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Nappi F, Avtaar Singh SS, Jitendra V, Fiore A. Bridging Molecular and Clinical Sciences to Achieve the Best Treatment of Enterococcus faecalis Endocarditis. Microorganisms 2023; 11:2604. [PMID: 37894262 PMCID: PMC10609379 DOI: 10.3390/microorganisms11102604] [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: 08/01/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Enterococcus faecalis (E. faecalis) is a commensal bacterium that causes various infections in surgical sites, the urinary tract, and blood. The bacterium is becoming a significant concern because it tends to affect the elderly population, which has a high prevalence of undiagnosed degenerative valvular disease and is often subjected to invasive procedures and implanted medical devices. The bacterium's actions are influenced by specific characteristics like pili activity and biofilm formation. This resistance significantly impedes the effectiveness of numerous antibiotic therapies, particularly in cases of endocarditis. While current guidelines recommend antimicrobial therapy, the emergence of resistant strains has introduced complexity in managing these patients, especially with the increasing use of transcatheter therapies for those who are not suitable for surgery. Presentations of the condition are often varied and associated with generalised symptoms, which may pose a diagnostic challenge. We share our encounter with a case study that concerns an octogenarian who had a TAVI valve and developed endocarditis. We also conducted a literature review to identify the essential treatment algorithms for such cases.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | | | - Vikram Jitendra
- Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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Nappi F, Avtaar Singh SS. Host-Bacterium Interaction Mechanisms in Staphylococcus aureus Endocarditis: A Systematic Review. Int J Mol Sci 2023; 24:11068. [PMID: 37446247 DOI: 10.3390/ijms241311068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/21/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Staphylococci sp. are the most commonly associated pathogens in infective endocarditis, especially within high-income nations. This along with the increasing burden of healthcare, aging populations, and the protracted infection courses, contribute to a significant challenge for healthcare systems. A systematic review was conducted using relevant search criteria from PubMed, Ovid's version of MEDLINE, and EMBASE, and data were tabulated from randomized controlled trials (RCT), observational cohort studies, meta-analysis, and basic research articles. The review was registered with the OSF register of systematic reviews and followed the PRISMA reporting guidelines. Thirty-five studies met the inclusion criteria and were included in the final systematic review. The role of Staphylococcus aureus and its interaction with the protective shield and host protection functions was identified and highlighted in several studies. The interaction between infective endocarditis pathogens, vascular endothelium, and blood constituents was also explored, giving rise to the potential use of antiplatelets as preventative and/or curative agents. Several factors allow Staphylococcus aureus infections to proliferate within the host with numerous promoting and perpetuating agents. The complex interaction with the hosts' innate immunity also potentiates its virulence. The goal of this study is to attain a better understanding on the molecular pathways involved in infective endocarditis supported by S. aureus and whether therapeutic avenues for the prevention and treatment of IE can be obtained. The use of antibiotic-treated allogeneic tissues have marked antibacterial action, thereby becoming the ideal substitute in native and prosthetic valvular infections. However, the development of effective vaccines against S. aureus still requires in-depth studies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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da Costa FDA. Commentary: We should not forget the aortic valve allograft. J Thorac Cardiovasc Surg 2023; 165:1316-1317. [PMID: 34059341 DOI: 10.1016/j.jtcvs.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
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Skific M, Golemovic M, Safradin I, Duric Z, Biocina B, Golubic Cepulic B. Cryopreserved human heart valve allografts: a ten-year single centre experience. Cell Tissue Bank 2022; 24:401-416. [PMID: 36222968 PMCID: PMC9555264 DOI: 10.1007/s10561-022-10043-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/21/2022] [Indexed: 11/29/2022]
Abstract
This study provides an overview of tissue banking activities at the Croatian Cardiovascular Tissue Bank (CTB) during past ten years and presents the outcomes of cryopreserved heart valve allografts (CHAs) use in different patient groups. From June 2011 until December 2021, 75 heart donations were referred to CTB: 41 recipient of heart transplant (RHT), 32 donors after brain death (DBD) and 2 donors after circulatory death (DCD) donations. Processing resulted in 103 valves of which 65 met quality requirements for clinical use. Overall tissue discard rate was 37%. The most frequent reasons for discard were inadequate morphology (12%) in RHT donations and microbiological contamination (19%) in DBD donations. Altogether, 38 CHAs were transplanted to 36 patients. Recipients were divided in three groups; infective endocarditis (IE), non-infectious heart disease and congenital heart disease group. In the IE group, the 30-day, 1-year and 3-year survival was 71%, 53% and 47%, respectively. Freedom from re-operation due to all graft-related causes was 76% and due to structural valve deterioration 88%. There were no cases of graft reinfection. In the congenital heart disease group CHAs were predominantly (94%) used for right ventricular outflow tract reconstruction and 88% of patients recovered without graft-related complications. At present, the number of demands for CHAs at CTB considerably outweighs their availability.
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Affiliation(s)
- Marijana Skific
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Mirna Golemovic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Ivica Safradin
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Zeljko Duric
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Salata 3, 10000, Zagreb, Croatia
| | - Branka Golubic Cepulic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.,University of Zagreb School of Medicine, Salata 3, 10000, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, 10000, Zagreb, Croatia.,University of Split, University Department of Health Studies, Rudera Boskovica 35, 21000, Split, Croatia
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Yousif A, Ali K, Anssar M, Harringer W, El-Essawi A, Brouwer R. A 20-year experience with cryopreserved allografts as the valve replacement of choice in aortic root reconstruction for destructive endocarditis with abscess formation. Interact Cardiovasc Thorac Surg 2022; 35:6628590. [PMID: 35786719 PMCID: PMC9270860 DOI: 10.1093/icvts/ivac188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Afram Yousif
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Khaldoun Ali
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Marcel Anssar
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Wolfgang Harringer
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
| | - Aschraf El-Essawi
- Department of Cardiothoracic and Vascular Surgery, University of Göttingen , Göttingen, Germany
| | - René Brouwer
- Department of Cardiothoracic and Vascular Surgery, Braunschweig Clinic , Braunschweig, Germany
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The New Challenge for Heart Endocarditis: From Conventional Prosthesis to New Devices and Platforms for the Treatment of Structural Heart Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7302165. [PMID: 34222484 PMCID: PMC8219429 DOI: 10.1155/2021/7302165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use "low fouling coats" with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.
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