. There were significant differences in 7- and 30-day mortality. One- year survival was 62% for the E-Group and 79% for the C-Group. Five-year survival was 47% for the E-Group and 67% for the C-Group. CONCLUSIONS This study demonstrates that surgery for infective endocarditis is a high-risk procedure, especially for elderly people. Nevertheless, as it is more or less the only concept to increase long-term survival, it should be offered generously to all patients who are still able to take care of themselves.
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Mutagaywa RK, Vroon JC, Fundikira L, Wind AM, Kunambi P, Manyahi J, Kamuhabwa A, Kwesigabo G, Chamuleau SAJ, Cramer MJ, Chillo P. Infective endocarditis in developing countries: An update. Front Cardiovasc Med 2022; 9:1007118. [PMID: 36172579 PMCID: PMC9510687 DOI: 10.3389/fcvm.2022.1007118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Despite advances in diagnostic and treatment, morbidity and mortality due to infective endocarditis (IE) has not decreased. There is a discrepancy in epidemiology of IE between developed and developing countries. Over the last years, increased early detection and consequently prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) which are considered predisposing conditions for IE, is noted. Here, we present a review of literature on IE in developing countries. Methods We conducted a systematic literature search of IE studies in developing countries through PubMed and Embase. We have divided the studies into two groups: studies published before 2015 (group 1) and studies ≥ 2015 (group 2). The outcome was defined as a difference in epidemiology, microbiology, treatment, and mortality over time. The Scale for Assessment of Narrative Review Articles guidelines was applied. Findings In total, 16 studies were included. The total number of IE cases was 1,098 and 1,505 in groups 1 and 2, respectively. We compared 4/7 cohorts from group 1 (n = 789) with 5/9 cohorts from group 2 (n = 636). Six studies were not included in the comparison because they were interacting between the two cohorts. Males predominated in all studies. Rheumatic heart disease was higher in group 1 than in group 2 (42.3% vs. 30.3%, p < 0.001) while for CHD there was no change (17.6% vs. 16.7%, p = 0.672). Streptococci infections was lower in group 1 than group 2 (26.2% vs. 37.7%, p < 0.001). The proportion of Staphylococcus aureus was 15.3% in group 1 and 23.6% in group 2, p < 0.001. Negative blood culture (NBC) was higher in group 1 than in group 2 (42.2% vs. 34.1%, p = 0.002). Patients in group 1 received more surgery than in group 2 (38.8% vs. 28.8%, p < 0.001). Mortality was similar in the two groups (20.9% vs. 22.3%, p = 0.518). Conclusion This review shows a scarcity of studies on IE in developing countries. Rheumatic heart disease and congenital heart disease are common predisposing conditions. Other risk factors are prosthetic valves, degenerative valve disease (DVD), intravenous drug use, and human immunodeficiency virus infection. While the proportion of IE cases caused by Streptococcus and Staphylococcus has increased, the number of NBC and patients getting surgery has decreased. Mortality has not changed over time. Timely diagnosis and management of patients with RHD and CHD and comprehensive management of IE are warranted.
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Affiliation(s)
- Reuben K. Mutagaywa
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Reuben K. Mutagaywa
| | - Josephine C. Vroon
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lulu Fundikira
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Maria Wind
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Cardiology, Diakonessen Hospital, Utrecht, Netherlands
| | - Peter Kunambi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Apollinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Steven A. J. Chamuleau
- Amsterdam UMC Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Maarten J. Cramer
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Pilly Chillo
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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11
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Perez-Rivera JA, Armiñanzas C, Muñoz P, Kestler M, Pinilla B, Fariñas MC, Alvarez-Rodriguez I, Cuervo G, Rodriguez-Esteban A, de Alarcón A, Gutiérrez-Villanueva A, Pello-Lazaro A, Sellés MM. Comorbidity and Prognosis in Octogenarians with Infective Endocarditis. J Clin Med 2022; 11:jcm11133774. [PMID: 35807059 PMCID: PMC9267499 DOI: 10.3390/jcm11133774] [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: 05/29/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Infective endocarditis (IE) in older patients is associated with a high morbidity, mortality, and functional impairment. The purpose of this study was to describe the current profile of IE in octogenarians and to analyze the prognostic impact of baseline comorbidities in this population. Methods. Patients ≥ 80 years and definite IE from the Spanish IE Prospective Database were included. The effect of Charlson Comorbidity Index (CCI) on in-hospital and 12-month mortality was analyzed. Results. From 726 patients, 357 (49%) had CCI ≥ 3 and 369 (51%) CCI < 3. A total of 265 patients (36.6%) died during hospital admission and 338 (45.5%) during 1-year follow-up. CCI ≥ 3 was an independent predictor of in-hospital and 1-year mortality (odds ratio 1.46, 95% confidence interval 1.07−1.99, p = 0.017; hazard ratio 1.34, 95% confidence interval 1.08−1.66, p = 0.007, respectively). Surgical management was less common in patients with high comorbidity (CCI ≥ 3 68 [19.0%] vs. CCI < 3 112 ((30.4%) patients, p < 0.01). From 443 patients with surgical indication, surgery was only performed in 176 (39.7%). Patients with surgical indication treated conservatively had higher mortality than those treated with surgery (in-hospital mortality: 147 (55.1%) vs. 55 (31.3%), p < 0.001), (1-year mortality: 172 (64.4%) vs. 68 [38.6%], p < 0.001). Conclusion. About half of octogenarians with IE had high comorbidity with CCI ≥ 3. CCI ≥ 3 was a strong independent predictor of in-hospital and 1-year mortality. Our data suggest that the underperformance of cardiac surgery in this group of patients might have a role in their poor prognosis.
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Affiliation(s)
- Jose-Angel Perez-Rivera
- Unidad Especializada de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario de Burgos, Universidad Isabel I, 09003 Burgos, Spain;
| | - Carlos Armiñanzas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla IDIVAL, 39008 Santander, Spain;
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Martha Kestler
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain;
| | - Blanca Pinilla
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain;
| | - Maria-Carmen Fariñas
- Servicio de Enfermedades Infecciosas Hospital Universitario Marqués de Valdecilla IDIVAL, CIBER de Enfermedades Infecciosas-CIBERINFEC (CB21/13/00068), Instituto de Salud Carlos III, Universidad de Cantabria, 39008 Santander, Spain;
| | - Ignacio Alvarez-Rodriguez
- Servicio de Enfermedades Infecciosas, Hospital Donostia, OSI Donostialdea, 20014 San Sebastián, Spain;
| | - Guillermo Cuervo
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, 08036 Barcelona, Spain;
| | | | - Aristides 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, 41013 Seville, Spain;
| | - Andrea Gutiérrez-Villanueva
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Universitario Puerta de Hierro, Majadahonda, 28222 Madrid, Spain;
| | - Ana Pello-Lazaro
- Servicio de Cardiología, Unidad de Hospitalización, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, 28040 Madrid, Spain
- Facultad de Medicina, Universidad Europea, 28670 Madrid, Spain
- Correspondence: ; Tel.: +34-91586-8293; Fax: +34-9158-6827
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12
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Pazdernik M, Iung B, Mutlu B, Alla F, Riezebos R, Kong W, Nunes MCP, Pierard L, Srdanovic I, Yamada H, De Martino A, Miglioranza MH, Magne J, Piper C, Laroche C, Maggioni AP, Lancellotti P, Habib G, Selton-Suty C. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 2022; 50:1191-1202. [PMID: 35290614 DOI: 10.1007/s15010-022-01792-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. METHODS Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. RESULTS As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). CONCLUSION Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
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Affiliation(s)
- Michal Pazdernik
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.,Department of Cardiology, Second Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université de Paris, Paris, France
| | - Bulent Mutlu
- Department of Cardiology, Marmara University Hospital, Pendik, Istanbul, Turkey
| | | | | | - William Kong
- National University Heart Centre Singapore, Singapore, Singapore
| | | | - Luc Pierard
- University Hospital Sart Tilman, University of Liege, Liege, Belgium
| | | | - Hirotsugu Yamada
- Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | | | | | - Julien Magne
- Cardiology Dept, CHU Limoges, INSERM 1094, University Hospital Dupuytren, 87042, Limoges, France
| | - Cornelia Piper
- Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Biot, France
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Biot, France.,Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | | | - Gilbert Habib
- Cardiology Dept, APHM, La Timone Hospital, Marseille, France.,Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, Marseille, France
| | - Christine Selton-Suty
- Cardiology Dept, CIC-ECCHU Nancy-Brabois, 54000, Nancy, France. .,Association pour l'Etude et la Prevention de l'Endocardite Infectieuse (AEPEI), Paris, France.
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13
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Ghanta RK, Pettersson GB. Surgical Treatment of Infective Endocarditis in Elderly Patients: The Importance of Shared Decision Making. J Am Heart Assoc 2021; 10:e022186. [PMID: 34558288 PMCID: PMC8649145 DOI: 10.1161/jaha.121.022186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Ravi K Ghanta
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery Heart, Vascular, and Thoracic Institute Cleveland Clinic Cleveland OH
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